F. Veneziani

Advances in meta-analysis: examples from internal medicine to neurology.

Objective: We review the state of the art in meta-analysis and data pooling following the evolution of the statistical models employed. Methods: Starting from a classic definition of meta-analysis of published data, a set of apparent antinomies which characterized the development of the meta-analytic tools are reconciled in dichotomies where the second term represents a possible generalization of the first one. Particular attention is given to the generalized linear mixed models as an overall framework for meta-analysis. Bayesian meta-analysis is discussed as a further possibility of generalization for sensitivity analysis and the use of priors as a data augmentation approach. Results: We provide relevant examples to underline how the need for adequate methods to solve practical issues in specific areas of research have guided the development of advanced methods in meta-analysis. Conclusions: We show how all the advances in meta-analysis naturally merge into the unified framework of generalized linear mixed models and reconcile apparently conflicting approaches. All these complex models can be easily implemented with the standard commercial software available.

Innovative biomarkers in psychiatric disorders: a major clinical challenge in psychiatry

ABSTRACT Introduction: Currently, the diagnosis of psychiatric illnesses is based upon DSM-5 criteria. Although endophenotype-specificity for a particular disorder is discussed, the identification of objective biomarkers is ongoing for aiding diagnosis, prognosis, or clinical response to treatment. We need to improve the understanding of the biological abnormalities in psychiatric illnesses across conventional diagnostic boundaries. The present review investigates the innovative post-genomic knowledge used for psychiatric illness diagnostics and treatment response, with a particular focus on proteomics. Areas covered: This review underlines the contribution that psychiatric innovative biomarkers have reached in relation to diagnosis and theragnosis of psychiatric illnesses. Furthermore, it encompasses a reliable representation of their involvement in disease through proteomics, metabolomics/pharmacometabolomics and lipidomics techniques, including the possible role that gut microbiota and CYP2D6 polimorphisms may play in psychiatric illnesses. Expert opinion: Etiologic heterogeneity, variable expressivity, and epigenetics may impact clinical manifestations, making it difficult for a single measurement to be pathognomonic for multifaceted psychiatric disorders. Academic, industry, or government’s partnerships may successfully identify and validate new biomarkers so that unfailing clinical tests can be developed. Proteomics, metabolomics, and lipidomics techniques are considered to be helpful tools beyond neuroimaging and neuropsychology for the phenotypic characterization of brain diseases.

Prevalence of Anxiety Disorders and Comorbid Affective Disorders in the Elderly of Castellana Grotte (italy).

Introduction The prevalence of Anxiety Disorders (ADs) among the elderly (65 plus) varies across studies, because of differences in diagnostic criterias definition and the heterogeneity of clinical presentation. Furthermore the comorbidity of anxiety with affective disorders is controversial. Objectives Estimate the prevalence of ADs in 65 years plus subjects in a random sampling of the general population and provide current estimates of comorbidity with affective disorders. Methods The sample was collected in the Great Age study, a population-based study conducted in a random sampling of the elderly residents in Castellana, South-East Italy. It includes 719 participants (56,33% males). Through the SCID-IVTR interview performed by a psychiatrist, ADs diagnosis and classification in subtypes (phobia, generalized anxiety disorder, OCD, panic disorder, post-traumatic stress disorder, adjustment disorder and AD nos) were assessed. Results The 30,25% of females and 15,30% of males were positive for any DSM-VI disorder. The ADs prevalence was 10,43% (14,97% of women; 6,91% of men; mean age at interview 72 years). Rates prevalence in 65-74 age stratum was 11,78%; 8,1% in 75-84 and 10,26% in the oldest age. The ADs were classified as phobia (1,49%), GAD (2,22%), OCD (0,28%), panic disorder (0,7%), PTSD (0,55%), adjustment disorder (1,67%) and AD nos (3,75%). 21,33% of the ADs had apparently new-onset (Late OnsetADs). Affective disorders occur in 25,33% of ADs. Conclusions The prevalence rates of ADs in late life tend to decline, but remain the most common psychiatric disorders, especially in women. Anxiety co-occurs with affective disorders in similar rate to Late OnsetADs. Founding: PRIN2009E4RM4Z

EPA-1250 – The greatage study: Prevalence of late onset depression in elderly rural community of castellana grotte (Italy)

Introduction Despite the increasing interest and social impact of mood disorders in elderly, there is no consensus regarding the frequency of depression in later life (LLD). A lack of epidemiological data mainly concerns the depression that occurs at age≥ 65 years, named Late Onset Depression (LOD). Objective To provide current estimates of the prevalence of LLD and LOD in elderly of the population-based GreatAge Study and to determine the prevalence of untreatment in both positive groups. Method A cross-sectional analysis of the 500 participants (60% males) of the population-based GreatAge Study, aged≥ 65 years, was performed. Depression diagnosis was assessed through the SCID and categorized as major and minor depression (dysthymia, adjustment disorders and depression nos). The antidepressants use was obtained from a standardized anamnestic interview. Results The prevalence of positive population for any DSM-VI disorder amounted to 22% (29% females; 17,3% males). The prevalence of LLD was estimated to be 10% (14,5% of women; 7% of men) distinct as major (5,4%) and minor (4,6%) depression. The prevalence of LOD was estimated to be 5,2%. No differences for gender were recorded (p=0.694). In the whole sample major and minor LOD are equally distributed (2,6%). The prevalence of treated subjects amounts to 40% for LLD and 46,2% for LOD (p=0.355). Conclusions Population-based studies have been useful in defining clinical characteristics and prognostic indicators of LOD. Our frequency rates are generally comparable with the range identified by previous studies conducted in other Western countries. Exceptions are represented by subtypes and gender frequency.