How Lung Volume Recruitment Maneuvers Enhance Respiratory Function in Multiple Sclerosis Patients: A Quasi-Randomized Pilot Study.

Background and Objectives: In patients with multiple sclerosis (MS), a decrease in muscle strength can lead to limitations in pulmonary functions, potentially causing respiratory complications. To address these challenges, the lung volume recruitment (LVR) maneuver has emerged as a potential intervention. This study sought to evaluate the impact of a four-week LVR protocol on respiratory function in secondary progressive MS patients. Materials and Methods: In a quasi-randomized pre/post-controlled trial, 24 patients with secondary progressive MS were recruited. Participants aged 20-70 years with an EDSS score of 2 to 9 were alternately allocated to intervention (n = 12) or control groups (n = 12). The intervention group underwent a 4-week respiratory rehabilitation training focused on LVR, using a standardized cough machine treatment protocol twice daily. The control group received no respiratory intervention. Outcomes measured included forced vital capacity (FVC), maximal insufflation capacity (MIC), and peak cough flow (PCF), using turbine spirometry and other associated equipment. All measurements were taken at baseline (T0) and after 4 weeks (T1) by a blinded assessor. Results: For the intervention group, the mean difference pre/post-treatment in MIC (mL) was 0.45 (SD 1.13) (p = 0.02), and in MIC (%), it was 0.13 (SD 0.24) (p = 0.03). Compared to the control group (n = 10), the between-group mean difference for MIC (mL) was 0.54 (p = 0.02), and for MIC (%), it was 0.15 (p = 0.02). Conclusions: The short-term daily LVR protocol notably improved passive lung capacity, despite minimal changes in active lung capacity or cough force. The LVR maneuver offers promise for enhancing respiratory function, especially passive lung capacity, in secondary progressive MS patients. Further research should explore optimal treatment durations and frequencies for more extensive respiratory gains.

Tocophobia in the DSM-5 era: Outcomes of a new cut-off analysis of the Wijma delivery expectancy/experience questionnaire based on clinical presentation.

INTRODUCTION AND AIMS: Diagnosis of tocophobia using existing instruments is an area of active investigation. Although a range of Wijma Delivery Experience Questionnaire (W-DEQ) cut-off scores has been suggested for detecting tocophobia, there is no consensus among researchers about an optimal cut-off score. The primary goal of the present study was to identify a cut-off value while referring to the DSM-5 Specific Phobia criteria as a gold standard, and to accordingly evaluate how the fearful component of the childbirth experience and psychopathology in the post-natal period are affected by tocophobia. METHODS: We conducted an observational, longitudinal study on nulliparous women (n = 106). Routine pregnancy data and data from psychometric questionnaires investigating depression, anxiety, and fear of childbirth were collected. A psychiatric Structured Clinical Interview for DSM-5 (SCID-5) was also conducted. The same parameters were re-evaluated one month after parturition. RESULTS: A W-DEQ score of 85 was found to be the optimal cut-off score for detecting tocophobia, with sound sensitivity (100%) and specificity (93.8%). We found substantial agreement between the W-DEQ A and SCID-5 Specific Phobia Criteria (Cohen's Kappa coefficient, κ = 0.720). CONCLUSIONS: A W-DEQ cut-off value of 85 is a reliable tool for detecting clinically relevant fear of childbirth according to the DSM-5 diagnosis of Specific Phobia. Therefore, accurate psychopathological investigation must be administered to women with W-DEQ scores greater than this cut-off score.

Atomoxetine for hoarding disorder: A pre-clinical and clinical investigation.

Despite several studies suggested that inattention and impulsivity-compulsivity could represent two core dimensions of hoarding disorder (HD), only a small case series study investigated the effectiveness of attention-deficit-hyperactivity-disorder (ADHD) medications in HD. The aim of the present study was to target attentional and inhibitory control networks in HD patients through the ADHD medication atomoxetine, moving from a preclinical investigation on an animal model of compulsive-like behavior (marble burying test) to a clinical investigation on both medicated and unmedicated patients with a primary diagnosis of HD without ADHD. Our preclinical investigation showed that acute administration of atomoxetine significantly reduced the compulsive-like behaviours of mice in the marble burying test without affecting neither locomotor activity and coordination nor exploration behaviours. When compared, atomoxetine and fluoxetine showed similar effects on the marble burying test. However, fluoxetine impaired both locomotor and exploratory activity. In our clinical investigation 12 patients were enrolled and 11 patients completed an open trial with atomoxetine at flexible dose (40-80 mg) for 12 weeks. At the endpoint the mean UCLA Hoarding Severity Scale score decreased by 41.3% for the whole group (p = 0003). Six patients were classified as full responders (mean symptom reduction of 57.2%) and three patients as partial responders (mean symptom reduction of 27.3%). Inattentive and impulsivity symptoms showed a significant mean score reduction of 18.5% from baseline to the endpoint (F (1,9) = 20.9, p = 0.0013). Hoarding symptoms improvement was correlated to reduction of patients' disability and increased in their global functioning. These preclinical and clinical data suggest that atomoxetine may be effective for HD and therefore should be considered for future controlled trials.