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News Article | April 26, 2017
Site: www.eurekalert.org

More research needed to determine whether easily identified patient characteristics can help doctors choose the best drug for each patient, according to a new study in Personalized Medicine in Psychiatry Philadelphia, PA, April 26, 2017 - Although drug therapy is the accepted first-line treatment for panic disorders (PDs), 17% to 64% of patients do not respond adequately and continue to exhibit one of the most common symptoms of PD, the panic attack (PA). In a comprehensive new analysis published in Personalized Medicine in Psychiatry, researchers carefully reviewed scientific data to establish whether a personalized treatment approach could help physicians prescribe the drug that will work most effectively for a specific patient. "The major goal of a personalized treatment approach is to tailor interventions according to each patient's unique profile and characteristics," explained lead investigator Daniela Caldirola, MD, PhD, of the Department of Clinical Neurosciences, Hermanas Hospitalarias, Como, Italy, "Although still a challenging issue for clinicians, a personalized approach, based on reliable predictors of pharmacotherapy course, may provide relevant advances in the treatment of psychiatric disorders. PD, a common and debilitating psychiatric condition, could greatly benefit from such an approach, because from a clinical perspective there is still a strong unmet need for more efficacious pharmacological interventions in this disorder." Several medications are effective for treating PD, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and benzodiazepines. However, in short-term clinical trials, 17%-64% of participants with PD did not respond adequately to pharmacotherapy and continued to have PAs and/or exhibited negative behavior related to PAs. After a careful review of more than 1,000 studies, investigators identified 22 randomized, placebo-controlled studies of three drugs, paroxetine, venlafaxine XR, and alprazolam, suitable for inclusion in this meta-analysis. The primary goals were to identify sociodemographic and clinical characteristics that clinicians can easily evaluate in clinical practice before beginning treatment, i.e., gender, age, duration of PD, presence/severity of agoraphobia, number of the PAs, severity of the disorder, and severity of general anxiety/depressive symptoms, and both clinical outcomes and tolerability of FDA-approved medications for PD. "To the best of our knowledge, this is the first meta-analysis with this aim. In case of significant results, clinicians could use these variables as predictive tools to maximize therapeutic efficacy and minimize side effects of antipanic treatments according to each patient's characteristics," noted Dr. Caldirola. The meta-analysis provided very limited support for the moderating effects of sociodemographic and clinical variables on short term clinical outcomes and tolerability of paroxetine, venlafaxine XR, and alprazolam in treatment of PD. However, researchers found three important correlations: (1) longer illness duration was significantly associated with lower rate of patients free from PAs at the end of trials that compared venlafaxine XR to placebo, (2) higher age at the beginning of trials that compared paroxetine to placebo was significantly associated with higher rate of patients who dropped out of the studies because of adverse side effects, and (3) the longer the treatment, the higher the rate of patients free from PAs at the endpoint of RCTs with venlafaxine XR. Contributing to the advancement of the emerging field of personalized psychiatry in PD, the results will be useful for future studies on this topic and help to overcome the paucity of available data and shortcomings of current pharmacological studies in PD. "Our research does underscore the fact that, in the realm of pharmacotherapy for PD, reliable conclusions regarding the usefulness of sociodemographic and clinical variables as moderators of outcomes cannot yet be drawn," commented Dr. Caldirola. "The personalized approach to pharmacotherapy for PD, although at an early stage, appears to be the most promising way for increasing, within a reasonable timeframe, the rate of successful outcomes in this disorder, similar to trends in other fields of medicine, like oncology."


Riva V.,Scientific Institute Eugenio Medea | Marino C.,Scientific Institute Eugenio Medea | Marino C.,University of Québec | Marino C.,Laval University | And 4 more authors.
European Child and Adolescent Psychiatry | Year: 2015

Both genetic and socio-demographic factors influence the risk for behavioral problems in the developmental age. Genetic studies indicate that shared genetic factors partially contribute to behavioral and learning problems, in particular reading disabilities (RD). For the first time, we explore the conjoint role of DCDC2 gene, an identified RD candidate gene, and socioeconomic status (SES) upon behavioral phenotypes in a general population of Italian children. Two of the most replicated DCDC2 markers [i.e., regulatory element associated with dyslexia 1 (READ1), rs793862] were genotyped in 631 children (boys = 314; girls = 317) aged 11–14 years belonging to a community-based sample. Main and interactive effects were tested by MANOVA for each combination of DCDC2 genotypes and socioeconomic status upon emotional and behavioral phenotypes, assessed by Child Behavior Check-List/6–18. The two-way MANOVA (Bonferroni corrected p value = 0.01) revealed a trend toward significance of READ1(4) effect (F = 2.39; p = 0.016), a significant main effect of SES (F = 3.01; p = 0.003) and interactive effect of READ1(4) × SES (F = 2.65; p = 0.007) upon behavioral measures, showing higher attention problems scores among subjects ‘READ1(4+) and low SES’ compared to all other groups (p values range 0.00003–0.0004). ANOVAs stratified by gender confirmed main and interactive effects among girls, but not boys. Among children exposed to low socioeconomic level, READ1 genetic variant targets the worst outcome in children’s attention. © 2014, Springer-Verlag Berlin Heidelberg.


Alciati A.,Hermanas Hospitalarias | Sarzi-Puttini P.,University of Milan | Batticciotto A.,University of Milan | Torta R.,University of Turin | And 3 more authors.
Clinical and Experimental Rheumatology | Year: 2012

Objectives: To test the hypothesis that the premorbid overactivity previously described in subjects with fibromyal gia is a core feature of the manic/hy pomanic symptoms characterising bi polar spectrum disorders. Methods: 110 consecutive patients with fibromyalgia were assessed for bipolar spectrum disorders using both categorical and dimensional approach es. The first was based on a version of the DSM-IV SCID-CV interview, modi fied to improve the detection of bipo lar spectrum disorders, the second on the hypomania symptom checklist HCL-32, which adopts a dimensional perspective of the manic/hypomanic component of mood by including sub syndromal hypomania. Results: Both DSM-IV and Zurich cri teria diagnosed high rates of bipolar spectrum disorder in patients with fi bromyalgia (70% and 86.3%, respec tively). Individuals with a major bipo lar spectrum disorder (bipolar II disor der) and with a minor bipolar spectrum disorder (subthreshold depression and hypomania) did not differ in their de mographic and clinical aspects. Hypomanic symptom counts on the HCL-32 confirmed high estimates of the bipolar spectrum, with 79% of subjects with fibromyalgia scoring 14 (threshold for hypomania) or above. Conclusion: Overactivity reported in previous studies may be considered a core feature of hypomanic symptoms or syndromes comorbid with bipolar spectrum disorders. Major and minor bipolar spectrum disorders are not associated with dif ferences in demographic or clinical characteristics, suggesting that fibro myalgia rather than being related specifically to depression is related to bipolar spectrum disorders and in par ticular to the hypomania/overactivity component. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2012.


Perna G.,Hermanas Hospitalarias | Perna G.,Maastricht University | Perna G.,University of Miami | Alciati A.,Hermanas Hospitalarias | And 3 more authors.
Current Psychiatry Reports | Year: 2016

Many aspects of long-term pharmacological treatments for anxiety disorders (AnxDs) are still debated. We undertook an updated systematic review of long-term pharmacological studies on panic disorder (PD), generalized anxiety disorder (GAD), and social anxiety disorder (SAD). Relevant studies dating from January 1, 2012 to August 31, 2015 were identified using the PubMed database and a review of bibliographies. Of 372 records identified in the search, five studies on PD and 15 on GAD were included in the review. No studies on SAD were found. Our review confirms the usefulness of long-term pharmacological treatments for PD and GAD and suggests that they can provide further improvement over that obtained during short-term therapy. Paroxetine, escitalopram, and clonazepam can be effective for long-term treatment of PD. However, further studies are needed to draw conclusions about the long-term benzodiazepine use in PD, particularly for the possible cognitive side-effects over time. Pregabalin and quetiapine can be effective for long-term treatment of GAD, while preliminary suggestions emerged for agomelatine and vortioxetine. We did not find any evidence for determining the optimal length and/or dosage of medications to minimize the relapse risk. Few investigations have attempted to identify potential predictors of long-term treatment response. Personalized treatments for AnxDs can be implemented using predictive tools to explore those factors affecting treatment response/tolerability heterogeneity, including neurobiological functions/clinical profiles, comorbidity, biomarkers, and genetic features, and to tailor medications according to each patient’s unique features. © 2016, Springer Science+Business Media New York.


Perna G.,Hermanas Hospitalarias | Perna G.,University of Miami | Perna G.,Maastricht University
Rivista di Psichiatria | Year: 2013

The mental defence system plays a central role in ensuring individual and species survival from dangers. The cost of its activation is a decrease in freedom in favour of an increase in safety. Anxiety, fear and panic are the organizing principles of this system: anxiety arising in response to the anticipation of a threat, fear arising in response to external environmental threats and panic arising in response to internal somatic homeostatic threats. Beyond the correct identification of the above-mentioned organizing principles, making correct therapeutic choices is linked to the ability to discriminate among physiological, pathological and pathophysiological anxiety phenomena. The intensity of the defence reaction is inadequate in determining that its pathological nature is related to the subjective evaluation of a disproportional reaction between individual resources and the potential threat. Very often, the anxious defensive reaction, which to an external observer seems disproportional, is coherent and adequate relative to the personal experience of the patient, and thus, it is not pathological. © Il Pensiero Scientifico Editore.


Alciati A.,Hermanas Hospitalarias | Sgiarovello P.,University of Milan | Atzeni F.,University of Milan | Sarzi-Puttini P.,University of Milan
Reumatismo | Year: 2012

Objective. To review the literature addressing the relationship between mood disorders and fibromyalgia/chron-ic pain and our current understanding of overlapping pathophysiological processes and pain and depression circuitry. Methods. We selectively reviewed articles on the co-occurrence of mood disorders and fibromyalgia/chronic pain published between 1990 and July 2012 in PubMed. Bibliographies and cross references were considered and included when appropriate. Results. Forty-nine out of 138 publications were retained for review. The vast majority of the studies found an association between depression and fibromyalgia. There is evidence that depression is often accompanied by symptoms of opposite polarity characterised by heights of mood, thinking and behaviour that have a considerable impact on pharmacological treatment. Recent developments support the view that the high rates of fibromyalgia and mood disorder comorbidity is generated by largely overlapping pathophysiological processes in the brain, that provide a neurobiological basis for the bidirectional, mutually exacerbating and disabling relationship between pain and depression. Conclusions. The finding of comparable pathophysiological characteristics of pain and depression provides a framework for understanding the relationship between the two conditions and sheds some light on neurobio-logical and therapeutic aspects.


Alciati A.,Hermanas Hospitalarias | Atzeni F.,Ospedale Universitario cco | Sgiarovello P.,Ospedale Universitario cco | Sarzi-Puttini P.,Ospedale Universitario cco
Reumatismo | Year: 2014

Medically unexplained symptoms are considered 'somatoform disorders' in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The introduction of this nosographic category has been helpful in drawing attention to a previously neglected area, but has not been successful in promoting an understanding of the disorders' biological basis and treatment implications, probably because of a series of diagnostic shortcomings. The newly proposed DSM-V diagnostic criteria try to overcome the limitations of the DSM-IV definition, which was organised centrally around the concept of medically unexplained symptoms, by emphasising the extent to which a patient's thoughts, feelings and behaviours concerning their somatic symptoms are disproportionate or excessive. This change is supported by a growing body of evidence showing that psychological and behavioural features play a major role in causing patient disability and maintaining high level of health care use. Pain disorders is the sub-category of DSM-IV somatoform disorders that most closely resembles fibromyalgia. Regardless of the diagnostic changes recently brought about by DSM-V, neuroimaging studies have identified important components of the mental processes associated with a DSM- IV diagnosis of pain disorder.


Crippa A.,Scientific Institute | Crippa A.,National Research Council Italy | Salvatore C.,National Research Council Italy | Perego P.,Scientific Institute | And 5 more authors.
Journal of Autism and Developmental Disorders | Year: 2015

In the present work, we have undertaken a proof-of-concept study to determine whether a simple upper-limb movement could be useful to accurately classify low-functioning children with autism spectrum disorder (ASD) aged 2–4. To answer this question, we developed a supervised machine-learning method to correctly discriminate 15 preschool children with ASD from 15 typically developing children by means of kinematic analysis of a simple reach-to-drop task. Our method reached a maximum classification accuracy of 96.7 % with seven features related to the goal-oriented part of the movement. These preliminary findings offer insight into a possible motor signature of ASD that may be potentially useful in identifying a well-defined subset of patients, reducing the clinical heterogeneity within the broad behavioral phenotype. © 2015, Springer Science+Business Media New York.


Gomar J.J.,Feinstein Institute for Medical Research | Gomar J.J.,Hermanas Hospitalarias | Conejero-Goldberg C.,Feinstein Institute for Medical Research | Davies P.,Feinstein Institute for Medical Research | Goldberg T.E.,Feinstein Institute for Medical Research
Alzheimer's and Dementia | Year: 2014

Background This study examined the predictive value of different classes of markers in the progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD) over an extended 4-year follow-up in the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Methods MCI patients were assessed for clinical, cognitive, magnetic resonance imaging (MRI), positron emission tomography-fluorodeoxyglucose (PET-FDG), and cerebrospinal fluid (CSF) markers at baseline and were followed on a yearly basis for 4 years to ascertain progression to AD. Logistic regression models were fitted in clusters, including demographics, APOE genotype, cognitive markers, and biomarkers (morphometric, PET-FDG, CSF, amyloid-β, and tau). Results The predictive model at 4 years revealed that two cognitive measures, an episodic memory measure and a Clock Drawing screening test, were the best predictors of conversion (area under the curve = 0.78). Conclusions This model of prediction is consistent with the previous model at 2 years, thus highlighting the importance of cognitive measures in progression from MCI to AD. Cognitive markers were more robust predictors than biomarkers. © 2014 The Alzheimer's Association. All rights reserved.


PubMed | Hermanas Hospitalarias and University of Miami
Type: Journal Article | Journal: Psychiatry investigation | Year: 2017

Our pilot study aims to investigate the efficacy of a Short-Term (4 weeks) Psychiatric Rehabilitation Program (S-T PsyRP), without specific cognitive remediation trainings, on the neuropsychological performance and psychosocial functioning of inpatients with Major Depressive Disorder (MDD) or Bipolar Disorder (BD). Published studies with similar aims are lacking.Fifty-three inpatients with MDD and 27 with BD (type I/II) were included. The S-T PsyRP was usually performed as clinical practice at Villa San Benedetto Menni Hospital and included a variety of activities aimed at promoting personal autonomies, interpersonal/social skills, and self-care. At the beginning and the end of the hospitalization we evaluated: neuropsychological performance (cognitive tests on verbal/visual working memory, attention, visual-constructive ability, language fluency, and comprehension); psychosocial functioning by the Rehabilitation Areas Form (RAF, handbook VADO); illness severity by the Brief Psychiatric Rating Scale (BPRS). Repeated-measure ANOVA and Pearsons linear correlation were used.We found significant improvement (p<0.01) in all the neuropsychological tests except for one, in 4 out of 6 RAF psychosocial areas (involvement in ward activities, autonomies, self-care, and self-management of health) and in clinical symptoms severity. No associations were found between the amelioration of clinical symptoms and neuropsychological or psychosocial improvement.A S-T PsyRP without specific cognitive remediation trainings may improve several cognitive/functional domains in MDD or BD inpatients, probably by offering opportunities to engage in demanding problem-solving conditions and cognitively stimulating activities.

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