Attitude toward prescription and clinical monitoring of lithium salts in a sample of Italian psychiatrists: preliminary data

Results of international prescribing patterns show that lithium prescription and biochemical drug monitoring seem to differ from a country to another. In spite of clear-cut supporting scientific evidence lithium monitoring is often disregarded, incorrectly used or underused. In Italy the trend of lithium prescriptions and biochemical monitoring is far from what suggested in guidelines; even if there's an impressive paucity of data about lithium monitoring and related iatrogenic risks in our country. In order to assess the current attitude in Italy toward lithium treatment in bipolar disorder we asked to a number of senior psychiatrists, working within the national territory, to fill a 34 items interview. Items were grouped in 8 domains, ranging from prescription pattern to therapeutic drug monitoring and other safety measures to prevent iatrogenic harm during lithium therapy. A preliminary analysis of the very first data, collected mainly in Tuscany, suggested that overall knowledge about lithium prescription and biochemical monitoring were good and the few critical topics found in this preliminary study may be addressed with an improvement in information about lithium therapy

Melatonin and pro-hypnotic effectiveness of the antidepressant Trazodone: A preliminary evaluation in insomniac mood-disorder patients

Objective To preliminary investigate the link between the darkness hormone melatonin (MLT) and the pro-hypnotic effectiveness of the atypical antidepressant Trazodone (TRZ) in a group of mood disorder patients suffering of insomnia. Design and methods The study's design comprised: i) the enrolment of insomniac outpatients, ii) baseline (t0) psychiatric and biochemical examinations; iii) the subsequent patients' introduction into a treatment with TRZ for 3–4 weeks, followed by post-therapy re-evaluations (t1). The MLT function was investigated by t0/t1 ELISA determinations of 6-hydroxy-MLT sulfate (6-OH-MLTs) levels in early-morning urines and HPLC analysis of morning MLT serum amount. Concomitantly, TRZ and its metabolite m-chloro-phenylpiperazine (m-CPP) were measured by HPLC in serum to monitor patients' compliance/metabolism. Results Seventeen insomniac outpatients, displaying mild symptoms of depression/anxiety resistant to antidepressants, completed TRZ therapy (dose:10–20 mg/day, bedtime). Serum TRZ levels (127 ± 57 ng ml− 1, mean ± SD) confirmed patients' compliance, while the anxiogenic metabolite m-CPP resulting almost undetectable. Moreover, the 6-OH-MLTs output was found increased at t1 vs. baseline values (t1: 58.4 ± 45.02 ng ml− 1; t0: 28.6 ± 15.8 ng ml− 1; mean ± SD, P < 0.05) in 9 patients who recovered both insomnia and depression/anxiety (P < 0.01). Unresponsive subjects showed instead no post-therapy 6-OH-MLTs variation (t1: 48.53 ± 50.70 ng ml− 1; t0: 49.80 ± 66.53 ng ml− 1). Morning MLT in serum slightly diminished at t1 without reaching the statistical significance, not allowing therefore to define the patients' outcome. Conclusions This initial investigation encourages to explore MLT networks as possible correlates of TRZ pro-hypnotic responses

1st international experts' meeting on agitation. Conclusions regarding the current and ideal management paradigm of agitation

Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients' care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts' Meeting on Agitation was held in October 2016 in Madrid. It was attended by 20 experts from Europe and Latin America with broad experience in the clinical management of agitated patients. The present document summarizes the key conclusions of this meeting and highlights the need for an updated protocol of agitation management and treatment, the promotion of education and training among healthcare professionals to improve the care of these patients and the necessity to generate clinical data of agitated episodes

Trattamento con escitalopram e peso corporeo, dati preliminari.

Introduction Weight gain is a common problem during antidepressant treat- ment, and is also an important factor contributing to noncompli- ance. It is also a key issue influencing obesity-related illnesses. Selective serotonin reuptake inhibitors (SSRIs) seem to differ from each another in terms of their effects on body weight, but the available literature on this topic is sparse, contradictory and lacking of data about new generation SSRIs. Methods This work evaluated weight changes during the first three months of escitalopram treatment in 34 outpatients with an ICD- 10 diagnosis of depression with comorbid anxiety, assessed in a naturalistic follow-up. Outcome measures were weight change and clinical improvement assessed with CGI. Results After the first three months of therapy, there was a slight de- crease in average body weight compared to baseline. However, the weight loss at three months did not reach statistical signifi- cance. Response to treatment was demonstrated by a statisti- cally significant reduction in CGI score. Limitations Both the small sample size and short follow-up times limit our results. Other variables such as depressive severity, atypical features and pre- morbid weight should be taken into account during further follow-up. Conclusions Our preliminary data suggest that escitalopram may not be as- sociated with weight gain, and further confirm the efficacy of escitalopram for treatment of depression with comorbid anxiety

Escitalopram treatment and weight changes : preliminary data

Introduction Weight gain is a common problem during antidepressant treatment, an important factor contributing to noncompliance, and a key issue influencing obesity-related illnesses. Selective serotonin reuptake inhibitors (SSRIs) seem to differ in terms of their effects on body weight, but the available literature on this topic is sparse, contradictory and lacking of data about new generation SSRIs. Methods This work evaluated clinical improvement and weight changes during the first three months of escitalopram treatment in 34 outpatients affected with depression and comorbid anxiety, assessed in a naturalistic follow-up. Outcome measures were weight change and clinical improvement assessed with CGI. Results After the first three months of therapy, there was a slight decrease in average body weight compared to baseline. However, the weight loss at three months did not reach statistical significance. Response to treatment was demonstrated by a statistically significant reduction in CGI score. Limitations Both the small sample size and short follow-up times limit our results. Other variables such as depressive severity, atypical features and premorbid weight should be taken into account during further follow-up. Conclusions Our preliminary data suggest that escitalopram may not be involved in weight gain, and confirm the efficacy of escitalopram treatment for depression with comorbid anxiety.Depto. de Antropología Social y Psicología SocialFac. de Ciencias Políticas y SociologíaTRUEpu

Psychiatric support of healthcare workers undergoing periodic health assessment

Abstract INTRODUCTION: An integrated mental health surveillance program was developed by the department of occupational medicine at S. Chiara University Hospital in Pisa, Italy, in order to better assist and treat hospital staff suffering from psychiatric disorders in a preventive medical setting. MATERIAL AND METHODS: During the occupational medical surveillance of 4000 employees of S. Chiara Hospital in Pisa (Italy), 30 health care workers with psychiatric disorders were included in our program, which provided psycho-educational support and pharmacological treatment. Measures of effectiveness were: Clinical Global Impression (CGI scale) and a comparison between the average number of lost workdays due to mental illness before and after treatment. RESULTS: At the end of the observation period there was a decrease in the CGI severity score with a improved CGI score ranging from 1 to 2 and a reduction in absenteeism, from an annual average of 36.70 to 25.10 lost workdays. CONCLUSION: Our outcome measures data seem to indicate that a preventive medicine setting can offer effective psychiatric support that is better accepted and tolerated by health care workers and that this approach may reduce absenteeism