F. Perris

Insight and Resistance in Patients with Obsessive-Compulsive Disorder

The aim of this study was to evaluate the degree of insight and resistance in a sample of obsessive-compulsive patients, and the predictive value of poor insight with respect to response to treatment with serotonin reuptake inhibitors (SRIs). Ninety-three patients fulfilling DSM-IV criteria for obsessive-compulsive disorder were evaluated. Seventy patients were treated with an SRI in a 24-week open-label trial. Sixteen percent of the patients did not recognize obsessions and compulsions as unreasonable or senseless. Fifty-two percent of the patients did not try to resist, 72% had little or no control over obsessions, and 64% were not able to exercise an effective control over compulsions. Patients with poor insight had a greater severity of obsessive-compulsive symptoms, a higher rate of schizophrenia spectrum disorders in their first-degree relatives and a higher frequency of a history of psychiatric disorders during childhood. Fifty-two percent of the patients with normal insight responded to SRIs, whereas none of the patients with poor insight were found to be responders. These results suggest the utility of the assessment of insight and resistance in obsessive-compulsive patients, also for the prediction of response to treatment with SRIs.

Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS)

BackgroundDSM-IV identifies three stress response disorders (acute stress Disorder (ASD), post-traumatic stress Disorder (PTSD) and adjustment disorders (AD)) that derive from specific life events. An additional condition of complicated grief (CG), well described in the literature, is triggered by bereavement. This paper reports on the reliability and validity of the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) developed to assess the spectrum of stress response. The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising clinical and subsyndromal manifestations.MethodsStudy participants, enrolled at 6 Italian Departments of Psychiatry located at six sites, included consecutive patients with PTSD, 44 with CG and a comparative group of 48 unselected controls.ResultsWe showed good reliability and validity of the SCI-TALS. Domain scores were significantly higher in participants with PTSD or CG compared to controls. There were high correlations between specific SCI-TALS domains and corresponding scores on established measures of similar constructs. Participants endorsing grief and loss events reported similar scores on all instruments, except those with CG who scored significantly higher on the domain of grief reactions.ConclusionThese findings provide strong support for the internal consistency, the discriminant validity and the reliability of the SCI-TALS. These results also support the existence of a specific grief-related condition and the proposal that different forms of stress response have similar manifestations.

The 3111T/C polymorphism of the CLOCK gene confers a predisposition to a lifetime lower body weight in patients with anorexia nervosa and bulimia nervosa: a preliminary study.

Feeding is subjected to circadian regulation; therefore, changes in the components of the endogenous oscillator regulating circadian rhythms may be involved in disordered rhythmicity of eating behavior as it occurs in anorexia nervosa (AN) and bulimia nervosa (BN). We investigated whether the 3111T/C polymorphism of the CLOCK gene, which is part of the endogenous oscillator system, was associated to AN and/or BN. A total of 241 women, including 90 healthy controls, 60 patients with AN and 91 patients with BN, participated into the study. The frequencies of 3111T/C genotypes and alleles did not significantly differ among the groups. In both the AN and BN group, subjects carrying one copy of the C allele had a lifetime body weight significantly lower than those carrying the T/T genotype. These findings, although preliminary, suggest that the 3111T/C polymorphism of the CLOCK gene does not play a major role in the genetic vulnerability to AN and BN, but it seems to predispose eating disorders (EDs) patients to a more severe lifetime body weight loss.

Aripiprazole augmentation strategy in clomipramine-resistant depressive patients: an open preliminary study.

Recent evidence supports the use of second generation antipsychotics in drug resistant depression. The aim of the present open-label study was to evaluate the effect of aripiprazole as an add-on medication in drug-resistant depressed patients who had not responded to clomipramine. Thirty-five patients with major depressive disorder (MDD) were included in the study. All patients had not responded to a previous adequate treatment with an SSRI and had been receiving clomipramine (daily doses ranging from 100 to 300 mg) for 113.9 ± 18.9 days without getting significant clinical improvement. Aripiprazole was added at the fixed dose of 5mg/day and clinical status as well as clomipramine plasma levels were monitored before and after 4, 8, and 24 weeks of combined treatment. Hamilton depression rating scale scores significantly decreased over the follow-up period with 91.4% and 34.3% of patients getting a response or a remission, respectively, after 24 weeks of combined treatment. No worsening of clomipramine-related side effects nor new side effects were observed. The clinical improvement was accompanied by a progressive and significant increase in clomipramine plasma levels. With the limitation of an open-label design, these data suggest for the first time the putative efficacy and safety of aripiprazole in combination with a tricyclic medication in drug resistant depressed patients. The role of the observed pharmacokinetic interaction in the mechanism of aripiprazole antidepressant activity remains to be proved.

Clozapine versus other antipsychotics during the first 18 weeks of treatment: A retrospective study on risk factor increase of blood dyscrasias

Blood dyscrasias excluding agranulocytosis received limited attention in antipsychotic-treated patients during the first 18 weeks of therapy, although severe clinical conditions have been reported in a few cases. We extracted data records of 285 Caucasian patients after 18 weeks of antipsychotic treatments to investigate risk factors of blood dyscrasias. We observed a higher risk to develop both transient and persistent anemia, neutrophilia and eosinophilia in clozapine-treated patients, whereas in those treated with other atypical antipsychotics when compared to a reference group under typical antipsychotics, emerged an increased risk for transient neutrophilia and eosinophilia. Male patients revealed a higher risk of persistent eosinophilia, neutrophilia, and leukocytosis. Concomitant treatments with mood stabilizers or benzodiazepines proved to be risk factors for transient anemia, antidepressants for transient eosinophilia. Severe complications emerged in 3 cases of agranulocytosis. Cross-tabulation analysis showed a higher probability of a poor response in clozapine-treated patients with persistent anemia and a positive with persistent neutrophilia and eosinophilia. Our data evidenced that emerging blood dyscrasias were not associated with critical adverse effects, and only agranulocytosis required a treatment interruption. Other atypical antipsychotics might represent a viable alternative to potentially harmful clozapine and typical antipsychotics at the onset of life-threatening haematological alterations.

Olanzapine Is Faster than Haloperidol in Inducing Metabolic Abnormalities in Schizophrenic and Bipolar Patients

The effects of olanzapine and haloperidol on metabolic parameters in bipolar patients have been evaluated much less comprehensively than in schizophrenic patients. Therefore, in this study, medical records of 343 schizophrenic and bipolar patients treated with haloperidol or olanzapine for 1 year were retrospectively reviewed and metabolic outcomes were evaluated. After 12 months of follow-up, 25.9% of patients showed ≥3 metabolic abnormalities with a point prevalence of 27.2% in the bipolar and 24.9% in the schizophrenic group: 22.0% of the schizophrenic patients treated with haloperidol and 29.8% of those treated with olanzapine achieved ≥3 metabolic alterations; in bipolar patients, these percentages were 15.8% of those treated with haloperidol and 37.8% of those treated with olanzapine (p < 0.0001). Significant changes were reported over time in fasting glucose, triglycerides and cholesterol blood levels, systolic and diastolic blood pressure, body weight, and BMI. Overall, a significant number of schizophrenic and bipolar patients treated with olanzapine showed ≥3 metabolic alterations in the first month of treatment when compared to those treated with haloperidol. Moreover, the number of olanzapine-treated patients developing metabolic changes in the first month was significantly higher in both diagnostic groups when compared to those who reached metabolic abnormal values in the subsequent 11 months. These data suggest that both antipsychotics could increase the metabolic risk in schizophrenic and bipolar patients with a higher prevalence in olanzapine-treated patients. On the other hand, olanzapine-treated patients seem to achieve metabolic abnormalities faster than haloperidol-treated subjects in both diagnostic groups.

Dissociative phenomena in a sample of outpatients

AIM The study describes the frequency and the quality of dissociative phenomena and their relationship with axis I disorders and the psychopathological severity in outpatients. METHODS The sample (N=383) was subjected to MINI diagnostic interview and self-assessment scales DES and SCL-90. The data were analysed using SPSS. RESULTS The 11,0% of subjects has a score ≥20 on DES. The 5,2% has no dissociative symptoms. The absorption images is the most frequent dissociative phenomenon, the less common is the dissociation amnesia. A relationship between dissociative phenomena and conditions unemployment, marital separation and single parties and an inverse relationship with age founded. Dissociative phenomena are more frequent in participants who have been diagnosed at least one axis I disorder and their severity is positively correlated with the number of diagnosed diseases and scores to the General Symptomatic Index. DISCUSSION Our results point towards the existence of three types of dissociative experiences. The first type, represented by the factor absorption/imaginative involvement, is expressed along a continuum from normal to pathological; a second type, represented by the factor depersonalization/derealization, occurs in a significantly more intense and specific among subjects with axis I disorders; the latest manifestation dissociative, described by the dissociation amnesia, seems to have a predominantly typological feature that qualifies it as an experience not commonly distributed in the general population. The identifying of dissociative symptoms is necessary for the psychopathologic evaluation and to improve the effectiveness of treatment programs.

EPA-0283 – Olanzapine is faster than haloperidol in inducing metabolic syndrome in schizophrenics but not in bipolar patients

Metabolic profile of olanzapine as compared to haloperidol has been evaluated much less comprehensively in bipolar than in schizophrenic patients. Medical records of 343 patients who completed a 3-year treatment with haloperidol or olanzapine were retrospectively reviewed, and metabolic outcomes were evaluated. Twenty-three percent of patients fulfilled MetS criteria with a point prevalence of 25.3% in bipolar and 21.2% in schizophrenic group; 20.3% of schizophrenics treated with haloperidol and 22.4% of those treated with olanzapine developed MetS, which was detected, instead, in 17.1% of haloperidol-treated bipolar patients and 32.9% of those treated with olanzapine. Significant changes were detected overtime in fasting cholesterol, systolic BP, BW and BMI; some of these parameters at the 3-year follow-up presented more severe changes with olanzapine than haloperidol in both diagnostic groups. Overall, a significant number of subjects fulfilled MetS criteria in the first month of treatment, but only in schizophrenics olanzapine was faster than haloperidol in inducing such an effect. These data suggest that haloperidol and olanzapine increase the risk for MetS in both schizophrenic and bipolar patients with a higher prevalence for olanzapine only in bipolar patients. Morever, as compared to haloperidol, olanzapine has a faster dismetabolic action in schizophrenic but not in bipolar patients.

EPA-0282 – Clozapine treatment and other atypical and typical antipsychotics: incidence and course of blood dyscrasias during the first eighteen weeks of treatment

Blood dyscrasias induced by clozapine treatment and other Typical and Atypical Antipsychotics have received little attention. The aim of the present study was to shed more light on the incidence and course of clozapine-induced blood dyscrasias that occour during the first eighteen weeks of treatment compared to dyscrasias induced by other Typical and Atypical Antipsychotics. The study included 135 clozapine-treated patients (M 75 and F 60), 75 patients treated with other Atypical (M 35 and F 40), and 75 treated with Typical (M 39 and F 36). Persistent eosinophilia appeared in 36.8% of clozapine-treated patients, in 4%, (p

2643 – Metabolic syndrome and antipsychotic treatment: How about schizophrenia and bipolar disorder?

Many published studies underlined the relationship between Atypical Antipsychotic treatment and Metabolic Syndrome (MS) onset, but only few have compared the effects of Typical and Atypical Antipsychotics to this respect. The present study examined in schizophrenic and bipolar patients the impact of haloperidol (mean dose 3.37±2.28 mg and 2.51±1.48 mg, respectively) and olanzapine treatment (mean dose 12.42±6.53 mg and 9.97±5.36 mg, respectively) on glycemia, blood pressure, BMI, triglycerides and HDL cholesterol. A higher prevalence and a different time of appearance of Metabolic Syndrome was observed in Bipolar patients when treated with olanzapine. Moreover, weight increase was greater in bipolar patients treated with olanzapine (p