Prominent autistic traits and subthreshold bipolar/mixed features of depression in severe anorexia nervosa

Autistic traits are associated with a burdensome clinical presentation of anorexia nervosa (AN), as is AN with concurrent depression. The aim of the present study was to explore the intertwined association between complex psychopathology combining autistic traits, subthreshold bipolarity, and mixed depression among people with AN

L’impatto della terapia chirurgica sulla riduzione della pressione arteriosa e sui parametri indicativi di danno d’organo nel Morbo di Conn.

Il morbo di Conn è una patologia eterogenea che pone problemi reali nella selezione dei pazienti che presentano indicazione chirurgica. Inoltre, sebbene sia l’opzione terapeutica chirurgica sia quella farmacologica curino o migliorino l’ipertensione arteriosa, esistono pochi dati in letteratura sugli effetti cardiovascolari a lungo termine. METODI: È stato effettuato uno studio osservazionale su tutti i pazienti sottoposti a surrenectomia dal 1992 al 2009, presso il Dipartimento di Chirurgia dell’Università di Pisa, con diagnosi di ammissione di morbo di Conn, per la valutazione dei dati clinici, biochimici e cardiovascolari (ecocardiografia, ecodoppler carotideo) al fine di valutare l’impatto dell’opzione chirurgica sul profilo pressorio, sul rischio cardiovascolare e di fornire un’interpretazione adeguata di tutte le tecniche di studio preoperatorie. Inoltre, sono stati confrontati i dati dei pazienti sottoposti a surrenectomia con quelli di 41 pazienti afferenti dal Centro Ipertensione dell’Università di Pisa trattati farmacologicamente, al fine di confrontare l’outcome nei due tipi di trattamento. RISULTATI: La corretta selezione dei pazienti con malattia monolaterale è estremamente importante in quanto la surrenectomia offre migliori risultati rispetto alla terapia medica in termini di controllo del profilo pressorio e dei danni d’organo, anche in considerazione delle minime complicanze di cui è gravato l’approccio laparoscopico. Inoltre, al fine di diagnosticare correttamente il sottotipo di iperaldosteronismo primario, è necessario affiancare sempre alle tecniche di imaging il cateterismo delle vene surrenali.

Patterns of management of patients with dual disorder (psychosis) in Italy: a survey of psychiatrists and other physicians focusing on clinical practice

© 2018 Clerici, de Bartolomeis, De Filippis, Ducci, Maremmani, Martinotti and Schifano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).Patients with severe psychotic disorders such as schizophrenia, schizoaffective and bipolar disorders frequently suffer from concomitant substance use disorders (SUDs) – Dual Disorder (DD) patients. In order to better understand current practices for management of patients with psychotic episodes and concomitant SUD in Italy, we carried out a survey of psychiatrists on current routine practice among prescribers. These aspects can help to identify at-risk patients, improve current prescribing practices, and favor early intervention. An ad hoc survey of 17 questions was administered to psychiatrists via electronic polling and on-line distribution; 448 completed questionnaires were collected. Comorbid substance abuse was most frequently diagnosed within the context of anxiety disorder (46%), followed by bipolar disorder (25%), and schizophrenia/schizoaffective disorder (12%). The vast majority of respondents felt that patient management was becoming more complex due to substance abuse. The areas reported to be most affected in patients with SUD were functioning, interpersonal relations, and impulsivity, while sensory perception disorders, ideation, agitation, and impulsivity were the most frequently reported symptoms. In the acute setting, haloperidol was used as the first-line agent of choice followed by aripiprazole and olanzapine. In the maintenance phase, aripiprazole was the dominantly used first-line agent, followed by olanzapine. Almost half of respondents used long-acting agents, while about one-third did not. Among those prescribing long-acting agents, efficacy, control of impulsivity, and control of specific symptoms were cited as motivators, while in the maintenance phase, better adherence and tolerability were mainly cited. From the responses to the present survey, it is clear that the respondents are aware of the problem of SUD in psychotic patients. While treatment be optimized in terms of the choice and formulation of antipsychotics, greater emphasis should be placed on efficacy, tolerability and the negative metabolic consequences of some antipsychotics. When considering the ideal antipsychotic, long-acting agents were considered to be superior in reducing relapse, even if current treatment guidelines often give preference to oral formulations.Peer reviewe