Interazione tra familiarità e complicanze ostetriche nel rischio di psicosi

La psicosi costituisce una dimensione trasversale a diversi disturbi psichiatrici altamente invalidanti, quali i disturbi dello spettro schizofrenico e le psicosi affettive, con manifestazioni che possono comprendere deliri, allucinazioni e/o disorganizzazione psicomotoria. La sindrome psicotica ha prevalenza lifetime di 3.06% ed incidenza di 31.7/100000/anno nella popolazione generale, con un enorme peso sociale in termini di morbidità e mortalità. Studi di genetica epidemiologica hanno stimato tassi di ereditarietà dell’80% ma un grosso peso va probabilmente attribuito anche a fattori di rischio ambientali. Probabilmente perciò i fattori genetici operano rendendo alcuni individui selettivamente suscettibili a fattori ambientali (interazione geni x ambiente). Le complicanze ostetriche sono tra i fattori ambientali più estesamente studiati. Obiettivi: Valutare l’effetto delle complicanze ostetriche sul rischio di sviluppare psicosi. Determinare il ruolo della familiarità e se essa interagisca con le complicanze ostetriche nell’influenzare il rischio di sviluppare schizofrenia e/o psicosi affettive. Materiali e Metodi: Nell’ambito di uno studio multicentrico di collaborazione tra l’Università di Pisa e l’Institute of Psychiatry, King’s College of London, è stato raccolto un campione di 374 soggetti, di cui 203 casi e 171 controlli. Il campione è costituito da 207 maschi e 167 femmine, con età media di 31.82 anni (± 7.94). È stata somministrata la SCID-I per l’assessment psicopatologico e la PANSS per la valutazione della severità dei sintomi psicotici. Abbiamo usato la FIGS per determinare la storia di disturbi psichiatrici nei familiari di primo grado. Le informazioni sulle complicanze ostetriche sono state ottenute intervistando le madri, e valutate secondo la Scala di Lewis-Murray. Per il calcolo del sinergismo biologico tra la familiarità per psicosi e le complicanze ostetriche ci siamo avvalsi di un modello statistico additivo di interazione. Risultati: L’esposizione a complicanze perinatali è più frequente nei soggetti affetti da sindromi psicotiche rispetto al gruppo dei controlli non psicotici: p=0.012; OR = 1.79 (95% CI: 1.16 – 2.77). Il 100% dei soggetti con familiarità sono affetti da psicosi: non ci sono soggetti aventi familiarità per psicosi tra i controlli, mentre tra i casi, il 44% ha anamnesi familiare positiva per psicosi. L’analisi del sinergismo biologico rivela che il 13.3%-26.6% di coloro che sono stati esposti sia al carico familiare che alle complicanze ostetriche, potrebbero aver sviluppato psicosi come risultato dell’azione sinergica dei due fattori. Conclusione: Insieme al carico familiare, le complicanze ostetriche costituiscono un fattore di rischio per lo sviluppo di psicosi. Varianti genetiche condivise nei parenti rendono alcuni soggetti vulnerabili ad alterazioni del neurosviluppo in seguito all’esposizione ad eventi pre- e peri-natali avversi

Antibiotic susceptibility of Legionella pneumophila strains isolated from hospital water systems in Southern Italy

The purpose of this study was to describe the susceptibility of environmental strains of Legionella spp. to 10 antimicrobials commonly used for legionellosis therapy. A study of environmental strains could be useful to timely predict the onset of antibiotic resistance in the environment before it is evidenced in clinical specimens

Transdiagnostic Individualized Clinically Based Risk Calculator for the Detection of Individuals at Risk and the Prediction of Psychosis: Model Refinement Including Nonlinear Effects of Age

Background: The first rate-limiting step for primary indicated prevention of psychosis is the detection of young people who may be at risk. The ability of specialized clinics to detect individuals at risk for psychosis is limited. A clinically based, individualized, transdiagnostic risk calculator has been developed and externally validated to improve the detection of individuals at risk in secondary mental health care. This calculator employs core sociodemographic and clinical predictors, including age, which is defined in linear terms. Recent evidence has suggested a nonlinear impact of age on the probability of psychosis onset.Aim: To define at a meta-analytical level the function linking age and probability of psychosis onset. To incorporate this function in a refined version of the transdiagnostic risk calculator and to test its prognostic performance, compared to the original specification.Design: Secondary analyses on a previously published meta-analysis and clinical register-based cohort study based on 2008–2015 routine secondary mental health care in South London and Maudsley (SLaM) National Health Service (NHS) Foundation Trust.Participants: All patients receiving a first index diagnosis of non-organic/non-psychotic mental disorder within SLaM NHS Trust in the period 2008–2015.Main outcome measure: Prognostic accuracy (Harrell’s C).Results: A total of 91,199 patients receiving a first index diagnosis of non-organic and non-psychotic mental disorder within SLaM NHS Trust were included in the derivation (33,820) or external validation (54,716) datasets. The mean follow-up was 1,588 days. The meta-analytical estimates showed that a second-degree fractional polynomial model with power (−2, −1: age1 = age−2 and age2 = age−1) was the best-fitting model (P < 0.001). The refined model that included this function showed an excellent prognostic accuracy in the external validation (Harrell’s C = 0.805, 95% CI from 0.790 to 0.819), which was statistically higher than the original model, although of modest magnitude (Harrell’s C change = 0.0136, 95% CIs from 0.006 to 0.021, P < 0.001).Conclusions: The use of a refined version of the clinically based, individualized, transdiagnostic risk calculator, which allows for nonlinearity in the association between age and risk of psychosis onset, may offer a modestly improved prognostic performance. This calculator may be particularly useful in young individuals at risk of developing psychosis who access secondary mental health care

Long term outcomes of acute and transient psychotic disorders:The missed opportunity of preventive interventions

AbstractBackground:Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear.Methods:Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals.Results:A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83–17.47%), 28.41% at 2-year (95%CI 26.80–30.09%), 33.96% at 3-year (95% CI 32.25–35.75%), 36.85% at 4-year (95%CI 35.07–38.69%), 40.99% at 5-year (95% CI 39.12–42.92%), 42.58% at 6-year (95%CI 40.67–44.55%), 44.65% at 7-year (95% CI 42.66–46.69%), and 46.25% at 8-year (95% CI 44.17–48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09–38.27%).Conclusions:Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.</jats:sec

Peripheral oxytocin and vasopressin:Biomarkers of psychiatric disorders? A comprehensive systematic review and preliminary meta-analysis

AbstractA large array of studies have investigated peripheral oxytocin (OT) and vasopressin (ADH) as potential biomarkers of psychiatric disorders, with highly conflicting and heterogenous findings. We searched Web of KnowledgeSM and Scopus® for English original articles investigating OT and/or ADH levels in different biological fluids (plasma/serum, saliva, urine and cerebrospinal fluid) across several psychiatric disorders. Sixty-four studies were included. We conducted 19 preliminary meta-analyses addressing OT alterations in plasma/serum, saliva, urine and cerebrospinal fluid of 7 psychiatric disorders and ADH alterations in plasma/serum, saliva, urine and cerebrospinal fluid of 6 psychiatric disorders compared to controls. Hedge's g was used as effect size measure, together with heterogeneity analyses, test of publication biases and quality control. None of them (except serum OT in anorexia nervosa) revealed significant differences. There is no convincing evidence that peripheral ADH or OT might be reliable biomarkers in psychiatric disorders. However, the lack of significant results was associated with high methodological heterogeneity, low quality of the studies, small sample size, and scarce reliability of the methods used in previous studies, which need to be validated and standardized

Emotion dysregulation links pathological eating styles and psychopathological traits in bariatric surgery candidates

ObjectivesApproximately one-third of bariatric surgery patients experience weight regain or suboptimal weight loss within five years post-surgery. Pathological eating styles and psychopathological traits (e.g., emotion dysregulation) are recognized as potential hindrances to sustain weight loss efforts and are implicated in obesity development. A comprehensive understanding of these variables and their interplays is still lacking, despite their potential significance in developing more effective clinical interventions for bariatric patients. We investigate the prevalence of and interactions between pathological eating styles and psychopathological traits in this population.Materials and methods110 bariatric surgery candidates were characterized using the Binge Eating Scale (BES), Hamilton Depression/Anxiety Scales (HAM-D/A), Barratt Impulsiveness Scale (BIS-11), Experiences in Close Relationships (ECR), Difficulties in Emotion Regulation Scale (DERS). We analyzed these variables with multiple logistic regression analyses and network analysis.ResultsPatients with pathological eating styles showed more pronounced anxiety/depressive symptoms and emotion dysregulation. Network analysis revealed strong connections between BES and DERS, with DERS also displaying robust connections with HAM-A/D and ECR scales. DERS and attention impulsivity (BIS-11-A) emerged as the strongest nodes in the network.DiscussionOur findings demonstrate the mediating role of emotion dysregulation between pathological eating styles and psychopathological traits, supporting existing literature on the association between psychopathological traits, insecure attachment styles, and pathological eating behaviors. This research emphasizes the significance of emotion regulation in the complex network of variables contributing to obesity, and its potential impact on bariatric surgery outcomes. Interventions focusing on emotion regulation may thus lead to improved clinical outcomes for bariatric patients

Connectome dysfunction in patients at clinical high risk for psychosis and modulation by oxytocin

Abnormalities in functional brain networks (functional connectome) are increasingly implicated in people at Clinical High Risk for Psychosis (CHR-P). Intranasal oxytocin, a potential novel treatment for the CHR-P state, modulates network topology in healthy individuals. However, its connectomic effects in people at CHR-P remain unknown. Forty-seven men (30 CHR-P and 17 healthy controls) received acute challenges of both intranasal oxytocin 40 IU and placebo in two parallel randomised, double-blind, placebo-controlled cross-over studies which had similar but not identical designs. Multi-echo resting-state fMRI data was acquired at approximately 1 h post-dosing. Using a graph theoretical approach, the effects of group (CHR-P vs healthy control), treatment (oxytocin vs placebo) and respective interactions were tested on graph metrics describing the topology of the functional connectome. Group effects were observed in 12 regions (all p  < 0.05) most localised to the frontoparietal network. Treatment effects were found in 7 regions (all p  < 0.05) predominantly within the ventral attention network. Our major finding was that many effects of oxytocin on network topology differ across CHR-P and healthy individuals, with significant interaction effects observed in numerous subcortical regions strongly implicated in psychosis onset, such as the thalamus, pallidum and nucleus accumbens, and cortical regions which localised primarily to the default mode network (12 regions, all p  < 0.05). Collectively, our findings provide new insights on aberrant functional brain network organisation associated with psychosis risk and demonstrate, for the first time, that oxytocin modulates network topology in brain regions implicated in the pathophysiology of psychosis in a clinical status (CHR-P vs healthy control) specific manner. [Abstract copyright: © 2024. The Author(s).