Medication overuse headache, addiction and personality pathology: a controlled study by SWAP-200

Background: Medication Overuse Headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. Some empirical investigations examining the addiction-like behaviors and processes, as well as personality characteristics underlying MOH development, reached contrasting findings. This study aimed at detecting personality and its disorders (PDs) in MOH patients, with a specific attention to the features of addiction. Methods: Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with Substance Use Disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200). MANCOVAs were performed to evaluate personality differences among MOH, SUD and PD groups, controlling for age and gender. Results: MOH patients showed lower traits of the SWAP-200’s clusters A and B disorders than SUD and PD patients, whom presented more severe levels of personality impairment. No differences in the SWAP-200’s cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients presented higher obsessive and dysphoric traits, as well as better overall psychological functioning than SUD and PD patients. Conclusions: The study supported the presence of a specific pattern of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities with drug addicted and personality-disordered patients were found. Practitioners’ careful understanding of the personality of MOH patients may be useful to provide more effective treatment strategies and patient-tailored intervention programs

Metabolic frailty in malnourished heart failure patients

Muscular wasting (MW) and cardiac cachexia (CC) are often present in patients with chronic heart failure (HF). Aim: To identify whether MW and CC are due to malnutrition or impairment of protein metabolism in HF patients. Material and Method: In 78 clinically stable HF patients (NYHA class II-III), aged from 32 to 89 years, we measured anthropometrical parameters and nutritional habits. In the identified 35 malnourished patients, we also measured: insulin resistance, gluconeogenetic amino acids blood concentration and nitrogen balance. Results: Seventy-five patients had eating-related symptoms. However we found significant nutritional impairment in 35 patients only. In addition, these 35 patients had: 1) significant increase of blood Alanine independently from both presence of insulin resistance or food intake reduction and 2) positive nitrogen balance. Conclusion: Food intake is not impaired in CHF patients. In spite of normal food intake, 35 of 78 patients had nutritional impairment with reduced anthropometric parameters and increased blood Alanine. These findings show alteration of proteins metabolism with proteolysis. We believe that specific physical training with nutritional supplement can be an additional therapy able to prevent protein disarrangement in CHF patients

La violenza psicologica: uno studio sulla percezione con il Tom Pvs Rev6

Il Tom Pvs Rev6 è uno strumento, costruito appositamente dagli Autori, finalizzato all’analisi della percezione che le personehanno della violenza psicologica e delle trasgressioni di tipo convenzionale. Il termine “persone” non è un errore terminologicopoiché il questionario non è stato costruito solamente per le vittime di violenza né per una sola categoria di genere.Il Tom Pvs Rev6 è basato sulla teoria della mente e sul test di distinzione morale/convenzionale che è parte della batteriadi intelligenza ideata da Prior, Sartori e Marchi nel 2003. Nello specifico, l’obiettivo è quello di comprendere la percezione che le persone hanno della violenza psicologica attraverso le risposte che queste danno a situazioni ambigue descritte in sette storie nelle quali il personaggio principale reagisce in modi diversi. Ci possono essere risposte “attive”, “passive” o proteste. In altre circostanze, invece, può non esserci alcuna reazione ma solo un’acquiescenza alla situazione da parte del personaggio principale. Altre situazioni possono essere neutrali o illecite e possono indurre risposte nelle quali i partecipanti non valuteranno solo la violenza psicologica ma anche le emozioni associate e come affronterebbero il problema se fossero loro stesse le vittime. I risultati di questo studio pilota mostrano come le persone intervistate siano di gran lunga inclini a condannare qualsiasi comportamento esaminato sia in situazioni attive, sia in situazioni passive, sia in situazioni assolutamente illecite. Inoltre, anche a distanza di tempo, tali comportamenti non sarebbero passibili di giustificazione o perdono.Alla luce dei risultati ottenuti, gli Autori credono che una campagna informativa e preventiva sui servizi attivi nel territorio,anche attraverso le nuove tecnologie telematiche, possa concretamente essere d’aiuto per le vittime di violenza psicologica

Psychological needs and mental health in women aged ≥ 65 years after cardiac surgery: an exploratory study

Background. Recent developments in cardiac care have led to an increase survival even among elderly cardiac patients. Previous studies showed that women have worse health related outcomes compared with men. The main aims of this study are to assess psychological needs and factors promoting mental health among women aged ≥ 65 years following heart surgery. Methods. 74 consecutive women aged ≥ 65 years and referred to a cardiac rehabilitation unit in Northern Italy after heart surgery were enrolled in this exploratory study. Psychological questionnaires exploring cognitive functioning, psychological needs, anxiety, depression, physical and mental health status, self-esteem were administered by a psychologist to each patient using a face-to-face interview. Results. The main areas of psychological needs reported by patients were relational and emotional support, assistance and treatment, information about diagnosis and future conditions and information concerning economic-insurance issues. Multivariate linear regression analysis showed that factors significantly associated with patients’ mental health were anxiety (p = 0.01) and locus of control (p = 0.01). Conclusions. In order to improve older cardiac women’s mental health after cardiac surgery is important to offer tailored rehabilitative interventions able to meet their specific needs such as the management of anxiety symptoms and loss of control, the need to regain the family role, the need of more information concerning the diagnosis and prognosis and emotional support

Elderly patient-centered rehabilitation after cardiac surgery

The rate of over-70 year post-surgery patients referred to the Cardiac Rehabilitation Units is increasing. Strategies designed to encourage and facilitate participation in rehabilitation programs in the elderly should be developed. Aim of this paper is to present our elderly-centered program, specifically designed on patient’s needs and frailty, and its short- and medium-term results in 160 consecutive over-70 year patients, admitted in our Cardiac Rehabilitation Unit soon after cardiac surgery. The program was safe, well accepted by the patients, and effective in improving objective and subjective functional status

A multicenter, randomized, controlled trial on short-term feasibility and impact on functional capacity, symptoms and neurohumoral activation

RE-START is a multicenter, randomized, prospective, open, controlled trial aiming to evaluate the feasibility and the short- and medium-term effects of an earlystart AET program on functional capacity, symptoms and neurohormonal activation in chronic heart failure (CHF) patients with recent acute hemodynamic decompensation. Study endpoints will be: 1) safety of and compliance to AET; 2) effects of AET on i) functional capacity, ii) patient- reported symptoms and iii) AET-induced changes in beta-adrenergic receptor signaling and circulating angiogenetic and inflammatory markers. Two-hundred patients, randomized 1:1 to training (TR) or control (C), will be enrolled. Inclusion criteria: 1) history of systolic CHF for at least 6 months, with ongoing acute decompensation with need of intravenous diuretic and/or vasodilator therapy; 2) proBNP >1000 pg/ml at admission. Exclusion criteria: 1) ongoing cardiogenic shock; 2) need of intravenous inotropic therapy; 3) creatinine >2.5 mg/dl at admission. After a 72-hour run-in period, TR will undergo the following 12-day early-start AET protocol: days 1-2: active/passive mobilization (2 sessions/day, each 30 minutes duration); days 3-4: as days 1-2 + unloaded bedside cycle ergometer (3 sessions/day, each 5-10 minutes duration); days 5-8: as days 1-2 + unloaded bedside cycle ergometer (3 sessions/day, each 15-20 minutes duration); days 9-12: as days 1-2 + bedside cycle ergometer at 10-20 W (3 sessions/day, each 15-20 minutes duration). During the same period, C will undergo the same activity protocol as in days 1-2 for TR. All patients will undergo a 6- minWT at day 1, 6, 12 and 30 and echocardiogram, patient- reported symptoms on 7-point Likert scale and measurement of lymphocyte G protein coupled receptor kinase, VEGF, angiopoietin, TNF alfa, IL-1, IL-6 and eNOS levels at day 1, 12 and 30

Personality and personality disorders in medication-overuse headache: a controlled study by SWAP-200

Background. Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved inMOHdevelopment has been advanced but was poorly studied.Thehypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings. Objectives. This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect. Methods. Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender. Results. MOH patients were predominantly women and older. They showed lower traits of the SWAP-200’s cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200’s cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients. Conclusion. Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drugaddicted and personality-disordered patients were found. Practitioners’ careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs

Increased skeletal muscle amino acid release with light exercise in deconditioned patients with heart failure

This study shows that, during light exercise, untrained patients with Chronic Heart Failure (CHF) release a number of muscle amino acids, suggesting a possible abnormal muscle amino acid metabolism. It is conceivable that repeated daily-life physical activities by untrained CHF patients may contribute to a negative nitrogen balance and to muscular wastin

Cardiac Magnetic Resonance in Stable Coronary Artery Disease: Added Prognostic Value to Conventional Risk Profiling

Aims. Cardiovascular magnetic resonance (CMR) permits a comprehensive evaluation of stable coronary artery disease (CAD). We sought to assess whether, in a large contemporaneous population receiving optimal medical therapy, CMR independently predicts prognosis beyond conventional cardiovascular risk factors (RF). Methods. We performed a single centre, observational prospective study that enrolled 465 CAD patients (80% males; 63±11 years), optimally treated with ACE-inhibitors/ARB, aspirin, and statins (76-85%). Assessments included conventional evaluation (clinical history, atherosclerosis RF, electrocardiography, and echocardiography) and a comprehensive CMR with LV dimensions/function, late gadolinium enhancement (LGE), and stress perfusion CMR (SPCMR). Results. During a median follow-up of 62 months (IQR 23-74) there were 50 deaths and 92 major adverse cardiovascular events (MACE). CMR variables improved multivariate model prediction power of mortality and MACE over traditional RF alone (F-test p<0.05 and p<0.001, respectively). LGE was an independent prognostic factor of mortality (hazard ratio [95% CI]: 3.4 [1.3−8.8]); moreover, LGE (3.3 [1.7−6.3]) and SPCMR (2.1 [1.4−3.2]) were the best predictors of MACE. Conclusion. LGE is an independent noninvasive marker of mortality in the long term in patients with stable CAD and optimized medical therapy. Furthermore, LGE and SPCMR independently predict MACE beyond conventional risk stratification