Werner Natta

Duration of untreated illness and outcomes in unipolar depression: A systematic review and meta-analysis

BACKGROUND To systematically review evidence of the effects of the duration of untreated depression on the clinical outcomes of patients suffering from Unipolar Major Depression. METHODS A systematic review and meta-analysis of the evidence of duration of untreated depression and the effect it has on clinical outcomes in Unipolar Major Depression. Data used to this purpose were obtained from a literature search of the MEDLINE, Psychoinfo and Embase databases. Comparable data extracted from studies were entered and analysed using Cochrane Collaborations Review Manager software Version 5.2. RESULTS Ten studies were identified as meeting the inclusion criteria. Only three studies reported comparable data and were consequently used for the meta-analysis. Pooled data indicates the overall positive effect of shorter duration of untreated illness both in a patients response to treatment (RR 1.70) and remission (RR 1.65). Other studies which were not included in the meta-analysis confirmed the importance of reducing delays in the treatment of depression in order to prevent the risk of worse outcomes and chronicity, in particular in patients presenting with a first episode of depression. Data regarding the association between the duration of untreated episode in recurrent depression and clinical outcomes are less evident. LIMITATIONS The heterogeneity of the selected studies was cause for limitations with regard to the carrying out of adequate meta-analysis. CONCLUSIONS There is evidence highlighting the importance of a reduced no-treatment interval for patients suffering Unipolar Depression. In particular, there is emphasis on the first episode of depression corresponding to the notion of reducing the duration of untreated illness.

Duration of untreated depression influences clinical outcomes and disability

BACKGROUND The duration of untreated depression (DUD) might have a substantial impact on the clinical outcomes; however, there are important knowledge gaps including the effects on disability and potential differences between first-episode and recurrent episodes of depression. METHODS We recruited 121 outpatients with first episode and recurrent major depression, and conducted prospective clinical assessments over six months. Clinical outcomes included response to antidepressant therapy, remission and changes in disability. RESULTS Patients with a DUD of six months or shorter were more frequently young, unemployed and had higher levels of physical illnesses than those with a longer DUD (all p<0.05). A shorter DUD was associated with significantly higher odds of response at 12 weeks (adjusted odds ratio 2.8; 95% CI: 1.2-6.8) and remission at 24 weeks (4.1; 95% CI: 1.6-10.5) after adjusting for relevant confounders. Changes in disability ratings were analyzed with growth curve analysis and showed steeper declines among those with a shorter DUD. The associations of DUD on clinical outcomes were evident both in patients with first-episode and recurrent depression. LIMITATIONS Naturalistic design. Self-rated assessment of disability. Findings from subgroup analyses should be replicated in larger sample size. CONCLUSIONS A shorter duration of untreated depression is associated with more favorable outcomes for major depression, including depression-related disability. This association seems to work both at the first and recurrent episodes, which might have direct implications for both primary and secondary prevention.

Process of implementation and development of early psychosis clinical services in Italy: a survey.

Aim: To carry out an in‐depth survey into the method of providing early intervention in schizophrenia in Italy and to evaluate the process of development of early psychosis clinical services following the pilot programme ‘Programma 2000’ and the publishing of Italian National Guidelines.

Antipsychotic utilisation and polypharmacy in Italian residential facilities: a survey

OBJECTIVE To evaluate the prescribing practices in psychiatric residential facilities, with particular focus both on the antipsychotic dose and polypharmacy as well as the variation of antipsychotic patterns during a patients stay within the facilities. METHODS Fifteen residential facilities of Liguria region in Italy were included. Data were collected through a chart review during a one-day census. Frequency of psychotropic patterns was estimated. Different non-parametric tests were used to analyse the changes in prescription patterns as well as the relationship among antipsychotic dose, the number of antipsychotics and anticholinergic use. RESULTS The study sample includes 362 patients, 61.9% males. On the census day 77.5% of patients received psychotropic polypharmacy and 57.2% antipsychotic polypharmacy. Antipsychotic polypharmacy was related to the total antipsychotic daily dose and to anticholinergic use. A trend towards an increase of antipsychotic and psychotropic polypharmacy and higher doses of antipsychotics over the period of stay within the facilities was noted. This tendency was related to the length of stay in the facility. CONCLUSIONS Compared to earlier studies in the same clinical environment a significant increase in the use of psychotropic and antipsychotic polypharmacy was observed. The risk of prescribed polypharmacy seems to be related to time spent in the facility.

Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants.

The number of immigrants in Italy has doubled every 10 years from 1972 and Genoa hosts two large communities of immigrants from South America and Africa. We investigated differences in the somatic perception between immigrants and Italians and between South Americans and Africans living in the city of Genoa. During a 7 month period, an anonymous questionnaire asking for sociodemographic information and the Modified Somatic Perception Questionnaire (MSPQ) were administered to all immigrants accessing an outpatient clinic or the general practitioners offices. MSPQ mean scores were significantly higher in immigrant patients than in Italian patients, after adjusting for sex and age differences. We found no differences between South Americans and Africans in MSPQ score. The tendency to express discomfort through physical symptoms appears to be related to being a foreigner who arrived in Italy through a migratory trip and also to being a person who comes from a cultural context that is very different from the one of developed countries.

Unmet needs and research challenges for late-life mood disorders

Mood disorders are common and often under-recognised in older people whereby, together with the general ageing of the population, they are becoming a significant and growing public health problem worldwide. However, the need to address the problem of late life mood disorders in a real-world setting is met with a surprising lack of strong evidence in this field. Randomised clinical trials which focus on elderly mood disorders are not very common and the majority of them focus on pharmacological treatment of major depression. The aim of this study was to review first the main unmet needs and research challenges in late-life mood disorders as a basis to then review the state of the art evidence resulting from randomised clinical trials and the main critical aspects of their implementation. Comorbidity as well as polypharmacy, cognitive decline, unpredictable placebo response, and uncertainty on optimal duration of trials are some of the challenges the investigator has to address. Moreover, some methodological limitations of randomised clinical trials reduce the applicability of the results of such studies to common clinical practices and have encouraged some authors to investigate the existence of possible alternative research designs such as pragmatic randomised clinical trials.

Combined venlafaxine and olanzapine prescription in women with psychotic major depression: a case series.

Patients with psychotic major depression suffer prolonged duration and greater severity of illness, including an increased likelihood of recurrent episodes and resistance to conventional pharmacotherapies. They do not respond to placebo and respond poorly to antidepressant or antipsychotic monotherapy. On the other hand, as has been demonstrated, they do respond well to antidepressant and antipsychotic combination therapies. Different combinations of drugs were studied, but little is known up to now with regard to the combination of venlafaxine and olanzapine. The following paper presents three separate case studies of female patients suffering from psychotic unipolar major depression, all of whom were admitted to a psychiatric ward and successfully treated with a combination of venlafaxine and olanzapine.

The diagnostic challenge of frontotemporal dementia in psychiatric patients: a case report

Frontotemporal dementia (FTD) is often misdiagnosed early in the clinical course and may be confused with primary psychiatric disorders. This is especially true when patients have a psychiatric history. In this report, we describe a case that illustrates the diagnostic challenge of FTD in a patient with a history of obsessive-compulsive disorder.

Cognitive impairment and psychopharmacological treatment: a drug utilization study in the emergency department

addition to a higher specificity in CDT2. Our data lead us to conclude that the use of different clock timepoints in CDT1 and CDT2 does not give rise to major differences, but we cannot exclude the possibility that other time points might be more sensitive and specific. In conclusion, the findings that emerged from the two examined settings support the conception that the result of the CDT test does not appear to depend on the positions of the hand, and additionally suggest that the semiquantitative evaluation method is as sensitive as the quantitative method.

Data of the Modified Somatic Perception Questionnaire (MSPQ) administered to a sample of immigrants in Genoa (Italy)

This article reports the data of the Modified Somatic Perception Questionnaire (MSPQ) administered to a sample of 143 immigrants accessing an outpatient clinic or the general practitioners offices in Genoa (Italy) compared with 186 Italian patients. For further details and for the interpretation of the data, the reader is referred to the original publication “Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants” by Bragazzi et al. (2014) [1].