[The management of long-term treatment of patient with schizophrenia: results of a survey carried out in Italy]. / La gestione del trattamento a lungo termine del paziente con schizofrenia: risultati di una survey effettuata in Italia.

The management plan of patients with schizophrenia includes a multidimensional and integrated approach, consisting of pharmacological, psychological and psychosocial interventions. Among pharmacological approaches, the development of long-acting injectable antipsychotics (LAI) has radically changed the treatment plan of patients with schizophrenia. LAI can be successfully used in patients with multiple episodes, with partial or poor adherence to treatments and are very useful also in first episode patients. LAIs have been proven to be effective and with a good safety and tolerability profile, but they are still used in a few cases in the clinical routine practice. Therefore, the present study aims to evaluate attitudes and preferences of psychiatrists in the Italian routine care towards LAI and to identify the communication skills adopted in the routine care for the prescription of LAI. The final sample consists of 274 clinicians, recruited by phone call (n=257) and online (n=17). The main findings are: the psychoeducational approach is essential for improving patients' adherence to pharmacological treatments and their personal and social functioning; the involvement of family members is essential for improving adherence to treatments; LAIs are frequently used due to their efficacy and good tolerability profile, compared to first generation depot antipsychotics. Based on our findings, the ideal patient to be switched to LAI treatment is represented by a person with poor adherence to treatments, at the onset of the disorder, or with a poor tolerability to side effects.

New Pharmacological Targets for the Treatment of Schizophrenia: A Literature Review.

BACKGROUND: The pharmacological treatment of schizophrenia is currently based on the employment of antipsychotic medications showing an antagonism of dopaminergic and serotoninergic inhibitors. 20-40% of patients are drug-resistant or residually symptomatic in the long-term antipsychotic treatment, and new strategies are needed for improving their functional and cognitive impairment. METHODS: This systematic review has summarized evidences from the literature regarding the newer pharmacological targets proposed for the treatment of psychosis. We included 128 peer-reviewed articles and 5 other relevant sources published from 2002 to 2020 on PubMed EMBASE, The Cochrane Library, and Google Scholar. RESULTS: The possible role of glutamate and its receptors as targets of the antipsychotic mechanism of action has been described. Glutamatergic neurotransmission and NMDA receptors hypofunction are involved in the neurobiological explanatory model of psychosis and possibly targeted for the successful treatment of cognitive and residual symptoms. Results show an efficacy of D-cycloserine (antagonist at the Glycine site of the NMDA-R) in the treatment of negative symptoms of schizophrenia as well as Memantine (NMDA- Receptor antagonist) for cognition and psychopathology. The putative antipsychotic effect of cannabidiol on positive symptoms and cognition will also be discussed. The action on serotoninergic and GABAergic receptors will be considered as a new pharmacological target, with a possible efficacy of Vabicaserin on symptoms of psychosis. Mynocicline has shown to induce improvements in cognitive symptoms in schizophrenia, as well as Erythropoietin. Oxytocin has been reported to have an antipsychotic-like effect; moreover, COX-2 inhibitors lead to a reduction in positive symptoms of psychosis, specifically in the first episode of illness. CONCLUSION: This narrative report suggests a promising role of new agents in the treatment of Schizophrenia; however, more research is needed to approve their clinical employment.

Lattice quantum electrodynamics in (3+1)-dimensions at finite density with tensor networks.

Gauge theories are of paramount importance in our understanding of fundamental constituents of matter and their interactions. However, the complete characterization of their phase diagrams and the full understanding of non-perturbative effects are still debated, especially at finite charge density, mostly due to the sign-problem affecting Monte Carlo numerical simulations. Here, we report the Tensor Network simulation of a three dimensional lattice gauge theory in the Hamiltonian formulation including dynamical matter: Using this sign-problem-free method, we simulate the ground states of a compact Quantum Electrodynamics at zero and finite charge densities, and address fundamental questions such as the characterization of collective phases of the model, the presence of a confining phase at large gauge coupling, and the study of charge-screening effects.

Psychosocial interventions in schizophrenia: Focus on guidelines.

BACKGROUND: Schizophrenia is a lifelong condition with acute exacerbations and varying degrees of functional disability. Acute and long-term treatments are based on antipsychotic drugs, even if some domains of personal and social functioning are not addressed by psychopharmacotherapy. In fact, psychosocial interventions show a positive impact on patient's functioning and clinical outcome. In addition, psychosocial interventions are significantly associated with a lower number of relapses and hospitalizations in schizophrenia. METHODS: An analytical review of the International Guidelines on Psychosocial Interventions in Schizophrenia has been performed; we included the National Institute for Health and Care Excellence (NICE) guidelines, the Scottish Intercollegiate Guidelines Network (SIGN) guidelines, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines, the Schizophrenia Patient Outcomes Research Team (PORT) guidelines and the American Psychiatric Association (APA) guidelines. RESULTS: The international guidelines recommend psychosocial interventions as supportive treatments alongside pharmaceutical or psychotherapeutic ones. CONCLUSION: More research studies need to be conducted and included in the updated version of the international guidelines to confirm the effectiveness of psychosocial interventions in the long-term outcome of schizophrenia.

Placebo and cultural responses.

BACKGROUND: Features of placebo response in medicine have been forgotten and ignored over the last decade. AIM: To explore why patients do get better with placebo despite its perceived inertness. METHODS: This lecture reviews the relation between illness perception, psychopharmacology and culture. RESULTS: Placebo response must be considered in the context of how patients perceive their experience of disease (illness) and through their own cultures, which determine cognitive schema and explanatory model of illness. Most of the placebo response relies on the classical conditioning and expectancy of patients. Moreover, the colour, size, formulation, cost of medications can affect the psychological response to any pharmacological treatment. CONCLUSIONS: Modern psychopharmacology should consider placebo and cultural variations as relevant factors of treatment response.

Lévy processes and stochastic von Bertalanffy models of growth, with application to fish population analysis.

The study of animal growth is a longstanding crucial topic of theoretical biology. In this paper we introduce a new class of stochastic growth models that enjoy two crucial properties: the growth path of an individual is monotonically increasing and the mean length at time t follows the classic von Bertalanffy model. Besides the theoretical development, the models are also tested against a large set of length-at-age data collected on Atlantic herring (Clupea harengus): the mean lengths and variances of the cohorts were directly estimated by least squares. The results show that the use of subordinators can lead to models enjoying interesting properties, in particular able to catch some specific features often observed in fish growth data. The use of subordinators seems to allow for an increased fidelity in the description of fish growth, whilst still conforming to the general parameters of the traditional von Bertalanffy equation.