Pharmacological treatment for social cognition: Current evidence

Cognitive impairment is currently considered a core feature of schizophrenia (SZ) and is gaining attention as a fundamental therapeutic target. Standard treatment for SZ involves the use of antipsychotics that are successfully used to control positive symptoms and disorganized behaviour. However, it is still unclear whether they are effective on social cognition (SC) impairment. Furthermore, different medications are currently being studied to improve SC in patients with SZ. A literature search on this topic was conducted using the PubMed database. All kinds of publications (i.e., reviews, original contributions and case reports) written in English and published in the last 15 years were included. The aim of our literature review is to draw a picture of the current state of the pharmacological treatment of SC impairment in SZ

COVID-19 integrated surveillance in Italy: Outputs and related activities

OBJECTIVES: to describe the integrated surveillance system of COVID-19 in Italy, to illustrate the outputs used to return epidemiological information on the spread of the epidemic to the competent public health bodies and to the Italian popu-lation, and to describe how the surveillance data contributes to the ongoing weekly regional monitoring and risk assessment system. METHODS: the COVID-19 integrated surveillance system is the result of a close and continuous collaboration between the Italian National Institute of Health (ISS), the Italian Ministry of Health, and the regional and local health authorities. Through a web platform, it collects individual data of laboratory confirmed cases of SARS-CoV-2 infection and gathers information on their residence, laboratory diagnosis, hospital-isation, clinical status, risk factors, and outcome. Results, for different levels of aggregation and risk categories, are published daily and weekly on the ISS website, and made avail-able to national and regional public health authorities; these results contribute one of the information sources of the regional monitoring and risk assessment system. RESULTS: the COVID-19 integrated surveillance system mon-itors the space-time distribution of cases and their character-istics. Indicators used in the weekly regional monitoring and risk assessment system include process indicators on com-pleteness and results indicators on weekly trends of newly di-agnosed cases per Region. CONCLUSIONS: the outputs of the integrated surveillance system for COVID-19 provide timely information to health authorities and to the general population on the evolution of the epidemic in Italy. They also contribute to the continuous re-assessment of risk related to transmission and impact of the epidemic thus contributing to the management of COV-ID-19 in Italy

Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system

BACKGROUND: International literature suggests that disadvantaged groups are at higher risk of morbidity and mortality from SARS-CoV-2 infection due to poorer living/working conditions and barriers to healthcare access. Yet, to date, there is no evidence of this disproportionate impact on non-national individuals, including economic migrants, short-term travellers and refugees. METHODS: We analyzed data from the Italian surveillance system of all COVID-19 laboratory-confirmed cases tested positive from the beginning of the outbreak (20th of February) to the 19th of July 2020. We used multilevel negative-binomial regression models to compare the case fatality and the rate of admission to hospital and intensive care unit (ICU) between Italian and non-Italian nationals. The analysis was adjusted for differences in demographic characteristics, pre-existing comorbidities, and period of diagnosis. RESULTS: We analyzed 213 180 COVID-19 cases, including 15 974 (7.5%) non-Italian nationals. We found that, compared to Italian cases, non-Italian cases were diagnosed at a later date and were more likely to be hospitalized {[adjusted rate ratio (ARR)=1.39, 95% confidence interval (CI): 1.33-1.44]} and admitted to ICU (ARR=1.19, 95% CI: 1.07-1.32), with differences being more pronounced in those coming from countries with lower human development index (HDI). We also observed an increased risk of death in non-Italian cases from low-HDI countries (ARR=1.32, 95% CI: 1.01-1.75). CONCLUSIONS: A delayed diagnosis in non-Italian cases could explain their worse outcomes compared to Italian cases. Ensuring early access to diagnosis and treatment to non-Italians could facilitate the control of SARS-CoV-2 transmission and improve health outcomes in all people living in Italy, regardless of nationality

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

Background. Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Methods. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. Results. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. Conclusions. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem

Capecitabine in association with epirubicin and docetaxel as a first line treatment in advanced breast cancer a multicenter phase II study

The combination of Epirubicin and Taxotere (ET), both drugs given at 75 mg/ m2day 1q. 21 days, is widely used in the treatment of advanced breast cancer. We previously reported a phase I study which indicated that Capecitabine 2000 mg/m2/day for 14 consecutive days could be safely combined with full doses of ET. Among 23 patients treated 21 (91%), responded to the treatment. On these premises, we undertook a multicenter phase II trial to confirm the activity of the this regimen (Taxotere 75 mg/m2 IV bolus on day 1. Epirubicin 75 mg/m2 IV bolus on day 1, Capecitabine 2000 mg/m2/day for 14 consecutive days, q. 21 days). From March 2000 to February 2001, six Italian Centers enrolled 67 advanced breast cancer patients (pts), with measurable disease. To date, 65 pts have been evaluated. The median age was 53 years (range 31-68); 33 pts (51%) had locally advanced disease, 32 pts (49%) distant metastasis and 17 (26 %) of them had two or more metastatic sites. Severe non-hematological toxicity was rarely reported. Only one patient experienced a grade 4 non-hematological toxicity (mucositis). Grade 3 non-hematological toxicities were: asthenia 4 pts (6%), mucositis 3 pts (5%), hand-foot syndrome 2 pts (3%). nausea and vomiting 6 pts (9%), diarrhea 1 pts (3%), allergy 1 pt (2%), dyspnea 1 pt (2%). venous thrombosis 1 pt (2%). A mild or moderate increase of ALT and bilirubin was observed in 17 pts (26%), and 7 pts (11%), respectively. Thrombocytopenia was seldom reported: two (3%) pts suffered from it of grade 3. Grade 3/4 anemia was observed in 2 pts (3%). Neutropenia was the predominant toxicity. Forty-six percent of pts had grade 3/4 neutropenia. Ten pts (15%) had febrile neutropenia. Preliminary data on 50 evaluable pts showed an objective response (CR+PR) in 21/26 (81%) locally advanced pts and 17/ 24 (71%) metastatic pts. These data confirmed that Capecitabine can be incorporated with full doses of ET and that this new regimen is highly active in advanced breast cancer. Based on these data, a large multicenter randomized Phase III trial is ongoing