Changes in attitude towards LAI antipsychotic maintenance treatment: A two-year follow-up study.

BACKGROUND: To present real-world evidence on the effects of switching from oral to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) in a sample of clinically stable patients with schizophrenia, with regard to subjective experience of treatment, attitude towards drug and quality of life. METHODS: 50 clinically stable adult schizophrenic outpatients were recruited. At the time of enrolment (T0), all patients were under a stabilized therapy with a single oral second-generation antipsychotic (SGA) and were switched to the equivalent maintenance regimen with the long-acting formulation of the same antipsychotic. 43 patients completed the 24-month prospective, longitudinal, open-label, observational study. Participants were assessed at baseline (T0), after 12 (T1) and 24 months (T2), using psychometric scales (PANSS, YMRS and MDRS) and patient-reported outcome measures (SWN-K, DAI-10 and SF-36). RESULTS: The switch to LAI-AMT was associated with a significant clinical improvement at T1 and T2 compared to baseline (T0). All of the psychometric indexes, as well as patients' subjective experience of treatment (SWN-K), and quality of life (SF-36) showed a significant improvement after one year of LAI-AMT, with stable results after two years. Patients' attitude towards drug (DAI-10) increased throughout the follow-up period, with a further improvement during the second year. CONCLUSIONS: The switch to LAI-AMT may help to address the subjective core of an optimal recovery in stabilized schizophrenic patients. A sustained improvement in patients' attitude towards drug may help to achieve patient's compliance. The size of this study needs to be expanded to produce more solid and generalizable results.

The effects of switching from oral to LAI antipsychotic treatment on subjective experience of schizophrenic and schizoaffective patients: Preliminary results.

OBJECTIVE: To present real-world preliminary evidence on the specific effects of switching from oral to long-acting injectable (LAI) antipsychotic treatment on patient's subjective experience and quality of life (QoL) in a sample of clinically stable psychotic subjects. METHODS: Twenty-six clinically stable adult schizophrenic and schizoaffective outpatients were recruited. All patients were under a stabilized therapy with a single oral second-generation antipsychotic and were switched to the equivalent maintenance regimen with the long-acting formulation of the same antipsychotic. Two subgroups of patients were created on the basis of the presence/absence of a complete clinical remission at enrollment. Anthropometric (body mass index), psychometric (Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale, and Positive And Negative Syndrome Scale), and patient's reported outcome (Subjective Well-Being Under Neuroleptics scale short form, Drug Attitude Inventory short version, and Short Form-36 health survey) data were collected at enrollment (T0) and after 6 months from the treatment switch (T1). RESULTS: Significant improvements in psychometric indexes, and patients' subjective experience of treatment and attitudes toward drug (reflecting in an enrichment of patients' health-related QoL) were found both in initial remitters and non-remitters. CONCLUSIONS: Our preliminary results suggest that the switch from oral to LAI antipsychotic treatment may help to address the subjective core of an optimal and satisfying recovery of psychotic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.

[Female sexual functioning: the role of psychopathology]. / Funzionamento sessuale femminile: il ruolo della psicopatologia.

BACKGROUND: In the study of the relationship between sexuality and psychopathology, female sexual functioning appears to be relatively poorly explored. In addition, most studies have been conducted on clinical samples, so that the question of whether non-clinically relevant psychopathological symptoms may have a negative impact on women's sexual response still remains unanswered. The aim of this study was to analyze the influence of psychopathology on specific phases of sexual functioning (desire, arousal, lubrication, orgasm, satisfaction) and pain in a sample of young women without psychiatric case history. METHODS: Two questionnaires were administered to a sample of female students in Psychology of the University of Florence (n=75): the Symptom Checklist (SCL-90) to evaluate psychic distress and the Female Sexual Function Index (FSFI) for data collection on sexual functioning. RESULTS: 44 questionnaires were valid. The dimensions of SCL-90 explain a relatively high percentage of variance of the global severity index of sexuality (R²=0.49); significant predictors were: somatization (Beta=-0.75), depression (Beta=-0.89), anxiety (Beta=-0.79), and hostility (Beta=-0.48). The same variables were significant predictors, though at a lesser extent, for all the single dimensions of sexuality, with the exception of pain, on which only hostility had a significant correlation (Beta=-0.55). CONCLUSIONS: Although the small size and the peculiar characteristics of the sample do not allow to extrapolate the results, the findings of this study show that psychopathological dimensions can affect female sexual functioning at subclinical level in the absence of the confounding effect of drug therapy.

The role of life events and HPA axis in anxiety disorders: a review.

Stressful life events and dysfunctional Hypothalamic Pituitary Adrenal (HPA) axis have been implicated in the pathogenesis of psychiatric disorders, including anxiety disorders. This paper attempts to review the existing literature on childhood traumata, recent life events, HPA axis functioning and their relationship in Post-Traumatic Stress Disorder, Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder and Social Phobia. Preclinical and clinical models will be analyzed. Stressful life events seem to have a role in the onset and in the course of these disorders and HPA axis abnormalities have been reported in almost all anxiety disorders. The hypothesis that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology, will be evaluated.

Childhood stressful events, HPA axis and anxiety disorders.

Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.

[Sexuality and eating disorders]. / Sessualità e disturbi del comportamento alimentare.

AIM: The aim of the present study is to explore the sexual functioning of an Eating Disorders (ED) sample composed by Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS) patients. METHODS: 98 patients (AN: 23; BN: 14; EDNOS: 61) have been compared with 88 health subjects. All participants have filled in the following questionnaires: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), Eating Disorders Examination (EDE-q), Binge Eating Scale (BES), Emotional Empathy Scale (EES). For the evaluation of the sexual activity Female Sexual Function Index (FSFI) was applied. RESULTS: 67 patients (68.4%) and 80 healthy controls (90.9%) reported a sexual activity with a partner or masturbation in the four latest weeks. Only one healthy control (1.1%) reported masturbation and 79 (89.8%) controls showed sexual activity with a partner, on the contrary 11 patients (11.2) reported masturbation and 56 (57.1%) patients showed sexual activity with a partner. Moreover patients showed higher scores on every FSFI subscales. No significant differences were observed between AN, BN and BED in terms of FSFI scores. DISCUSSION: Women with ED show a lower sexual activity with a partner, a six-fold increase in the risk of sexual dysfunction and an higher frequency of masturbation as the only sexual activity when compared with healthy controls. The cognitive distraction produced by the discomfort to show own body during a sexual intercourse with the partner may explain our results.

[Use of psychotropic drugs in children, adolescents and subjects with intellectual disability: a review]. / Revisione dell'uso di psicofarmaci in età evolutiva e in pazienti con disabilità intellettiva.

AIM: In children, adolescents and subjects with intellectual disability (ID), psychotropic drugs are being used in large and increasing quantities. The aim of this article is to review efficacy and safety evidences of psychotropic drugs use in the above-mentioned patients. METHODS: A literature search on this argument was conducted on Medline electronic archives encompassing english-language and other languages publications. RESULTS: In children, adolescents and subjects with ID, the use of antidepressants, antipsychotics and mood stabilizers, besides being effective for indications in psychiatric disorders of adults without ID, is proved to have good clinical efficacy in disorders which are characteristic of such patients categories, such as pervasive developmental disorders, disruptive behavior disorders and problem behaviours. In both patients populations non-medication based strategies should be considered first. The adverse effects profiles of psychotropic drugs administered in children, adolescents and subjects with ID seems to be different from the ones registered in adults without ID, thus particular caution and precautions are recommended. DISCUSSION: Given the paucity of data (especially in the long term) and the metodological limitations of currently available researches, more studies are needed to develop scientific evidences able to guide practitioners in the use of psychotropic medications among childhood, adolescence and ID.

[Neuroimaging and neurobiology of social anxiety]. / Neuroimaging e neurobiologia dell'ansia sociale.

AIM: Social Anxiety Disorder (SAD) represents one of the most frequent psychiatric disorders. The results of a systematic review of the literature published until January 2010 on the neurobiology of SAD are reported, giving prominence to functional neuroimaging (fNI) findings. METHODS: A literature search of neuroimaging and neurobiology studies of SAD was conducted on PubMed and Medline electronic archives and by canvassing English-language and other European languages publications. Eligible studies were restricted to those on adult population (age 16 to 65) and using DSM and ICD criteria. RESULTS: The 19 reviewed fNI studies on SAD agree in identifying a dysfunction of five main cerebral areas: the amygdala, the medial prefrontal cortex, the insula, the hippocampus and the dorsolateral prefrontal cortex. Those findings strongly suggest the presence, in this disorder, of functional alterations in the neural systems involved in the genesis of fear, in the processing of emotional stimuli, in the "self" perception and in the evaluation of others' intentions. DISCUSSION: Neurobiology research on SAD is still relatively young and, up to today, available findings are still not exhaustive. Nonetheless, a growing evidence from different lines of research seems to suggest that SAD patients may present a distinct biologic background compared to control subjects. Until now, however, no specific neurobiological aspect has been proposed for the SAD only. Per contra, results from fNI studies seem to indicate the presence of a common pattern of neural dysfunction in all the major anxiety disorders.