Anna Romano

Use of Street Methadone in Italian Heroin Addicts Presenting for Opioid Agonist Treatment

ABSTRACT It is commonly assumed that people who are addicted to certain substances would abuse any substance. This position has never been supported by validly collected and analyzed research data. In this study, the authors examine the use of street methadone by heroin addicts seeking their first agonist opioid treatment in a clinical setting. Fifty-four heroin addicts who resorted to street methadone use were compared by socio-demographic, current clinical, and disease-related variables to 251 peers who do not use street methadone. Heroin addicts who resort to street methadone use are more likely to be females and to have a higher degree of education, are less likely to engage in polyabuse (use of more than three substances), are less severely ill, have been addicted for a shorter period of time, and have been seeking treatment sooner in the course of their disease. Also, they suffer from a wider range of psychopathological distress symptoms. In Italy, resorting to street methadone does not seem to be a surrogate form of heroin addiction, but rather represents means of harm reduction, with treatment seeking occurring shortly after its initiation. This should be accounted for when deciding on take-home policies and issues of potential methadone diversion.

Diagnosis, assessment and management of delusional jealousy in Parkinson's disease with and without dementia

Patients with Parkinson’s disease (PD) may present delusional jealousy (DJ). In a previous cross-sectional prevalence study we identified 15 cognitively preserved and five demented PD patients with DJ. The current study aimed at evaluating their clinical (motor and non-motor) characteristics and the pharmacological treatments associated with DJ, and its subsequent pharmacological management. Patients were assessed by neurologists and psychiatrists using the Hoehn and Yahr scale, the Unified Parkinson’s Disease Rating Scale, the Brief Psychiatric Rating Scale, the Beck Depression Inventory, the Hamilton Anxiety Scale and the Neuropsychiatric Inventory. Efficacy of DJ management was evaluated in follow-up visits. All patients were in therapy with dopamine agonists. A subgroup of five cognitively preserved patients developed DJ after a short period of treatment of therapy with dopamine agonists, while other patients developed DJ after a longer period of dopaminergic treatment. Psychiatric comorbidities were common in cognitively preserved and in demented patients. The pharmacological management included the interruption of dopamine agonists in two patients and the reduction of dopamine agonist dose plus the use of antipsychotics in other patients. These clinical data suggest that the management of medicated PD patients should include investigation for the presence of DJ and the evaluation of clinical characteristics potentially relevant to the prevention or the early recognition of delusions.

A case of severe oral self-injurious Tourette's syndrome alleviated by pregabalin

Self-injurious behavior (SIB) associated with Tourettes syndrome (TS) is a severe neuropsychiatric condition that causes significant distress and can impair social functioning. The current treatment options for the condition include pharmacological, physical and psychosocial interventions. However, given the need for more effective interventions, especially for those patients who are unresponsive and/or intolerant to standard medications, further exploration of novel treatments is imperative. In this report, we present a case of SIB-TS that was successfully treated with pregabalin. The patient received 1-year of follow-up and was noted to have considerable improvement in symptoms. Although rigorous controlled studies are required, based on our case study, pregabalin may be a potential treatment option in some cases of SIB with TS.

PSYCHOPATHOLOGICAL ASSESSMENT OF A SAMPLE OF KIDNEY-PANCREAS TRANSPLANT CANDIDATES: 2092.

Objectives Patients awaiting kidney/pancreas transplants are affected by end-stage renal disease (ESRD) or by severe insulindependent mellitus diabetes (IDMD), that have progressively lead to severe renal insufficiency. With the progression of those chronic illnesses, patients are susceptible to experiencing symptoms that affect their daily lives. Anxiety and depression may be induced by somatic condition and awaiting transplantation, contributing to the perception of quality of life (QOL). Aim of the study is to assess quality of life, lifetime and current DSM-IV Axis-I and II disorders, and finally sub-threshold mood and panic-agoraphobic phenomenology in a large sample of ESRD and IDMD patients awaiting kidney-pancreas transplants. Methods 227 consecutive transplant candidates of both genders, aged between 18 and 65 years. Axis-I and II diagnoses were performed using SCID-I and II. Patients were also administered the MOODS-SR and the PAS-SR to assess mood and panic-agoraphobic spectrum and the Q-LES-Q to assess quality of life, enjoyment and satisfaction. Results The prevalence of current Axis-I disorders was 13.2%. The most common current axis-I disorders were Agoraphobia (4.8%) and Major Depressive Episode (4.0%) No difference was found in the diagnostic distribution between the two groups. Quality of life among overall sample was poorer than that of a healthy adult population. Conclusions Our findings underlined the importance of careful evaluation of depressive symptoms during the pre-transplant and post-transplant course that include a sub-syndromal symptoms assessment. A systematic screening for depressive symptoms by means of self-report spectrum instruments, during the pre and posttransplant course, is valuable.

Alterazioni ormonali nei disturbi della condotta alimentare

RiassuntoNumerose alterazioni di origine biologica, psicologica e ambientale sono state evidenziate nei disturbi del comportamento alimentare (DCA). La regolazione dell’introito del cibo, il senso di sazietà e di fame sono regolati da fattori di origine centrale e periferica. In questi circuiti sono coinvolti neuropeptidi e neurotrasmettitori la cui secrezione è alterata nel corso della sintomatologia dei DCA, ma tende a normalizzarsi in gran parte dopo la remissione sintomatologica. Questo dato lascia ipotizzare che le alterazioni presenti possono essere secondarie alla malnutrizione o al calo ponderale. Le modifiche ormonali e neurotrasmettitoriali presenti nei DCA non possono essere considerate la causa del comportamento alimentare disfunzionale, poiché molte di tali alterazioni insorgono secondariamente ai DCA. Non è comunque da escludere che queste possano contribuire al perpetuarsi della sintomatologia, influenzando così il decorso clinico. Ad esempio, il deficit della trasmissione serotoninergica contribuisce sia alla manifestazione di un DCA sia alla sintomatologia dello spettro depressivo e ossessivo associato al DCA; oppure le modificazioni dei peptidi regolatori della fame e della sazietà possono contribuire a mantenere alterato il pattern alimentare (ridotta ghrelina e maggior numero di abbuffate, aumentata colecistochinina e maggiore sazietà, ecc.). Possiamo dunque affermare che i DCA insorgono a seguito di una complessa interazione tra fattori biologici, personologici-psicologici e ambientali. Le modificazioni endocrine indotte dagli squilibri nutrizionali possono rinforzare e favorire il mantenimento dei comportamenti disfunzionali, entrando in un circolo vizioso che si automantiene. È auspicabile pertanto programmare adeguate strategie di prevenzione e interventi terapeutici integrati in una prospettiva multidisciplinare.