The brief international cognitive assessment for multiple sclerosis (BICAMS): Normative values with gender, age and education corrections in the Italian population

Background: BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) has been recently developed as brief, practical and universal assessment tool for cognitive impairment in MS subjects. It includes the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test-2 (CVLT2) and the Brief Visuospatial Memory Test-Revised (BVMT-R) . In this study we aimed at gathering regression based normative data for the BICAMS battery in the Italian population.Methods: Healthy subjects were consecutively recruited among patient friends and relatives. Corrections for demographics were calculated using multivariable linear regression models. Test-retest reliability was assessed using the Pearson correlation coefficient.Results: The BICAMS battery was administered to 273 healthy subjects (180 women, mean age 38.9 ± 13.0 years, mean education 14.9 ± 3.0 years). Test-retest reliability was good for all the tests.Conclusions: The study provided normative data of the BICAMS for the Italian population confirming good test-retest reliability which can facilitate the use of the battery in clinical practice, also for longitudinal patient assessments

Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry

[Abstract] Aims. Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results. We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66±13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion. Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Prescrizioni al telefono. Chi ci tutela?

Gli autori analizzano gli aspetti medico-legali della prescrizione telefonica in ambito pediatric

Cross-informant agreement on preadolescent's emotional and behavioral problems in a non-clinical cohort of northern Italy subjects : a pilot study

Background: The emotional-behavioral repertoire has been extensively studied in children and adolescents, devoting less effort to preadolescence. Objective: To investigate the emotional-behavioral repertoire compared to different sources of information \u2013 parents versus children \u2013 on a pilot non-clinical sample of Italian preadolescents. Methods: Thirty pre-adolescents aged 11 to 14 years old (16 females, 14 males) are consecutively referred to the Service of Psychotherapy, Ospedale Maggiore Policlinico, Milan for an evaluation of their mental health status. Pre-adolescents and their parents were respectively asked to fill in the Youth Self- Report (YSR) and the Child Behavior Check List (CBCL). Results: Significant differences between mothers and fathers emerged at Syndrome Scales (SSs): Anxious/ Depressed (p=0.026), Social Problems (p=0.035); at DSM-oriented Scales (DOSs) in Emotional Problems (p=0.012) and at the scales in Internalization (p=0.019). There are also significant differences on the total score (p=0.035). Comparing answers reported by pre-adolescents versus those reported by their parents, the number of scales with significant differences increases (SSs. Anxious/Depressed: p=0.032; Somatic Complaints: p=0.004; Thought Problems: p=0.010; DOSs. Anxiety Problems: p=0.044; Somatic Problems: p=.006; Internalization: p=0.016), with influences also the total score (p=0.049). Discreet correlations in all the global scales and in total scores between pre-adolescents and mothers, but not fathers, were found. Conclusions: Parents show differences in their perception of children\u2019s emotional- behavioral problems, especially of internalizing behaviors. These results suggest the specific importance of an extended family analysis at this stage of development

L’accordo tra fonti d’informazione nel repertorio emotivo-comportamentale del preadolescente : uno studio pilota.

Introduzione. Il repertorio emotivo-comportamentale nello sviluppo \ue8 stato ampiamente studiato in bambini e adolescenti, dedicando minore spazio alla preadolescenza, delicato periodo di cambiamenti nell\u2019immagine di s\ue9 e del proprio rapporto con gli altri. Le ricerche italiane, spesso focalizzate su soggetti reclutati in Centri di Salute Mentale o popolazioni specifiche (es.DSA, ipotiroidismo, spina bifida), hanno dato maggiore importanza all\u2019epidemiologia della popolazione generale, rispetto alle correlazioni tra fonti d\u2019informazione. Obiettivo: Indagare il repertorio emotivo-comportamentale rispetto alle diverse fonti d\u2019informazione, genitori-ragazzi, su un campione pediatrico pilota di preadolescenti. Metodologia. Trenta ragazzi dai 10 ai 14anni (16femmine,14maschi) vengono inviati consecutivamente, dopo visita pediatrica di routine, al Servizio di Psicologia clinica e Psicoterapia, Dipartimento di Neuroscienze e Salute Mentale, Ospedale Maggiore Policlinico di Milano per effettuare un bilancio di salute psichica. Sottoscritto il Consenso Informato e riportate le informazioni anagrafiche di base, viene chiesto a ragazzi e genitori (29madri,20padri) di compilare, rispettivamente, la YouthSelf-Report-YSR (Achenbach et al.,2001) e le ChildBehaviorCheckList\u2013CBCL (Achenbach et al.,2001). Risultati. Differenze significative tra madri e padri emergono alle Scale Sindromiche(SS) in AnsiaDepressione (t=2.294,df=46,p=.026) e ProblemiSociali (t=2.178,df=46,p=.035); alle Scale DSM-oriented(S-DSMo) in ProblemiAffettivi (t=2.617,df=46,p=.012) e alle Scale di Carattere Generale(SCG) in Internalizzazione (t=2.431,df= 46,p=.019). Significative anche le differenze sui totali (t=2.178,df=46,p=.035). Rispetto ai figli, il numero di scale con differenze significative cresce (SS. AnsiaDepressione: F=3.613,df=2,p=.032; LamenteleSomatiche: F=5.854,df=2,p=.004; ProblemiDiPensiero: F=4.864,df=2,p=.010. S-DSMo. ProblemiD\u2019Ansia: F=3.269,df=2,p=.044; ProblemiSomatici: F=5.477,df=2,p=.006. SCG. Internalizzazione: F=4.367,df=2,p=.016), con influenze anche sul punteggio totale (F=3.147,df=2,p=.049). Discrete le correlazioni in tutte le SCG e nel totale tra ragazzi e madri, ma non con i padri. Indagando variabili intervenienti emerge, tuttavia, una correlazione diretta tra il numero totale di figli e la differenza tra il punteggio CBCL/YSR totale madri-figli (r=.428,p=.026), alterazione non rilevata per i padri. Nessuna associazione tra l\u2019et\ue0 del figlio, l\u2019et\ue0 o la scolarit\ue0 dei genitori e queste differenze. Conclusioni. I genitori mostrano divergenze rispetto alla percezione dell\u2019assetto emotivo-comportamentale dei figli, soprattutto sulle problematiche internalizzate. Le risposte delle madri, generalmente pi\uf9 vicine a quelle dei ragazzi, risultano, tuttavia, maggiormente divergenti all\u2019aumentare del numero di figli. I risultati, pur con qualche differenza, paiono in linea con gli studi internazionali, suggerendo l\u2019importanza dell\u2019assetto familiare allargato in questa fase di sviluppo

La psicoterapia basata sulla mentalizzazione (STMBP) nella depressione cronica : uno studio preliminare longitudinale

Recenti sviluppi nell\u2019ambito della STPP (Short Term Psychodynamic Psychotherapy) emersi in trial randomizzati e in diverse meta-analisi confermano che tali interventi sono di provata efficacia clinica anche in casistiche di pazienti con Disturbi Depressivi Maggiori. Metodologia Sono stati reclutati 24 soggetti con Disturbo Depressivo Maggiore seguiti anche in un follow-up dopo 12 mesi dal T0 (T2). Tutti i pazienti assumevano antidepressivi a dosaggi standard (SSRI-SNRI) interrotti prima della fine della psicoterapia ( 1 seduta, 1volta/settimana per ca 40 settimane). La metodologia dell\u2019intervento integra la metodologia della Short Term Psychodynamic Psychotherapy (STPP di Malan, 1996) con le tecniche basate sulla mentalizzazione (STMBP) di Allen, Fonagy e Bateman (2006). Al T0 (baseline) ai pazienti sono stati somministrati: 1. SCID I e II ( DSM-IV-TR; First et al, 2001; Pfhol et al, 1995) 2. GAF (Global Assessment of Functioning Scale-DSM-IV-TR) 3. HAM-D (Hamilton,1960) 4. Reflective Functioning Adult Attachment Interview (AAI-RF) (Fonagy P; Target M Steele H;1998) 5. TAS-20 (Bressi et al., 1996) Lo stesso assessment testale \ue8 stato risomministrato dopo 40 sedute (termine della terapia,T1) e dopo un follow-up di 12 mesi (T2). Risultati: al T0 il dato pi\uf9 significativo emerso \ue8 la correlazione inversa tra i punteggi della TAS-20 e della RF (r=-.843, p=.000) mentre i punteggi della Funzione Riflessiva (Mentalizzazione) non correlano con i punteggi della Depressione (r=-.210, p=193). Inoltre i valori della Depressione e dell\u2019Alessitimia non sono linearmente associati al T0 (r=.070, p=737). L\u2019analisi statistica conferma attraverso ripetute misure che l\u2019intervento ha avuto un positivo effetto sui punteggi depressivi misurati con l\u2019HAM-D (Media T0: 33.20; media T1: 18.16). [t(23)= 15.72, p=.000]. Inoltre si riduce anche lo scoring della TAS-20 (media T0: 58.33; media T1: 50.35). Al T1 i valori ridotti dell\u2019HAM-D al T1 si mantengono anche al T2 confermando che i valori depressivi si mantengono ridotti nel tempo dopo la STMBP Inoltre il fattore 3 della Tas-20 dimostra significativit\ue0 statistica nella correlazione con l\u2019HAM-D. Conclusioni: La mentalizzazione permette di percepire desideri, intenzioni, pensieri, sentimenti presenti nella mente dell\u2019altro e nella propria. Verr\ue0 dimostrata l\u2019efficacia dell\u2019intervento sulle variabili cliniche al T1 e al T2

Cardiac surgery outcomes in patients with coronavirus disease 2019 (COVID-19): A case-series report

Objective: The impact of coronavirus disease 2019 (COVID-19) on the postoperative course of patients after cardiac surgery is unknown. We experienced a major severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in our cardiac surgery unit, with several patients who tested positive early after surgery. Here we describe the characteristics, postoperative course, and laboratory findings of these patients, along with the fate of the health care workers. We also discuss how we reorganize and reallocate hospital resources to resume the surgical activity without further positive patients. Methods: After diagnosis of the first symptomatic patient, surgery was suspended. Nasopharyngeal swabs were performed in all patients and health care workers. Patients who were positive for SARS-CoV-2 were isolated and monitored throughout the in-hospital stay and followed up after discharged until death or clinical recovery. Results: Twenty patients were found to be positive for SARS-CoV-2 sometime after cardiac surgery (mean age 69 ± 10.4 years; median European System for Cardiac Operative Risk Evaluation II score 3 [interquartile range, 5.1]); the median time from surgery to diagnosis was 15 days (interquartile range, 11). Among the patients, 18 had undergone cardiac surgery and 2 of them transcatheter aortic valve replacement. Overall mortality was 15%. Specific COVID-19–related symptoms were identified in 7 patients (35%). Among the 12 health care workers infected, 1 developed a bilateral mild-grade interstitial pneumonia. Conclusions: COVID-19 infection after cardiac surgery, regardless the time of the onset, is a serious condition. The systemic inflammatory state that follows extracorporeal circulation may mask the typical COVID-19 laboratory findings, making the diagnosis more difficult. A strict reorganization of the hospital resources is necessary to safely resume the cardiac surgical activity

Short-Term Psychodynamic Psychotherapy with Mentalization-Based Techniques in Major Depressive Disorder patients: Relationship among alexithymia, reflective functioning, and outcome variables : A Pilot study

OBJECTIVES: In depressed patients, recent advances have highlighted impairment in mentalizing: identifying and interpreting one's own or other's mental states. Short-Term Psychodynamic Psychotherapy (STPP) has proven to be effective in reducing symptoms and improving relational/functional abilities in these subjects. Therefore, the first aim of our study was to evaluate effectiveness of STPP with Mentalization-Based Techniques (STMBP) on their clinical outcomes and the second, to investigate Reflective Functioning and alexithymia concerning treatment outcomes in depressed subjects. DESIGN: A baseline evaluation of reflective functioning, alexithymia and depression was conducted before an STMBP treatment. Patients were re-tested successively after 40 weeks (T1) and in a follow-up after 1 year at the end of the treatment (T2). METHODS: A total of 24 patients principally diagnosed with Major Depressive Disorder (MDD) underwent a STMBP conducted by two expert therapists. Global Assessment Functioning (GAF), Toronto Alexithymia Scale-20 (TAS-20) and Hamilton Depression Rating Scale (HAM-D) data were collected at the baseline (T0) by two clinical therapists, along with RF scores rated by two trained raters. HAM-D, TAS-20 and GAF follow-ups were conducted at the end of the treatment after 40 weeks (T1) and after 1-year follow-up (T2). RESULTS: Results highlighted an improvement of both HAM-D and TAS-20 scores in our sample. Moreover, a negative correlation between RF and TAS-20 was found. Both HAM-D and RF at T0 influenced depressive outcomes at the end of the treatment. CONCLUSIONS: Results confirmed the effectiveness of STMBP in MDD, suggesting also an inverse association between RF and alexithymia. PRACTITIONER POINTS: Our study demonstrates how STMBP could be effective in MDD even after 40 sessions, maintaining its effect in a 1-year follow-up. STMBP improves subjective capability of reflecting on the mental states of oneself and others. Our intervention allows patients to orientate thoughts from inside to outside, reducing negative beliefs also in absence of a pharmacological therapy (during the follow-up)