Aripiprazole augmentation in treating comorbid bipolar disorder and obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder (BD) since the gold standard treatment for one disease (antidepressants for OCD) can worsen the other. This case report describes the efficacy of aripiprazole augmentation as maintenance therapy in a young patient with comorbid BD-OCD. Our patient presented complete remission of affective and obsessive-compulsive symptoms with remarkable improvement in social and occupational functioning for 24 months. Adverse drug reactions were not severe enough to result in drug discontinuation. In consideration of the important nosological, clinical and therapeutic implications, future research efforts may lead to more grounded guidelines, which are greatly needed in patients with comorbid BD-OCD

Four Italian experiences on vaccination policies: Results and lessons

Introduction. In 2018 the Council of Europe adopted a Recommendation on strengthened cooperation against vaccine preventable diseases. Among EU Member States, Italy has a long-lasting tradition of immunization policies implemented in the context of the National Health Service over the last forty years. Methods. We identify, report and critically appraise four immunization strategies implemented in Italy in recent years and quantitatively assess their impact on coverage rates and other selected indicators. Results. First: the regional law that suspended mandatory vaccination in the Veneto Region in 2007 to stimulate a proactive approach to vaccine uptake was not successful. Second: a strengthened political commitment started in 2014 brought to the release of an innovative and updated National Immunization Prevention Plan and to encouraging increase in vaccine confidence and vaccination uptake. Third: the success of social media influencers is exemplified by the case of Roberto Burioni, professor of microbiology, who in 2015 started a personal social media campaign to contrast anti-vaccinists. Fourth: The new 2017 Italian law extending mandatory vaccinations has successfully impacted on vaccine coverage which increased by more than 1% and 4% for polio and MMR vaccines, respectively, in the first six months since its entering into force, and has continued to raise in 2018. Discussion. Our data and real-life case studies offer to the broader European public health community a solid basis for discussion and ground to evaluate similar polices implemented in different European settings, with the common goal to share best practices and promote the culture of immunization

Scale Invariant Interest Points with Shearlets

Shearlets are a relatively new directional multi-scale framework for signal analysis, which have been shown effective to enhance signal discontinuities such as edges and corners at multiple scales. In this work we address the problem of detecting and describing blob-like features in the shearlets framework. We derive a measure which is very effective for blob detection and closely related to the Laplacian of Gaussian. We demonstrate the measure satisfies the perfect scale invariance property in the continuous case. In the discrete setting, we derive algorithms for blob detection and keypoint description. Finally, we provide qualitative justifications of our findings as well as a quantitative evaluation on benchmark data. We also report an experimental evidence that our method is very suitable to deal with compressed and noisy images, thanks to the sparsity property of shearlets

Clinical management of comorbid bipolar disorder and obsessive-compulsive disorder: A case series

Background: Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry and it has important nosological and therapeutic implications. Although antidepressants are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. Methods: Longitudinal clinical observation of three severe OCD patients who developed a manic episode during treatment with different classes of antidepressants. Results: In our cases, three features support the hypothesis of an underlying bipolarity unmasked by the antidepressant used to treat OCD: positive family history for affective disorders, manic switch induced by antidepressant and improvement of affective and obsessive-compulsive symptoms with mood stabilizers and atypical antipsychotics. Conclusions: Osler\u2019s view that medicine should be treatment of diseases, not of symptoms, is consistent with the approach of mood stabilization as a first objective in BD-OCD patients, as opposed to immediate treatment with antidepressants. Only persistent OCD patients should be prescribed antidepressants in as low a dose as feasibl

The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review and meta-analysis

Abstract Background: Although some authors have recently investigated the co-occurrence of anxiety and bipolar disorders, the topic remains insufficiently studied. Defining the prevalence and predictors of BD-OCD comorbidity has important nosological, clinical and therapeutic implications. Methods: A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-OCD. Relevant papers published through March 30th, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. Results: 46 articles met inclusion criteria. The pooled prevalence of OCD in BD was 17.0% (95% CI 12.7-22.4%), which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%, 95% CI 13.2-24.8%). With regard to OCD-BD predictors, a higher mean age predicted a lower prevalence of OCD in BD patients. Sub group meta-analyses reported higher OCD prevalence rates in BD children and adolescents (24.2%, compared to 13.5% in adults), in BD-I patients (24.6%, compared to 13.6% in mixed BD patients), and among population-based studies (22.2%, compared to 13.2% in hospital-based studies). Limitations: Most studies use retrospective assessment scales with low sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations that may bias results towards an overestimation of obsessive symptom prevalence. Conclusions: This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-OCD confirms that BD-OCD comorbidity is a common condition in psychiatry with children and adolescents and BD-I patients as the most affected subgroups

Knowledge, attitudes, and practices of influenza and pneumococcal vaccines among agricultural workers: Results of an Italian a cross-sectional study

Background: Working age is increasing across Europe. Seasonal influenza (SID) and pneumococcal disease (PND) immunization programmes might be successfully implemented at the workplace. We conducted a cross-sectional survey among to assess SID and PND vaccine status, as well as knowledge, attitudes and practices (KAP) in a representative sample of agricultural workers (AWs) aged ≥55 years in North-Eastern Italy. Methods: A structured questionnaire was administered in person by trained personnel. Bivariate and multivariate logistic regression analyses were carried out to identify behavioral and work-related factors associated with SID and PND vaccine uptake. Results: Among 707 participants, 238 were aged 55 years or more (33.7% of total). Of them, 39.1% had an up-to-date immunization status towards influenza, and 17.6% towards pneumococcus. Factors associated with inadequate immunization were doubts about influenza vaccine safety (40.0%) and the confidence in natural immunity towards pneumococcus (30.8%). Attitude towards vaccinations was somehow favorable in 44.5% of participants for SID, and 37.8% for PND. Overall, 37.4% and 21.8% workers were aware of national recommendations on SID and PND immunization, respectively. This factor was characterized as a significant predictor for SID vaccination (multivariated Odds Ratio, OR 32.688 95%CI 12.015-88.930), as well as the perception of SID as a severe disease (OR 7.539 95%CI 3.312-17.164), and the perceived value of preventing new infections (OR 3.215 95%CI 1.205-8.578). A somehow favorable attitude towards vaccinations was the main predictor (OR 39.214 95%CI 10.179-151.1) for PND vaccination. Conclusions: Our study indicates that older workers lack appropriate knowledge of national recommendations and correct risk perception of SID and PND infections, but also vaccines’ side effects. As the latter has been recognized as predictive factor for SID vaccination, our results stress the importance for tailored informative interventions in the workplaces aimed to increase risk perception and vaccine acceptance. (www.actabiomedica.it)

Innovative Covid-19 diagnostics and testing strategies in Italy, Denmark, UK, Israel and Sweden: a comparative analysis including tests, incidence and mortality

Background and aim: Detecting SARS-CoV-2 remains a critical component in the global effort to control COVID-19, particularly with the emergence of variants. Since the outbreak, diagnostic techniques have evolved to meet different contexts and needs. Methods: In this study, we analyzed the use of these techniques in five countries (i.e. Italy, Denmark, the United Kingdom, Sweden, and Israel) based on their specific national testing and contact tracing strategies. We also examined the number of tests performed per week, the positivity rate of tests, and the mortality rate in these populations during the same time periods. These countries were chosen based on the directives of the consortium involved in the CORONADX project. Results: During the three-year period under review, Italy and Denmark adopted large-scale testing strategies over a long period of time, with different results: in Italy an average of 4.5% of the population adhered to diagnosis, in Denmark 21%, while Israel reached 6.5%. The UK prioritised mass testing for short periods, outperforming the other countries with 1,882,596,198 total swabs and an average adherence of 28.1% of the population. Despite this, it recorded the highest number of deaths related to COVID-19 (211,155), with a lethality rate of 0.87%, second only to Sweden with 0.88%, where the average adherence to diagnosis was 1.7% of the population. Significant are the data for Israel, where as deaths increased, so did testing (r = 0.62, p < 0.001). Conclusions: To control future outbreaks it’s fundamental satisfying the need for effective testing strategies and government communication, equitable healthcare access, and education in public health and hygiene principles. (www.actabiomedica.it)

COVID-19 lockdown: The relationship between trait impulsivity and addictive behaviors in a large representative sample of Italian adults

open9noBackground: The importance of trait impulsivity in development, continuation and escalation of addictive behaviors has long been recognized. Methods: A cross-sectional population-based survey was conducted during the COVID-19 lockdown on 6003 Italian adults aged 18–74 years, representative of the Italian general population, to investigate the relationship between impulsivity (Barratt Impulsiveness Scale – BIS) and selected addictive behaviors (gambling habits, smoking status, cannabis use, average alcohol daily use). Results: A statistically significant relationship was found between motor impulsivity and starting/increasing drinking and increasing gambling (high vs. low motor impulsivity: multivariate odds ratio, OR=3.12; 95% confidence interval, CI: 1.45–6.74; p for trend=0.004 for start and OR=1.53; 95% CI: 1.26–1.86; p for trend&lt;0.001 for increase drinking, respectively; OR=2.09; 95% CI: 1.41–3.12; p for trend&lt;0.001 for increasing gambling). Limitations: Potential information and recall bias. The necessity to limit the length of the questionnaire not to reduce the quality of the answers of study participants. Conclusions: The multifaceted nature of impulsivity, potentially either cause or effect, hampers the understanding of its proper role in addictive behaviors. If confirmed by future longitudinal studies, our findings might support the planning, implementation and monitoring of evidence-based preventive interventions, to reduce addictive behaviors during public health emergencies.openAmerio A.; Stival C.; Lugo A.; Fanucchi T.; Gorini G.; Pacifici R.; Odone A.; Serafini G.; Gallus S.Amerio, A.; Stival, C.; Lugo, A.; Fanucchi, T.; Gorini, G.; Pacifici, R.; Odone, A.; Serafini, G.; Gallus, S

Epidemiology of leprosy in Italy (1920-2019): A comprehensive review on existing data

Background and aims: Incidence of leprosy in Italy has declined steadily over the last century, but available evidence remains fragmentary. Our review aims to summarize available data on the epidemiology of leprosy cases in Italy. Methods: The following keywords were used to explore PubMed and Embase: leprosy, Hansen’s disease, (Mycobacterium) leprae, Italy, without any chronological restriction. Results: We identified a total of 39 reports, including 7 national reports, 11 international reports, 20 case reports. Notified leprosy cases were: 839 between 1925 and 1948; 434 between 1955 and 1979; 76 cases for the decade 1980-1989; 112 between 1990 and 1999; 62 between 2000 and 2009, and a total of 25 cases since 2009. Since 2003, 53% of all cases occurred in illegal residents. Focusing on individual cases, latency between early signs/symptoms and a proper diagnosis ranged between 2 and 20 years in 52.1% of individual cases. Conclusion: Imported cases of leprosy are responsible for most leprosy incidence in Italy, and social stigma, the unfamiliarity of healthcare professionals with such disorders, and difficulties of some high-risk groups to be appropriately assessed hint to a possible under-diagnosis. Professionals should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic. (www.actabiomedica.it)