Treating depression in patients with borderline personality disorder: clinical clues on the use of antidepressants.

Personality disorders (PD) are described as enduring patterns of markedly deviant and pervasive inner experiences and behaviors, with onset in adolescence, which lead to severe distress or impairment. Patients suffering from major depressive disorder (MDD) display higher rates of comorbidity with personality disorders, often complicating the treatment, and worsening the outcomes. Borderline personality disorder (BPD) is the most common of PD and is frequently associated with MDD, with which shares several features. The most part of research agrees on the fact that comorbid BPD in MDD patients quite doubles the poor response to treatments. Moreover, no treatment strategy stands out currently to emerge as more effective in these cases, thus urging the call for the need of new approaches. Herein, we revise the current literature on BPD, its neurobiology and comorbidity with MDD, as well as the more recent treatment strategies used. Then, based on its pharmacology, we propose a possible role of trazodone as a valuable tool to approach comorbid BPD-MDD.

Factors associated with involuntary admissions: a register-based cross-sectional multicenter study.

BACKGROUND: Despite the EU recommendations on mental health, involuntary admission has been under researched in Italy for a long time and the overall picture of involuntary admission still appears fragmentary. The aims of this study are to evaluate involuntary admission rates in the Piedmont Region (Italy) and to investigate clinical and service-related variables associated with involuntary admission. METHODS: This is a cross-sectional retrospective multicenter study involving all psychiatric inpatients units of the general hospitals of Piedmont Region. Data on hospitalizations during 2016 were collected by consulting hospital discharge registers. The analyses were performed on two samples: 6018 patients (data analysis was run on first hospitalization during the study period for those with multiple admissions) and 7881 inpatient episodes. The association between involuntary admission and socio-demographic and clinical characteristics was examined through t-test for continuous variables, and Pearson's Chi-square test for categorical variables. Multilevel modeling was applied in logistic regression models with two levels: for the first model center and participants and for the second model center and inpatient episodes. RESULTS: Of 6018 inpatients, 10.1% were admitted involuntarily at first hospitalization, while the overall compulsory treatment rate was slightly lower (9.1%) in the inpatient episodes sample (n = 7881). The involuntary admission rates ranged from 0.8 to 21% among study centers. Involuntary admissions were primarily associated with younger age, diagnosis of schizophrenia or substance use disorders, longer duration of hospital stay, mechanical restraint episodes, and fewer subsequent hospitalizations during the study period. CONCLUSIONS: The rate of involuntary admission in the Piedmont Region was lower than the mean rate across countries worldwide. There were noteworthy differences in rates of involuntary admission among psychiatric units, although no relationship was found with characteristics of the psychiatric wards or of the areas where hospitals are located.

Vortexes tune the chirality of graphene oxide and its non-covalent hosts.

Graphene oxide (GO) is one of the most appealing bidimensional materials able to interact non-covalently with achiral molecules and to act as chiral inducers. Vortexes can tune chirality and, consequently transfer a specific handedness to non-covalent host molecules, either when dispersed in water or when deposited on a solid surface.

Clinical outcome and length of stay in an Italian Psychiatric Emergency Service.

PURPOSE: The aims of the present study were to analyze outcome and to evaluate diagnosis-specific pattern of improvement during a brief hospitalization in a Psychiatric Emergency Service (PES) in a catchment area in Turin, Italy. METHODS: A sample of 848 acute patients, consecutively hospitalized between January 2007 and December 2008 in the PES of the San Giovanni Battista Hospital, with diagnoses of non-affective psychosis-affective psychosis, depressive disorder and mania-and personality disorder (DSM-IV-TR) was recruited. All patients were assessed with the Brief Psychiatric Rating Scale (BPRS). One-way analysis of variance was used to measure patients' individual reliable and clinically significant change speed between BPRS assessments, in which change speed was referred to the division of the gap between admission and discharge scores over the number of days of length of stay (LOS). RESULTS: The overall sample showed a significant improvement of BPRS total score and each domain during a brief hospitalization (mean LOS 10.5 days), with a different pattern between the diagnostic groups. A significant difference in change speed of BPRS resulted in the whole sample and in each diagnostic groups; patients with mania showed a significantly faster improvement. CONCLUSIONS: A brief hospitalization in our service was shown to be highly effective. A different and diagnosis-specific patients' individual reliable and clinically significant change speed was observed, with a significantly faster improvement in patients with mania.

Emergency psychiatry.

Up to 15% of people that are visited in the Emergency Department of a Hospital have a mental disorder and/or a psychiatric symptom: often this is not recognized or not properly treated. The reasons for this are more than one and involve: the emergency physicians that are not always prepared and sensible to face this kind of disorders; the psychiatrists that are not always well tuned with the language and the clinic of the emergency; and the patients, that can ignore or deny the psychiatric nature of their problems. After an initial definitions of the most important terms and concepts (Psychiatric Emergency and Urgency, Behavioral Emergency, Acute Presentations of Mental Disorders, and Crisis) the Medical and Psychiatric Assessment are discussed with different Clinical Presentations and Classifications, Psychosocial Evaluation and Risk Assessment. Finally the Clinical Management and the Pharmacological Treatment are presented with special attention to the underlying medical causes and to the use of new drugs, especially second generation antipsychotics, alone or combined with benzodiazepines.

The enhancement of isoflavones water solubility by complexation with modified cyclodextrins: a spectroscopic investigation with implications in the pharmaceutical analysis.

The improvement of isoflavones bioavailability by complexation with chemically modified cyclodextrins (CyDs) has been exploited to analyse the drug/macrocycle binding affinity by a conventional method with new useful measures. Genistein (Gen) and daidzein (Daidz) were investigated in aqueous medium and in presence an amount of (2-hydroxypropyl)-beta-cyclodextrin (HP-beta-CyD) at different host/guest molar ratios. The solubility in pure water, approximately 3 x 10(-6)M for Gen and approximately 10 x 10(-6)M for Daidz, was obtained by distributing the of guest molecule between water and the organic solvent. The stoichiometric ratios and stability constants describing the extent of formation of the complexes have been determined by phase-solubility UV-vis measurements and confirmed by circular dichroism data. These results have implications in the determination of the carrier's capacity for the complexation of the drug in water solution.

Focus on the aggregation processes of Photosystem II complexes.

In this work the effect of temperature and n-dodecyl-beta-d-maltoside (DM) on PSII complexes organization was investigated. An aggregation process of PSII monomers and dimers was documented at different temperatures and low DM concentration by steady-state fluorescence, absorption, circular dichroism, Rayleigh and dynamic light-scattering experiments. Measures of oxygen evolution enabled us to estimate the change in photoactivity of PSII during the aggregation. This process was found to be extensively reversed by increasing DM concentration as proved by means of steady-state fluorescence and dynamic light-scattering experiments.

Study of the aggregation of insulin glargine by light scattering.

Insulin glargine (Lantus, Aventis Pharma, Deutschland, GmbH) is a new long-acting human insulin analog. Structural modification of the insulin molecule at two sites alters its pH, causing insulin glargine to precipitate in the neutral environment of subcutaneous tissue and to form a depot that is slowly absorbed into the bloodstream. In this paper insulin glargine aggregation is investigated by light scattering. This study shows that, in a physiologic-like pH (even at low ionic strength) conditions, aggregation phenomena occur, giving rise to compact structures with radius of hundreds of nanometers. The aggregation of insulin glargine can be responsible for its slow in situ absorption allowing for a more controlled release.

The inclusion complexes of hesperetin and its 7-rhamnoglucoside with (2-hydroxypropyl)-beta-cyclodextrin.

The effect of (2-hydroxypropyl)-beta-cyclodextrin (HP-beta-CyD) on the solubility properties and spectroscopic features of hesperetin and its 7-rhamnoglucoside, hesperidin, was qualitatively and quantitatively investigated in water, by means of UV-vis absorption and fluorescence spectroscopy. The stoichiometric ratios and stability constants describing the extent of formation of the complexes have been determined by phase-solubility measurements; in both cases type-A(L) diagrams have been obtained (soluble 1:1 complexes). The higher degree of interaction showed by hesperetin may be attributed to the higher hydrophobicity and smaller size of the aglycone molecule, which therefore exhibits a greater affinity for the CyD and fits better into the cavity. The effect of molecular encapsulation on the two flavanones antioxidant activity was afterwards evaluated by means of different biological assays, concerned to the different mechanisms of in vivo action. The protection efficacy was in all cases higher for the complexed drugs, with respect to the free ones; these results are of great interest for their potential usefulness in pharmaceutics.

The rutin/beta-cyclodextrin interactions in fully aqueous solution: spectroscopic studies and biological assays.

In the present work the feasibility of beta-cyclodextrin complexation was explored, as a tool for improving the aqueous solubility and antioxidant efficacy of rutin. By means of 1H NMR, UV-vis and circular dichroism spectroscopy the single aromatic ring of rutin was found to be inserted into the beta-cyclodextrin cavity to form a 1:1 inclusion complex. The effect of beta-cyclodextrin on the spectral features of rutin was quantitatively investigated, in fully aqueous medium, by holding the concentration of the guest constant and varying the host concentration. The associated binding constants were estimated to be 142+/-20 and 153+/-20 M(-1), respectively, on the basis of the observed UV-vis absorption and circular dichroism intensities. The antioxidant activity of rutin was also investigated, as affected by molecular encapsulation within beta-cyclodextrin (batophenanthroline test; comet assay; lipid peroxidation); the inclusion complex revealed improved antioxidant efficacy that may be in part explained by an increased solubility in the biological moiety.

[Subphrenic adipose tissue, an infrequent cause of increased distance between the diaphragm and liver. Radiological study and echographic comparison]. / Tessuto adiposo sub-frenico, causa non frequente di aumento della distanza tra diaframma e fegato. Studio radiologico e confronto ecografico.

Nine obese patients (4M/5F) showing on a standard chest-X-ray a right subdiaphragmatic radiolucent area were submitted to ecography. This method excluded pathologic causes and showed adipose tissue as the cause of the increased distance between diaphragm and liver. Besides, ecography showed some limits in the evaluation of adipose area, because of the difficulty in studying obese patients.