IL DISTURBO OSSESSIVO- COMPULSIVO E I DISTURBI PSICHIATRICI ASSOCIATI

2002/2003XV Ciclo1969Versione digitalizzata della tesi di dottorato cartacea

Eating disorders: What age at onset?

Age at onset (AAO) of eating disorders has classically been described in adolescence. We analyzed data from 806 subjects with anorexia nervosa (AN) or bulimia nervosa (BN) and performed a normal distribution admixture analysis to determine their AAO. No significant differences were found concerning the AAO functions of AN and BN subjects. Both groups had a mean AAO of about 18 years. Most of the subjects with AN (75.3%) and BN (83.3%) belonged to the early onset group. The definition of AAO for ED may be crucial for planning treatment modalities, with specific consideration of their clinical history and course

Affective recurrences in bipolar disorder after switching from lithium to valproate or vice versa: A series of 57 cases

Affective Recurrences in Bipolar Disorder After Switching From Lithium to Valproate or Vice Versa A Series of 57 Case

Suicide risk in Obsessive-Compulsive Disorder and exploration of risk factors: a systematic review

Historically, OCD has been considered to be associated with a relatively low risk of suicide. Recent studies, on the contrary, revealed a significant association between OCD and suicide attempts and ideation. A huge variation in prevalence rates, however, is reported. OBJECTIVE: To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with OCD, and to identify predictors of suicide risk among subjects with OCD. METHOD: We systematically reviewed the literature on suicide risk (ideation and/or attempts) and OCD. We included studies with appropriate definition of OCD, cross-sectional or prospective design, separating clinical samples from epidemiological studies, that employed a quantitative measure of suicidality and/or reported an outcome measure of the association between suicidality and OCD or examined factors associated with suicidality. RESULTS: In clinical samples, the mean rate of lifetime suicide attempts is 14.2% (31 studies: range 6- 51.7%). Suicidal ideation is referred by 26.3-73.5% of individuals (17 studies, mean 44.1%); current suicidal ideation rate ranges between 6.4 and 75% (13 studies, mean 25.9). Epidemiological studies found that OCD increases significantly the odds of having a lifetime suicidal ideation as compared to the general population (OR: 1.9-10.3) and a history of lifetime suicide attempts (OR: 1.6- 9.9). Predictors of greater suicide risk are severity of OCD, the symptom dimension of unacceptable thoughts, comorbid Axis I disorders, severity of comorbid depressive and anxiety symptoms, past history of suicidality and some emotion-cognitive factors such as alexithymia and hopelessness. CONCLUSION: Overall, suicidality appears a relevant phenomenon in OCD

Antipsychotics in treatment-resistant Obsessive-Compulsive Disorder: which antipsychotic, which dose and how long antipsychotic addition should be maintained

Objectives: Treatment-resistant Obsessive-Compulsive Disorder (OCD) patients are defined as those who undergo adequate trials of first-line therapies without achieving a satisfactory response. First line treatments for OCD include both serotonin reuptake inhibitors (SRIs) and cognitive behavior therapy (CBT). Because of the high number of OCD patients not responding to first-line treatments (40-60%) and considering the even greater prevalence rate of residual symptoms and significant impairment shown in patients previously described as \u201cclinical responders\u201d, the question of the proper treatment of resistant OCD is a clinically meaningful and a practical issue for psychiatrists. Antipsychotic augmentation proved to be an effective strategy for resistant OCD. However, there are unresolved questions concerning which antipsychotic is effective (or more effective) and how antipsychotics should be used in terms of doses and duration of treatment. The purpose of this study is to systematically review available studies on antipsychotic augmentation for treatment-resistant OCD, in order to guide the practical choice. Materials and methods: We searched on PubMed, Psychnet and Cochrane Libraries from inception to January 2016. Articles published in English and related to the use of antipsychotics in OCD were considered. We evaluated meta-analyses, systematic reviews and randomized controlled trials of adult patients with treatment-resistant OCD. Results: Antipsychotic augmentation is an evidence-based option for treatmentresistant OCD, with a response rate of approximately 50% within the first 4-to6 weeks. Aripiprazole (10-15\ua0mg/day) and risperidone (0.5-2\ua0mg/day) are effective, olanzapine (10\ua0mg/day) is possibly effective. Haloperidol addition is also a viable option, particularly in patients with comorbid tic disorders. Given results of studies performed to date quetiapine should be regarded as non-effective. Preliminary results from open label studies suggest that antipsychotic augmentation, once effective, should be maintained in order to maintain remission. Conclusions: Not all antipsychotics are effective as add-on treatments in resistant OCD. Characteristics of patients and side effects generally associated with each different antipsychotic may guide the practical choice. Further research is required concerning the comparative effectiveness among antipsychotics, the optimal target dose and the ideal duration of antipsychotic addition. In our opinion, antipsychotic augmentation in patients who responded to this treatment should be maintained in order to prevent relapses. However, clinicians must remember patients\u2019 exposure to the common and serious adverse effects associated with long-term antipsychotic administration, especially metabolic disturbances

SOCIAL AND CLINICAL DETERMINANTS OF COMPULSORY AND VOLUNTARY ADMISSIONS WITHIN THE FRAMEWORK OF AN ITALIAN COMMUNITY MENTAL HEALTH SYSTEM

Social and clinical determinants of 30 compulsory admissions (CAs) to a psychiatric ward during a six-month period were compared to 134 voluntary admissions (VAs), and outcomes of hospitalisation were assessed in relation to its types. Psychosocial and clinical characteristics at admission and discharge were measured using 5 scales. Unemployment, hospitalisations >7 days and continuing hospitalisation in Community Mental Health Centres were positively associated with CA. At admission, CAs showed lower functioning, while outcome at discharge was similar. Social determinants had a main role in determining CAs. Clinical and psychosocial outcomes might have been improved by a mental health system community-based

Assessing suicide risk in patients with Obsessive-Compulsive Disorder: a dimensional approach

Objectives: Obsessive-Compulsive Disorder has recently been found to be associated with an increased risk of suicide; however, prevalence rates of both suicidal ideation and attempts vary considerably, being the phenomenon mainly categorically evaluated. Our aims were to evaluate the prevalence of suicidal ideation (SI) and behaviors (SB) using a dimensional approach. Methods: 129 patients with OCD were enrolled. Suicidality was assessed through the administration of the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of SI, severe SI, and SB. Results: Lifetime prevalence of SI and SB were 64.3% and 16.3%. Lifetime SI was associated with the number of stressful life events, the duration of illness, HAM-D scores, family history for mood disorders. A positive family history for OCD was associated with lower probability of lifetime SI. Severe SI was related to a greater severity of the highest stressful life event, HAM-D scores and a longer duration of untreated illness. The probability of lifetime SB was related to the HAM-A scores, symmetry obsessions, washing and checking compulsions. The probability of lifetime Non-Suicidal Self-Injurious Behaviors was related to HAM-A scores. Conclusions: The recognition of predictors of SI/SB is crucial to identify those patients at greater risk

Are patients improving during and after a psychiatric hospitalisation? Continuity of care outcomes of compulsory and voluntary admissions to an Italian psychiatric ward

Background: To compare the characteristics of compulsory admissions (CAs) and voluntary admissions (VAs) in a General Hospital Psychiatric Unit (GHPU), and to assess whether CA and VA patients' outcomes improved during hospitalisation and follow-up in mental health services (MHS) based on community continuity of care. Design and method: Observational longitudinal study comparing 19 CAs and 83 VAs consecutively admitted to GHPU of Udine, Italy, and followed up for six months by MHS. Five psychometric scales assessed psychosocial and clinical characteristics for each patient at admission (T0), discharge (T1) and follow-up (T2). Statistical analyses were performed using: multivariate logistic regression for comparing CA and VA; Friedman \u3c72 and Mann-Whitney tests for outcomes' improvement. Results: Being hospitalised for a psychotic crisis was the most significant predictor of CA (OR = 5.07). An outcomes' improvement was observed from T0 to T1 in almost all psychometric tests, while from T1 to T2 only for PSP-A (useful social activities), CGI-S (severity of illness) and CGI-EI (drug's efficacy related to side effects). CA was associated to lower performances in all scales at T0, in GAF and CGI-S at T1, while no difference with VA was observed at T2. Conclusion: CA and VA patients improved to a same extent during hospitalisation and follow-up, particularly in relation to social functioning. This fosters the hypothesis that community-based MHS using a longitudinal continuity of care model might achieve recovery in a long-term perspective. Future research may benefit by considering patients' subjective experiences and assessing long-term improvement in those who received person-centred interventions