IMPACT OF PHYSICAL EXERCISE ON PSYCHOLOGICAL WELL-BEING AND PSYCHIATRIC DISORDERS

Background: Physical exercise is one of the major features of human health, as it is involved in several physiological processes and related to major benefits in reducing body fat, myocardial infarction, hypertension and insulin resistance risk. Physical exercise also plays a positive role in achieving psychological well-being that can be defined as a state of happiness and serenity, with low levels of distress, overall good physical and mental health and outlook and a good quality of life. Aim of the paper: To review the positive effects of physical activity on psychological well-being and its possible neurobiological underpinnings, as well as its impact on several neuropsychiatric disorders, such as depression, anxiety, eating disorders, obsessive-compulsive disorder, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, schizophrenia and some neurodegenerative disorders such as Alzheimer’s and Parkinson’s disease. Methods: The PubMed, Scopus, Embase, PsycINFO and Google Scholar databases were searched for full text articles published in the latest thirty years on the benefits that physical activity exerts on psychological well-being. Objectives: This study aims to identify the common and differential elements of the DLD (SLI) and LD through a quantitative and qualitative analysis. Results: An impressive amount of data support the positive role of physical activity on psychological well-being and a large amount of research has focused on its beneficial effects in improving the symptoms of the main neuropsychiatric disorders, while highlighting its usefulness as an adjuvant option to psychopharmacological treatments and psychotherapy. In particular, exercise would deeply affect CNS morphology and function, through heterogeneous mechanisms including, amongst the others, the production of hormones, neurotransmitters and neurotrophins, the promotion of angiogenesis and neuroplasticity, and the regulation of gene expression. Conclusion: Literature indicates that the promotion of physical activity may work like an adjunctive and/or augmentation strategy to enhance drugs or psychological treatments, or even as an alternative option in major depression

Peritoneal carcinomatosis from ovarian cancer: chemosensitivity test and tissue markers as predictors of response to chemotherapy

<p>Abstract</p> <p>Background</p> <p>Platinum-based regimens are the treatments of choice in ovarian cancer, which remains the leading cause of death from gynecological malignancies in the Western world. The aim of the present study was to compare the advantages and limits of a conventional chemosensitivity test with those of new biomolecular markers in predicting response to platinum regimens in a series of patients with peritoneal carcinomatosis from ovarian cancer.</p> <p>Methods</p> <p>Fresh surgical biopsy specimens were obtained from 30 patients with primary or recurrent peritoneal carcinomatosis from ovarian cancer. <it>ERCC1, GSTP1, MGMT, XPD</it>, and <it>BRCA1 </it>gene expression levels were determined by Real-Time RT-PCR. An <it>in vitro </it>chemosensitivity test was used to define a sensitivity or resistance profile to the drugs used to treat each patient.</p> <p>Results</p> <p><it>MGMT </it>and <it>XPD </it>expression was directly and significantly related to resistance to platinum-containing treatment (p = 0.036 and p = 0.043, respectively). Significant predictivity in terms of sensitivity and resistance was observed for <it>MGMT </it>expression (75.0% and 72.5%, respectively; p = 0.03), while high predictivity of resistance (90.9%) but very low predictivity of sensitivity (37.5%) (p = 0.06) were observed for <it>XPD</it>. The best overall and significant predictivity was observed for chemosensitivity test results (85.7% sensitivity and 91.3% resistance; p = 0.0003).</p> <p>Conclusions</p> <p>The in vitro assay showed a consistency with results observed in vivo in 27 out of the 30 patients analyzed. Sensitivity and resistance profiles of different drugs used in vivo would therefore seem to be better defined by the in vitro chemosensitivity test than by expression levels of markers.</p

Impact of the time interval between primary or interval surgery and adjuvant chemotherapy in ovarian cancer patients

IntroductionPrimary debulking surgery (PDS), interval debulking surgery (IDS), and platinum-based chemotherapy are the current standard treatments for advanced ovarian cancer (OC). The time to initiation of adjuvant chemotherapy (TTC) could influence patient outcomes.MethodsWe conducted a multicenter retrospective cohort study of advanced (International Federation of Gynecology and Obstetrics (FIGO) stage III or IV) OC treated between 2014 and 2018 to assess progression-free survival (PFS) and overall survival (OS) in relation to TTC. All patients underwent a germline multigene panel for BRCA1/2 evaluation.ResultsAmong the 83 patients who underwent PDS, a TTC ≥ 60 days was associated with a shorter PFS (hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.04–3.93, p = 0.038), although this association lost statistical significance when adjusting for residual disease (HR 1.52, 95% CI 0.75–3.06, p = 0.244, for TTC and HR 2.73, 95% CI 1.50–4.96, p = 0.001, for residual disease). Among 52 IDS patients, we found no evidence of an association between TTC and clinical outcomes. Ascites, type of chemotherapy, or germline BRCA1/2 mutational status did not influence TTC and were not associated with clinical outcomes in PDS or IDS patients.DiscussionIn conclusion, longer TTC seems to negatively affect prognosis in patients undergoing PDS, especially those with residual disease

Bipolar disorder in adults with high-functioning autism: demographic and clinical features

Background: Autism spectrum disorder (ASD) is a wide broad pervasive neurodevelopment condition that shares persistent deficits in social communication and social interactions; restricted, repetitive patterns of behaviours, interests or activities, but with several differences both in cognitive and language performances and global functioning. ASD clinical features are heterogeneous and are a consequence of different levels of functioning. Low functioning (LFA) and high functioning (HFA) clinical forms of ASD are classically distinguished according to a dimensional approach. HFA is often ignored during childhood and a proper diagnosis does not occur until adulthood, when individuals come to the clinician's attention by the emergence of psychiatric comorbidities, especially mood disorders. Bipolar disorder (BD) and HFA association in adult clinical populations has been confirmed by a growing number of studies. However, identifying and treating BD is a clinical challenge in HFA individuals, as is recognizing autistic traits in patients with BD, and requires careful assessment and adequate knowledge of both disorders. Indeed, the atypical clinical presentation of mood disorders in HFA, together with the overlap of some features of ASD with symptoms of other mental illnesses, can lead to inaccurate diagnoses and thereby, improper treatment. In spite, current literature reports the frequent co-occurrence of bipolar disorder (BD) and high-functioning autistic spectrum disorders (HFA), demographic and clinical characterization of BD in adult subjects are still lacking. Aim of the study: We described demographic and symptomatologic features, as well as response to pharmacological treatments in individuals with BD-HFA. Moreover, in order to identify specific clinical features, we compared demographic and clinical features of BD in patients with and without co-existing HFA. Methods: A cross-sectional naturalistic study was performed in a sample of 62 patients aged ≥ 18 with BD-HFA comorbidity. We evaluated demographic and clinical features, comorbidity, family history, severity of psychopathology, temperament, response to pharmacological treatment and overall functioning using the Semi-Structured Interview for Mood Disorder-Revised (SIMD-R), the brief version of temperament evaluation of Memphis, Pisa, Paris, and San Diego self-questionnaire (TEMPS-M), the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) scales. Clinical diagnosis of HFA was confirmed by the Autism Quotient (AQ), the Empathy Quotient (EQ) and the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) scales. Afterwards, we compared our sample with a BD control group without ASD (N-ASD). Results: In comparison with patients without coexisting ASD, patients with HFA reported higher rates of bipolar disorder other specified (BD-OS), with early age onset of mood disorder, more hospitalization and psychiatric treatment, with lower rates of full remission between the episodes, higher cyclothymic temperamental rates at the TEMPS-M questionnaire, compared to N-ASD. ADHD and anxiety disorders were the main comorbidities. Family history for BD and depression disorders were highly represented. Remarkably rates of mood destabilization and adverse effects with the use of antidepressants and antipsychotics were observed. Conclusions: Our results suggest that BD in HFA adult is characterized by specific demographic and clinical hallmarks. BD-HFA co-existence was associated with worse prognosis and poor response to antidepressant and antipsychotic treatments. Further research is needed to confirm our observation in a larger samples and to better evaluate longitudinal course and long-term treatment outcome

Pharmacotherapy for bipolar disorder in adults with high-functioning autism

Introduction The association between high-functioning autism (HFA) and bipolar disorder (BD) in adult subjects has been confirmed by a growing number of studies. However, identifying and treating BD in this population is a clinical challenge and requires careful assessment and adequate knowledge of both disorders. Areas covered This review aims to provide a clinical presentation of mood episodes in HFA individuals, and an update on the pharmacotherapy of BD in these individuals, sharing with the reader expert opinion on the current state of the art and future perspectives. Expert opinion BD has an atypical clinical presentation in HFA subjects with the possibility of diagnostic and therapeutic mistakes. Despite the absence of controlled studies, the available evidence indicates mood stabilizers, especially lithium, as the first treatment option. HFA subjects are particularly vulnerable to pharmacological side effects, such as extrapyramidal and catatonic symptoms with antipsychotics, or activation syndrome with antidepressants. Accordingly, initial titration of these drugs should be slow and their use should be limited in time. Among antipsychotics, dopamine receptor antagonists with combined serotonergic activity are preferable. Further research is needed to improve the diagnostic process and to delineate the effectiveness of different drugs for BD in HFA subjects

Bipolar Disorder and Manic-like Symptoms in Alzheimer's, Vascular and Frontotemporal Dementia: A Systematic Review

An increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different subtypes of dementia have not been thoroughly investigated

Chromogranin A is a potential prognostic marker in prostate cancer patients treated with enzalutamide

BACKGROUND: In this retrospective study, we assessed chromogranin A (CgA) baseline value as a possible factor associated with poor prognosis in metastatic castration-resistant prostate cancer (CRPC). METHODS: Thirty-five patients with metastatic CRPC progressing after docetaxel chemotherapy treated with enzalutamide are subdivided into three groups: serum CgA level was normal when <120 ng/ml (group A, n = 10), within three times the upper normal value (UNV) when between 120 and 360 (group B, n = 17), more than three times the UNV when ≥360 ng/ml (group C, n = 8). RESULTS: No correlation was observed in three groups among CgA baseline values and PSA response rates (RR) (P = 0.4648), whereas a significative difference was associated with median progression-free survival (PFS) and overall survival (OS) among three CgA groups (P = 0.0301 and P = 0.0011, respectively). In the multivariate analysis, PSA RR (nonresponsive vs. responsive) and CgA levels (group 3 vs. groups 1 + 2) were predictors of OS (P = 0.0029 and P = 0.0025, respectively), whereas they only were not significantly correlated with PFS, even had a borderline significance (P = 0.0628 and P = 0.0772, respectively). CONCLUSIONS: In CRPC patients treated with enzalutamide, the evaluation of serum CgA levels could be an useful prognostic factor because of the strong association between CgA value more than three times the UNV and clinical outcome, independently from PSA response

The impact of mild behavioral impairment on the prognosis of geriatric depression: preliminary results

: Our study aimed to examine how the presence of Mild Behavioral Impairment (MBI) symptoms influenced the outcome of late-life depression (LLD). Twenty-nine elderly (≥ 60 years) depressive patients, including eleven (37.9%) with MBI, were recruited and followed-up on average for 33.41 ± 8.24 weeks. Psychiatric symptoms severity and global functioning were assessed, respectively, using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) scale. BPRS total score significantly decreased from baseline to follow-up (P &lt; 0.001, d = 1.33). The presence of MBI had no significant effect on mood and cognitive symptoms improvement. On the contrary, while a significant increase in GAF score was observed in patients without MBI (P = 0.001, d = 1.01), no significant improvement of global functioning was detected in those with MBI (P = 0.154, d = 0.34) after 6-month follow-up. The presence of MBI in patients with LLD may negatively affect long-term outcome, slowing or preventing functional improvement

Oxaliplatin plus leucovorin and 5-fluorouracil (FOLFOX-4) as a salvage chemotherapy in heavily-pretreated platinum-resistant ovarian cancer

Abstract Background The purpose of this study was to evaluate the clinical impact of oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX-4) chemotherapy in terms of the response rate, progression-free/overall survival (PFS/OS) and safety profile in patients with heavily pretreated recurrent epithelial ovarian cancer. Methods Clinical data were reviewed in 29 patients who received FOLFOX-4 as more than third-line chemotherapy, consisting of 85 mg/m2 of oxaliplatin, 200 mg/m2 of leucovorin, and bolus 400 mg/m2 on day 1 of 5-fluorouracil, followed by a 22-h infusion of 600 mg/m2 of 5-fluorouracil for 2 consecutive days every 3 weeks. We also compared the efficacy and toxicity of FOLFOX-4 with that of topotecan, a standard treatment, given at a dosage of 1.5 mg/m2 every three weeks in 26 patients. Results The median age of enrolled patients was 60 years (range 33 to 85). A median of 4 cycles (range 1–17) of FOLFOX-4 were administered. Complete response and partial response were observed in one (3.5%) and 5 (17.2.2%) patients, respectively, while stable disease was reported in 8 (27.6%) patients. Among all patients, grade 3–4 anemia, neutropenia, and thrombocytopenia were observed in 0 (0%), 5 (17.2%), and 3 (10.3%) cases, respectively. Grade 3–4 fatigue was recorded in one (3.4%) patient and diarrhea in 2 (6.9%). Median PFS and OS were 2.8 months [95% confidence interval (CI) 1.7–4.9] and 6.2 months (95% CI 2.4–14.6), respectively. No significant differences in terms of efficacy and toxicity were observed between patients receiving FOLFOX-4 and those treated with topotecan. Conclusions The FOLFOX-4 regimen would seem to obtain similar survival rates to those of standard therapy with topotecan in platinum-resistant ovarian cancer. Further randomized trials are warranted to confirm our findings