PREDICTORS OF RELAPSE IN LONG-TERM NATURASTIC FOLLOW-UP OF BIPOLAR PATIENTS TREATED WITH ELECTROCONVULSIVE THERAPY.

Objective: The long-term stabilization is a major challenge in the treatment of bipolar disorder (BD) and, despite continual pharmacological treatment, a high rate of relapse/recurrence has been observed. ECT is a highly effective treatment for the acute phases of depressive, manic, and mixed episodes of bipolar disorder; less information is available on long-term relapse rate after successful ECT treatment. In a naturalistic, prospective, and observational study, we evaluated the long-term outcome and the predictors of relapse/recurrence in a sample of ECT-responder bipolar patients. Method: During a follow-up ranging from 26 to 160 weeks, we explored the rate and the characteristics of the depressive and mixed relapse/recurrence of 70 with Bipolar Disorder according to DSM-IV-TR diagnostic criteria. Patients were selected from a population of 475 patients who received ECT between December 2008 and December 2017 at the Department of Psychiatry of the University of Pisa. All patients involved in this study were responders to ECT. They were evaluated 1 day prior to ECT and a week after the treatment termination using the Clinical Global Impression Scale (CGI), the Hamilton Rating Scale for Depression-17 item (HAM-D-17), the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS) and the Mini Mental State examination (MMSE). Clinical Global Impression-Improvement (I-CGI) sub-scale was used for the definition of response. The Longitudinal Interval Follow-up Evaluation (LIFE), administered at least every 16 weeks, was used to assess time to relapse (defined as LIFE scores >/= 5 for at least 2 consecutive weeks or as the need of hospitalization), as well as periods of response and remission. Descriptive and comparative analyses were performed and survival analysis were used to identify if length of current episode, psychotic symptoms and comorbidity could affect the time of relapse/recurrence. Results: The mean duration of follow-up was 57.04 +/- 27.2 weeks (range, 26-160 weeks). All patients were followed up for at least 6 months; 44 patients (62.9%) for at least one year. Sixty-five patients (92.8%) spent in response more than 90% of the time; thirty-two patients (45.7%) were in remission for more than 60% of the time. Patients with depressive index episode compared with patients with mixed index episode showed a significative difference in percentage of patients in remission (83.3% vs 61.8%; p = 0.043). Relapse rate at one-year follow-up was 37.1% (n=26); 60% of total relapses were within the first 6 months of follow-up. The remaining 40% was distributed along the whole observation period. No manic switches or episodes occurred after the ECT course and during the follow-up. No significant differences were found either in demographic, clinical and ECT characteristics or in the type and duration of psychopharmacological treatment between the patients who relapsed and the patients who did not. Twenty-four patients (34.3%) showed a depressive relapse. Psychotic symptoms were less frequent among the patients who fulfill relapse criteria [5 (20.8%) vs 21 (45.7%); p = 0.041]. The index episode mean duration was longer in the patients with depressive relapses (10.25 +/- 10.3 vs 6.6 +/- 5.0 months; p = 0.05). Eleven patients (15.7%) showed a mixed relapse at any time during the follow-up. Patient with mixed episode have more frequently mixed relapse than patients with depressive episode (29.4% vs 2.8%; p = 0.002). Patients whit mixed relapse showed a higher burden for anxiety comorbidity (81.8% vs 42.4%, p = 0.002) in general and panic disorder in particular (81.8% vs 39%; p = 0.009. Patients with mixed relapse reported a higher number of ECT during the follow-up than patients with depressive relapses. (63.6% vs 21.1%; p = 0.020). There was an association between time to relapse and the lifetime panic comorbidity: patients with panic disorder relapsed in a shorter time. The 70,6% of the patients in this group relapsed within 26 weeks, whereas 53,8% of the patients without panic disorder did it in the same time [Log Rank (Mantel-Cox) chi-square = 0.05]. Neither the length of index episode, nor the presence of psychotic symptoms correlates with the time of relapse. Conclusions: In our study, electroconvulsive therapy showed a positive impact on the clinical course of severe and treatment-resistant patients with bipolar disorder, as suggested by the high number of weeks spent in remission during the follow-up period. The duration of index episode was related to higher probability of depressive relapse, while psychotic symptoms were more frequent in patients who did not relapsed. As regard mixed relapses, lifetime panic disorder comorbidity and the mixed polarity of index episode may predict the probability of relapse. Further research on clinical predictors of early relapse is needed in order to identify therapeutic strategies to improve long-term outcomes in bipolar ECT-responder patients

Rischio Suicidario e Aree Problematiche Interpersonali in pazienti di genere maschile con Disturbi dell'Umore

Background: L’ideazione suicidaria, i propositi autolesivi, la presenza di specifici piani anticonservativi e i tentativi di suicidio sono molto frequenti nel decorso dei Disturbi dell’Umore. Numerosi sono i fattori che aumentano il rischio di condotte suicidarie. La specificità di questi fattori appare, tuttavia, limitata, a causa della loro diffusione sia nella popolazione generale, sia nei campioni clinici. La valutazione della multi-fattorialità associata all’aumento del rischio suicidario in soggetti che presentino un disturbo dell’umore, comprende i potenziali stressor interpersonali concomitanti con l’insorgenza dell’episodio in atto o con l’attuazione del gesto anticonservativo. Un modello di raccolta sistematica delle aree problematiche associate alla insorgenza degli episodi di un disturbo dell’umore è compreso nell’assessment della Psicoterapia Interpersonale (IPT) e della Psicoterapia Interpersonale e dei Ritmi Sociali (IPSRT), indicate sia per la Depressione Unipolare sia per il Disturbo Bipolare dalle linee guida dell’APA (2002, 2010). IPT e IPSRT considerano quattro aree problematiche principali: il contrasto di ruolo, la transizione di ruolo, il lutto ed il deficit interpersonale; IPSRT include anche una quinta area problematica: la ‘perdità del sé sano’ (‘lost healty self’). Materiale e Metodo: la presenza di una o più aree problematiche interpersonali correlabili con l’insorgenza dell’episodio in atto e con l’eventuale concomitanza di condotte anticonservative è stata valutata in uno studio cross-sectional condotto presso la Clinica Psichiatrica di Pisa, con soggetti di sesso maschile ospedalizzati. E’ stato adottato come unico criterio di inclusione la diagnosi di un disturbo dello spettro dell’umore, secondo i criteri del DSM-IV. Sono state raccolte le principali variabili di tipo anagrafico, socio-economico e diagnostico. E’ stata, inoltre, considerata la presenza di tentativi di suicidio, ideazione o progettualità suicidaria al momento del ricovero e in anamnesi. Le aree interpersonali sono state valutate da un rater indipendente, con la ‘Interpersonal Problem Areas Rating Scale’. Risultati: nel campione valutato (n=122), le aree problematiche sono così distribuite: deficit interpersonale, 44.3%; conflitto interpersonale, 41%; perdita del sé sano, 28.7%, transizione di ruolo, 21.3%; lutto 3.3%. I pazienti sono risultati essere affetti da disturbo bipolare nell’82% dei casi, depressione unipolare nel 7.4%, disturbo dell’umore con manifestazioni psicotiche nel 9% e ciclotimia nel restante 1.6% dei casi. Nel 43% dei pazienti s è riscontrata la presenza di almeno un tentativo di suicidio, in anamnesi o a motivo del ricovero attuale. Ideazione e pianificazione di progetti suicidari, rispettivamente nel 24 e nel 9% dei pazienti. È emersa una significativa maggior durata del numero totale di ospedalizzazioni nei pazienti con storia di tentativo i suicidio; si è riscontrata inoltre una minor durata globale di malattia nei pazienti con transizione di ruolo. L’esiguità numerica del campione non ha consentito di porre correlazione tra uno o più focus interpersonali e un aumento del rischio di condotte appartenenti allo spettro suicidario. Conclusioni: questo studio preliminare ha confermato la diffusione delle aree interpersonali identificate da IPT e IPSRT in pazienti con disturbi dello spettro dell’umore. In particolare, il deficit interpersonale costituisce il focus più frequentemente rappresentato. Ulteriori studi saranno necessari su campioni più ampi per esplorare la correlazione tra specifiche aree interpersonali e la presenza di condotte suicidarie

First record of the invasive mosquito species Aedes (Stegomyia) albopictus (Diptera: Culicidae) on the southernmost Mediterranean islands of Italy and Europe

Abstract Background Aedes albopictus, a known worldwide vector of several mosquito-borne disease pathogens including dengue, chikungunya and Zika viruses, was introduced into Europe in the late 1970s through global trade. First recorded in northern Italy in 1990, this mosquito species has rapidly spread throughout the country, where it was responsible for an outbreak of chikungunya in 2007 that affected more than 200 people. As part of the VectorNet project, which is aimed at improving preparedness and responsiveness for animal and human vector-borne diseases in Europe, a mosquito targeted study was carried out on the three southernmost Italian islands. The objective was to verify the current European southern distribution limits of Ae. albopictus and the potential occurrence of other invasive mosquito species, in the light of the introduction of high risk for vector-borne disease pathogens into Europe via migration flows. Results In the summer 2015, six surveys for container-breeding mosquitoes were carried out by setting up a network of oviposition traps and BG Sentinel traps in selected areas on the islands of Pantelleria, Lampedusa and Linosa. Aedes albopictus was found on all three islands under investigation. The consequences on public health with regard to the presence of this mosquito vector and the migrant people entering the country from Africa and the Middle East are also discussed here. Conclusions The detection of the Asian tiger mosquito on these islands, which represent the last European strip of land facing Africa, has important implications for public health policy and should prompt the national authorities to implement tailored surveillance activities and reinforce plans for preparedness strategies in such contexts

Larvicidal activity of Ocimum campechianum, Ocotea quixos and Piper aduncum essential oils against Aedes aegypti

Aedes aegypti, the main arbovirus vector of the Yellow fever, Dengue, Chikungunya and Zika viruses, is widely distributed in tropical and subtropical areas throughout the world. Preventive control efforts have been implemented worldwide aimed at reducing its impact on human health. The recent reduction of chemicals available for vector control due to their negative impact on the environment and human health and the increase in mosquito resistance to insecticides have driven the research community to identify and evaluate sustainable alternatives to synthetic insecticides. In this study, the potential larvicidal effect of essential oils extracted from Ocimum campechianum, Ocotea quixos and Piper aduncum were tested in vitro. GC and GC-MS analyses showed that the main compounds were eugenol (18%), 1,8-cineole (39%) and dillapiole (48%), respectively. Susceptibility to essential oils was measured according to the WHO protocol. After 24 h, the mean percentage mortality ranged from 2.7 to 100% for P. aduncum, from 2.2 to 100% for O. campechianum, and from 2.9 to 100% for O. quixos. The highest potential was displayed by P. aduncum, followed by O. campechianum and O. quixos, with LC50 values of 25.7, 69.3 and 75.5 ppm, respectively. The rapid and effective larvicidal activity of these three oils led us to consider these results to be promising, also considering the possibility of local cultivation of these plants in tropical and subtropical areas and the simple technology for their large-scale preparation and production. Further studies are needed to evaluate the individual components and their activity as larvicides

Italian validation of the Italian multidimensional psychological flexibility inventory (MPFI)

The Multidimensional Psychological Flexibility Inventory (MPFI) is a recently developed measure of psychological flexibility and inflexibility based on the psychological functioning model of behavior change that underpins Acceptance and Commitment Therapy (ACT). The present study sought to develop a validation of this measure in Italian language from its English original version and explored the factor structure and reliability as well as convergent and concurrent validity of the Italian version of the MPFI. A total of 1,542 participants (71% female, M = 38.6 years old, SD = 15.0 years) completed an online cross-sectional survey including the Italian MPFI, other measures of psychological flexibility, and measures of metal health (anxiety, depression, and well-being). Confirmatory factor analysis replicated the factor structure of the original MPFI. The Italian MPFI had a two second-order factor structure composed of six first-order factors of flexibility and six first-order factors of inflexibility, with good construct validity. The Italian MPFI evinced good internal consistency, and convergent and concurrent validity. It also exhibited measurement invariance for gender, age, and mental health status. The Italian MPFI is a psychometrically sound measure of psychological flexibility and inflexibility in the Italian context. The Italian MPFI offers new tools in ACT theoretical and intervention research in Italy