Is There a Major Role for Undetected Autism Spectrum Disorder with Childhood Trauma in a Patient with a Diagnosis of Bipolar Disorder, Self-Injuring, and Multiple Comorbidities?

This case report highlights the relevance of the consequences of trauma in a female patient with an undetected autism spectrum disorder (ASD) affected by bipolar disorder (BD) with multiple comorbidities. A 35-year-old woman with BD type II, binge eating disorder and panic disorder was admitted in the Inpatient Unit of the Psychiatric Clinic of the University of Pisa because of a recrudescence of depressive symptomatology, associated with increase of anxiety, noticeable ruminations, significant alteration in neurovegetative pattern, and serious suicide ideation. During the hospitalization, a diagnosis of ASD emerged besides a history of childhood trauma and affective dysregulation, marked impulsivity, feeling of emptiness, and self-harm behavior. The patient was assessed by the Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale (RAADS-R), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), Trauma and Loss Spectrum (TALS-SR), and Ruminative Response Scale (RRS). Total scores of 38/50 in the AQ, 146/240 in the RAADS-R, 99/160 in the AdAS Spectrum emerged, compatible with ASD, 47/116 in the TALS-SR, and 64/88 in the RRS. We discuss the implications of the trauma she underwent during her childhood, in the sense that caused a complex posttraumatic disorder, a lifelong disease favored and boosted by the rumination tendency of high functioning ASD

A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid (FOLFOX-4) as first-line treatment of advanced gastric cancer patients

The aim of the study was to assess the toxicity and the clinical activity of biweekly oxaliplatin in combination with infusional 5-fluorouracil (5-FU) and folinic acid (FA) administered every 2 weeks (FOLFOX-4 regimen) in patients with advanced gastric cancer (AGC). A total of 61 previously untreated AGC patients were treated with oxaliplatin 85 mg m−2 on day 1, FA 200 mg m−2 as a 2 h infusion followed by bolus 5-FU 400 mg m−2 and a 22 h infusion of 5-FU 600 mg m−2, repeated for 2 consecutive days every 2 weeks. All patients were assessable for toxicity and response to treatment. Four (7%) complete responses and 19 partial responses were observed (overall response rate, 38%). Stable disease was observed in 22 (36%) patients, with progressive disease in the other six (10%) patients. Median time to progression (TTP) and median overall survival (OS) were 7.1 and 11.2 months, respectively. National Cancer Institute Common Toxicity Criteria grade 3 and 4 haematologic toxicities were neutropenia, anaemia and thrombocytopenia in 36, 10 and 5% of the patients, respectively. Grade 3 peripheral neuropathy was recorded in three (5%) patients. FOLFOX-4 is an active and well-tolerated chemotherapy. Response rate (RR), TTP and OS were comparable with those of other oxaliplatin-based regimens, suggesting a role for this combination in gastric cancer

Analisi di costo-utilità probabilistica di lurasidone rispetto allo standard di cura in pazienti con schizofrenia in Italia.

Background: Schizophrenia is a psychotic disorder, con- sidered among the most serious and debilitating mental dis- orders. Lurasidone belongs to a group of medicines called antipsychotics and is indicated for the treatment of schizo- phrenia in adults from 18 years of age. Objective: The aim of this study was to evaluate costs and outcomes generated using lurasidone compared to the sec- ond-generation antipsychotics currently used in Italy for the treatment of adult patients with schizophrenia. Methods: A decision tree with a 1-year follow-up was de- veloped from the National Service Perspective (NHS). Hos- pitalization risk for each treatment and the utility estimates associated with each health state have been obtained from the literature. Hospitalization costs were estimated through the national tariffs associated with DRGs, while the costs of drugs were obtained from regional bargaining tenders for the Standard of Care (SoC) and using the market price (net of non-transparent discounts) for lurasidone. A determinis- tic and a probabilistic sensitivity analysis were conducted to evaluate parameter uncertainty. Results: The model estimated a total annual cost of € 68,413.7 per 100 patients treated with lurasidone (approxi- mately 70% related to the hospitalization cost) and a total annual cost of € 50,966.9 per 100 patients treated with SoC. The total QALYs obtained were lower for patients treated with SoC compared to lurasidone (74.5 vs 75.3 respective- ly). The incremental cost-effectiveness ratio (ICER) was estimated at € 22,552.7 per QALY. The Monte Carlo simu- lations showed that with a maximum threshold for the will- ingness to pay of € 40,000 per QALY, the probability of cost-effectiveness of lurasidone was approximately 71%. Conclusions: The deterministic results showed that lurasi- done could be a cost-effective treatment option compared to SoC considering a minimum threshold for the willingness to pay of € 25,000 per QALY gained. Taking into account the intrinsic variability of the parameters included in the model, the probability of cost-effectiveness of lurasidone was high- er than 55% and 70% considering a threshold for the will- ingness to pay of € 25,000 and € 40,000 per QALY gained respectively

Subthreshold autism spectrum in bipolar disorder: Prevalence and clinical correlates

While few previous studies highlighted a higher prevalence of autistic traits among adults with Bipolar Disorder (BD), little is known about their clinical significance in this population

Disrupted Rhythmicity and Vegetative Functions Relate to PTSD and Gender in Earthquake Survivors

Background: Increasing evidence indicates that survivors to traumatic events may show disruption of sleep pattern, eating and sexual behaviors, and somatic symptoms suggestive of alterations of biorhythmicity and vegetative functions. Therefore, the aim of this study was to investigate these possible alterations in a sample of survivors in the aftermath of earthquake exposure, with particular attention to gender differences and impact of post-traumatic stress disorder (PTSD). Methods: High school senior students, who had been exposed to the 2009 L'Aquila earthquake, were enrolled 21 months after the traumatic event and evaluated by the Trauma and Loss Spectrum Self-Report to investigate PTSD rates and by a domain of the Mood Spectrum Self-Report–Lifetime Version (MOODS-SR), to explore alterations in circadian/seasonal rhythms and vegetative functions. Results: The rates of endorsement of MOODS-SR rhythmicity and vegetative functions domain and subdomain scores were significantly higher in survivors with PTSD with respect to those without it. Among all earthquake survivors, women reported higher scores than men on the rhythmicity and vegetative functions domain and subdomain scores, except for the rhythmicity and sexual functions ones. Female survivors without PTSD showed significantly higher scores than men in the rhythmicity and vegetative functions total scores and the sleep and weight and appetite subdomains. Potentially traumatic events burden predicted rhythmicity and vegetative functions impairment, with a moderation effect of re-experiencing symptoms. Conclusions: We report impairments in rhythmicity, sleep, eating, and sexual and somatic health in survivors to a massive earthquake, particularly among subjects with PTSD and higher re-experiencing symptoms, with specific gender-related differences. Evaluating symptoms of impaired rhythmicity and vegetative functions seems essential for a more accurate assessment and clinical management of survivors to a mass trauma