Predictive value of bipolar-spectrum clinical features in a large cohort of fluoxetine treated patients with major depressive disorder

Objective: The presence of unrecognized bipolar disorder or “bipolar spectrum” features has been suggested to contribute to poor treatment response in major depressive disorder. We aimed to investigate the association between putative bipolar spectrum features and clinical outcomes in a cohort of fluoxetine-treated patients with MDD. Method: N= 602 outpatients aged 18-65 years with major depressive disorder recruited at 2 academic medical centers first entered a 12-week phase of open-label treatment with fluoxetine titrated up to 60mg/day. Patients who met the response criteria by week 12 entered the second phase of the study during which they were double-blindly randomized either to continue the same fluoxetine doses to which they had responded or to take placebo, for 52 weeks or until the occurrence of a relapse. The following clinical features suggestive of bipolar illness were selected for analysis: a history of early onset and recurrent depression, baseline atypical depressive features, irritability, psychoticism, suicidality, interpersonal sensitivity, comorbid anxiety disorders, and substance abuse/dependence. These measures were condensed into a summary score of bipolarity ranging from 0 to 10 points. We considered as primary outcomes time to response, remission, and discontinuation during acute treatment and time to relapse in the second phase of the study, utilizing survival analyses. Results: Higher scores on the summary measure of bipolarity were not associated with differential acute treatment outcomes. They were significantly associated with a shorter time to relapse (p = 0.016). The median time until first recurrence was 52.0 weeks in the group with lower scores vs. 12.0 wk in the group with higher scores. Conclusion: Bipolar spectrum features may be associated with shorter time to recurrence in MDD patients after recovery, suggesting some predictive validity for this measure

Bipolar disorder in late life: clinical characteristics in a sample of older adults admitted for manic episode

BACKGROUND: Although manic episodes in older adults are not rare, little published data exist on late-life manic episodes. Resistance to treatment and concomitant neurological lesions are frequent correlates of elderly mania. The aim of this study was to investigate the prevalence of hospitalizations due to mania in patients older than 64 years through a period of 5 years in an Italian public psychiatric ward. Moreover, we aimed at describing clinical presentation of elderly manic episodes. METHODS: A retrospective chart review was conducted in order to describe clinical presentation of 20 elderly patients hospitalized for manic episode; moreover, we compared age at onset, the presence of family history for mood disorders, psychosis and irritability between the elderly group and a matched group of 20 younger manic inpatients. RESULTS: Seven percent of the whole inpatient elderly people suffered from mania. Half of those patients had a mood disorder age at onset after 50 years and 5 patients were at their first manic episode. Geriatric- and adulthood mania showed similar clinical presentation but younger people had more frequently a mood disorders family history. CONCLUSION: Half of our older manic inpatients consisted of "classic" bipolar patients with an extension of clinical manifestations into later life; the other half of our sample was heterogeneous, even though it was not possible to identify clearly which patients may have had vascular lesions related to the onset of mania

Box Behnken design-based optimized extraction of non-dioxin-like PCBs for GC-ECD and GC-MS analyses in milk samples

Abstract A multivariate optimization process of the sample extraction procedure by Box-Behnken design through a global desirability function is described for the determination of six non-dioxin-like polychlorinated biphenyls (NDL-PCBs # 28, 52, 101, 153, 138 and 180) in milk by GC-ECD and mass spectrometry. Three factors were involved in refining the extraction conditions: the acetone percentage in the extraction mixture, the sample/solvent ratio, and the extraction time. The three-factor design required 26 experiments that were carried out in duplicate and in a randomized order to minimize the bias effects of uncontrolled variables. The optimized factors (acetone percentage: 30%; sample-to-solvent ratio: 0.11 g mL−1; extraction time: 45 min) ensured a low solvent consumption and a reduced extraction time, allowing a rapid and simultaneous preparation of multiple sample extracts. The method was validated according to the European directives (Decision 657/2002/EC, SANTE 2017/11813/EC) through the evaluation of linearity, selectivity, LOD, LOQ, recovery, precision, and ruggedness

Ziprasidone as Adjunctive Therapy in Severe Bipolar Patients Treated with Clozapine

Aim. To confirm the efficacy and tolerability of ziprasidone as adjunctive therapy in bipolar patients partially responding to clozapine or with persisting negative symptoms, overweight, or with metabolic syndrome. Methods. Eight patients with psychotic bipolar disorder were tested with the BPRS, the HAM-D, and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels and BMI were tested at T0 and T1. Results. Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course

Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study

AIM: To evaluate the efficacy and safety of the augmentation of clozapine with aripiprazole in patients with treatment-resistant schizoaffective and psychotic bipolar disorders in a retrospective manner. Pharmacodynamic and pharmacokinetic interactions between the two drugs were also investigated. PATIENTS: Three men and 4 women (median age 36 and 40 years, respectively) who had mean scores at BPRS and CGI-Severity of 59.1+/-12.0 and 5.4+/-0.5, respectively, were treated with clozapine (mean dose 292.9+/-220.7 mg/day). Patients received an adjunctive treatment with aripiprazole (mean dose 6.8 +/- 3.7 mg/day). Clozapine, norclozapine and aripiprazole plasma levels were measured by means of a high performance liquid chromatograpy with UV detection. RESULTS: Total scores at BPRS decreased significantly (from 59.1+/-12.0 to 51.1+/-15.6, p=0.007) after aripirazole augmentation. In particular, the factors "thought disorder" (from 10.4+/-4.4 to 9.0+/-4.5, p=.047) and "anergia" (from 10.0+/-2.7 to 8.0+/-2.4, p=.018) significantly improved. Concomitant administration of aripiprazole and clozapine did not result in an increase in side effects over the period of treatment. Dose-normalized plasma levels of both clozapine and norclozapine and the clozapine/norclozapine metabolic ratio in all patients did not vary as well. CONCLUSION: The augmentation of clozapine with aripirazole was safe and effective in severe psychotic schizoaffective and bipolar disorders which failed to respond to atypical antipsychotics. A possible pharmacokinetic interaction between clozapine and aripiprazole does not account for the improved clinical benefit obtained after aripiprazole augmentation

life threatening acute myocardial infarction due to left main dissection during radiofrequency transcatheter ablation of atrial tachycardia

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Wastewater-based epidemiology for early warning of SARS-COV-2 circulation: A pilot study conducted in Sicily, Italy

There is increasing evidence of the use of wastewater-based epidemiology to integrate conventional monitoring assessing disease symptoms and signs of viruses in a specific territory. We present the results of SARS-CoV-2 environmental surveillance activity in wastewater samples collected between September 2020 and July 2021 in 9 wastewater treatment plants (WTPs) located in central and western Sicily, serving over 570,000 residents. The presence of SARS-CoV-2, determined in 206 wastewater samples using RT-qPCR assays, was correlated with the notified and geo-referenced cases on the areas served by the WTPs in the same study period. Overall, 51% of wastewater samples were positive. Samples were correlated with 33,807 SARS-CoV-2 cases, reported in 4 epidemic waves, with a cumulative prevalence of 5.9% among Sicilian residents. The results suggest that the daily prevalence of SARS-CoV-2 active cases was statistically significant and higher in areas with SARS-CoV-2 positive wastewater samples. According to these findings, the proposed method achieves a good sensitivity profile (78.3%) in areas with moderate or high viral circulation (≥133 cases/100,000 residents) and may represent a useful tool in the management of epidemics based on an environmental approach, although it is necessary to improve the accuracy of the process