A 12-month longitudinal naturalistic follow-up of cariprazine in schizophrenia.

Background: Cariprazine, a third-generation antipsychotic (TGAs), has demonstrated efficacy in the treatment of schizophrenia with good tolerability profile. Actual real-world literature data are lacking, particularly when exploring its efficacy in the long term. The present study examined the effects of cariprazine treatment on specific psychopathological domains with a particular focus on outcomes and side effects in real-life experience, after a long-term treatment. Methods: The present 12-month longitudinal naturalistic study included a sample of subjects with a DSM-5-TR diagnosis of schizophrenia, recruited in the outpatients' psychiatric services of university and community hospitals in Italy, naturally treated with cariprazine. The assessments included: a sociodemographic data sheet, the Structured Clinical Interview for the DSM-5 (SCID-5), the Positive and Negative Symptom Scale (PANSS) and the St. Hans Rating Scale (SHRS). The PANSS was also administered after 6 (T1) and 12 (T2) months of treatment with cariprazine while the SHRS at T1. Results: The total sample consisted of 31 patients, 15 males and 16 females. A significant decrease of the PANSS' subscales, Marder factors and total mean scores emerged at both T1 and T2 with respect to T0. Extrapyramidal symptoms occurred in a minority of patients and in mild or mild/moderate forms: no patient showed moderate forms of psychic/motor akathisia or dystonia, three subjects showed moderate parkinsonism. Conclusions: This study confirms a good efficacy profile of cariprazine in both positive and negative symptoms in patients with Schizophrenia, combined with a good tolerability profile in extrapyramidal symptoms.

The influence of psychiatric comorbidity on sexual satisfaction in fibromyalgia patients.

OBJECTIVES: To investigate the influence of psychiatric comorbidity on sexual satisfaction in premenopausal and postmenopausal female affected by fibro-myalgia (FM). METHODS: We enrolled 100 FM females and 40 age-matched healthy females. Psychiatric diagnoses were carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition; sexual satisfaction was evaluated using the Index of Sexual Satisfaction (ISS), clinical assessment included the Fibromyalgia Impact Questionnaire (FIQ), tender point (TP) count and pain evaluation by means of a visual analogue scale (VAS). RESULTS: The data were analysed according to the presence and absence of psychiatric comorbidity in FM patients (all FM, only FM, FM with a lifetime psychiatric disorder, FM with a current psychiatric disorder). FM patients with a current psychiatric comorbidity (n=24) showed ISS values significantly higher (41.5±17.5) with respect to patients with only FM (n=45) (27.3±17.4, p<0.05) and healthy controls (24.1±12.8, p<0.01). The FIQ values of patients with current psychiatric comorbidity were significantly higher (68.4±13.5) compared to the values of patients with only FM (55.7±17.9) (p<0.05). No differences were found between VAS pain or the number of TP of the three groups of patients. CONCLUSIONS: Our results suggest that psychiatric comorbidity has more influence on the sexual satisfaction of FM patients than the presence of the rheumatic disease itself. Because the ISS gives an indication of the relationship with partners, this finding suggests that emotional aspects may play a crucial role in sexual behavior, in particular in those FM patients with current psychiatric comorbidity.

A multidisciplinary approach to study the effects of balneotherapy and mud-bath therapy treatments on fibromyalgia.

OBJECTIVES: To study the effects of both balneotherapy and mud-bath therapy treatments in patients affected by primary fibromyalgia (FM) using rheumatological, psychiatric, biochemical and proteomic approaches. METHODS: Forty-one FM patients (39 females, 2 males), who fulfilled the American College of Rheumatology criteria received a 2-week thermal therapy programme consisting of therapy once daily for 6 days/week. Twenty-one patients received mud-bath treatment, while the other twenty balneotherapy. Pain, symptoms, and quality of life were assessed. Oxytocin, brain-derived neurotrophic factor (BDNF), ATP and serotonin transporter levels during therapy were assayed. Comparative whole saliva (WS) proteomic analysis was performed using a combination of two-dimensional electrophoresis (2DE) and mass spectrometry techniques. RESULTS: We observed a reduction in pain, FIQ values and improvement of SF36 in both groups of patients treated with mud-bath or balneotherapy. The improvement of the outcome measures occurred with different timing and duration in the two spa treatments. A significant decrease in BDNF concentrations was observed either after balneotherapy or mud-bath therapy when assayed after twelve weeks, while no significant change in oxytocin levels, ATP levels and serotonin transporter were detected. Significant differences were observed for phosphoglycerate mutase1 (PGAM1) and zinc alpha-2-glycoprotein 1 (AZGP1) protein expression. CONCLUSIONS: Our results showed that the thermal treatment might have a beneficial effect on the specific symptoms of the disease. In particular, while balneotherapy gives results that in most patients occur after the end of the treatment but which are no longer noticeable after 3 months, the mud-bath treatment gives longer lasting results.

A multidisciplinary approach to study a couple of monozygotic twins discordant for the chronic fatigue syndrome: a focus on potential salivary biomarkers.

BACKGROUND: Chronic Fatigue Syndrome (CFS) is a severe, systemic illness characterized by persistent, debilitating and medically unexplained fatigue. The etiology and pathophysiology of CFS remains obscure, and diagnosis is formulated through the patient's history and exclusion of other medical causes. Thereby, the availability of biomarkers for CFS could be useful for clinical research. In the present study, we used a proteomic approach to evaluate the global changes in the salivary profile in a couple of monozygotic twins who were discordant for CFS. The aim was to evaluate differences of salivary protein expression in the CFS patient in respect to his healthy twin. METHODS: Saliva samples were submitted to two-dimensional electrophoresis (2DE). The gels were stained with Sypro, and a comparison between CFS subject and the healthy one was performed by the software Progenesis Same Spot including the Analysis of variance (ANOVA test). The proteins spot found with a ≥2-fold spot quantity change and p<0.05 were identified by Nano-liquid chromatography electrospray ionization tandem mass spectrometry. To validate the expression changes found with 2DE of 5 proteins (14-3-3 protein zeta/delta, cyclophilin A, Cystatin-C, Protein S100-A7, and zinc-alpha-2-glycoprotein), we used the western blot analysis. Moreover, proteins differentially expressed were functionally analyzed using the Ingenuity Pathways Analysis software with the aim to determine the predominant canonical pathways and the interaction network involved. RESULTS: The analysis of the protein profiles allowed us to find 13 proteins with a different expression in CFS in respect to control. Nine spots were up-regulated in CFS and 4 down-regulated. These proteins belong to different functional classes, such as inflammatory response, immune system and metabolism. In particular, as shown by the pathway analysis, the network built with our proteins highlights the involvement of inflammatory response in CFS pathogenesis. CONCLUSIONS: This study shows the presence of differentially expressed proteins in the saliva of the couple of monozygotic twins discordant for CFS, probably related to the disease. Consequently, we believe the proteomic approach could be useful both to define a panel of potential diagnostic biomarkers and to shed new light on the comprehension of the pathogenetic pathways of CFS.

Methodological approach to depressive symptoms in fibromyalgia patients.

OBJECTIVES: Depression is a common comorbid condition in fibromyalgia (FM) and a major contributor to poor quality of life and disability. However, depression can be difficult to assess in patients with FM due to overlapping symptoms between the two conditions. This review aims to present the most used rating scales for depression in FM patients by discussing their potential drawbacks. Moreover, we aimed to discuss the possible approach to mood symptoms in FM patients according to the mood spectrum model. METHODS: We included the main scales that have been used previously to assess depression in FM according to the literature data. Then, we reviewed the studies exploring the prevalence and the impact of sub-threshold mood symptoms on FM patients. RESULTS: Rating scales for depression such as the Hamilton Rating Scale for Depression, the Hospital Anxiety and Depression Scale, the Center for Epidemiologic Studies Depression Scale, the Beck Depression Inventory, the Montgomery Asberg Depression Rating Scale and the Zung Self-Rating Depression Scale have been largely used. However, almost all these instruments could suffer from a criterion contamination bias by somatic symptoms of chronic pain patients. Many studies have shown a critical role of sub-threshold mood psychopathology on worsening quality of life, disability and pain in FM patients. Specific questionnaires (Mood Spectrum Self-Report [MOODS-SR]) for subsyndromal phenomenology have been validated and used also in patients with medical diseases. CONCLUSIONS: The need of a careful screening of depressive symptoms and of their proper management is primary in FM. In our opinion instruments like MOODS-SR are particularly suitable for screening FM patients because they allow to recognise also sub-threshold mood symptoms with minimal contamination by somatic conditions.

Bipolar disorder in late life: clinical characteristics in a sample of older adults admitted for manic episode.

BACKGROUND: Although manic episodes in older adults are not rare, little published data exist on late-life manic episodes. Resistance to treatment and concomitant neurological lesions are frequent correlates of elderly mania. The aim of this study was to investigate the prevalence of hospitalizations due to mania in patients older than 64 years through a period of 5 years in an Italian public psychiatric ward. Moreover, we aimed at describing clinical presentation of elderly manic episodes. METHODS: A retrospective chart review was conducted in order to describe clinical presentation of 20 elderly patients hospitalized for manic episode; moreover, we compared age at onset, the presence of family history for mood disorders, psychosis and irritability between the elderly group and a matched group of 20 younger manic inpatients. RESULTS: Seven percent of the whole inpatient elderly people suffered from mania. Half of those patients had a mood disorder age at onset after 50 years and 5 patients were at their first manic episode. Geriatric- and adulthood mania showed similar clinical presentation but younger people had more frequently a mood disorders family history. CONCLUSION: Half of our older manic inpatients consisted of "classic" bipolar patients with an extension of clinical manifestations into later life; the other half of our sample was heterogeneous, even though it was not possible to identify clearly which patients may have had vascular lesions related to the onset of mania.