Prevalence of anxiety and depression risk during the prepartum period in the different groups of women and responses from the Italian National Health Service.

BACKGROUND: Specific screening for anxiety and depression in pregnant women is important to identify those at risk and to provide timely intervention. The aims of the study were: 1) to compare the risk of anxiety and depression in four groups of pregnant women belonging to four types of healthcare centers distinguished by the level of risk: at low-risk; at high-risk for an obstetric reason; at high-risk for fetal anomalies; at high-risk for psychiatric conditions and 2) to identify the response that the National Health Service offers to women positively screened for anxiety and depression. METHODS: A cross-sectional study was conducted on 2801 pregnant women, cared for by National Health Service, divided into four groups: 1) low-risk pregnancy (N.=1970); 2) high-risk pregnancy for an obstetric reason (N.=218); 3) high-risk for fetal anomalies (N.=505); and 4) high-risk for psychiatric conditions (N.=108). Participants were screened using the Edinburgh Postnatal Depression Scale, the General Anxiety Disorder, and sociodemographic, anamnestic, and clinic questionnaires. RESULTS: 28.9% of participants obtained an EPDS Score ≥9 and 17.1% a GAD-7 Score ≥8. The group at high-risk for fetal anomalies presented the highest prevalence of anxiety (29.3%) and depression (49.1%) while the group at low risk presented the lowest prevalence of anxiety (13%) and depression (24.6%). The groups at risk for obstetric reasons presented an intermediate prevalence. Psychiatric conditions constituted a higher risk for anxiety than depression. Counselling is recommended for about 70% of women at risk for anxiety and depression. Moreover, about 15% of women positive for screening were initiated into psychotherapy and about 1.5% into pharmacotherapy. 15% of women positive for screening were referred to other specialists. CONCLUSIONS: This study underlined the relevance of a prompt response by the National Health Service to mental health needs, especially in the risk conditions related to obstetric and/or fetal anomalies and psychopathology.

The hypometabolic state: a good predictor of a better prognosis in amyotrophic lateral sclerosis.

BACKGROUND: Malnutrition and weight loss are negative prognostic factors for survival in patients with amyotrophic lateral sclerosis (ALS). However, energy expenditure at rest (REE) is still not included in clinical practice, and no data are available concerning hypometabolic state in ALS. OBJECTIVE: To evaluate in a referral cohort of patients with ALS the prevalence of hypometabolic state as compared with normometabolic and hypermetabolic states, and to correlate it with clinical phenotype, rate of progression and survival. DESIGN: We conducted a retrospective study examining REE measured by indirect calorimetry in patients with ALS referred to Milan, Limoges and Tours referral centres between January 2011 and December 2017. Hypometabolism and hypermetabolism states were defined when REE difference between measured and predictive values was ≤-10% and ≥10%, respectively. We evaluated the relationship between these metabolic alterations and measures of body composition, clinical characteristics and survival. RESULTS: Eight hundred forty-seven patients with ALS were recruited. The median age at onset was 63.79 years (IQR 55.00-71.17). The male/female ratio was 1.26 (M/F: 472/375). Ten per cent of patients with ALS were hypometabolic whereas 40% were hypermetabolic. Hypometabolism was significantly associated with later need for gastrostomy, non-invasive ventilation and tracheostomy placement. Furthermore, hypometabolic patients with ALS significantly outlived normometabolic (HR=1.901 (95% CI 1.080 to 3.345), p=0.0259) and hypermetabolic (HR=2.138 (95% CI 1.154 to 3.958), p=0.0157) patients. CONCLUSION: Hypometabolism in ALS is not uncommon and is associated with slower disease progression and better survival than normometabolic and hypermetabolic subjects. Indirect calorimetry should be performed at least at time of diagnosis because alterations in metabolism are correlated with prognosis.

Gender-Specific Behaviour in Obesity Stages I-II: Imbalance of Aminothiol Status and Adipomyokine Profile in Subjects with Different Insulin Resistance Severity.

The hyperproduction of oxidative stress and inflammatory biomarkers, which is paralleled by decreased levels of antioxidant and anti-inflammatory mediators, is part of cellular mechanisms that contribute to the disruption of metabolic homeostasis in obesity. Whether gender-specific alterations and gender-restricted associations in these biomarkers underlie the increased cardiometabolic risk in men compared to women is unclear. We enrolled 31 women and 29 men, aged ≥50 and ≤70 years and with body mass index ≥ 30 and <40 kg/m2. We assessed the concentrations of aminothiols (cysteine, homocysteine, and glutathione), expression of oxidant/antioxidant balance, adipomyokines (leptin, adiponectin, myostatin, and interleukin-6), markers of chronic inflammation, and vitamin D, an index of nutritional state, in plasma and serum samples by using HPLC, ELISA, and chemiluminescent immunoassay methods. We measured insulin resistance (IR) by the homeostasis model assessment (HOMA) index. Despite comparable levels of visceral adiposity, IR, and a similar dietary regimen, men showed, with respect to women, higher oxidant concentrations and lower antioxidant levels, which paralleled IR severity. Myostatin levels correlated with prooxidant aminothiols among men only. Gender-specific alterations in aminothiol status and adipomyokine profile and the gender-restricted association between these biomarkers and metabolic derangement are consistent with an increased cardiometabolic risk in men compared to age-matched women with stage I-II obesity. Strict control of redox and inflammatory status, even addressing gender-specific nutritional targets, may be useful to prevent obesity-related metabolic alterations and comorbidities.

A structured program for perinatal depression and anxiety to be adopted in the emergencies.

Quarantine, loss of routine and social support can negatively impact mothers who have just given birth and their babies, generating concerns and reactions of intense fear. Following the COVID-19 emergency, we described a structured program for screening and treatment of perinatal depression and anxiety as a medium for constant monitoring of perinatal risk factors and early screening, which can also be implemented in emergencies with remote intervention methods, to offer women an appropriate, timely and effective treatment. In this scenario, it is desirable that the monitoring of the psychological well-being of women in postpartum is maintained over time, with the participation of all the professional figures with whom the woman comes into contact, to intercept any forms of psychological distress related to the epidemic and that could occur even after some time.

Feasibility and effectiveness of the Australian perinatal mental health approach in the Italian health services: progress and challenges.

The perinatal depression is one of the leading pathologies in the world causing disabilities and represents an important public health problem. Since 2003, the Center for Behavioral Sciences and Mental Health (Istituto Superiore di Sanità - ISS) has promoted studies and research on the mental health of women, children, partners and family in the perinatal period, leading to the realization of a structured program adopted in many Italian services. In this article, we describe the feasibility and effectiveness of the perinatal mental health approach in Italian health services and discuss the progress and new challenges.

Correlates of olfactory impairment in middle-aged non-diabetic Caucasian subjects with stage I-II obesity.

PURPOSE: This study evaluates among middle-aged subjects with obesity the prevalence of olfactory impairment (OI) with respect to normative values and its correlation with body composition, cognition, sleep quality, and inflammation. METHODS: In 60 (31 women, 29 men) volunteers with a body mass index ≥ 30 to ≤ 40 kg/m2, aged ≥ 50 to ≤ 70 years, we assessed olfaction by the Sniffin' Stick test. We measured anthropometrics, body composition and metabolic profiles and evaluated cognition by the MiniMental State Examination (MMSE) and sleep disturbances by the Insomnia Severity Index (ISI). Patients were classified into two groups according to a total olfactory score (odor Threshold, Discrimination, Identification, TDI) below or above the 25th percentile from age and gender-adjusted normative data. RESULTS: Overall, 25 subjects (42%) had OI (TDI < 25th percentile). The largest differences between subjects with and without OI were observed in discrimination and identification scores, with a large overlap in olfactory threshold. Subjects with an abnormal TDI showed significantly higher fat mass index, ISI scores and urinary neopterin and lower MMSE scores than those without OI. By multivariable logistic regression, MMSE, ISI score and urinary neopterin were significantly associated to OI. CONCLUSIONS: Among middle-aged subjects with stage I and II obesity, OI is highly prevalent and is independently associated with poor self-reported sleep quality, lower cognition scores and higher levels of the inflammatory marker neopterin.

Irisin and markers of metabolic derangement in non-diabetic Caucasian subjects with stage I-II obesity during early aging.

Irisin concentrations are decreased in subjects with overt diabetes and upregulated in those with obesity or impaired fasting glucose. However, gender-balanced data in older populations, in whom risk factors commonly culminate in overt cardiovascular disease, are scarce. We assessed in non-diabetic Caucasian subjects with stage I-II obesity in the early aging range (50 to 70 years), the relationship between irisin, body composition and markers of metabolic derangement by gender. In 60 (31 women, 29 men) non-diabetics with a body mass index ≥30 - ≤40 kg/m2, we measured anthropometrics and body composition (Air Displacement Plethysmography). We assayed lipid and glucose profile by routine methods, plasma irisin by ELISA and measured insulin resistance by the HOMA index. Irisin levels were higher in women than in men (161 [105-198]) vs 83 [33-115] ng/ml, P<0.001), and correlated directly with HOMA index in both (rho 0.735, P<0.001 M, rho 0.452, P = 0.011 F). Sex differences were maintained across insulin resistance severity stages. In men, irisin concentrations correlated directly with body mass index (rho 0.755, P<0.001), waist circumference (rho 0.623, P<0.001), fat mass index (rho 0.762, P<0.001), glucose (rho 0.408, P = 0.028), the fatty liver index (rho 0.705, P<0.001) and FINDRISC score (rho 0.536, P = 0.003). Among non-diabetic Caucasian subjects with obesity in the early stages of aging, irisin levels reflect the amount of body fat and insulin resistance severity, independently of between-gender differences in the adipomyokine concentrations and are associated with markers of visceral adiposity in men but not in women.

A screening and treatment programme to deal with perinatal anxiety and depression during the COVID-19 pandemic.

During a pandemic, pregnancy and the postnatal period are complicated by multiple factors. On the one hand, worries about one's own health and the health of loved ones, in particular of the newborn child, can increase the risk of some mental disorders, such as depression and anxiety in the pregnant woman. On the other hand, as happened for the COVID-19 epidemic in Italy, given the need for physical distancing, the maintenance of the social and family network, so important for new parents in the perinatal period, is lacking. In addition, health services are forced to reorganize their offerings to ensure maximum safety for their operators and patients. This work proposes a model of screening and treatment aimed at identifying women at risk and providing them with effective and safe treatment.

[Effectiveness of a postnatal psychological treatment for women who had screened positive for depression]. / Efficacia di un intervento psicologico rivolto a donne positive allo screening per depressione post partum.

AIM: This study evaluates the effectiveness of a psychological intervention based on a brief cognitive behavioural and psycho-educational treatment for women suffering from post partum depression. METHOD: The sample was recruited within a programme of screening and early intervention for post partum depression risk. 1558 women were screened between the 6th and 12th week after birth. 110 (7.1%) of them resulted positive to the Edinburgh Postnatal Depression Scale (score ≥12) and 81 accepted a thorough clinical diagnostic examination through the administration of the Mini International Neuropsychiatric Interview and the self-assessment instruments Beck Depression Inventory, State-Trait Anxiety Inventory, Psychological Well-being Scales, Short-Form Health Survey and Positivity Scale. Women who had been confirmed with the diagnosis of major depression episode (N=65; 80.2%) were offered to follow the treatment (10 weekly sessions) and to fill in again the instruments at the end of the treatment and after six months. Out of the 81, 63 women accepted and begun the treatment. RESULTS: 56 (88.9%) women completed treatment and filled in the instruments. Most of them (N=43) completed the instruments even after 6 months. At the end of treatment and after 6 months significant improvements were found in all scores of the instruments used. Furthermore, up to 70% of women who had been treated showed a clinically significant improvement in one or more evaluated outcomes. Such improvements were persistent in women evaluated 6 months after the treatment. CONCLUSION: The results of the study are consistent with studies that in other Countries evaluated, even experimentally, the same intervention or similar interventions with postnatal women and based on cognitive behavioural techniques. Such brief and structured interventions are most likely effective and easily accepted by women who suffer from post partum depression even in the routine practice of Italian health care services.

[Positive screening and risk factors of postpartum depression in women who attended antenatal courses]. / Positività allo screening e fattori di rischio della depressione post partum in donne che hanno partecipato a corsi preparto.

AIM: This study was designed to evaluate the prevalence of women screened positive for postpartum depression (PPD) and to investigate the main risk factors for PPD, in a large sample of Italian women. METHOD: The sample (N=567) was recruited as part of 91 antenatal courses. Women were screened between the 6th and 12th week after birth, by filling the EPDS (Edinburg Postnatal Depression Scale). The validated cut-off score of ≥12 was used. Socio-demographic and clinical variables were investigated. RESULTS: Out of the 567 screened women, 42 (7.4%) were positive. A higher risk was found in women who, during pregnancy, had a depressed mood (OR=3.2) or suffered from anxiety (OR=6.3), had little (OR=4.8) or no (OR=6.5) psychological support from friends or family, or their partner (OR=4.4), had a baby given to crying (OR=7.8), had a low self-esteem (OR=4.8), or had had, as children, a mother that was often (OR=4.6) or always (OR=12.5) critical of them. DISCUSSIONS AND CONCLUSIONS: The results of the study are in agreement with the literature considering social and family support and the presence of anxiety and/or depression during pregnancy as main risk factors for PPD. In disagreement with previous studies on risk factors for depressive disorders, we found that the economic status was not associated to PPD.

Metabolic and nutritional needs to normalize body mass index by doubling the admission body weight in severe anorexia nervosa.

Anorexia nervosa exhibits one of the highest death rates among psychiatric patients and a relevant fraction of it is derived from undernutrition. Nutritional and medical treatment of extreme undernutrition present two very complex and conflicting tasks: (1) to avoid "refeeding syndrome" caused by a too fast correction of malnutrition; and (2) to avoid "underfeeding" caused by a too cautious refeeding. To obtain optimal treatment results, the caloric intake should be planned starting with indirect calorimetry measurements and electrolyte abnormalities accurately controlled and treated. This article reports the case of an anorexia nervosa young female affected by extreme undernutrition (BMI 9.6 kg/m(2)) who doubled her admission body weight (from 22.5 kg to 44 kg) in a reasonable time with the use of enteral tube feeding for gradual correction of undernutrition. Refeeding syndrome was avoided through a specialized and flexible program according to clinical, laboratory, and physiological findings.

[Effectiveness of a manualized cognitive-behavioural intervention for postnatal depression]. / Efficacia di un intervento cognitivo-comportamentale manualizzato nella depressione post-partum.

AIM: Important guidelines recommend cognitive-behavioural interventions for postnatal depression but in the clinical practice they are not really diffused. This study describes the results and effectiveness of a structured cognitive-behavioural intervention implemented in a public mental health department. METHODS: The study involved 54 depressed women drawn from a community screening programme for postnatal depression in Bergamo province. Intervention was conducted on group and individual basis following a cognitive-behavioural programme of 10-15 weeks duration, including at least one partner session and adhered to a structured manual. Baseline and post intervention measures of depression and health were collected through validated rating scales. RESULTS: Following treatment, a significant improvement was demostrated on Edinburgh Post Natal Depression Scale, Beck Depression Inventory, Patient Health Questionnaire-9, Short Form-12. The improvements were manteined after a 12 mounths follow up. CONCLUSIONS: These results are encouraging and suggest that brief and structured cognitive behavioral interventions can be effective as a treatment for depression in postnatal period and routinely implemented in the clinical practice.

[Prevalence and risk factors of postnatal depression among women attending antenatal courses]. / Prevalenza e fattori di rischio della depressione post parto tra le donne che partecipano ai corsi pre parto.

AIMS: Postnatal depression, the most frequent complication occurring after pregnancy, is often not recognized. The prevalence of postnatal depression is currently considered to be 10-15% in western countries. A wide range of risk factors related to postnatal depression were researched in international studies. Our aim was to evaluate the risk factors and their frequency in a women population of Bergamo Province and compare the results with findings of international literature. METHODS: 595 women taking part to antenatal courses in three hospitals in Bergamo Province were screened for Postnatal Depression using EPDS and clinical interview. Prevalence and possible psychosocial risk factors data were collected and subsequently analysed and compared with literature findings. RESULTS: Thirty six (7.1%) women of our sample had postnatal depression. Depressed mood and depression during pregnancy, anxiety during pregnancy, poor social support, recent life events, a history of depression or other psychiatric history, presence of maternity blues were the strongest predictors of postnatal depression in our sample. CONCLUSIONS: The Psychosocial risk factors emerged from our study are substantially the same indicated by international studies, on the contrary prevalence is a little lower. This result may be explained considering that our women sample wasn't completely representative of general population.