M. Corbo

Psychotropic drugs and ventricular repolarisation: The effects on QT interval, T-peak to T-end interval and QT dispersion:

Objective: We aimed to investigate in a clinical setting, the effects of different classes of psychotropic drugs on cardiac electrophysiological measures linked with an increased risk of sudden cardiac death. Methods: We conducted a cross-sectional study in a population of 1059 psychiatric inpatients studying the effects of various psychotropic drugs on the T-peak to T-end (TpTe) interval, QT dispersion and QT interval. Results: Methadone use showed a strong association with TpTe prolongation (odds ratio (OR)=12.66 (95% confidence interval (CI), 3.9–41.1), p<0.001), an effect independent from action on QT interval. Mood stabilisers showed significant effects on ventricular repolarisation: lithium was associated with a TpTe prolongation (OR=2.12 (95% CI, 1.12–4), p=0.02), while valproic acid with a TpTe reduction (OR=0.6 (95% CI, 0.37–0.98), p=0.04). Among antipsychotics, clozapine increased TpTe (OR=9.5 (95% CI, 2.24–40.39), p=0.002) and piperazine phenothiazines increased QT dispersion (OR=2.73 (95% CI, 1.06–7.02), p=0.037). Conclusions: Treatment with psychotropic drugs influences TpTe and QT dispersion. These parameters might be considered to better estimate the sudden cardiac death risk related to specific medications. Beyond antipsychotics and antidepressants, mood stabilisers determine significant effects on ventricular repolarisation.

Substance-related psychopathology and aggressiveness in a nightlife holiday resort: Results from a pilot study in a psychiatric inpatient unit in Ibiza

We aimed to describe a sample of subjects admitted to a psychiatric unit after the intake of psychoactive substances for recreational purposes.

Prevalence of Orthorexia Nervosa in a Population of Young Italian Adults

Introduction Orthorexia nervosa (ON) is an alleged eating disorder in which the person is excessively preoccupied with healthy food. First described by Bratman in 1997, ON entails a fixation on healthy food or a health food dependence. The term orthorexia nervosa arises from the Greek words orthos (=accurate) and orexis (=hunger) meaning obsession with healthy food and proper nutrition. Fears and worries about health, eating, and the quality of food are significant. Objectives We investigated the prevalence of ON in a a population of young Italian adults by using a validated questionnaire (ORTO-15). Aims We aimed to assess the prevalence of ON in a large sample of general population and to identify some possible specific correlation such as gender and Body Mass Index (BMI). Methods 1453 adult subjects from the general population were administered the ORTO-15 test and investigated for gender, age and BMI. Statistical analyses were performed referring to diagnostic threshold (40). Results Orthorexia had a 10,9% prevalence in our sample, with a female prevalence statistically significant (female vs male= 72,8% vs 27,2%). Moreover, age and Body Mass Index did not seem to be significant factors. Conclusions ON is not currently considered as a full-fledged and discrete mental disorder. Again, the definition and diagnostic criteria of ON remain unclear. Further studies are needed to clarify appropriate diagnostic methods and the place of ON among psychopathological categories. This should be accompanied by a vigorous research effort aimed at understanding the core nature of this condition.

The melatonergic system: effects on sleep and implications for the treatment of psychiatric disorders

Correspondence: Domenico De Berardis National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, “G. Mazzini” Hospital, p.zza Aldo Moro 1, 64100 Teramo, italy Tel +39 0861429708 Fax +39 0861429706 email dodebera@aliceposta.it Abstract: The circadian pacemaker or biological clock, located in the hypothalamic suprachiasmatic nucleus, is the generation site of circadian rhythms. The light/dark cycle is the circadian pacemaker’s dominant synchronizing agent, though it is also influenced by neurotransmitters and the phase-shifting effects of various chemical and pharmacological components, of which melatonin (N-acetyl-5-methoxytryptamine) is the most well established. In recent years, melatonin and melatonin analogs have been commercialized in many countries, mainly with hypnotic purposes. A new compound, agomelatine, has been recently synthesized and studied. Among melatonin analogs, this drug possesses unique pharmacological and clinical features; it is an antagonist at 5-HT2B and 5-HT2C receptors and has well established antidepressant and anxiolytic properties. Agomelatine opens new perspectives in the chronobiotic treatment of depression. The purpose of the present review was to elucidate the effects of the melatonergic system on sleep and the implications for the treatment of psychiatric disorders.

Polydrug Use in a Population of Young Italian Adults

Introduction Polydrug use is mostly common among adolescents and young adults, often with the intention of enhancing or counteracting the effects of another drug. It significantly increases the risks, due to drug synergy and increased side effects. Objectives We investigated the prevalence of polydrug users in a population of Italian young adults using a specifically designed questionnaire. Aims We aimed to assess the prevalence of polydrug abusers in a large sample of general population, and also to identify possible associations between alcohol misuse (e.g., binge drinking behaviours) and polydrug use. Methods We administered the questionnaire to a sample of 3000 subjects, aged 18 to 26, investigating socio-economic characteristics, alcohol abuse (with a specific focus on binge drinking) and use of psychoactive substances (cannabis, cocaine and Novel Psychoactive Substances-NPS). Collected data underwent statistical analyses. Results 80.5% of the sample habitually consumed alcoholic beverages. Among alcohol consumers, 34.2% used cannabis, 5.4% cocaine, 3.7% NPS, and 79,2% had binge drinking behaviours. Among those who did not consume alcohol, 4% used cannabis, 0.4% used cocaine, and 0% used NPS. Polydrug use was more common among binge drinkers. 35.6% of cocaine abusers also used NPS, in comparison to 1.4% of non-abusers. Conclusions According to scientific literature, alcohol and cocaine are the substances most commonly involved in risky polydrug use. Binge drinking and NPS appear to ben involved in polydrug use too. The combined effects of the different drugs need to be considered in identifying an appropriate and timely intervention strategy

Factors associated with first- versus second-generation long-acting antipsychotics prescribed under ordinary clinical practice in Italy

Background For many years, long-acting intramuscular (LAI) antipsychotics have been prescribed predominantly to chronic and severe patients, as a last resort when other treatments failed. Recently, a broader and earlier use of LAIs, particularly second-generation LAIs, has been emphasized. To date, few studies attempted to frame how this change in prescribing took place in real-world practice. Therefore, this study aimed to describe the clinical features of patients prescribed with LAIs, and to explore possible prescribing differences between first- and second-generations LAIs under ordinary clinical practice in Italy. Methods The STAR Network “Depot” Study is an observational, longitudinal, multicenter study involving 35 centers in Italy. In the cross-sectional phase, patients prescribed with LAIs were consecutively recruited and assessed over a period of 12 months. Descriptive statistics and multivariable logistic regression analyses were employed. Results Of the 451 recruited patients, 61% were males. The level of social and working functioning was heterogeneous, as was the severity of disease. Seventy-two per cent of the patients had a diagnosis of the schizophrenia spectrum. Seventy per cent were prescribed with second-generation antipsychotic (SGA) LAIs (mostly paliperidone, aripiprazole and risperidone). Compared to first-generation antipsychotic (FGA) LAIs, patients prescribed with SGA LAIs were more often younger; employed; with a diagnosis of the schizophrenia spectrum or bipolar disorder; with higher levels of affective symptoms; with fewer LAI prescriptions in the past. Discussion LAIs’ prescribing practices appear to be more flexible as compared to the past, although this change is mostly restricted to SGA LAIs.

Borderline personality disorder and working memory: A systematic review

Purpose of the study The purpose of this study was to investigate cognitive functioning in Borderline Personality Disorder subjects, with particular reference to the Working Memory functioning. The Working Memory seems to be relate to core features of the disturb. The final aim was to better understand the disorder and to implement a cognitive training to improve the deficits. Methods A literature search was conducted in April 2015. Pubmed and Scopus databases were used to find studies to include in the systematic review. The keywords used for the literature search were: “borderline personality disorder”, “borderline personality”, “working memory”, “executive functioning”. In each search, the keywords were used together with the logical operator “and”. Summary Three studies were included in this systematic review ( Table 1 ). In each study, the working memory was investigated using N-back test. In two of those studies significantly differences were found between patients and healthy group in N-back task. In the third study, which used more tests to investigate working memory domain, no differences were found between the two groups. Conclusions Borderline personality disorder patients performed significantly worse on the N-back test compared to healthy controls and the impairment increased with increasing working memory load. In the third study the working memory domain was investigated using four different tests and single scores were not included therefore it was impossible to compare N-back data.

Cannabis and Methylphenidate-Induced Manic Symptoms

Methylphenidate (MPH) prescription rates have been increasing steadily in the last few years, and diversion of the drug is becoming an issue, especially among young people. As is commonly known from scientific literature, high doses of stimulants may induce symptoms similar to those typical of mood disorders or schizophrenia, but with a wide range of variability in symptoms severity, duration and presentation. Poly drug abuse represents another under-evaluated issue, especially with regards to MPH and Δ-9-tetrahydrocannabinol. Here we present a case of methylphenidate and cannabis-induced manic-like episode, involving a 23-year-old male student. The case presentation and management is described in details, and poly drug abuse-related problems are discussed. In conclusion, future studies should explicitly examine the effects of the combination of MPH and THC as well as other possible new patterns of poly drug intake, in order to fully understand their synergistic desirable effects and associated clinical and toxicological implications.

Manic Symptoms Associated with Stimulant and Cannabis Misuse: a Case Report

We report a clinical case of a patient with a manic episode after taking methylphenidate (up to 120mgr per day) and cannabis in order to improve performance during exam period. He was hospitalized for disorganized behaviour, increased aggresion, delusions, grandiosity. He was affected by attention deficit and hyperactivity during childhood and recent episods of subthreshold depression. The therapy consisted of benzodiazepine and hydratation. In conclusion clinicians shuould ha ve caution in prescribing neurostimulant in vulnerable subjects.