International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders. Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method. Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders. Conclusion: The administration of prolonged release melatonin at 2–10 mg, 1–2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders

Changes of consultation-liaison psychiatry practice in Italian general hospitals: A comparative 20-year multicenter study

Introduction: Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry (CLP) activity in Italy (SIPC-2—2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1—1998). Methods: We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same ad hoc 60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation-related, interventions and outcome. Results: Compared with participants from the previous study, SIPC-2-2018 participants were significantly older (d = 0.54) and hospitalized for a longer duration (d = 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (Φ = 0.13), antipsychotics (Φ = 0.09), mood stabilizers (Φ = 0.24), and less often benzodiazepines (Φ = 0.07). Conclusion: CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy

Sandhoff's disease (type II GM2 gangliosidosis). Clinical, biochemical and ultrastructural study of a case.

A case of GM2 gangliosidosis is reported: the diagnosis has been made by clinical findings showing macular cherry-red spot and a progressive neurologic symptomatology with epilepsy, by electron microscopic observation in conjunctival fibroblasts of numerous vacuoles ("zebra bodies") and by absence of total hexosaminidase activity in leukocytes. An abnormal increase of urinary oligosaccharides has also been found

Late Quaternary evolution of the Metaponto coastal plain, southern Italy, inferred from geomorphological and borehole data.

A multidisciplinary study of a sector of the Ionian coastal belt, southern Italy, mainly based on two new bore- holes approximately 25 m (MSA) and 20 m (MSB) deep, was carried out in the frame of a wider geo- archaeological project. Stratigraphic and Paleoecological data, together with geomorphological observations, have been used in order to define the Late Quaternary morpho-sedimentary evolution and its relationships with tectonic and climate forcing. The analyses of core sediments and geomorphic interpretations allowed us to reconstruct the changes in depositional setting and physical landscape starting from the MIS 5.5. To this scope, new data about sedimentary facies, benthic foraminifera and ostracod assemblages, and a set of 14C ages spanning from about 33 to 15 kyr BP are here presented. All these data revealed a strong modification of the depositional setting within the coastal plain, as inferred by the presence of marine, transitional, and continental deposits, and suggest an anomalous position of sea-level reference points. Such anomalies are clustered in two homogenous arrays that can be explained only admitting a significant tectonic uplift in recent times (i.e. about 4 mm/yr over the last 15,000 years)

Evaluation and management of insomnia in clinical practice and in the time of CoViD-19 in Italy. Expert consensus and task-force recommendations from five scientific societies [Valutazione e trattamento dell'insonnia nella pratica clinica e ai tempi di CoViD-19 in Italia. Raccomandazioni del panel di esperti e della task-force integrata di cinque società scientifiche]

L’insonnia può colpire fino al 60% della popolazione italiana. È una sindrome delle “24 ore” e un fattore di rischio per disturbi psichiatrici e medici e dovrebbe essere sempre valutata e trattata nella pratica clinica. La terapia cognitivo-comportamentale è il trattamento di prima scelta ma poco accessibile in Italia. L’opzione farmacologica comprende: la melatonina 2 mg a rilascio prolungato di prima scelta nei pazienti di età ≥55 anni, fino a 13 settimane di trattamento; per un uso a breve termine (≤4 settimane), un farmaco Z-drug o una benzodiazepina a emivita breve (in soggetti <65 anni) o un antidepressivo sedativo.Insomnia symptoms might affect about 60% of the Italian population. Insomnia is a “24 hours syndrome” and a risk factor for medical and mental disorders. It should always be assessed and treated in the clinical practice. Cognitive Behavioral Therapy for Insomnia is the first line treatment but its availability in Italy is scarce. Pharmacological options in Italy are: melatonin 2 mg prolonged release that should be the first choice in subjects ≥55 years old and used until 13 weeks; and for a short term use (≤4 weeks) Z-drugs or short-acting benzodiazepines (in subjects <65 years old) or a sedating antidepressant