Factors associated with first- versus second generation long-acting antipsychotics prescribed un-der ordinary clinical practice in Italy.

Background For many years, long-acting intramuscular (LAI) antipsychotics have been prescribed predominantly to chronic and severe patients, as a last resort when other treatments failed. Recently, a broader and earlier use of LAIs, particularly second-generation LAIs, has been emphasized. To date, few studies attempted to frame how this change in prescribing took place in real-world practice. Therefore, this study aimed to describe the clinical features of patients prescribed with LAIs, and to explore possible prescribing differences between first- and second-generations LAIs under ordinary clinical practice in Italy. Methods The STAR Network \u201cDepot\u201d Study is an observational, longitudinal, multicenter study involving 35 centers in Italy. In the cross-sectional phase, patients prescribed with LAIs were consecutively recruited and assessed over a period of 12 months. Descriptive statistics and multivariable logistic regression analyses were employed. Results Of the 451 recruited patients, 61% were males. The level of social and working functioning was heterogeneous, as was the severity of disease. Seventy-two per cent of the patients had a diagnosis of the schizophrenia spectrum. Seventy per cent were prescribed with second-generation antipsychotic (SGA) LAIs (mostly paliperidone, aripiprazole and risperidone). Compared to first-generation antipsychotic (FGA) LAIs, patients prescribed with SGA LAIs were more often younger; employed; with a diagnosis of the schizophrenia spectrum or bipolar disorder; with higher levels of affective symptoms; with fewer LAI prescriptions in the past. Discussion LAIs' prescribing practices appear to be more flexible as compared to the past, although this change is mostly restricted to SGA LAI

COVID-19 and Substance Use Disorders:Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine (ISAM) Practice and Policy Interest Group Position Paper

Coronavirus disease 2019 (COVID-19) is escalating all over the world and has higher morbidities and mortalities in certain vulnerable populations. People Who Use Drugs (PWUD) are a marginalized and stigmatized group with weaker immunity responses, vulnerability to stress, poor health conditions, high-risk behaviors, and lower access to health care services. These conditions put them at a higher risk of COVID-19 infection and its complications. In this paper, an international group of experts on addiction medicine, infectious diseases, and disaster psychiatry explore the possible raised concerns in this issue and provide recommendations to manage the comorbidity of COVID-19 and Substance Use Disorder (SUD).Publisher PDFPeer reviewe

Family interventions for schizophrenia in Italy : randomized controlled trial

Objective: To evaluate the effectiveness of multiple group family treatment for Schizophrenia. Method: Relatives were randomly provided with an informative programme (n = 50), or allocated to receive an additional support programme (n = 26). Patients did not attend the programme to overcome cultural and organizational implementation barriers. The 12 and 24 months clinical and family outcomes were assessed. Results: Patients' compliance with standard care was greater at 12 months in the more intensive behavioural management group over a control group receiving treatment as usual (TAU) (n = 25). A reduction in levels of expressed emotion (EE), significantly more frequent in those receiving the additional support programme than just the informative, occurred after treatment completion. Other clinical and family outcomes did not differ. However, treatment benefits declined at 24 months, when baseline high EE was again predictive of patient's admission and relatives were more vulnerable to objective burden. Baseline illness severity variables predicted a number of medium and long-term poor clinical outcomes. Conclusions: Although family psychoeducation has been tested in a wide range of Anglo-Saxon settings, there remains need to assess outcomes more internationally. Effective family interventions for people with schizophrenia probably require continued administration of key-elements or ongoing informal support to deal with the vicissitudes of illnesses

Episomal DNA of a BK virus variant in a human insulinoma.

BK virus (BKV) DNA was detected by blot hybridization in a human adenoma of pancreatic islets from patient I.R. BKV DNA was free, and no evidence was found of viral sequences integrated into cellular DNA. Virus was rescued by transfection of human embryonic fibroblasts with tumor DNA. The DNA from rescued virus (BKV-IR) was different from wild-type BKV DNA by restriction endonuclease mapping. The genome of BKV-IR is 235 base pairs (bp) shorter than the genome of wild-type BKV. This alteration originates from a deletion of approximately 300 bp involving HindIII fragments B and D, and an insertion of 70 bp in the region of HindIII fragment C. Transformation of hamster kidney cells was induced by total tumor DNA as well as by BKV-IR and BKV-IR DNA. No antibodies to BKV tumor (T) antigen were detected in the patient's serum by immunofluorescence. The significance of episomal BKV DNA in a human tumor is discussed

Prevalence and correlates of QTc prolongation in Italian psychiatric care: cross-sectional multicentre study

In recent years several warnings have been issued by regulatory authorities on the risk of electrocardiogram abnormalities in individuals exposed to psychotropic drugs. As a consequence of these warnings, monitoring of the QT interval corrected for heart rate (QTc) has become increasingly common. This study was conducted to measure the frequency of QTc prolongation in unselected psychiatric patients, and to document the associated factors using a cross-sectional approach

Formation of oligomeric free BK virus DNA is required for tandem integration of viral genomes into cellular DNA.

Mouse kidney cells have been transformed by linear BK virus (BKV) DNA with cohesive ends. These BKV genomes can circularize and subsequently replicate or physically join end to end yielding oligomeric viral DNA molecules. Blot hybridization analysis of transformed cells showed the presence of BKV DNA both in free circular forms and integrated into cellular DNA in a tandem head-to-tail array of full-length viral genomes. Formation of oligomers either by replication via previous circularization or by end to end joining is hindered after elimination of cohesive termini by digestion with the single-strand-specific nuclease S1. After treatment of linear BKV DNA with nuclease S1 only integrations of single viral genomes were observed in transformed cells; tandem insertions and free viral DNA were absent. These results support the hypothesis that formation of tandems of free viral DNA is a necessary prerequisite for tandem integration of viral genomes

Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: a latent mediated and moderated structural equation modeling analysis across diagnostic groups

Although 96-100% of individuals with eating disorders (EDs) report insecure attachment, the specific mechanisms by which adult insecure attachment dimensions affect ED symptomatology remain to date largely unknown. This study examined maladaptive perfectionism as both a mediator and a moderator of the relationship between insecure attachment (anxiety and avoidance) and ED symptomatology in a clinical, treatment seeking, sample. Insecure anxious and avoidant attachment, maladaptive perfectionism, and ED symptomatology were assessed in 403 participants from three medium size specialized care centres for EDs in Italy. Structural equation modeling indicated that maladaptive perfectionism served as mediator between both insecure attachment patterns and ED symptomatology. It also interacted with insecure attachment to predict higher levels of ED symptoms - highlighting the importance of both insecure attachment patterns and maladaptive aspects of perfectionism as treatment targets. Multiple-group comparison analysis did not reveal differences across diagnostic groups (AN, BN, EDNOS) in mediating, main and interaction effects of perfectionism. These findings are consistent with recent discussions on the classification and treatment of EDs that have highlighted similarities between ED diagnostic groups and could be viewed through the lens of the Trans-theoretical Model of EDs. Implications for future research and intervention are discussed

Promoting recovery of schizophrenic patients: Discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project [Promuovere il recupero dei pazienti con schizofrenia: Discrepanze fra pratiche di routine ed evidenze. Il Progetto SIEP-DIRECT'S]

AIMS: The aim of this work is to present the main discrepancies, as evidenced by the SIEP-DIRECT'S Project, between the evidence-based NICE guidelines for schizophrenia and the usual practices of the Italian mental health services in order to promote the recovery of patients with schizophrenia. METHODS: Starting from the main NICE recommendations on recovery promotion, 41 indicators were developed. These were experimented in 19 participating Italian Mental Health Departments (MHD) or Psychiatric Services through self-evaluation of the activities carried out to promote patient recovery with the aim of assessing the level of adherence to the recommendations. The data required by most of the indicators were obtained from the psychiatric informative system or from the Direction of the MHD. Moreover, specific research was carried out on the clinical records and on representative patient samples. Furthermore, for 14 indicators, there was requested an assessment by the part of "multidisciplinary" or "specialistic" focus groups who then attributed a score according to a defined "ad hoc" scale. RESULTS: According to the data obtained, although the mental health services seem to care about the physical condition of their patients, they do not routinely examine principle parameters such as blood pressure, glycaemia etc., and collaboration with general practitioners is often complex or not uniformly practiced. Most psychiatrists and psychologists possess the basic communication skills but not enough competences in cognitive-behavioural treatments; such treatments, and every other form of structured individual psychotherapy, are seldom carried out and seem to have become marginal activities within the Services. Also family psycho-educational interventions are under-used. The Services are very active in the care of multi-problem schizophrenia patients, who make up a large percentage (almost a quarter, on average) of the patients in their care. These patients are offered specific and integrated treatment plans with the involvement of other health services and social agencies operating in the territory. The strategies adopted by the services for the pharmacological treatment in the prevention of relapses and for patients with frequent crises or with treatment-resistant schizophrenia are all in line with the NICE recommendations. Finally, the Services promote activities of vocational training and supported employment, but the outcomes of these are often unsatisfactory. CONCLUSIONS: The results of the study show a picture of the Italian mental health services with bright yet also dark areas as regards recovery promotion activities. The Services seem to guarantee adequate pharmacological evidence-based treatments, an integrated assistance and good management of multi-problem patients. They have difficulty, however, with respect to the monitoring of the physical health of the patients, psychotherapeutic activities, including those for families, and the promotion of supported employment. Moreover, they still show problems regarding the structuring and formalizing of care processes. To improve this situation, they should make greater use of professional guidelines, protocols and written procedures