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Servicios Comunitarios de Salud Mental/normas , Evaluación de Procesos y Resultados en Atención de Salud , Mejoramiento de la Calidad , Calidad de la Atención de Salud , Política de Salud , Humanos , Italia , Servicios de Salud Mental/normas , Indicadores de Calidad de la Atención de SaludRESUMEN
OBJECTIVE: At least 50% of bipolar disorder (BD) patients have an additional diagnosis, one of the most difficult to manage being obsessive-compulsive disorder (OCD). Defining the nosology of BD-OCD comorbidity has important clinical implications, given that treatments for OCD can worsen BD outcomes. METHOD: A systematic review was conducted on: i) BD-OCD comorbidity lifetime prevalence and ii) on standard diagnostic validators: phenomenology, course of illness, heredity, biological markers, and treatment response. Relevant papers published through March 30th 2013 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library. RESULTS: Sixty-four articles met inclusion criteria. Lifetime comorbidity prevalence was 11-21% in BD patients and 6-10% in OCD patients. Compared to non-comorbid subjects, BD-OCD has a more episodic course of OC symptoms (up to 75% vs. 3%), typically with worsening during depression (78%) and improvement during mania/hypomania (64%), as well as a higher total mean number of depressive episodes (8.9±4.2 vs. 4.1±2.7) and perhaps more antidepressant-induced mania/hypomania (39% vs. 9%). CONCLUSION: In this first systematic review of BD-OCD comorbidity, it appears that OC symptoms are usually secondary to BD, rather than representing a separate disease.
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Síntomas Conductuales/diagnóstico , Trastorno Bipolar , Manejo de la Enfermedad , Trastorno Obsesivo Compulsivo , Edad de Inicio , Trastorno Bipolar/epidemiología , Trastorno Bipolar/etiología , Trastorno Bipolar/psicología , Trastorno Bipolar/terapia , Comorbilidad , Estudios Epidemiológicos , Humanos , Trastorno Obsesivo Compulsivo/epidemiología , Trastorno Obsesivo Compulsivo/etiología , Trastorno Obsesivo Compulsivo/psicología , Trastorno Obsesivo Compulsivo/terapia , Evaluación de Resultado en la Atención de Salud , Prevalencia , Reproducibilidad de los ResultadosRESUMEN
AIMS: Depression is among the main contributors to older adults' mental health burden. Retirement, one of the major life transitions, has been claimed to influence mental health substantially. Following up on a previous meta-analysis, the study aims to assess from a longitudinal perspective short- and long-term impacts of transitioning to retirement on depression risk and suicidality in older adults across Europe. METHODS: We conducted a longitudinal study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected between 2004 and 2020 in 27 European countries plus Israel. To estimate relative risks (RR) and 95% confidence intervals (95% CIs) for depression and suicidality at seven time intervals before and after retirement, we fitted adjusted generalized estimating equation models for repeated measures. RESULTS: We included 8,998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). Compared to the year of retirement, the risk of depression was 11% lower in the following year (RR 0.89; 95% CI 0.81-0.99), 9% lower after 2 years (RR 0.91; 95% CI 0.82-1.00) and after 3 years (RR 0.91; 95% CI 0.81-1.01). Significant estimates remained among females, married individuals, those with an intermediate or higher level of education, former manual workers and those who retired at or before their country's median retirement age. A significant increase in depressive symptoms emerged from the tenth year after retirement among former non-manual workers (RR 1.21; 95% CI 1.05-1.40) and late retirees (RR 1.37; 95% CI 1.16-1.63). No heterogeneity emerged among strata. As for suicidality, we reported an increase in risk only 5 years or more after retirement, namely +30% 5-9 years after retirement (RR 1.30; 95% CI 1.04-1.64) and +47% 10 or more years after retirement (RR 1.47; 95% CI 1.09-1.98). Sensitivity analyses excluding subjects who reported a diagnosis of depression over the study period and those retirees who declared to receive a disability pension confirmed the results obtained in the overall analysis. CONCLUSIONS: Longitudinal adjusted data suggest an independent effect of retiring associated with a reduction in depression and suicidality risk in the short run, with its effect decreasing in the long run. Such trends are particularly evident among selected subgroups of elderly populations. If greater flexibility in pensionable age may help prevent depression late in life, the transition to retirement is to be accompanied by targeted health promotion interventions. In an ageing society, welfare policies should be evaluated, considering their long-term impact on mental health.
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Jubilación , Suicidio , Femenino , Humanos , Anciano , Jubilación/psicología , Estudios Longitudinales , Depresión/epidemiología , Depresión/psicología , Envejecimiento , Europa (Continente)/epidemiologíaRESUMEN
OBJECTIVE: While pharmacological strategies appear to be ineffective in treating long-term addiction, repetitive transcranial magnetic stimulation (rTMS) is emerging as a promising new tool for the attenuation of craving among multiple substance dependent populations. METHOD: A systematic review of randomized controlled trials (RCTs) was conducted on the efficacy and tolerability of rTMS in treating cocaine use disorder (CUD). Relevant papers published in English through November 30th 2022 were identified, searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: Eight studies matched inclusion criteria. The best findings were reported by the RCTs conducted at high-frequency (≥5 Hz) multiple sessions of rTMS delivered over the left dorsolateral prefrontal cortex (DLPFC): a significant decrease in self-reported cue-induced cocaine craving and lower cocaine craving scores and a considerable amelioration in the tendency to act rashly under extreme negative emotions (impulsivity) were found in the active group compared to controls. CONCLUSION: Although still scant and heterogeneous, the strongest evidence so far on the use of rTMS on individuals with CUD support the high frequency stimulation over the left DLPFC as a well tolerated treatment of cocaine craving and impulsivity.
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Trastornos Relacionados con Cocaína , Cocaína , Trastornos Relacionados con Sustancias , Humanos , Trastornos Relacionados con Cocaína/terapia , Estimulación Magnética Transcraneal , Corteza Prefrontal/fisiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Trastornos Relacionados con Sustancias/etiología , Ansia/fisiología , Resultado del TratamientoRESUMEN
Accumulating scientific and clinical evidence highlighted pathological hyperinflammation as a cardinal feature of SARS-CoV-2 infection and acute COVID-19 disease. With the emergence of long COVID-19 syndrome, several chronic health consequences, including neuropsychiatric sequelae, have gained attention from the public and medical communities. Since inflammatory mediators have also been accredited as putative biomarkers of suicidal ideations and behaviors, hyper- and neuroinflammation might share some colliding points, overlapping and being interconnected in the context of COVID-19. This review aims to provide a summary of current knowledge on the molecular and cellular mechanisms of COVID-19-associated hyper/neuroinflammation with focus on their relevance to the inflammatory hypothesis of suicide development. Subsequently, strategies to alleviate COVID-19 hyper/neuroinflammation by immunomodulatory agents (many of which at experimental stages) as well as psychopharmacologic/psychotherapeutic approaches are also mentioned. While suicide risk in COVID-19 survivors - until now little known - needs further analysis through longitudinal studies, current observations and mechanistic postulates warrant additional attention to this possibly emerging mental health concern.
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COVID-19 , Suicidio , COVID-19/complicaciones , Humanos , Enfermedades Neuroinflamatorias , SARS-CoV-2 , Ideación Suicida , Síndrome Post Agudo de COVID-19RESUMEN
AIMS: Retirement is a major life transition that may improve or worsen mental health, including depression. Existing studies provide contradictory results. We conducted a systematic review with meta-analysis to quantitatively pool available evidence on the association of retirement and depressive symptoms. METHODS: We applied PRISMA guidelines to conduct a systematic review and meta-analysis to retrieve, quantitatively pool and critically evaluate the association between retirement and both incident and prevalent depression and to understand better the potential role of individual and contextual-level determinants. Relevant original studies were identified by searching PubMed, Embase, PsycINFO and the Cochrane Library, through 4 March 2021. Subgroup and sensitivity meta-analyses were conducted by gender, study design (longitudinal v. cross-sectional studies), study quality score (QS) and considering studies using validated scales to diagnose depression. Heterogeneity between studies was evaluated with I2 statistics. RESULTS: Forty-one original studies met our a priori defined inclusion criteria. Meta-analysis on more than half a million subjects (n = 557 111) from 60 datasets suggested a protective effect of retirement on the risk of depression [effect size (ES) = 0.83, 95% confidence interval (CI) = 0.74-0.93], although with high statistical heterogeneity between risk estimates (χ2 = 895.19, df = 59, I2 = 93.41%, p-value < 0.0001). Funnel plot asymmetry and trim and fill method suggested a minor potential publication bias. Results were consistent, confirm their robustness and suggest stronger protective effects when progressively restricting the included studies based on quality criteria: (i) studies with the highest QS [55 datasets, 407 086 subjects, ES = 0.81, 95% CI = 0.71-0.91], (ii) studies with a high QS and using validated assessment tools to diagnose depression (44 datasets, 239 453 subjects, ES = 0.76, 95% CI = 0.65-0.88) and (iii) studies of high quality, using a validated tool and with a longitudinal design (24 datasets, 162 004 subjects, ES = 0.76, 95% CI = 0.64-0.90). We observed a progressive reduction in funnel plot asymmetry. About gender, no statistically significant difference was found (females ES = 0.79, 95% CI = 0.61-1.02 v. men ES = 0.87, 95% CI = 0.68-1.11). CONCLUSIONS: Pooled data suggested that retirement reduces by nearly 20% the risk of depression; such estimates got stronger when limiting the analysis to longitudinal and high-quality studies, even if results are affected by high heterogeneity.As retirement seems to have an independent and protective effect on mental health and depressive symptoms, greater flexibility in retirement timing should be granted to older workers to reduce their mental burden and avoid the development of severe depression. Retirement may also be identified as a target moment for preventive interventions, particularly primary and secondary prevention, to promote health and wellbeing in older ages, boosting the observed impact.
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Depresión , Jubilación , Anciano , Estudios Transversales , Depresión/diagnóstico , Depresión/epidemiología , Femenino , Promoción de la Salud , Humanos , Masculino , Salud Mental , Persona de Mediana EdadAsunto(s)
Trastorno Bipolar/clasificación , Trastorno Bipolar/diagnóstico , Trastorno Depresivo Mayor/clasificación , Trastorno Depresivo Mayor/diagnóstico , Adulto , Antidepresivos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Depresivo Mayor/tratamiento farmacológico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Compuestos de Litio/uso terapéutico , RecurrenciaRESUMEN
BACKGROUND: Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry, but treatment of BD-OCD remains a clinical challenge. Although serotonin reuptake inhibitors (SRIs) are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. METHODS: A systematic review was conducted on aripiprazole augmentation in treating comorbid BD-OCD patients. Relevant papers published through August 31st 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: Aripiprazole augmentation to mood stabilizers (lithium carbonate, valproate), even at low doses (10-15â¯mg/day), helped to achieve significant remission in affective and obsessive-compulsive symptoms. Aripiprazole was generally safe and well tolerated. LIMITATIONS: Most studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability. CONCLUSIONS: Keeping in mind scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that aripiprazole augmentation to mood stabilizers, even at low doses, is effective in BD-OCD patients.
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Aripiprazol/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Antimaníacos/uso terapéutico , Trastorno Bipolar/epidemiología , Trastorno Bipolar/psicología , Comorbilidad , Humanos , Carbonato de Litio/uso terapéutico , Trastorno Obsesivo Compulsivo/epidemiología , Trastorno Obsesivo Compulsivo/psicologíaRESUMEN
BACKGROUND: In the last five years, the debate around the comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) has flourished within the international psychiatric community and several studies have been published on therapeutic strategies. METHODS: An update of our previous systematic review was conducted on clinical management of comorbid BD-OCD patients. Relevant papers published from July 1st 2013 to September 30th 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: Fifteen studies were included. In all selected studies BD-OCD patients received mood stabilizers, alone or with second-generation antipsychotics (SGAs). Aripiprazole augmentation demonstrated to be effective as maintenance therapy and for treating obsessive-compulsive symptoms during manic episodes (40% of the studies, 6/15). Addition of antidepressants to mood stabilizers led to clinical remission of both conditions in only one case report. LIMITATIONS: Almost 50% of the selected studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability. CONCLUSIONS: Mood stabilization should be the primary goal in treating BD-OCD patients. Aripiprazole augmentation to lithium carbonate seemed to be the best option in treatment-resistance comorbid patients. Addition of SRIs may be needed only in a minority of BD patients with refractory OCD.
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Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Adulto , Antidepresivos/uso terapéutico , Aripiprazol/uso terapéutico , Trastorno Bipolar/psicología , Comorbilidad , Quimioterapia Combinada , Femenino , Humanos , Carbonato de Litio/uso terapéutico , Masculino , Trastorno Obsesivo Compulsivo/psicología , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Many clinicians are reluctant to use traditional mood-stabilizing agents, especially lithium, in children and adolescents. This review examined the evidence for lithium's safety and efficacy in this population. METHODS: A systematic review was conducted on the use of lithium in children and adolescents with bipolar disorder (BD). Relevant papers published through June 30th 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: 30 articles met inclusion criteria, including 12 randomized controlled trials (RCTs). Findings from RCTs demonstrate efficacy for acute mania in up to 50% of patients, and evidence of long-term maintenance efficacy. Lithium was generally safe, at least in the short term, with most common side effects being gastrointestinal, polyuria, or headache. Only a minority of patients experienced hypothyroidism. No cases of acute kidney injury or chronic kidney disease were reported. CONCLUSIONS: Though the available literature is mostly short-term, there is evidence that lithium monotherapy is reasonably safe and effective in children and adolescents, specifically for acute mania and for prevention of mood episodes.
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Antimaníacos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Compuestos de Litio/uso terapéutico , Adolescente , Niño , Enfermedades Gastrointestinales/inducido químicamente , Cefalea/inducido químicamente , Humanos , Hipotiroidismo/inducido químicamente , Poliuria/inducido químicamente , Insuficiencia Renal/inducido químicamente , Resultado del TratamientoRESUMEN
Our goal is to review vestibulo-oculomotor reflex (VOR) studies on several peripheral vestibular disorders (Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo, superior canal dehiscence syndrome, and vestibular neuroma), using the scleral search coil (SSC) technique. Head movements are detected by vestibular receptors and the elicited VOR is responsible for compensatory 3 dimensional eye movements. Therefore, to study the VOR it is necessary to assess the direction and velocity of 3 dimensional head and eye movements. This can be achieved using the SCC technique. Interaction between a scleral search coil and an alternating magnetic field generates an electrical signal that is proportional to eye position. Ideally, eye rotation axis is aligned with head rotation axis and VOR gain (eye velocity/head velocity) for horizontal and vertical head rotations is almost 1. The VOR gain, however, for torsional head rotations is smaller and about 0.7.
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Otolaringología/instrumentación , Reflejo Vestibuloocular/fisiología , Enfermedades Vestibulares/fisiopatología , Humanos , Enfermedad de Meniere/diagnóstico , Enfermedad de Meniere/epidemiología , Enfermedad de Meniere/fisiopatología , Canales Semicirculares/fisiopatología , Vértigo/diagnóstico , Vértigo/epidemiología , Vértigo/fisiopatología , Enfermedades Vestibulares/diagnóstico , Neuronitis Vestibular/diagnóstico , Neuronitis Vestibular/fisiopatologíaRESUMEN
Psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). We updated our recent systematic review searching the electronic databases MEDLINE, Embase, and PsycINFO to investigate course of illness in BD-OCD patients. We identified a total of 13 relevant papers which found that the majority of comorbid OCD cases appeared to be related to mood episodes. OC symptoms in comorbid patients appeared more often during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes.
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Trastorno Bipolar/fisiopatología , Comorbilidad , Progresión de la Enfermedad , Trastorno Obsesivo Compulsivo/fisiopatología , Trastorno Bipolar/epidemiología , Humanos , Trastorno Obsesivo Compulsivo/epidemiologíaRESUMEN
BACKGROUND: In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the perinatal period. Although AnxD are diagnosed in 4-39% of pregnant women and in up to 16% of women after delivery, evidence on their clinical management is limited. METHODS: A systematic review was conducted on pharmacological and non-pharmacological treatment of AnxD in the perinatal period. Relevant papers published from January 1st 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: 18 articles met inclusion criteria. Selected studies supported the use of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD), panic disorder (PD) and specific phobia both in pregnancy and postpartum. Selective serotonin reuptake inhibitors (SSRIs) led to significant OCD and PD improvement both in pregnancy and postpartum with no side effects for the babies. In the largest clinical sample to date, 65% of postpartum patients who entered the open-label trial of fluvoxamine (up to 300mg/day) experienced a 30% or greater decrease in the total score of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). During pregnancy, SSRIs and tricyclic antidepressants (TCAs) led to remission of panic symptoms and healthy outcomes for the babies. LIMITATIONS: Study design, mostly case reports, and enrolment of subjects mainly from outpatient specialty units might have limited community-wide generalisability. CONCLUSIONS: Keeping in mind the scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that CBT should be the first treatment offered to pregnant and breastfeeding women with AnxD. However SSRIs can represent a first line treatment strategy, and not exclusively in cases where AnxD is refractory to CBT.
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Trastornos de Ansiedad/tratamiento farmacológico , Trastornos de Ansiedad/terapia , Terapia Cognitivo-Conductual , Atención Posnatal/métodos , Atención Prenatal/métodos , Ansiolíticos/uso terapéutico , Antidepresivos/uso terapéutico , Femenino , Humanos , EmbarazoRESUMEN
BACKGROUND: Although some authors have recently investigated the co-occurrence of anxiety and bipolar disorders, the topic remains insufficiently studied. Defining the prevalence and predictors of BD-OCD comorbidity has important nosological, clinical and therapeutic implications. METHODS: A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-OCD. Relevant papers published through March 30th, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: 46 articles met inclusion criteria. The pooled prevalence of OCD in BD was 17.0% (95% CI 12.7-22.4%), which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%, 95% CI 13.2-24.8%). With regard to OCD-BD predictors, a higher mean age predicted a lower prevalence of OCD in BD patients. Sub group meta-analyses reported higher OCD prevalence rates in BD children and adolescents (24.2%, compared to 13.5% in adults), in BD-I patients (24.6%, compared to 13.6% in mixed BD patients), and among population-based studies (22.2%, compared to 13.2% in hospital-based studies). LIMITATIONS: Most studies use retrospective assessment scales with low sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations that may bias results towards an overestimation of obsessive symptom prevalence. CONCLUSIONS: This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-OCD confirms that BD-OCD comorbidity is a common condition in psychiatry with children and adolescents and BD-I patients as the most affected subgroups.
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Trastorno Bipolar/epidemiología , Trastorno Obsesivo Compulsivo/epidemiología , Factores de Edad , Comorbilidad , Humanos , PrevalenciaRESUMEN
The authors review their two-year experience of hernioplasty using a modified version of Shouldice's technique which includes the employment of a polyglyconate monofilament. Although the series of patients is chronologically limited, the findings appear to confirm that this is a valid alternative to other techniques proposed to date for treating inguinal hernia.
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Hernia Inguinal/cirugía , Músculos Abdominales/cirugía , Humanos , Métodos , Polímeros , Técnicas de Sutura , SuturasRESUMEN
The principal aim of this study is to set up a new microsurgical technique that can be reproducible easily for the execution of orthotopic homograft of stomach in rat. The vascularization of homograft is given, for arterial district by a termino-terminal anastomosis between celiac artery of donor and right renal artery of receiving, and, for venous district, by a termino-lateral anastomosis between portal vein of donor and vena cava of receiving. The middle survival of rats that were had a graft, in this first stage of research, has been of 3 days, therefore it hasn't't been possible to look into the function of graft.
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Microcirugia/métodos , Estómago/trasplante , Animales , Supervivencia de Injerto , Masculino , Ratas , Estómago/irrigación sanguínea , Técnicas de Sutura , Trasplante HomólogoRESUMEN
In examining some procedures of general evaluation of the operative risk the Authors direct their attention to the performance of cell-mediate reactivity skin tests and consider a set of 42 patients (of whom 11 as controls, and 31 "high risk"). The results obtained are interesting and evidence the high reliability of these tests in evaluation of infective morbidity and mortality in neoplastic and non-neoplastic patients: in fact a negative response means high morbidity and mortality while a positive response corresponds to normal surgical healing. In tumoral patients, moreover a relationship between skin tests and clinical stage of the disease is observed: negativity of the test means a terminal stage and hence absolute inoperability: positivity corresponds to an advanced stage and hence relative operability (exploratory laparatomy and thoracotomy). The Authors conclude by stressing that the tests have a practical utility and prognostic value higher than those of other methods.
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Inmunidad Celular , Pruebas Cutáneas/métodos , Procedimientos Quirúrgicos Operativos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/inmunología , Neoplasias/cirugía , RiesgoRESUMEN
The AA. intend to study the healing process of digestive sutures in dog that have been made with mechanical instruments that have metal agraphes. The used instruments are the American models of United Surgical Corporation in New York that have: --LDS pliers; --GIA pliers; --TA mod 90, 55, 30, pliers. They had made 15 operations of digestive surgery: gastric resections sec. Billroth II, anastomoses of ileum, colic anastomoses. In total they have made 45 sutures. After an established period the same animals were operated on again for controlling the results of made operations and the macro and microscopic evolution of sutures. The study of healing has shown a quick and exact repairing process for first intent, different from sutures that are made manually with threads that, notoriously, develop slowly for second intent.