Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

Background: Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses. Objective: Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors. Methods: The STAR Network ‘Depot Study’ was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively. Results: The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4–44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3–43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4–84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6–40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6–27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742–0.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003–4.634; p = 0.049). Conclusions: Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation

Off–label long acting injectable antipsychotics in real–world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction: Information on the off–label use of Long–Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on– vs off–label LAIs and predictors of off–label First– or Second–Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method: In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off– or on–label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off–label group. Results: SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on– and off–label use. Approximately 1 in 4 patients received an off–label prescription. In the off–label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion: Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off–label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co–morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

Analisi della popolazione immigrata afferente al Centro Psico Sociale di Pavia (2006-2009) e confronto con i nuovi dati aggiornati al 30 ottobre 2010

L’obiettivo del nostro studio è stato quello di realizzare un’analisi descrittiva delle caratteristiche demografiche, sociali e cliniche della popolazione immigrata che si è rivolta al Centro Psico Sociale di Pavia tra il 2006 e il 2009. Il nostro sta lavoro sta proseguendo attraverso la raccolta dei dati del 2010 tramite un questionario realizzato dal gruppo “Psichiatria e migrazione”in collaborazione con l’Istituto di Psichiatria dell’università di Bologna

Broadband serrodyne phase modulation for optical frequency standards and spectral purity transfer

We perform low phase noise, efficient serrodyne modulation for optical frequency control and spectral purity transfer between two ultrastable lasers. After characterizing serrodyne modulation efficiency and its bandwidth, we estimate the phase noise induced by the modulation setup by developing a novel, to the best of our knowledge, composite self-heterodyne interferometer. Exploiting serrodyne modulation, we phase locked a 698 nm ultrastable laser to a superior ultrastable laser source at 1156 nm by means of a frequency comb as a transfer oscillator. We show that this technique is a reliable tool for ultrastable optical frequency standards

Analisi della popolazione immigrata afferente al Centro Psico-Sociale di Pavia (2006-2009): drop out e presa in carico

Scopo dello studio e analizzare la popolazione immigrata afferente al Centro Psico-Sociale di Pavia dal 2006 al 2009; confrontare le caratteristiche cliniche e demografiche dei pazienti in carico e di coloro che hanno sospeso senza preavviso i contatti con i curanti, non ripresentandosi più entro ottobre 2010 (drop out)

Abuso-dipendenza da alcool e comorbilità psichiatrica

Gli autori presentano in questo lavoro un campione di soggetti con diagnosi di abuso-dipendenza da alcool associata ad altro disturbo psichiatrico. Questa ricerca fa parte di un'indagine più ampia riaguardante i pazienti alcolisti con comorbilità psichiatrica in trattamento presso i servizi psichiatrici, ambulatoriali ed ospedalieri. E' stato approfondito senza ipotizzare a priori alcuna relazione di causa-effetto tra la patologia alcolomanica e gli altri disturbi psichiatrici. Nostra intenzione è stata quella di indagare l'approccio clinico a pazienti caratterizzati da profili diagnostici complessi spesso difficilmente definibili e da relazioni di cura labili e discontinue

Coherent Optical-Fiber Link Across Italy and France

International audienceThe dissemination of atomic clocks with fiber-based techniques finds application in the fields of metrology, fundamental physics, navigation, and spectroscopy but is a challenge in terms of reliability, maintenance, and performance. Here, we describe the realization of a 1023-km-long fiber link between the metrological institutes of Italy and France that shares the infrastructure with the Internet traffic and exploits segmentation in shorter, cascaded spans to fight optical losses exceeding 280 dB. With four months of quasicontinuous operation of this link, we compared the Cs, Rb, and Yb atomic clocks at our laboratories, highlighting the potential of this tool to assess the clock uncertainty budgets, characterize advanced satellite techniques, and develop optical timescales. The integration of the metrological, fiberbased infrastructures in the two countries, connecting photonics and spectroscopy laboratories as well as telescope facilities, provides the research community with a physical layer over which applications can be built on

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

Background: Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses. Objective: Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors. Methods: The STAR Network \u2018Depot Study\u2019 was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively. Results: The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4\u201344.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3\u201343.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4\u201384.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6\u201340.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6\u201327.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742\u20130.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003\u20134.634; p = 0.049). Conclusions: Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation

Comparing 1-year effectiveness and acceptability of once-monthly paliperidone palmitate and aripiprazole monohydrate for schizophrenia spectrum disorders: Findings from the STAR Network Depot Study

In this prospective study, we assessed the effectiveness and acceptability of paliperidone palmitate 1-month (PP1M) and aripiprazole monohydrate (AM) over 1-year follow-up. We included 195 subjects (117 treated with PP1M and 78 with AM) with schizophrenia spectrum disorders from real-world settings. We estimated no differences in hospitalization (Odds Ratio=1.59; p = 0.12), symptoms improvement (p = 0.90 adjusted for baseline severity), and discontinuation (Hazard Ratio=0.72; p = 0.20) at study endpoint. Although current evidence suggests the possible superiority of AM over PP1M, our findings showed comparable effectiveness between these drugs. Additional studies in real-world settings with direct comparisons between these two LAIs are needed