Feasibility of a psychoeducational family intervention for people with bipolar I disorder and their relatives: Results from an Italian real-world multicentre study.

BACKGROUND: Despite several guidelines recommend the use of psychoeducational family interventions (PFIs) as add-on in the treatment of patients with bipolar I disorder, their implementation on a large scale remains limited. The aim of the present study is to identify obstacles for the feasibility of PFIs in routine care. METHODS: This was a multicentre, real-world, controlled, outpatient trial, carried out in 11 randomly recruited Italian mental health centres. Two mental health professionals from each center attended a modular training course on PFI and provided the intervention. Difficulties and benefits experienced by mental health professionals in implementing the intervention were assessed through the Family Intervention Schedule (FIS-R), which was administered six times. RESULTS: Sixteen out of the 22 recruited professionals completed the training and administered the PFI to 70 patients with bipolar I disorder and their relatives. The retention rate of families receiving the intervention was 93%. Mental health professionals reported high levels of organizational difficulties, several benefits in their daily clinical work and low levels of intervention-related difficulties. The most important organizational obstacles were related to the need to integrate the intervention with other work responsibilities and to the lack of time to carry out the intervention. These difficulties did not decrease over time. Intervention-related difficulties were rated as less problematic since the first time assessment and tended to improve over time. LIMITATIONS: Low number of recruited professionals; use of a not previously validated assessment instrument. CONCLUSIONS: PFIs are feasible in routine care for the treatment of patients with bipolar I disorder and their relatives, and main obstacles are related to the organization/structure of mental health centres, and not to the characteristics of the intervention itself.

Melatonin in psychiatric disorders: a review on the melatonin involvement in psychiatry.

In normal subjects, the secretion of melatonin, the pineal hormone that regulates the rhythm of many functions, exhibits a circadian pattern synchronized with the day-night cycle. An alteration of this secretory pattern has been found in various psychiatric disorders (seasonal affective disorder, bipolar disorder, unipolar depression, bulimia, anorexia, schizophrenia, panic disorder, obsessive compulsive disorder). At present, it is not known if such alterations have an etiological role or are secondary to the dysfunctions underlying the different disorders. In addition, we do not know if the involvement of melatonin in several disorders has the same significance in the pathophysiology of each disorder. An understanding of the role of the pineal hormone and of its alterations in psychiatric diseases could help to identify the biological mechanisms underlying such disorders.

Electroretinogram B-wave amplitude in panic disorder.

Abnormal light-related behaviors have been described for patients with panic disorder (PD). The present study was undertaken to investigate the retinal light response in PD using electroretinography (ERG). The authors conducted b-wave ERG measurements with a bright light (after dark adaptation) in 28 patients with PD and 28 control subjects. There were no significant differences in the mean b-wave amplitude between the two groups, but the retinal response to light in PD patients was generally lower than in healthy subjects. A large interindividual variability was found; also noted was a significant difference in the mean b-wave amplitude between the right and left eyes in the control group. The data indicate subtle variation of retinal photosensitivity in a subgroup of patients with PD. Because dopaminergic retinal activity affects b-ERG amplitude, the authors hypothesize that the dopaminergic system is involved in the response to light in PD patients.

Season of birth in panic disorder.

Several studies have investigated the seasonal distribution of the birth dates of patients with psychiatric diseases. Our purpose was to verify if there is a specific distribution (by month) of birth dates in subjects with panic disorder (PD). The birth dates of 843 outpatients with a diagnosis of PD were compared with those of 1,181 subjects with other mental diseases. The birth dates of psychiatric patients were compared to those of the general Tuscane and Italian populations. The monthly distribution of birth in patients with PD (with and without comorbidity) peaked in September to December, while no relevant deviation in birth rate was observed in other mental diseases. Our results suggest a pathogenic role of birth seasonality in the development of PD.

Season of birth in psychiatry. A review.

Numerous studies suggest that seasonal birth may play a pathogenic role in the development of mental disorders. A birth excess of 10% during winter and spring has been shown in schizophrenia. The few studies carried out on affective disorders revealed a significant increase of births in the first quarter of the year in bipolar disorders and major depressive disorder. Subjects with seasonal affective disorder show a peak of births in May. Data on personality, eating and 'neurotic' disorders are less consistent. At the moment there are no data in the literature about anxiety disorders.

Composition of free fatty acids and adipose tissue triglycerides in portacaval shunted rats.

This study was designed to determine the individual fatty-acid pattern in plasma and in two adipose tissue sites of rats submitted to portacaval shunt (PCS) using the button technique. The animals were studied both in a fed state and after a 48-hour fast. Glucose, ketone bodies (KB), lactate and pyruvate levels were also measured. The results of the shunted animals were compared with pair-fed and freely fed control groups. In PCS rats, plasma free fatty-acid (FFA) levels were not significantly higher than in freely fed controls. beta-Hydroxybutyrate was significantly lower in PCS rats compared with both control groups. A 48-hour fast caused an elevation of plasma FFA and KB in all groups, but in PCS rats this increase was less pronounced. Lactate levels did not decrease during fasting in PCS rats, as they did in the control groups. PCS did not modify plasma FFA or the adipose tissue composition, neither in fed nor in fasted rats. We conclude that the PCS rats operated upon by using the button technique show mild modifications in lipid metabolism, affecting the fatty-acid composition neither in plasma FFA nor in adipose tissue.

Fatty acid composition of adipose tissue in patients with chronic liver disease.

In this study plasma free fatty acids and adipose tissue fatty acid composition in 10 cirrhotic patients, 5 patients with non-cirrhotic chronic liver disease and in 5 controls have been investigated. Fatty acid composition of adipose tissue in cirrhotic patients demonstrated a significant increase of 16:1 and a decrease of 18:2. Monounsaturated fatty acids represented the major fraction both in cirrhotic patients (57.5%) and in controls (55.2%). Polyunsaturated fatty acids were significantly lower in cirrhotic patients (9.1%) than in controls (14.3%). In plasma, total free fatty acids were higher in cirrhotics (732 +/- 111 microM) than in controls (319 +/- 38 microM; mean +/- SE) and the individual fatty acid profile showed a prevalence of monounsaturated fatty acid (increase of 16:1 and 18:1 and decrease of 16:0 and 18:0). The decrease in polyunsaturated fatty acids in the composition of adipose tissue triglycerides could represent a marker of long-term reduction in lipid absorption, intake and/or enhanced lipid consumption. The resemblance between plasma and adipose tissue pattern in cirrhotic patients supports the hypothesis that increased lipolysis in such patients plays the most important role in influencing plasma free fatty acid composition.

Aminoacid imbalance and malnutrition in liver cirrhosis.

The reason branched chain aminoacids are decreased and aromatic aminoacids increased in chronic liver failure is unclear. Branched chain aminoacids are mainly catabolised in muscles, and it is known that protein energy malnutrition may decrease the concentration of these aminoacids in plasma. In this study we have evaluated the nutritional status of a group of cirrhotics and compared it with their plasma aminoacid imbalance. Fourteen patients were considered as well-nourished and nine as malnourished. Plasma levels of branched chain aminoacids were significantly decreased and the phenylalanine increased in the malnourished group. Arm muscle circumference was significantly correlated with branched chain aminoacids. In conclusion our data suggest that malnutrition may contribute to the low levels of these aminoacids in patients with liver cirrhosis.