Asenapine in the management of impulsivity and aggressiveness in bipolar disorder and comorbid borderline personality disorder: an open-label uncontrolled study

Borderline personality disorder (BPD) often co-occurres with bipolar disorder (BD). Impulsivity and aggressiveness represent core shared features and their pharmacological management is mainly based on mood stabilizers and antipsychotics, although scarce evidence is available for this context of comorbidity. The aim of the present study was to evaluate the role of Asenapine as an adjunctive drug for reducing aggressiveness and impulsivity in a sample of Italian BD type I outpatients with or without a comorbid BPD. This was an observational 12-week open-label uncontrolled clinical study carried out from April to October 2014 in two psychiatric clinics in Sicily. Each patient was treated with asenapine at two dose options, 5\u2009mg (twice daily) or 10\u2009mg (twice daily), and concomitant ongoing medications were not discontinued. We measured impulsivity using the Barratt Impulsiveness Scale (BIS) and aggressiveness using the Aggressive Questionnaire (AQ). For the analysis of our outcomes, patients were divided into two groups: with or without comorbid BPD. Adjunctive therapy was associated with a significant decrease of BIS and AQ overall scores in the entire bipolar sample. Yet, there was no significant difference in BIS and AQ reductions between subgroups. Using a regression model, we observed that concomitant BPD played a negative role on the Hostility subscale and overall AQ score variations; otherwise, borderline co-diagnosis was related positively to the reduction of physical aggression. According to our post-hoc analysis, global aggressiveness scores are less prone to decrease in patients with a dual diagnosis, whereas physical aggressiveness appears to be more responsive to the add-on therapy in patients with comorbidity

Psychoeducational intervention and prevention of relapse among schizophrenic disorders in the Italian community psychiatric network

<p>Abstract</p> <p>Background</p> <p>The lack of compliance is associated with an increased risk of hospitalization and switching or augmentation of therapy when compared with being compliant. A synergy of drug therapy and psychosocial interventions can give more benefits in treatment.</p> <p>Methods</p> <p>A perspective study was conducted on 150 patients with schizophrenia over 15 centers in Italy. The experimental group was treated with drug therapy, traditional psychosocial and psychoeducation for the patients and their families, while the control group received traditional psychosocial and drug intervention over 1 year.</p> <p>Results</p> <p>The experimental group showed a significant statistical improvement (p < 0,05) in almost all the scales that have been assessed (BPRS, SAPS, SANS, SIMPSON-ANGUS SCALE, LANCASHIRE QL SCALE). Significant was the reduction of the number of hospitalizations and of days of hospital stay.</p> <p>Conclusion</p> <p>As it is shown in international literature, psychoeducational intervention with schizophrenic patients and their families can reduce the occurrence of relapse.</p

The Management of Long-Term Psychiatric Sequelae in a Young Woman Who Suffered From Suspected Autoimmune Limbic Encephalitis:

We report the case of a 23-year-old woman who presented to our Psychiatry Unit with a complex psychiatric symptomatology, 6 years after suffering from a form of encephalopathy which was retrospectively and hypothetically labeled as autoimmune limbic encephalitis. Over the years, several psychopharmacological therapies had been initiated, but none of them led to substantial remission of symptomatology. During the first visit, symptoms were characterized by dysphoric mood with suicidal ideation, anxiety, delusional thoughts. Self-harm and psychogenic seizures with daily frequency were also reported. A therapy with slow-release lithium sulfate, lurasidone, and lorazepam was prescribed. After 6 months of treatment, psychopathological manifestations significantly improved

Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte and Monocyte-to-Lymphocyte Ratio in Bipolar Disorder

Background: Several inflammatory hypotheses have been suggested to explain the etiopathogenesis of bipolar disorder (BD) and its different phases. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios have been proposed as potential peripheral biomarkers of mood episodes. Methods: We recruited 294 patients affected by BD, of which 143 were experiencing a (hypo)manic episode and 151 were in a depressive phase. A blood sample was drawn to perform a complete blood count. NLR, PLR, and MLR were subsequently calculated. A t-test was performed to evaluate differences in blood cell counts between depressed and (hypo)manic patients and a regression model was then computed. Results: Mean values of neutrophils, platelets, mean platelet volume, NLR, PLR, and MLR were significantly higher in (hypo)manic than depressed individuals. Logistic regression showed that PLR may represent an independent predictor of (hypo)mania. Conclusions: Altered inflammatory indexes, particularly PLR, may explain the onset and recurrence of (hypo)manic episodes in patients with BD. As inflammatory ratios represent economical and accessible markers of inflammation, further studies should be implemented to better elucidate their role as peripheral biomarkers of BD mood episodes

Impact of a multimodal rehabilitative intervention on demented patients and their caregivers

Alzheimer's disease is becoming a social, political, and economic issue as a result of both the growing number of people affected and the enormous economic, social, and emotional costs involved in caring for Alzheimer's patients. The aim of this study is to evaluate the effects of a multimodal intervention program for patients with Alzheimer's disease and their caregivers. The study was conducted on a sample of 32 subjects: 16 Alzheimer's patients and their caregivers. The results obtained after the multimodal rehabilitation program showed that the Alzheimer's patients had a more stable cognitive status and improved mood. Regarding the psychoeducational program, the results demonstrate the efficacy of such interventions in terms of increasing and preserving the caregivers' coping skills and enhancing their perception of the value of support groups

Exploration of mood spectrum symptoms during a major depressive episode: The impact of contrapolarity-Results from a transdiagnostic cluster analysis on an Italian sample of unipolar and bipolar patients

Background Subthreshold hypomania during a major depressive episode challenges the bipolar-unipolar dichotomy. In our study we employed a cross-diagnostic cluster analysis - to identify distinct subgroups within a cohort of depressed patients. Methods A k-means cluster analysis- based on the domain scores of the Mood Spectrum Self-Report (MOODS-SR) questionnaire-was performed on a data set of 300 adults with either bipolar or unipolar depression. After identifying groups, between-clusters comparisons were conducted on MOODS-SR domains and factors and on a set of sociodemographic, clinical and psychometric variables. Results Three clusters were identified: one with intermediate depressive and poor manic symptomatology (Mild), one with severe depressive and poor manic symptomatology (Moderate), and a third one with severe depressive and intermediate manic symptomatology (Mixed). Across the clusters, bipolar patients were significantly less represented in the Mild one, while the DSM-5 "Mixed features" specifier did not differentiate the groups. When compared to the other patients, those of Mixed cluster exhibited a stronger association with most of the illness-severity, quality of life, and outcomes measures considered. After performing pairwise comparisons significant differences between "Mixed" and "Moderate" clusters were restricted to: current and disease-onset age, psychotic ideation, suicidal attempts, hospitalization numbers, impulsivity levels and comorbidity for Cluster B personality disorder. Conclusions In the present study, a clustering approach based on a spectrum exploration of mood symptomatology led to the identification of three transdiagnostic groups of patients. Consistent with our hypothesis, the magnitude of subthreshold (hypo)manic symptoms was related to a greater clinical severity, regardless of the main categorical diagnosis

Neural Circuits Underlying Motor Facilitation during Observation of Implied Motion

In the present study we used single and paired-pulse Transcranial Magnetic Stimulation (TMS) to evaluate the effect of implied motion on primary motor cortex microcircuits. We found that observation of the implied motion of a static image increases MEP amplitude and reduces short-interval intracortical inhibition (SICI), without significant modulation of intracortical facilitation and sensory-motor integration. Our results add to the existing literature on the activation of the observation-execution matching system and describe a selective modulation of GABAergic cortical microcircuits during observation of implied motion

PW08-03 The use of drugs for mood disorders in Italy: Preliminary results

Background:Some community surveys in Italy have shown that a proportion of subjects without lifetime psychiatric diagnosis (anxiety/depression) used antidepressants. The prescription of AD in bipolar depression appears to be another largely underestimated problem in the clinical practice and is difficult to recognise by means of traditional epidemiological methods (lay interview and structured diagnostic tools).Objectives:The purpose is to use defined and validated international semi-structured interview as diagnostic instrument administered by expert clinicians to evaluate appropriateness and amount of over and under prescription of psychotropic drugs in different Italian community areas. The focus is on general antidepressant use and use in subjects with bipolar disorder and in subsyndromal depression.Methods:Study design: Community survey. Study population: sample randomly drawn, after stratification by sex and age, from the adult population of Municipal records in 6 Italian Regions: about 4000 persons will be interviewed. Tools: Questionnaire on psychotropic drugs consumption, prescription, health services utilisation;diagnostic Structured Clinical Interview np version;Mood Disorders Questionnaire; Short Form Health Survey. Ethical aspects: a signed informed consent for each candidate. The study was approved by the ethical committee of theItalain National Health Institute.Expected results:The study aims to identify the frequency of over and under prescription of psychotropic drugs in different Italian regions and the determinants of prescription related to physicians, patients, comorbidity and symptoms and to establish the basis for a cohort prospective study to assess the future changes

The role of attitudes toward medication and treatment adherence in the clinical response to LAIs: findings from the STAR Network Depot Study

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time. Methods: The STAR Network "Depot Study" was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS &lt; 41 or BPRS ≥ 41). Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions-conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently-showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline. Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders