Camilla Callegari

Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?

BackgroundPolypharmacy is regarded as an important risk factor for fallingand several studies and meta-analyses have shown an increased fall risk in users of diuretics, type 1a antiarrhythmics, digoxin and psychotropic agents. In particular, recent evidence has shown that fall risk is associated with the use of polypharmacy regimens that include at least one established fall risk-increasing drug, rather than with polypharmacy per se. We studied the role of polypharmacy and the role of well-known fall risk-increasing drugs on the incidence of injurious falls.MethodsA retrospective observational study was carried out in a population of elderly nursing home residents. An unmatched, post-stratification design for age class, gender and length of stay was adopted. In all, 695 falls were recorded in 293 residents.Results221 residents (75.4%) were female and 72 (24.6%) male, and 133 (45.4%) were recurrent fallers. 152 residents sustained no injuries when they fell, whereas injuries were sustained by 141: minor in 95 (67.4%) and major in 46 (32.6%). Only fall dynamics (p = 0.013) and drugs interaction between antiarrhythmic or antiparkinson class and polypharmacy regimen (≥7 medications) seem to represent a risk association for injuries (p = 0.024; OR = 4.4; CI 95% 1.21 - 15.36).ConclusionThis work reinforces the importance of routine medication reviews, especially in residents exposed to polypharmacy regimens that include antiarrhythmics or antiparkinson drugs, in order to reduce the risk of fall-related injuries during nursing home stays.

Association between CYP1A2 polymorphisms and clozapine-induced adverse reactions in patients with schizophrenia

We investigated the relationships between common polymorphisms in CYP1A2 (CYP1A2(⁎)1C and (⁎)1F), CYP1A2-mRNA levels in circulating lymphocytes and clozapine(CLZ)-induced adverse drug reactions (ADRs) in 34 patients. Patients with ADRs had a higher frequency of CYP1A2 low activity allele combinations (8/12; 67%) and lower CYP1A2-mRNA levels than patients without ADRs (6/22; 27%, P=0.019).

Psicofarmaci e polifarmacoterapia come fattori di rischio per le cadute negli anziani istituzionalizzati. uno studio trasversale in una residenza socio assistenziale lombarda

: Aim of the study was to investigate polypharmacy and psychotropic drugs as risk factors for falls in a Long-term Care Setting for elderly patients. In a cross-sectional study we investigated the characteristics of 414 subjects: 207 fallen patients 44 (21.3%) male e 163 (78.7%) female mean age 84.16 +/- 8.3 y.o. First generation neuroleptics (OR 1.739 CI 95% 1.047-2.889), benzodiazepines (OR 2.357 CI 95% 1.5-3.702) and mood stabilizers (OR 1.889 CI 95% 1.091-3.270) were associated to falls when adjusted for age, sex and comorbidities. Polypharmacotherapy (> or = 4 drugs) was a risk factor for falls when associated to a risk medication in the daily regimen only (OR 2.157 CI 95% 1.447-3.217). What raised has to be taken into account in the prescriptive activities in a Long term Care Setting for elderly patients.

Gluten encephalopathy with psychiatric onset: case report

Many cases of coeliac disease, a gastrointestinal autoimmune disorder caused by sensitivity to gluten, can remain in a subclinical stage or undiagnosed. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders.A 38-year-old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.

Reliability and validity of the Italian version of the 14-item Resilience Scale

Background In recent years resilience has gained clinical relevance in sociological, psychological, and medical disciplines, and a lot of scales measuring resilience have been developed and have been utilized in the western countries. The aim of the study was to assess the psychometric properties of the Italian version of the 14-item Resilience Scale (RS-14), by describing its validity and reliability. As agreed with the authors of the original English version of the RS-14, it was translated into Italian. Then the standard procedure for back-translation was followed. Methods In total, 150 participants among the nursing and professional education students of the University of Insubria of Varese and health workers of the “ASST dei Sette Laghi-Ospedale di Circolo” of Varese were enrolled. The responses to the questionnaires were collected only from the students and the health workers between the ages of 18 and 65 years who gave their consent to participate in the study from April to September 2015. A subsample of 26 students and health workers was retested on the RS-14, 5 weeks after the first assessment. The questionnaires were handed out to 214 people, and 150 sets of questionnaires (70%) were returned, of which eight were subsequently removed because >60% of the answers were missing. In order to ensure anonymity, every completed questionnaire was identified only via a code. Results No significant differences were found between the mean values of the resilience scores between women (76.1) and men (76.3), with unpaired t-test = −0.08 and P=0.93. Similarly, no difference between resilience scores were found between mean age group of 18–25 years (75.3) and 26–65 years (78.7), with t-test = 1.6. The overall Cronbach’s alpha of the RS-14 is 0.88, P=0.10. The RS-14 is negatively correlated with the Beck Depression Inventory-Primary Care Version and the 12-item General Health Questionnaire and positively correlated with the World Health Organization Quality of Life-Brief Version. The test-retest reliability, assessed on the 26 subjects 5 weeks after the first evaluation, highlighted an intraclass correlation coefficient value equal to 0.65. Factor analysis retains three factors, and it considers the factor loadings >0.40: RS-14-06 (‘I am determined’) is loaded on all the factors and RS-14-12 (‘In an emergency, I am someone people can generally rely on’) is not loaded on any factor. Conclusion This study demonstrates that the Italian RS-14 has psychometric properties with a good level of internal consistency (Cronbach’s alpha = 0.88), an adequate concurrent validity, verified by relationships with the other scales and as it was expected from literature, and an acceptable test-retest reliability.

Epidemiology and evolution of the diagnostic classification of factitious disorders in DSM-5

A systematic search for all case reports and case series of adult patients with factitious disorders (FD) in the databases MEDLINE, Scopus, and PsycINFO was conducted. FD is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of a patient, without any obvious gain. The clinical and demographic profile of patients with FD has not been sufficiently clear. Thus, the aims of this study were to outline a demographic and clinical profile of a large sample of patients with FD and to study the evolution of the position of FD in the Diagnostic and Statistical Manual of Mental Disorders. One thousand six hundred thirty-six records were obtained based on key search terms, after exclusion of duplicate records. Five hundred seventy-seven articles were identified as potentially eligible for the study, of which 314 studies were retrieved for full-text review. These studies included 514 cases. Variables extracted included age, gender, reported occupation, comorbid psychopathology, clinical presentation, and factors leading to the diagnosis of FD. In the sample, 65.4% of patients were females. Mean age at presentation was 33.5 years. A health care profession was reported most frequently (n=113). Patients were most likely to present in psychiatry, neurology, emergency, and internal medicine departments. The broad survey of sociodemographic profile of the sample has highlighted some important points for early diagnosis and early psychiatric treatment. The study showed that the patients did not meet Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria in 11.3% of cases.

The utility of pharmacogenetic testing to support the treatment of bipolar disorder

Background Bipolar disorder (BD) is a frequent cause of disability, health care costs, and risk of suicide. Pharmacogenetic tests (PGTs) could help clinicians to identify those patients predisposed to the occurrence of adverse events (AEs) improving the understanding of the correlation between genetic variants and drug response. Materials and methods The study evaluated 30 patients affected by BD type I or II (according to Diagnostic and Statistical Manual of Mental Disorders, version 5) who underwent the PGT Neurofarmagen® (AB-BIOTICS SA, Barcelona, Spain) between March 2016 and March 2017. The primary aim of this study was to identify if the treatment prescribed by the psychiatrists was consistent with the treatment suggested by the PGT at T0 (corresponding to the test report communication). As a secondary aim, we wanted to assess if clinicians had changed the treatment (in case of discordance) at T1 (3-month follow-up visit) according to the results of the PGT. Results At T0, only 4 patients (13%) had an optimal therapy in line with the PGT suggestions. At 3-month follow-up, 13 patients (40%) had received a change of therapy consistent to the test, showing a significant statistical improvement in the Clinical Global Impression item Severity (CGI-S) score over time compared to those not having changes consistent with the test. Regarding AEs, at baseline 9 out of 10 (90%) of the patients who received a therapy modification according to the test presented AEs, and a significant within-group reduction was observed after 3 months (p = 0.031). Conclusion Despite the small sample size, the study shows promising data about the usefulness of PGT to support clinicians in reaching a more effective and tolerated treatment in the routine approach of BD.

Influence of sleep disturbances on age at onset and long-term incidence of major cardiovascular events: The MONICA-Brianza and PAMELA cohort studies

OBJECTIVE We examined the prospective associations of sleep disturbances and sleep duration with the long-term incidence of major cardiovascular disease (CVD) events, in a large cohort of Italian adult men. METHODS A total of 2277 men aged 35-74 years of age and CVD free at baseline from the MONICA-Brianza and PAMELA population-based cohorts were followed up for a median of 17 years, for first coronary heart disease (CHD) or ischemic stroke events (fatal or nonfatal; n = 293). Sleep disturbances, based on the Jenkins Sleep Questionnaire, were categorized as none/some, moderate, or severe. Sleep durations were ≤6 hours (short), seven to eight hours, and ≥9 hours (long) per night. RESULTS At baseline, 855 men (38%) either reported sleep disturbances or were short or long sleepers. The presence of severe sleep disturbances increased the risk of first CVD (hazard ratio [HR] = 1.80, 95% confidence interval [CI] = 1.07-3.03) and CHD events (HR = 1.97, 95% CI = 1.09-3.56), in particular from the age of 48 years onward. In comparison to men sleeping seven to eight hours, long sleepers experienced a higher CVD risk (HR = 1.56, 95% CI = 1.10-2.22), due mainly to ischemic strokes, and starting at older ages (≥60 years). A joint effect between disturbed sleep and short sleep duration on CVD and CHD events was also observed. Adjustments for physical activity and depression did not substantially modify these associations. CONCLUSION Severe sleep disturbances and long sleep duration were associated with specific CVD endpoints and age at onset, potentially suggesting distinct underlying mechanisms. A short questionnaire discriminating different levels of sleep disturbances and sleep duration should be routinely adopted in CVD prevention programs to identify men at increased risk for early-onset events.

Cannabis use and genital self-mutilation: an update of case reports.

We reported and compared two case reports of genital self-mutilation with concurrent increasing psychotic symptoms resulting from substance abuse such as cannabis and alcohol.

[Factor analysis and psychometric properties of the Italian version of the Neuropsychiatric Inventory-Nursing Home in an institutionalized elderly population with psychiatric comorbidity].

AIM Aim of the study was to validate the Italian version of the Neuropsychiatric Inventory-Nursing Home (NPI-NH). The evaluation of neuropsychiatric symptoms in elderly patients with cognitive impairment and/or a chronic psychiatric disorder, is an essential need in nursing home. METHODS The Italian version of the NPI-NH was administered in 53 patients in a nursing home in Northern-Italy. RESULTS The internal consistency of the NPI-NH reported a value (α=0.62) according to the literature. The inter-rater reliability was ρ=0.991 and ρ=0.999 for the caregiver distress. There was an almost complete overlap between the assessments of individual items ranging from (ρ) 1 and 0.952. The test-retest reliability was ρ=0.961 and ρ=0.943 for the distress of the caregiver. Factor analysis revealed 4 factors that can explain 62.167% of the total variance: factor 1 hyperactivity, factor 2 mood, factor 3 psychosis and factor 4 withdrawal. CONCLUSIONS The NPI-NH can be used as an instrument for follow-up of patients and as a tool to support the activities of psychiatric referring and research in nursing home because of his demonstrated psychometric validity and its ease of use.