Prescrizione di Psicofarmaci nella popolazione anziana. Uno studio di popolazione.

Obiettivo: descrivere l’utilizzo di psicofarmaci in una popolazione ultrasettantacinquenne, mettendolo poi in relazione ai principali disturbi psichiatrici dell’età senile. Metodi: Il Cambridge-Mental-Disorders of the Elderly-Examination (CAMDEX) è stato somministrato a 462 anziani (età media 85.09±6.86 anni, 53.2% donne) arruolati nello studio di popolazione di Faenza. Informazioni riguardo all’uso di farmaci al momento dell’intervista sono state raccolte direttamente dagli intervistati e dai rispettivi care-giver nonché dalla documentazione medica disponibile. Le diagnosi di demenza, disturbi affettivi ed ansiosi sono state fatte sulla scorta dell’intervista e della valutazione clinica in base ai criteri del DSM-IV ed ICD-10. Risultati: Il 32.6% degli intervistati assume 5 farmaci o più rappresentati principalmente da anti-ipertensivi, anti-aggreganti piastrinici ed inibitori della pompa protonica. Le Benzodiazepine sono assunte dal 14% dei partecipanti allo studio, e si trovano così al primo posto tra gli psicofarmaci, e al quarto tra i farmaci di uso comune. Il 26.1% della popolazione assume almeno 1 psicofarmaco, di questi l’1.1% ne assume 3 o più. Tra gli psicofarmaci, gli Ipnoinducenti e gli Antidepressivi sono quelli più utilizzati. Conclusioni: Dallo studio emerge un largo utilizzo di psicofarmaci, tuttavia il trattamento non è sempre adeguato in quanto pazienti affetti da disturbi affettivi e da demenza sono sottotrattati. Grande cautela si osserva nell’utilizzo degli antipsicotici atipici, e sufficiente attenzione nella prescrizione di Benzodiazepine

Sex-specific issues in eating disorders: a clinical and psychopathological investigation

Objective: To highlight the characteristics of eating disorders (ED) in males, with particular attention to sex-related clinical features and psychiatric co-morbidities. Method: Out of 280 persons, referred to our outpatients ED clinic between January 2011 and June 2014, 267 with complete information were included in this retrospective observational study. Results: The men/women ratio was one to five (male 16.5% vs female 83.5%) with an increasing proportion of male patients over the years. The most frequent ED in males was binge eating disorder, whereas in females anorexia nervosa and bulimia nervosa prevailed. Excessive exercising and fasting were the most common compensation behaviours in males; while self-induced vomiting and laxativeâ\u80\u93diuretic abuse were more typical in females. Among women, the most represented psychiatric co-morbidities were mood and somatoform disorders, whereas among men, anxiety and psychosis spectrum disorders were the most frequent ones. Borderline and histrionic personality disorders were prevalent in female ED, while narcissistic and antisocial personality disorders prevailed in males. Discussion: ED in men is a growing phenomenon. Male ED, compared to female ED, show differences in clinical presentation, symptoms and co-morbidities. Despite the use of clinical and psychometric evaluating tools targeting female patients, sex differences do exist and additional studies are required to investigate male specific issues in ED. Level of Evidence Level V, cross-sectional descriptive study

Anxiety symptoms in 74+ community-dwelling elderly: associations with physical morbidity, depression and alcohol consumption.

OBJECTIVE: Anxiety among community-dwelling older adults has not been studied sufficiently. The aims of this cross-sectional population-based study were to estimate the point prevalence of clinically relevant anxiety symptoms and to describe their socio-demographic and clinical features, with particular focus on the association with somatic illnesses. METHODS: Three-hundred-sixty-six non-demented older adults (mean age 83.7±6.2, range 74-99 years) from the Faenza Project (Northern Italy) were assessed using the Cambridge Mental Disorders of the Elderly Examination-Revised (CAMDEX-R) and the Geriatric Anxiety Inventory short form (GAI-sf). Multi-adjusted regression analyses were used to estimate Odds Ratio (OR) and 95% Confidence Intervals (95% CI). RESULTS: Clinically relevant anxiety symptoms occurred in one out of five participants (point prevalence 21.0%) and were significantly associated with depression (OR 5.6 per rank; 95% CI: 3.1-10.1), physical morbidity (OR 3.5 per illness; 95% CI: 1.0-11.9) and female gender (OR 2.8; 95% CI: 1.4-5.5). Further, there were significant associations with a consumption of alcohol exceeding 1 alcoholic unit/day. CONCLUSIONS: Anxiety symptoms are very common in older subjects, especially when medically ill. Depression and alcohol consumption often co-occur with late-life anxiety symptoms, thus requiring special attention in daily clinical practice

Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial

Background: Automated continuous epidural administration of local anesthetics provides a more stable analgesic block with decreasing of healthcare staff compared to manual boluses administration (TOP-UP) but is associated to high rate of operative vaginal delivery. We hypothesized that the use of programmed intermittent automated boluses (PIEB) is able to provide a good quality of analgesia and decreasing of anesthesiologic workload without increasing the rate of instrumental vaginal birth in comparison with TOP-UP technique. Laboring nulliparous woman aged between 18 and 46 years were randomized to epidural analgesia with 0.0625% levobupivacaine and sufentanil administered by PIEB or by TOP-UP techniques. Primary outcome was instrumental vaginal delivery rate and secondary outcomes were quality of analgesia, total and time-related drugs doses used, motor block, newborn outcome, and anesthesiologic workload. Results: Six hundred twenty-nine were randomized, and 628 were included in the intention-to-treat analysis. The rate of instrumental vaginal delivery was similar in the PIEB and TOP-UP groups (13.2% vs 9.7%, OR 1.4 95% CI 0.8 to 2.5; p 0.21). There was no difference between groups regarding mode of delivery (cesarean section vs vaginal birth), newborn outcome, and motor block. Patients in the PIEB group received more total and time-related drugs doses and a better quality of analgesia. Anesthesiological workload was significantly reduced in the PIEB group. Conclusions: Our study demonstrated that epidural anesthesia with programmed intermittent epidural boluses by an automated device provides an effective and safe management of labor analgesia with improvement of pain control and sparing of man workload compared to manual top-up protocols

Absolute number of subjects with overlapping anxiety symptoms, depression and physical morbidity.

<p>As showed in the figure, anxiety symptoms co-occur with depression and physical morbidity in 25 older adults, 43,1% of the group with anxiety. Physical diseases are associated with anxiety symptoms in 29 subjects and with depression in 28 subjects. Anxiety symptoms were defined by the Geriatric Anxiety Inventory short form, using a cut-off score of three or more; depression was diagnosed according to ICD 10 Criteria; physical morbidity was defined as having at least one physical disease among anemia, diabetes, hypertension, coronary heart disease (CHD), cerebrovascular diseases, Parkinson’s Disease. Subjects with missing data for anxiety symptoms or depression or physical morbidity were excluded, leaving a total of 278 subjects.</p

Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19

Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic with lung disease representing the main cause of morbidity and mortality. Conventional chest-X ray (CXR) and ultrasound (US) are valuable instruments to assess the extent of lung involvement. We investigated the relationship between CXR scores on admission and the level of medical care required in patients with COVID-19. Further, we assessed the CXR-US correlation to explore the role of ultrasound in monitoring the course of COVID-19 pneumonia. Clinical features and CXR scores were obtained at admission and correlated with the level of intensity of care required [high- (HIMC) versus low-intensity medical care (LIMC)]. In a subgroup of patients, US findings were correlated with clinical and radiographic parameters. On hospital admission, CXR global score was higher in HIMCs compared to LIMC. Smoking history, pO2 on admission, cardiovascular and oncologic diseases were independent predictors of HIMC. The US score was positively correlated with FiO2 while the correlation with CXR global score only trended towards significance. Our study identifies clinical and radiographic features that strongly correlate with higher levels of medical care. The role of lung ultrasound in this setting remains undetermined and needs to be explored in larger prospective studies

Diamond-Blackfan anemia: genotype-phenotype correlation in Italian patients with RPL5 and RPL11 mutations

BACKGROUND: Diamond-Blackfan anemia is a rare, pure red blood cell aplasia of childhood due to an intrinsic defect in erythropoietic progenitors. About 40% of patients display various malformations. Anemia is corrected by steroid treatment in more than 50% of cases; non-responders need chronic transfusions or stem cell transplantation. Defects in the RPS19 gene, encoding the ribosomal protein S19, are the main known cause of Diamond-Blackfan anemia and account for more than 25% of cases. Mutations in RPS24, RPS17, and RPL35A described in a minority of patients show that Diamond-Blackfan anemia is a disorder of ribosome biogenesis. Two new genes (RPL5, RPL11), encoding for ribosomal proteins of the large subunit, have been reported to be involved in a considerable percentage of patients. DESIGN AND METHODS: In this genotype-phenotype analysis we screened the coding sequence and intron-exon boundaries of RPS14, RPS16, RPS24, RPL5, RPL11, and RPL35A in 92 Italian patients with Diamond-Blackfan anemia who were negative for RPS19 mutations. RESULTS: About 20% of the patients screened had mutations in RPL5 or RPL11, and only 1.6% in RPS24. All but three mutations that we report here are new mutations. No mutations were found in RPS14, RPS16, or RPL35A. Remarkably, we observed a higher percentage of somatic malformations in patients with RPL5 and RPL11 mutations. A close association was evident between RPL5 mutations and craniofacial malformations, and between hand malformations and RPL11 mutations. CONCLUSIONS: Mutations in four ribosomal proteins account for around 50% of all cases of Diamond-Blackfan anemia in Italian patients. Genotype-phenotype data suggest that mutation screening should begin with RPL5 and RPL11 in patients with Diamond-Blackfan anemia with malformations

Diamond-Blackfan anemia: genotype-phenotype correlations in Italian patients with RPL5 and RPL11 mutations

Diamond-Blackfan anemia is a rare, pure red blood cell aplasia of childhood due to an intrinsic defect in erythropoietic progenitors. About 40% of patients display various malformations. Anemia is corrected by steroid treatment in more than 50% of cases; non-responders need chronic transfusions or stem cell transplantation. Defects in the RPS19 gene, encoding the ribosomal protein S19, are the main known cause of Diamond-Blackfan anemia and account for more than 25% of cases. Mutations in RPS24, RPS17, and RPL35A described in a minority of patients show that Diamond-Blackfan anemia is a disorder of ribosome biogenesis. Two new genes (RPL5, RPL11), encoding for ribosomal proteins of the large subunit, have been reported to be involved in a considerable percentage of patients