Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study.

OBJECTIVES: A refractory chronic migraine (RCM) accompanied by medication-overuse headache (MOH) is an extremely disabling disease. Evidence suggests that in selected patients, chronic opioids may be a valuable therapeutic option for RCM. The aim of the present study was to evaluate the effectiveness and safety of prophylaxis with low-dose methadone (LDM) in patients affected by RCM with continuous headache and MOH. METHODS: A prospective cohort study was performed between May 2012 and November 2015 at the Headache Center and Toxicology Unit of the Careggi University Hospital. Eligible patients were treated with prophylactic LDM and followed up for 12 months. Headache exacerbations, pain intensity, use of rescue medications, and occurrence of adverse drug reactions (ADRs) were recorded. RESULTS: Thirty patients (24 females, median age 48 years) were enrolled. Nineteen (63%) patients dropped out, mainly because of early ADRs (n = 10), including nausea, vomiting, and constipation. At last available follow-up, LDM was associated with a significant decrease in the number of headache attacks/month (from a median of 45 (interquartile range 30-150) to 16 (5-30), p < 0.001), in pain intensity (from 8.5 (8-9) to 5 (3-6), p < 0.001), and in the number of rescue medications consumed per month (from 95 (34-240) to 15 (3-28), p < 0.001). No misuse or diversion cases were observed. CONCLUSION: LDM could represent a valuable and effective option in selected patients affected by RCM with continuous headache and MOH, although the frequency of early ADRs poses major safety concerns. Randomized controlled trials are needed to confirm the efficacy and safety of LDM prophylaxis.

Methadone Dose Adjustments, Plasma R-Methadone Levels and Therapeutic Outcome of Heroin Users: A Randomized Clinical Trial.

AIMS: We aimed to improve the retention in treatment and therapeutic outcome of methadone maintenance treatment (MMT) patients by adjusting the oral methadone dose in order to reach a "target" plasma R-methadone level (80-250 ng/mL). METHODS: A multicenter randomized controlled trial was organized. RESULTS: The intention-to-treat statistical analysis showed that repeated dose adjustments performed in order to obtain therapeutic plasma R-methadone levels did not improve retention in treatment of heroin-dependent patients. However, patients having plasma methadone levels in the "target range" at the beginning of the study had a better retention in treatment than controls. Furthermore, patients succeeding in keeping plasma R-methadone target levels (per protocol analysis) remained in treatment and improved their social scores better than controls. -Conclusion: Although the primary endpoint of this study was not demonstrated, a post hoc and a per protocol analysis suggested that patients in MMT with plasma R-methadone concentrations in the target range have a better therapeutic outcome than controls.

[Use of psychotropic drugs in children, adolescents and subjects with intellectual disability: a review]. / Revisione dell'uso di psicofarmaci in età evolutiva e in pazienti con disabilità intellettiva.

AIM: In children, adolescents and subjects with intellectual disability (ID), psychotropic drugs are being used in large and increasing quantities. The aim of this article is to review efficacy and safety evidences of psychotropic drugs use in the above-mentioned patients. METHODS: A literature search on this argument was conducted on Medline electronic archives encompassing english-language and other languages publications. RESULTS: In children, adolescents and subjects with ID, the use of antidepressants, antipsychotics and mood stabilizers, besides being effective for indications in psychiatric disorders of adults without ID, is proved to have good clinical efficacy in disorders which are characteristic of such patients categories, such as pervasive developmental disorders, disruptive behavior disorders and problem behaviours. In both patients populations non-medication based strategies should be considered first. The adverse effects profiles of psychotropic drugs administered in children, adolescents and subjects with ID seems to be different from the ones registered in adults without ID, thus particular caution and precautions are recommended. DISCUSSION: Given the paucity of data (especially in the long term) and the metodological limitations of currently available researches, more studies are needed to develop scientific evidences able to guide practitioners in the use of psychotropic medications among childhood, adolescence and ID.

[Sexuality and eating disorders]. / Sessualità e disturbi del comportamento alimentare.

AIM: The aim of the present study is to explore the sexual functioning of an Eating Disorders (ED) sample composed by Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS) patients. METHODS: 98 patients (AN: 23; BN: 14; EDNOS: 61) have been compared with 88 health subjects. All participants have filled in the following questionnaires: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), Eating Disorders Examination (EDE-q), Binge Eating Scale (BES), Emotional Empathy Scale (EES). For the evaluation of the sexual activity Female Sexual Function Index (FSFI) was applied. RESULTS: 67 patients (68.4%) and 80 healthy controls (90.9%) reported a sexual activity with a partner or masturbation in the four latest weeks. Only one healthy control (1.1%) reported masturbation and 79 (89.8%) controls showed sexual activity with a partner, on the contrary 11 patients (11.2) reported masturbation and 56 (57.1%) patients showed sexual activity with a partner. Moreover patients showed higher scores on every FSFI subscales. No significant differences were observed between AN, BN and BED in terms of FSFI scores. DISCUSSION: Women with ED show a lower sexual activity with a partner, a six-fold increase in the risk of sexual dysfunction and an higher frequency of masturbation as the only sexual activity when compared with healthy controls. The cognitive distraction produced by the discomfort to show own body during a sexual intercourse with the partner may explain our results.

[Neuroimaging and neurobiology of social anxiety]. / Neuroimaging e neurobiologia dell'ansia sociale.

AIM: Social Anxiety Disorder (SAD) represents one of the most frequent psychiatric disorders. The results of a systematic review of the literature published until January 2010 on the neurobiology of SAD are reported, giving prominence to functional neuroimaging (fNI) findings. METHODS: A literature search of neuroimaging and neurobiology studies of SAD was conducted on PubMed and Medline electronic archives and by canvassing English-language and other European languages publications. Eligible studies were restricted to those on adult population (age 16 to 65) and using DSM and ICD criteria. RESULTS: The 19 reviewed fNI studies on SAD agree in identifying a dysfunction of five main cerebral areas: the amygdala, the medial prefrontal cortex, the insula, the hippocampus and the dorsolateral prefrontal cortex. Those findings strongly suggest the presence, in this disorder, of functional alterations in the neural systems involved in the genesis of fear, in the processing of emotional stimuli, in the "self" perception and in the evaluation of others' intentions. DISCUSSION: Neurobiology research on SAD is still relatively young and, up to today, available findings are still not exhaustive. Nonetheless, a growing evidence from different lines of research seems to suggest that SAD patients may present a distinct biologic background compared to control subjects. Until now, however, no specific neurobiological aspect has been proposed for the SAD only. Per contra, results from fNI studies seem to indicate the presence of a common pattern of neural dysfunction in all the major anxiety disorders.

[Female sexual functioning: the role of psychopathology]. / Funzionamento sessuale femminile: il ruolo della psicopatologia.

BACKGROUND: In the study of the relationship between sexuality and psychopathology, female sexual functioning appears to be relatively poorly explored. In addition, most studies have been conducted on clinical samples, so that the question of whether non-clinically relevant psychopathological symptoms may have a negative impact on women's sexual response still remains unanswered. The aim of this study was to analyze the influence of psychopathology on specific phases of sexual functioning (desire, arousal, lubrication, orgasm, satisfaction) and pain in a sample of young women without psychiatric case history. METHODS: Two questionnaires were administered to a sample of female students in Psychology of the University of Florence (n=75): the Symptom Checklist (SCL-90) to evaluate psychic distress and the Female Sexual Function Index (FSFI) for data collection on sexual functioning. RESULTS: 44 questionnaires were valid. The dimensions of SCL-90 explain a relatively high percentage of variance of the global severity index of sexuality (R²=0.49); significant predictors were: somatization (Beta=-0.75), depression (Beta=-0.89), anxiety (Beta=-0.79), and hostility (Beta=-0.48). The same variables were significant predictors, though at a lesser extent, for all the single dimensions of sexuality, with the exception of pain, on which only hostility had a significant correlation (Beta=-0.55). CONCLUSIONS: Although the small size and the peculiar characteristics of the sample do not allow to extrapolate the results, the findings of this study show that psychopathological dimensions can affect female sexual functioning at subclinical level in the absence of the confounding effect of drug therapy.