Flexible and Convergent Enantioselective Total Synthesis of (R)-Juglanaloids A and B: Two Phthalide Spiro Alkaloids with Potential Alzheimer's Disease Inhibitory Activity.

Juglanaloids A and B are recently isolated natural products characterized by an unprecedented spiro bicyclic isobenzofuranone-tetrahydrobenzazepinone framework and a promising antiamyloid activity. Here reported is a straightforward convergent total synthesis of these natural products, which were obtained in high enantiomeric purity (94% and >99% ee for juglanaloids A and B, respectively) through an eight-step longest linear sequence, based on an efficient and reliable enantioselective phase-transfer-catalyzed alkylation step. Considering the interesting biological activity of juglanaloids, this convenient, highly enantioselective, flexible, and predictable synthetic strategy promises to be a powerful tool for accessing potentially bioactive spiro bicyclic phthalide-tetrahydrobenzazepinone derivatives.

Diet and Nutrition: Which Role for Mental Health?

INTRODUCTION: There is a correlation between food and mental health, as well as the increased prevalence of chronic diseases in psychiatric patients. Factors that can contribute to this include psychopharmacological treatment, unhealthy lifestyles, inadequate self-care, poor social and emotional integration, difficulty seeking help from doctors and low compliance with treatments. Studies have also shown that individual nutrients and dietary habits can impact psychophysical well-being. METHODS: The survey was conducted from February to March 2023 using Google Forms. It involved a questionnaire that was administered to a sample of 72 employees from the Departments of Mental Health in the Puglia Region. The questionnaire consisted of ten statements evaluating the importance of promoting adequate lifestyles and nutritional education in patients with psychiatric disorders through the role of the dietician. RESULTS: The survey shows that most operators recognize the importance of dietitians in managing the nutritional needs of psychiatric patients, but there is some disagreement regarding the extent of their competence and role. For example, some operators do not consider dietitians as the only qualified and competent professionals to apply dietary styles, and not all of them agree on the importance of including dietitians in mental health care teams. The survey also suggests that including dietitians in mental health care teams could help manage the metabolic changes induced by psychopharmacological treatment and reduce healthcare costs. CONCLUSIONS: Our data highlight the importance of nutrition in mental health and the need for greater recognition of the role of dietitians in treating psychiatric patients. Considering nutrition as a fundamental aspect of mental health is crucial to promoting overall wellness and preventing chronic conditions.

Is Mindfulness-Based Intervention a Feasible Treatment for Patients with Psychotic Spectrum Disorders? A Pilot Study.

INTRODUCTION: Mindfulness-based intervention (MBI) can be considered a useful strategy for coping with psychotic experiences, helping patients to respond differently to psychotic symptoms with a more conscious acceptance of thoughts, emotions and sensations. The purpose of this study was to examine the feasibility and potential clinical utility of a mindfulness-based intervention. METHODS: Twenty outpatients from a Mental Health Centre in Bari approached to participate in this study. Among the approached participants, 15 agreed to participate and provided data at pretreatment, among them only 10 completed the treatment protocol and provided data after the treatment. Patients were offered mindfulness-based psychoeducation intervention protocol (MBPP) proposed by Chien and Lee (2013). The structure of the program consisted of 8-week 120 min weekly group sessions. Outcome assessments were conducted at recruitment (time 0) and after mindfulness-based psychoeducation program (time 1). In order to compare scores at different times (T0 and T1), paired T-test was used, if normal distribution, or Exact Wilcoxon signed rank test; normal distribution was analyzed using Shapiro-Wilk test. RESULTS: The results obtained after the administration of the following rating scales Brief Psychiatric Rating Scale (BPRS), Drug attitude Inventory (DAI-10), Recovery Assessment Scale (RAS), Schedule for the assessment of the insight (SAI), Mindful Attention Awareness Scale (MAAS) show score variations at two times. MAAS and SAI show a significant increase at time 1 compared to time 0. CONCLUSIONS: The data obtained with this study highlight the feasibility of mindfulness-based interventions (MBI) in psychotic spectrum disorders in Community Mental Health Services. Our study underline furthermore the opportunity of mindfulness-based interventions to increase insight in a recovery-oriented rehabilitation process.

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic.

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.

Catatonia and neuroleptic malignant syndrome: two disorders on a same spectrum? Four case reports.

We present the history of four bipolar patients who developed neuroleptic malignant syndrome (NMS) after antipsychotic treatment, focusing on the relationship between NMS and catatonia. In all cases, the administration of antipsychotics has been suspended as soon as fever and autonomic disturbances occurred. A supportive therapy was initiated to stabilize general conditions, then every patient started electroconvulsive therapy (ECT) in combination with benzodiazepines (BDZ). The risk of complications was reduced by the quick adoption of supportive care, whereas the combination of ECT and BDZ was effective in resolving the clinical picture. These cases may provide further support to the hypothesis that catatonia and NMS are disorders pertaining to the same spectrum of illness because the onset or exacerbation of catatonic symptoms coincided with the administration of antipsychotics. Our experience confirms the efficacy and safety of ECT in combination with BDZ as treatment of NMS and residual catatonia.

[Catatonia and neuroleptic malignant syndrome: two disorders on a same spectrum? Three case reports]. / Catatonia e sindrome maligna da neurolettici: condizioni cliniche diverse di uno stesso spettro? Descrizione di tre casi.

AIM: The authors present the cases of three bipolar patients who developed Neuroleptic Malignant Syndrome (NMS) after antipsychotic treatment, both typical and atypical, focusing on relationship between NMS and catatonia. METHODS: In all three cases, administration of antipsychotics has been stopped at once, when fever and autonomic disturbances occurred. A supportive therapy (including rehydration, electrolyte restoration and blood pressure aids, together with antipyretics, antibiotics and anticoagulants) was prescribed in order to stabilize general conditions. Every patient started then Electroconvulsive Therapy (ECT) in combination with benzodiazepines. RESULTS: High risk of complications and lethal outcome, associated with NMS, were successfully reduced by the tempestive adoption of a supportive care, while combination between ECT and BDZ was effective in resolution of clinical picture. DISCUSSIONS; These cases may provide further evidences about hypothesis of catatonia and NMS as disorders on the same spectrum. In one patient, NMS occurred overlapping with a previous catatonic state, while two others exhibited catatonic features after resolution of NMS. However, catatonic symptoms arose or worsened with administration of antipsychotics, supporting hypothesis of neuroleptic-induced catatonia as a step of progressive development of NMS. Our experience also confirms efficacy and safety of ECT in combination with BDZ as treatment of NMS and residual catatonia.

Neuroleptic malignant syndrome: further lessons from a case report.

BACKGROUND: Neuroleptic malignant syndrome (NMS) represents an iatrogenic form of malignant catatonia, and simple catatonia has been shown to predispose to NMS. OBJECTIVE: The authors present the case of a bipolar patient with catatonic features who developed NMS after receiving haloperidol. METHOD: Supportive therapy, including rehydration, electrolyte restoration, and blood pressure aids were given, together with antipyretics, antibiotics, and anticoagulants. The patient was also started on bromocriptine and diazepam. RESULTS: Supportive care, diazepam, and dopamine agonists yielded only partial benefit. However, switching from diazepam to lorazepam, in combination with electroconvulsive therapy (ECT) and a long-acting dopamine agonist led to the resolution of NMS. CONCLUSION: This case sheds further light on the relationship between catatonia and NMS. As noted in the literature, ECT in combination with lorazepam proved to be safe and effective for NMS.

Augmentation of clozapine with aripiprazole in severe psychotic bipolar and schizoaffective disorders: a pilot study.

AIM: To evaluate the efficacy and safety of the augmentation of clozapine with aripiprazole in patients with treatment-resistant schizoaffective and psychotic bipolar disorders in a retrospective manner. Pharmacodynamic and pharmacokinetic interactions between the two drugs were also investigated. PATIENTS: Three men and 4 women (median age 36 and 40 years, respectively) who had mean scores at BPRS and CGI-Severity of 59.1+/-12.0 and 5.4+/-0.5, respectively, were treated with clozapine (mean dose 292.9+/-220.7 mg/day). Patients received an adjunctive treatment with aripiprazole (mean dose 6.8 +/- 3.7 mg/day). Clozapine, norclozapine and aripiprazole plasma levels were measured by means of a high performance liquid chromatograpy with UV detection. RESULTS: Total scores at BPRS decreased significantly (from 59.1+/-12.0 to 51.1+/-15.6, p=0.007) after aripirazole augmentation. In particular, the factors "thought disorder" (from 10.4+/-4.4 to 9.0+/-4.5, p=.047) and "anergia" (from 10.0+/-2.7 to 8.0+/-2.4, p=.018) significantly improved. Concomitant administration of aripiprazole and clozapine did not result in an increase in side effects over the period of treatment. Dose-normalized plasma levels of both clozapine and norclozapine and the clozapine/norclozapine metabolic ratio in all patients did not vary as well. CONCLUSION: The augmentation of clozapine with aripirazole was safe and effective in severe psychotic schizoaffective and bipolar disorders which failed to respond to atypical antipsychotics. A possible pharmacokinetic interaction between clozapine and aripiprazole does not account for the improved clinical benefit obtained after aripiprazole augmentation.

Efficacy of electroconvulsive therapy in Fahr disease associated with bipolar psychotic disorder: a case report.

We report a case of a patient with Fahr disease affected by bipolar disorder type I with psychotic symptoms. The complex clinical picture, characterized by both neurological and psychiatric symptoms, proved to be partially or completely resistant to several pharmacological trials. On the contrary, a marked improvement of clinical picture occurred after a cycle of 10 sessions of electroconvulsive therapy, followed by a complete and sustained resolution of mood, cognitive, motor, and behavioral symptoms during the next 4 years.

Aerobic Oxidation and Oxidative Esterification of 5-Hydroxymethylfurfural by Gold Nanoparticles Supported on Nanoporous Polymer Host Matrix.

The aerobic oxidation and oxidative esterification of 5-hydroxymethylfurfural (HMF) catalyzed by gold nanoparticles (AuNPs) supported on a semicrystalline nanoporous multiblock copolymer matrix consisting of syndiotactic poly(styrene)-cis-1,4-poly(butadiene) (sPSB) have been investigated. Depending on the reaction parameters (support nanoporosity, presence of water, solvent, temperature, cocatalyst, oxygen pressure), the conversion of HMF can be finely addressed to the formation of the desired oxidation product, such as 2,5-diformylfuran (DFF), 5-formylfuran-2-carboxylic acid (FFCA), methyl 5-(hydroxymethyl)furan-2-carboxylate (MHMFC), dimethyl furan-2,5-dicarboxylate (DMFC), and furan-2,5-dicarboxylic acid (FDCA), under optimized reaction conditions. The AuNP-sPSB catalyst is highly effective and selective because the polymer support acts as a conveyor and concentrator of the reactants toward the catalytic sites.

Highly Diastereoselective Crown Ether Catalyzed Arylogous Michael Reaction of 3-Aryl Phthalides.

The first arylogous Michael reaction of 3-aryl phthalides has been developed. The reaction, promoted by catalytic amounts of KOH or K3PO4 and dibenzo-18-crown-6, affords the corresponding 3,3-disubstituted phthalides in good to high yields and as single diastereomers in nearly all studied cases.