Panic disorder as a risk factor for post-partum depression: Results from the Perinatal Depression-Research & Screening Unit (PND-ReScU) study.

BACKGROUND: Although the role of anxiety disorders on the development of Post-partum Depression (PPD) have already been studied in literature, that of individual anxiety disorders has not received specific attention. The aim of this study is to investigate the role of Panic Disorder (PD) and family history for PD as risk factors for PPD. METHODS: Six hundred women were recruited in a prospective, observational study at the 3rd month of pregnancy and followed up until the 6th month after delivery. At baseline, risk factors for PPD, Axis-I disorders and family history for psychiatric disorders were assessed. We investigated minor and major depression (mMD) occurred at 1st, 3rd and 6th months post-partum. Logistic regression models were used to estimate the association between PD, family history for PD and PPD. RESULTS: Forty women had mMD in the post-partum. PD during pregnancy (RR=4.25; 95%CI:1.48-12.19), a history of PD (RR 2.47; 95%CI:1.11-5.49) and family history for PD (RR=2.1; 95%CI:1.06-4.4) predicted PPD after adjusting for lifetime depression and risk factors for PPD. LIMITATIONS: The response rate is moderately low, but it is similar to other studies. The drop out rate is slightly high, however the 600 women who completed the 6th month follow-up did not differ from the presence of PD at baseline. CONCLUSIONS: PD is an independent risk factor for PPD, underscoring need to assess PD symptoms during pregnancy. Furthermore, PD represents an important risk factor for the development of PPD and should be routinely screened in order to develop specific preventive interventions.

Risk factors for postpartum depression: the role of the Postpartum Depression Predictors Inventory-Revised (PDPI-R). Results from the Perinatal Depression-Research & Screening Unit (PNDReScU) study.

The aims of this study were to identify the frequency of the risk factors for postpartum depression (PPD) listed in the Postpartum Depression Predictors Inventory-Revised (PDPI-R) during pregnancy and 1 month after delivery and to determine the predictive validity of the PDPI-R. The study used a prospective cohort design. Women completed the PDPI-R at the 3rd and the 8th months of pregnancy and at the 1st month after childbirth. Women were prospectively followed across three different time points during the postpartum using Structured Clinical Interview for DSM-IV Disorders to determine the presence of major or minor depression. The prenatal version of the PDPI-R administered at two different time points during pregnancy predicted accurately 72.6% and 78.2% of PPD and the full version administered at the 1st month after delivery predicted 83.4% of PPD. The cutoffs identified were 3.5 for the prenatal version and 5.5 for the full version. The PDPI-R is a useful and a valid screening tool for PPD.

The psychotic spectrum: validity and reliability of the Structured Clinical Interview for the Psychotic Spectrum.

This study evaluates the validity and the reliability of a new instrument developed to assess the psychotic spectrum: the Structured Clinical Interview for the Psychotic Spectrum (SCI-PSY). The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising the clinical and subsyndromal psychotic manifestations. The items of the interview include, in addition to a subset of the DSM-IV criteria for psychotic syndromes, a number of features derived from clinical experience and from a review of the phenomenological descriptions of psychoses. Study participants were enrolled at 11 Italian Departments of Psychiatry located at 9 sites and included 77 consecutive patients with schizophrenia or schizoaffective disorder, 66 with borderline personality disorder, 59 with psychotic mood disorders, 98 with non-psychotic mood disorders and 57 with panic disorder. A comparison group of 102 unselected controls was enrolled at the same sites. The SCI-PSY significantly discriminated subjects with any psychiatric diagnosis from controls and subjects with from those without psychotic disorders. The hypothesized structure of the instrument was confirmed empirically.

Panic-agoraphobic spectrum: reliability and validity of assessment instruments.

DSM IV is a simple, reliable diagnostic system with many advantages. However, DSM diagnostic criteria may not provide sufficient characterization of clinically significant symptoms. We have undertaken a project to assess an array (spectrum) of clinical features associated with different DSM Disorders. The purpose of this paper is to report on reliability of assessment instruments for Panic-Agoraphobic Spectrum (PAS), to document convergent validity of PAS symptom groupings, and to confirm the relationship between PAS and DSM IV Panic Disorder (PD). We studied 22 normal controls and 95 outpatients who met criteria for Panic Disorder with and without lifetime Major Depression, and Major Depression or Obsessive Compulsive Disorder without lifetime Panic Disorder. Assessment instruments had excellent reliability and there was good concordance between interview and self-report formats. PAS scores were highest in subjects with PD, followed by outpatients without PD, and were lowest in normal controls. PAS scores varied among PD patients, and a subgroup of patients without PD scored high on PAS. We conclude that PAS can be reliably assessed, and that it describes a valid, coherent constellation of features associated with DSM IV Panic Disorder, but providing additional important clinical information.

Evaluation of clinical patterns in ulcerative colitis: a long-term follow-up.

The aim of this prospective research was to compare, in a seven-year follow-up, the clinical outcome of ulcerative pancolitis with that of non-progressive ulcerative colitis. The activity of the disease was evaluated by a Clinical Activity Index and an Endoscopic Index. Of 112 cases of ulcerative colitis observed, 95 showed no change in extent and were studied as examples of non-progressive UC, and in this group the extension of the disease was: pancolitis in 19%, left-sided colitis in 39%, proctosigmoiditis in 17% and proctitis in 25%. A colectomy had to be performed in 5%. None of the enrolled cases developed a cancer during the follow-up. The patients with ulcerative pancolitis or left-sided colitis were treated with 5-ASA 1.6 g/day in a delayed-release formulation, while the cases with proctosigmoiditis or proctitis were treated with 5-ASA enemas 4 g/day. The cases with more than one relapse/year were 39%. The proportion of patients with only one relapse/year was 53%. The patients with steady remission for all the seven years of the trial were only 8%, but with a statistically significant difference between the groups with initial diagnosis of proctosigmoiditis or proctitis and the group with initial diagnosis of pancolitis or left-sided colitis (12% versus 5%). Among the cases with continuous remission, 37% showed colonic alterations, with an endoscopic score higher than 4 but a clinical score less than 6. Side-effects were observed in 6% patients but without treatment withdrawal. Non-progressive ulcerative colitis throughout the colon has a relatively good prognosis which seems to be independent of the location of the disease, even if we have found a statistically significant higher percentage of cases with steady remission among the patients with more distal disease.

Sustained remission and viraemia in chronic hepatitis C treated with recombinant alpha-interferon (rIFN-alpha).

In this retrospective trial we report the immediate and long-term effects of rIFN-alpha therapy on serum aminotransferases, especially on their behaviour in relation to the disappearance of serum HCV-RNA at the end of the treatment and one year later. Eighty-eight subjects were eligible in our study. The diagnosis of hepatitis was based on clinical, serological and histological data in all patients. They showed ALT and AST levels at least twice the upper maximum normal value and detectable serum HCV-RNA before the study. These patients were treated with rIFN-alpha 3MU, 3 times a week, in 54 cases for 6 months and in 34 for 1 year. Patients were examined at monthly intervals. Serum HCV-RNA was assessed before and at the end of the treatment and every six months during the follow-up. A complete response was defined exclusively as a normalization of aminotransferases and disappearance of serum HCV-RNA. The two groups were homogeneous. During the treatment drop-outs were 5 (5.7%), and 7 patients (7.9%) stopped the therapy for side-effects. The treatment induced a complete response in 13 (25.4%) of 51 patients treated for 6 months, and in 8 (32%) of 25 cases treated for 12 months. The patients with normalization of aminotransferase levels but with still detectable HCV-RNA in serum were 20 (39.2%) of 51 treated for 6 months and 13 (41.9%) of 31 treated for 12 months. The cases with normalization of aminotransferases were followed up for one year after IFN withdrawal. Serum liver function tests and HCV-RNA were performed every 6 months in these patients. One year after IFN withdrawal the numbers with persistent normalization of liver enzymes and absence of serum HCV/RNA were 9 (69.2%) of 13 cases with complete response after a 6-month course, and 5 (62.5%) of 8 subjects with complete response after a 12-month course. The subjects with continuous normalization or liver enzymes but persistence of serum HCV-RNA at the end of the trial were 3 (15.7%) of 19 patients with normalization of liver enzymes and still detectable HCV-RNA after a 6-month course, and 2 (15.3%) of 13 cases with normalization of liver enzymes and still detectable HCV-RNA after a 12-month course. Overall at the end of our study the patients with normal aminotransferases were 19 (21.5%) of 88 cases studied. 14 of them (73.6%) being from the subjects with disappearance of serum HCV-RNA just after IFN treatment.

Re-treatment of interferon-resistant patients with chronic hepatitis C with interferon-alpha.

Non-responders to 6-months treatment with recombinant interferon (rIFN)-alpha, 3 MU thrice weekly (primary non-responders) were treated for 6 further months with the same therapy or with a double dose of rIFN-alpha or with a different type of IFN (L-IFN). 112 primary non-responders were randomly enrolled into four groups of 28 patients each over a period of 4 years and were followed up for 6 months: group A continued the same dose of rIFN-alpha, group B was treated with the same rIFN-alpha but received a double dose (6 MU thrice weekly), group C received L-IFN, 3 MU thrice weekly, and group D stopped IFN therapy and did not receive any treatment. Patients were examined at monthly intervals and response was defined as a complete normalization of alanine amino transferase (ALT). The four groups were homogeneous as to age, sex, duration of the disease, probable source of infection, histological diagnosis. ALT and gamma glutamyl transferase (gamma GT) levels. No patient discontinued therapy for side-effects. Further treatment with rIFN-alpha 3 MU thrice weekly (group A) induced normalization of ALT levels in four patients (14%); treatment with double-dosed rIFN-alpha (group B) induced normalization of liver enzymes in six cases (21%); a different type of interferon (L-IFN) (group C) achieved normalization of serum ALT in five patients (18%). None of 28 primary non-responders who did not receive any treatment (group D) showed normalization of ALT levels. None of the patients was anti-HCV negative at the end of the study and no statistically significant difference was noted between responders and non-responders to the second course of IFN therapy as to age, sex, duration of the disease. ALT and gamma GT levels at the end of the trial. Overall at the end of the study the primary non-responders with normal levels of ALT were 15/112 (13%), with a therapeutic advantage of 7%. No statistically significant difference in the response rate was found among patients who continued IFN therapy, but prolongation of rIFN-alpha treatment at double dosage seems to be the best therapeutic regimen.

Long-term therapy with 5-aminosalicylic acid in Crohn's disease: is it useful? Our four years experience.

At present it is not clear if long-term therapy with 5-aminosalicylic acid (5-ASA) is useful in the prevention of relapses of Crohn's disease (CD) in remission. Long-lasting randomized studies are necessary to gauge the efficacy of a long-term therapy, but actually the trials are rarely longer than 12 months. The aim of our study was therefore to evaluate the efficacy of 5-ASA in maintaining the remission in inactive CDs followed up for 4 years. Sixty-six patients, 41 males, mean age 35 +/- 8, having a definitive diagnosis of CD made at least 2 years before, with ileum localization in 39 and ileocolic in 27, entered the study when Crohn's disease activity index (CDAI) and a laboratory index (LI) values were lower than 150 and 100 respectively for at least 6 weeks. Subjects with previous surgical treatment or with an endoscopic index severity (CDEIS) more than 4 were excluded. The patients were randomly divided into two groups: 33 received 5-ASA at 2.4 g/day in a delayed-release formulation (Eudragit-S-coated Mesaline) while another 33 as a control group received non-specific therapy. CDAI and LI were evaluated every 6 months, relapse being defined by a CDAI > or = 150 and LI > or = 100. To confirm the clinical and laboratory diagnosis of relapse, all the patients with CDAI > or = 150 and LI > or = 100 underwent X-ray and/or endoscopic examination. Statistical analysis was made at the end of the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Management of hepatic encephalopathy with oral zinc supplementation: a long-term treatment.

OBJECTIVES: The effect of long-term oral zinc supplementation, in addition to standard therapy (protein-restricted diet and lactulose) on recurrent hepatic encephalopathy, was assessed in a double-blind study. METHODS: Ninety cirrhotic patients with stable recurrent hepatic encephalopathy, after following a one month period of standard therapy, were randomized to receive oral zinc acetate supplementation (600 mg/day) in addition to standard therapy or to continue only standard therapy (a diet containing 0.8 g/kg/day of protein and 90 g/day of lactulose) for six months. Psychometric tests, NCT (number correction test) and PSE (portal-systemic encephalopathy) Index, were used to evaluate the degree of hepatic encephalopathy, both at the beginning and the end of each treatment period. RESULTS: Oral zinc supplementation in addition to standard therapy was able to normalize serum zinc levels. The patients who never showed clinical signs of hepatic encephalopathy during the trial were 88.6% in zinc-group and 86% in only standard therapy group. Psychometric tests, NCT and PSE Index, were statistically better than basal values either in zinc-group or in only standard therapy group. CONCLUSIONS: Final values of psychometric tests were better in zinc-group than only standard therapy group but the differences were not statistically significant.

Therapy of active chronic hepatitis with recombinant alpha 2b-interferon: an 18 month follow-up.

OBJECTIVES: The aim of this study was to evaluate the efficacy of interferon therapy in patients with "active" chronic hepatitis. METHODS: A total of 115 patients with histological diagnosis of active chronic hepatitis were enrolled in the study and treated with recombinant alpha 2b-interferon at a dosage of 3 MU, 3 times a week, for a 6 month period. Patients who showed a complete normalization of serum aminotransferase levels were followed for further 12 months, in which no treatment was performed. RESULTS: After 6 months of treatment, 50 (43.4%) patients showed normalized serum aminotransferase levels and among these "responders", 18 (36%) showed a persistent normalization 12 months after stopping interferon therapy. Only 7 patients at the end of the study agreed to a second liver biopsy which showed a decrease in Knodell's index and a clear-cut reduction of inflammation and lobular necrosis. CONCLUSION: Interferon is useful for the treatment of chronic active anti-HCV positive hepatitis but the beneficial responses are often transient. Future therapeutic strategies and the development of direct assay for HCV in serum and liver are necessary to understand the real role of interferon in chronic anti-HCV positive hepatitis.

[The use of reduced glutathione in alcoholic hepatopathy]. / L'impiego del glutatione ridotto nell'epatopatia alcolica.

The aim of the study was to assess the efficacy and tolerance of the use of reduced GSH in patients suffering from alcoholic diseases of the liver. Eighty patients were randomly divided into two matched groups and treated for 30 days with 300 mg of reduced GSH or 10 mg of vitamin K. Clinical symptoms and the main indices of hepatic function were assessed before and after treatment. At the end of the study all patients had improved, but the group treated with reduced GSH showed a greater improvement of hepatic function indices (SAT, ALT, gamma-GT) which was statistically significant in comparison to that found in the vitamin K treatment group.

5-aminosalicylic acid in the prevention of relapses of Crohn's disease in remission: a long-term study.

The aim of the study was to evaluate the efficacy of 5-aminosalicylic acid (5-ASA) in maintaining the remission in patients with inactive Crohn's disease over a period of three years, using either the Crohn's Disease Activity Index (CDAI) and or the Laboratory Index (LI). Thirty-eight patients entered in the study; 20 received 5-ASA 1.6 g/day and 18 no specific therapy. The patients were followed for three years. Of the patients, 86% presented a relapse, 80% in the 5-ASA group and 94% in the control group. Two patients requested surgical therapy. All patients with clinical relapse had CDAI greater than 150 and LI greater than 100. 5-Aminosalicylic acid was well tolerated and was able to protect from relapse up to 60% of the patients in the first year of therapy. When treatment with 5-ASA is prolonged for periods longer than one year a progressive increase in the number of patients who present relapse can be observed, but of the 5-ASA group, 80% of relapses occurred in the three years whereas the control group showed 94% relapses at the end of the first year.