Affective recurrences in bipolar disorder after switching from lithium to valproate or vice versa: A series of 57 cases

Affective Recurrences in Bipolar Disorder After Switching From Lithium to Valproate or Vice Versa A Series of 57 Case

Antipsychotics in treatment-resistant Obsessive-Compulsive Disorder: which antipsychotic, which dose and how long antipsychotic addition should be maintained

Objectives: Treatment-resistant Obsessive-Compulsive Disorder (OCD) patients are defined as those who undergo adequate trials of first-line therapies without achieving a satisfactory response. First line treatments for OCD include both serotonin reuptake inhibitors (SRIs) and cognitive behavior therapy (CBT). Because of the high number of OCD patients not responding to first-line treatments (40-60%) and considering the even greater prevalence rate of residual symptoms and significant impairment shown in patients previously described as \u201cclinical responders\u201d, the question of the proper treatment of resistant OCD is a clinically meaningful and a practical issue for psychiatrists. Antipsychotic augmentation proved to be an effective strategy for resistant OCD. However, there are unresolved questions concerning which antipsychotic is effective (or more effective) and how antipsychotics should be used in terms of doses and duration of treatment. The purpose of this study is to systematically review available studies on antipsychotic augmentation for treatment-resistant OCD, in order to guide the practical choice. Materials and methods: We searched on PubMed, Psychnet and Cochrane Libraries from inception to January 2016. Articles published in English and related to the use of antipsychotics in OCD were considered. We evaluated meta-analyses, systematic reviews and randomized controlled trials of adult patients with treatment-resistant OCD. Results: Antipsychotic augmentation is an evidence-based option for treatmentresistant OCD, with a response rate of approximately 50% within the first 4-to6 weeks. Aripiprazole (10-15\ua0mg/day) and risperidone (0.5-2\ua0mg/day) are effective, olanzapine (10\ua0mg/day) is possibly effective. Haloperidol addition is also a viable option, particularly in patients with comorbid tic disorders. Given results of studies performed to date quetiapine should be regarded as non-effective. Preliminary results from open label studies suggest that antipsychotic augmentation, once effective, should be maintained in order to maintain remission. Conclusions: Not all antipsychotics are effective as add-on treatments in resistant OCD. Characteristics of patients and side effects generally associated with each different antipsychotic may guide the practical choice. Further research is required concerning the comparative effectiveness among antipsychotics, the optimal target dose and the ideal duration of antipsychotic addition. In our opinion, antipsychotic augmentation in patients who responded to this treatment should be maintained in order to prevent relapses. However, clinicians must remember patients\u2019 exposure to the common and serious adverse effects associated with long-term antipsychotic administration, especially metabolic disturbances

O Serviço Psiquiátrico de Diagnóstico e Tratamento no Hospital Geral: usuários e novas urgências

El Servizio di psichiatrico Diagnosis and Healing (SPDC), que nació como una representación del "territorio" dentro de la realidad del hospital. Objetivos. El objetivo de la investigación es mostrar qué nuevas emergencias en SPDC y cómo estas situaciones han cambiado en el pasado. Tres estudios diferentes se planearon. El primer estudio analizó el principio de los trastornos esquizofrénicos en el primer contacto con los servicios psiquiátricos, para evaluar una posible correlación entre la aparición de la esquizofrenia y el abuso de sustancias de 136 pacientes ingresados en el Consejo de Estado, en el período comprendido entre 2001 y 2007. El segundo estudio evaluó retrospectivamente a partir de 1985 a 1998, comparándolos con los del trienio 2007-2009. Y por último, el tercer estudio midió la tasa de agotamiento de casi todos los operadores de casi todos piamonteses SPDC. En todos los estudios publicados, las escalas psicopatológicas se han utilizado y reconocido pruebas. En 130 episodios esquizofrénicos, el 46,1% tiene una anamnesis positiva para el abuso de sustancias. Estos pacientes muestran una mayor resistencia al tratamiento inicial con hospitalizaciones más largas. El análisis mostró alteraciones, a través de los años, una reducción en las hospitalizaciones por psicosis esquizofrénica, lo que contrasta con un aumento en las hospitalizaciones por trastornos de la personalidad y agitación psicomotora. El análisis de las tasas de agotamiento, la mayoría de los operadores tienen valores medio-alto agotamiento emocional y despersonalización, mientras que el 47% tiene baja realización personal. Estas condiciones psicopatológicas casi siempre se asocia con una mayor carga para la asistencia social que se refleja operadores con el mismo riesgo de burnout

Involuntary admissions in Italy: the impact of seasonality

Abstract Objective: The aim of this study is to assess the prevalence of involuntary admissions with regard to seasonality and clinical associated features, in a sample of patients admitted to a psychiatric unit in a period of 24 months. Methods: All subjects consecutively admitted to the Psychiatric Inpatient Unit of the San Luigi Gonzaga Hospital, Orbassano (University of Turin, Italy) from September 2013 to August 2015 were recruited. Socio-demographic and clinical characteristics were collected. Results: Seven hundred and thirty admissions in psychiatric ward were recognized. The prevalence of involuntary admission was 15.4%. Patients with involuntary hospitalizations showed a higher education level, a higher prevalence of admission in spring/summer with a significant peak in June, a longer duration of hospitalization and a lower suicide ideation. Among involuntary admissions, physical restraint and suicide attempts were more prevalent during spring compared to the other seasons. Conclusions: Seasonality has an important role in the psychopathology of psychiatric disorders, particularly in bipolar and related disorder, and may represent an influencing factor in hospital admissions and hospitalizations. Seasonal pattern must be considered while managing diagnosis and treatment of mental disorders, with regard to prevention and psychoeducation of patients

Combining drug and psychological treatments for Obsessive-Compulsive Disorder: what is the evidence, when and for whom

serotonin reuptake inhibitors (SRIs) and cognitive-behavioral psychotherapy (CBT) are first-line treatments for obsessive-compulsive disorder (OCD). Since response is often inadequate, in recent years researchers investigated whether combining CBT and SRIs, either ab initio or sequentially, results in a greater reduction of obsessive-compulsive symptoms

Management of Malaria in Children Younger Than 5 Years Old During Coronavirus Disease 2019 Pandemic in Sierra Leone: A Lesson Learned?

Growing evidences are showing the potential indirect effects of the Coronavirus Disease 2019 (COVID-19) on the health systems of low-resource settings, where diseases such as Tuberculosis, Human Immunodeficiency Virus (HIV) and Malaria represent major killers. Therefore, we performed a retrospective study aimed to evaluate the impact of COVID-19 on Malaria programs in a peripheral region of Sierra Leone, previously involved by the Ebola outbreak in 2015, when malaria care have been impaired since local health systems were overwhelmed by Ebola cases. During COVID-19 in Sierra Leone, we did not notice a significant drop in malaria diagnosis in children, suggesting that a proactive approach in the management of malaria in endemic countries during COVID-19 may have had a positive impact. A comprehensive approach that include also educational activities to sensitize the local population, was useful to guarantee successful malaria diagnosis and treatment, and prevents excess of malaria deaths due to potential disruption of the local health systems related to the SARS-CoV-2 pandemic

A systematic review of evidence-based treatment strategies for obsessive-compulsive disorder resistant to first-line pharmacotherapy

Serotonin reuptake inhibitors (SRIs) and cognitive-behavioral psychotherapy (CBT) are first-line treatments for obsessive-compulsive disorder (OCD). However, a significant proportion of patients do not respond satisfactorily to first-choice treatments. Several options have been investigated for the management of resistant patients