Effectiveness of 1-year treatment with long-acting formulation of aripiprazole, haloperidol, or paliperidone in patients with schizophrenia: retrospective study in a real-world clinical setting

Background: Schizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level variability compared to corresponding oral preparations. Purpose: To compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate (PP-OM). Methods: We retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012 to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months before and after LAI implementation. Data were statistically analyzed. Results: The three LAI groups differed significantly only for “need for economic support from social service” (more frequent in the Hal-D group) and “schizoaffective disorder” (prevalent in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 months’ treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (P,0.001) and overlapping clinical and functioning improvement-scale scores (P,0.001), and 14.28% of patients dropped out, with no difference among the three LAI-APDs. Different kinds of adverse effects, though similar for number and severity, were reported in the three LAI groups. Conclusion: Our results suggest that both first- and second-generation LAI-APDs represent important therapeutic options, useful for improving schizophrenia’s clinical course and its economic burden. Our study, which offers a wide and comprehensive observation of real-world clinical settings, combined an effectiveness evaluation through mirror analysis performed for each individual patient to a subsequent comparison among the three LAI-APDs, allowing us a more complete evaluation of clinical efficacy

O015. Evaluation of the genetic polymorphism of the α3 (CHRNA3) and α5 (CHRNA5) nicotinic receptor subunits, in patients with cluster headache

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A genome-wide analysis in cluster headache points to neprilysin and PACAP receptor gene variants

Background: Cluster Headache (CH) is a severe primary headache, with a poorly understood pathophysiology. Complex genetic factors are likely to play a role in CH etiology; however, no confirmed gene associations have been identified. The aim of this study is to identify genetic variants influencing risk to CH and to explore the potential pathogenic mechanisms. Methods: We have performed a genome-wide association study (GWAS) in a clinically well-defined cohort of 99 Italian patients with CH and in a control sample of 360 age-matched sigarette smoking healthy individuals, using the Infinium PsychArray (Illumina), which combines common highly-informative genome-wide tag SNPs and exonic SNPs. Genotype data were used to carry out a genome-wide single marker case-control association analysis using common SNPs, and a gene-based association analysis focussing on rare protein altering variants in 745 candidate genes with a putative role in CH. Results: Although no single variant showed statistically significant association at the genome-wide threshold, we identified an interesting suggestive association (P = 9.1 7 10 126) with a common variant of the PACAP receptor gene (ADCYAP1R1). Furthermore, gene-based analysis provided significant evidence of association (P = 2.5 7 10 125) for a rare potentially damaging missense variant in the MME gene, encoding for the membrane metallo-endopeptidase neprilysin. Conclusions: Our study represents the first genome-wide association study of common SNPs and rare exonic variants influencing risk for CH. The most interesting results implicate ADCYAP1R1 and MME gene variants in CH susceptibility and point to a role for genes involved in pain processing. These findings provide new insights into the pathogenesis of CH that need further investigation and replication in larger CH samples

Italian Guidelines in diagnosis and treatment of alopecia areata

Alopecia areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration. The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations

Cibo ed emozioni: falsi miti o strumento clinico?

Stefania ha 29 anni. Orfana di padre, che soffriva di anoressia nervosa ed è deceduto prematuramente per infarto del miocardio, vive con la madre, che è invece affetta da una grave patologia renale in terapia dialitica 3 volte alla settimana. Si definisce una “bimba grassottella e serena” fino alla prima adolescenza: inizia allora ad acquisire uno stile alimentare restrittivo, con importante dimagramento che rende necessari svariati ricoveri in ambiente psichiatrico. Viene posta diagnosi di anoressia nervosa. In Day Hospital, dove è giunta per un intervento riabilitativo di reinserimento socio-lavorativo, presenta sin dall’inizio uno stile alimentare irregolare e disordinato, estremamente restrittivo da un punto di vista quantitativo ma non qualitativo: tende a saltare i pasti, salvo poi prediligere il consumo di cibi grassi durante le occasioni sociali. Sono evidenti rituali ossessivi di organizzazione dei pasti, su cui è imperniata tutta la sua vita. Estremamente seduttiva nelle relazioni con medici e pazienti, non abbandona neanche dopo mesi le sue abitudini alimentari, non riesce a raggiungere il peso auspicato e non elabora progetti lavorativi di nessun tipo. Anna ha invece 30 anni. Alta, magrissima, bella ragazza alla moda, lavora come commessa ma sogna di diventare una cantante famosa. La sua storia clinica è caratterizzata dal presentarsi e ripresentarsi di sintomi somatici vari, per i quali si sottopone a svariati accertamenti e terapie, tra cui: eritema nodoso; dermatite simil-psoriasica al cuoio capelluto ed acne; disturbi della fonazione; irregolarità mestruali con addominalgie; ed in particolare disturbi intestinali con alvo prevalentemente e marcatamente diarroico. In relazione a quest’ultima sintomatologia, molto invalidante, ed anche con riferimento alla presunta origine allergica dei sintomi cutanei, si sottopone a svariati regimi dietetici, che segue in modo rigido per un certo periodo e che poi abbandona, tornando ad uno stile alimentare irregolare e caotico, che la fa sentire in colpa proprio perché irregolare. Situazione familiare di grande invischiamento, madre ipercontrollante e svalutante, padre assente e inaffidabile. Figlia unica. Il cibo ha un’enorme importanza fisica e simbolica per l’essere umano. Indispensabile per la sopravvivenza, diventa un elemento anche metaforico di benessere ed equilibrio bio-psico-sociale. I due casi clinici presentati forniranno l’opportunità di riflettere sulle potenziali funzioni di prevenzione e terapia che interventi basati sull’alimentazione (psicoeducazione, riabilitazione tramite attività culinaria…) possono avere rispetto al disagio psichico

Disturbi del comportamento alimentare in pazienti uomini trattati presso un servizio di Day Hospital in Psichiatria

DCA in soggetti masch

Clinical improvement, relapse and treatment adherence with paliperidone palmitate 1-month formulation: 1-year treatment in a naturalistic outpatient setting

Purpose: To evaluate paliperidone palmitate 1-month formulation (PP1M) effectiveness in a naturalistic outpatient psychiatric setting. Materials and methods: We collected data from 50 outpatients affected by schizophrenia disorders treated with PP1M for 12 months in an Italian Mental Health Department. After analyzing selected demographic, clinical and pharmacological variables, we performed mirror analysis to compare psychiatric hospitalizations and urgent consultations required by the same patient 6 and 12 months before and after PP1M implementation (primary outcome). We analyzed clinical improvement in symptom (Clinical Global Impression-severity and improvement) and functioning (Global Assessment of Functioning) scales and drop-out rate during the 12-month PP1M treatment (secondary outcome). Data were statistically analyzed. Results: The mean PP1M dose was 93.5 mg (±27.7 SD) with a mean interval between each injection of 27.1 d (±4.5 SD). Twenty-three patients (46%) reported adverse effects (sexual dysfunctions, weight gain and extrapyramidal symptoms).Fifteen patients (30%) dropped out after 137.2 d (±103.1 SD) on average: six due to the lack of therapeutic adherence, six due to inefficacy and three due to adverse events. The drop-out patients presented more severe clinical profile in CGI-S and GAF scores at T0 in comparison with others. At mirror analysis, 12-month but not 6-month PP1M treatment statistically significantly reduced psychiatric hospitalizations (t = 2.3, p < .05) and urgent consultations (t = 2.1, p < .05). Both scale scores showed statistically significant improvement at T12 in comparison to T0. Conclusions: This naturalistic study indicates that long-term PP1M treatment was safe and effective in preventing hospitalizations and urgent consultations as well as in improving clinical course

Eating disorders in male patients: medical and psychiatric co-morbidity

ntroduction Men make up approximately 10% of the diagnoses of specified Eating Disorders (ED), with Bulimia Nervosa more common in men than Anorexia. However, Eating Disorder Not Otherwise Specified (EDNOS) are more prevalent in men than Anorexia and Bulimia combined. Rates of concurrent depression and personality disorders are also high in men with EDNOS, as well as rates of medical co-morbidity. Objectives To describe a sample of male patients attending a Psychiatric Day Hospital. Aims To understand possible links between the diagnosis of ED and medical and psychiatric co-morbidity among male subjects. Methods Clinical data about male patients attending the Psychiatric Day Hospital of Modena from 05/01/2009 to 13/06/2012 were collected and analyzed. Psychiatric diagnoses were defined according to DSM IV criteria, medical comorbidities according to ICD10 criteria. Results Male patients with ED were on the whole 11 (7.9% of total patients). Nine of them (81.8%) were diagnosed with EDNOS; 7 had medical co-morbidity, namely gastrointestinal (36.4%), respiratory (9.1%), renal (9.1%), rheumatologic (18.2%), cardiac (9.1%) and hypertension (16.6%); 9 had psychiatric co-morbidity, namely personality disorders (46.2%), major depression (30.8%), substance abuse (15.4%) and anxiety disorders (7.7%). Only 1 male patient (9.1%) was suffering from the ED, with no medical or psychiatric co-morbidity. Conclusions Male patients suffering from ED are increasing and knowledge on their clinical features are less clear than for female subjects, resulting in a more difficult and less effective clinical management. Despite the small sample size, this study attempts to increase the understanding of this clinical population

Metabolic syndrome and psychiatric comorbidity: the Modena protocol

Metabolic syndrome and psychiatric comorbidity: the Modena protoco