Angela Favaro - Academia.edu (original) (raw)
Papers by Angela Favaro
Molecular Psychiatry, 2014
was on the SAB of Expression Analysis (Durham, NC). Cynthia Bulik was a consultant for Shire Phar... more was on the SAB of Expression Analysis (Durham, NC). Cynthia Bulik was a consultant for Shire Pharmaceuticals at the time the manuscript was written. Federica Tozzi was full time employee of GSK at the time when the study was performed. David A. Collier was employed by Eli Lilly UK for a portion of the time that this study was performed. James L. Kennedy has received honoraria from Eli Lilly and Roche. Robert D. Levitan has received honorarium from Astra-Zeneca. Supplementary information is available at Molecular Psychiatry's website.
Translational Psychiatry
Bipolar patients (BD) in the euthymic phase show almost no symptoms, nevertheless possibility of ... more Bipolar patients (BD) in the euthymic phase show almost no symptoms, nevertheless possibility of relapse is still present. We expected to find a psychobiological trace of their vulnerability by analyzing a specific network—the Language Network (LN)—connecting many high-level processes and brain regions measured at rest. According to Crow’s hypothesis on the key role of language in the origin of psychoses, we expected an altered asymmetry of the LN in euthymic BDs. Eighteen euthymic BD patients (10 females; age = 54.50 ± 11.38 years) and 16 healthy controls (HC) (8 females; age = 51.16 ± 11.44 years) underwent a functional magnetic resonance imaging scan at rest. The LN was extracted through independent component analysis. Then, LN time series was used to compute the fractional amplitude of the low-frequency fluctuation (fALFF) index, which was then correlated with clinical scales. Compared with HC, euthymic patients showed an altered LN with greater activation of Broca’s area right ...
Objective: This study evaluated sodium and fluid balance disturbances in anorexia nervosa. Method... more Objective: This study evaluated sodium and fluid balance disturbances in anorexia nervosa. Methods: Serum urea, creatinine, urea nitrogen/creatinine ratio, protein concentration, osmolality, electrolytes, hemoglobin, and hematocrit were evaluated on admission, after intravenous fluid supplementation, and at discharge in 14 patients who had anorexia nervosa and were admitted to a medical unit for severe malnutrition and/or medical complications. Diet history and physical signs of salt and water depletion were also evaluated on admission. The diagnosis of plasma volume depletion was considered confirmed if serum urea nitrogen/creatinine ratio was higher than 25. Results: Mean body mass indexes were 12.9 2.4 kg/m 2 on admission and 14.2 2.0 kg/m 2 at discharge. Mean duration of hospitalization was 24.2 11.9 d. Plasma volume depletion was found on admission in nine patients (64%), and hyponatremia was associated with hypovolemia (hypo- volemic hyponatremia) in three of them. Most of the...
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2021
Purpose Recent evidence from neuroimaging research has shown that eating disorders (EDs) are char... more Purpose Recent evidence from neuroimaging research has shown that eating disorders (EDs) are characterized by alterations in interconnected neural systems, whose characteristics can be usefully described by connectomics tools. The present paper aimed to review the neuroimaging literature in EDs employing connectomic tools, and, specifically, graph theory analysis. Methods A systematic review of the literature was conducted to identify studies employing graph theory analysis on patients with eating disorders published before the 22nd of June 2020. Results Twelve studies were included in the systematic review. Ten of them address anorexia nervosa (AN) (AN = 199; acute AN = 85, weight recovered AN with acute diagnosis = 24; fully recovered AN = 90). The remaining two articles address patients with bulimia nervosa (BN) (BN = 48). Global and regional unbalance in segregation and integration properties were described in both disorders. Discussion The literature concerning the use of conne...
Journal of Affective Disorders, 2020
Background: Evidence provides inconsistent findings on risk factors and health outcomes associate... more Background: Evidence provides inconsistent findings on risk factors and health outcomes associated with loneliness. The aim of this work was to grade the evidence on risk factors and health outcomes associated with loneliness, using an umbrella review approach. Methods: For each meta-analytic association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity, evidence for small-study effect, excess significance bias and 95% prediction intervals were calculated, and used to grade significant evidence (p<0.05) from convincing to weak. For narrative systematic reviews, findings were reported descriptively. Results: From 210 studies initially evaluated, 14 publications were included, reporting on 18 outcomes, 795 studies, and 746,706 participants. Highly suggestive evidence (class II) supported the association between loneliness and incident dementia (relative risk, RR=1.26; 95%CI: 1.14-1.40, I 2 23.6%), prevalent paranoia (odds ratio, OR=3.36; 95%CI: 2.51-4.49, I 2 92.8%) and prevalent psychotic symptoms (OR=2.33; 95%CI: 1.68-3.22, I 2 56.5%). Pooled data supported the longitudinal association between loneliness and suicide attempts and depressive symptoms. In narrative systematic reviews, factors cross-sectionally associated with loneliness were age (in a U-shape way), female sex, quality of social contacts, low competence, socioeconomic status and medical chronic conditions. Limitations: low quality of the studies included; mainly cross-sectional evidence. Conclusions: This work is the first meta-evidence synthesis showing that highly suggestive and significant evidence supports the association between loneliness and adverse mental and physical health outcomes. More cohort studies are needed to disentangle the direction of the association between risk factors for loneliness and its related health outcomes.
European Eating Disorders Review, 2019
Two hundred forty six patients with eating disorders (EDs) recruited from eight Italian specializ... more Two hundred forty six patients with eating disorders (EDs) recruited from eight Italian specialized treatment centres were administered with the World Health Organization "Encounter Form," a standardized schedule that makes it possible to characterize the clinical pathways that patients follow to reach specialized care. The median time from symptoms onset to specialized care was 114 weeks. Primary "points of access to care" were general practitioners (25%), psychiatrists (18%), and clinical nutritionists (17%), followed by various other carers. All patients received specific psychotherapy, whereas only 11% of them were given psychotropic drugs. EDs are characterized by complex care pathways, with low rates of direct access to specialized care. Although the role of general practitioners remains crucial, they tend to follow different clinical routes to refer ED patients. Educational programmes on EDs should be addressed to general practitioners and clinical nutritionists, in order to ease the transition of ED patients to a mental health care setting.
International Journal of Eating Disorders, 2018
Objective: Growing evidence suggests an impact of weight suppression (WS) on severity and course ... more Objective: Growing evidence suggests an impact of weight suppression (WS) on severity and course of symptoms in patients with eating disorders (ED), but no study explored also the role of the weight loss speed (WLS) together with WS on the same clinical variables, which is the aim of the present work. Method: A mixed cross-sectional and longitudinal cohort study was employed. Four hundred and fourteen patients with anorexia nervosa (AN 5 208) or bulimia nervosa (BN 5 206) according to DSM-5 criteria were recruited and assessed at referral by means of clinical interviews and selfreported questionnaires. Body mass index and diagnostic status were re-evaluated at the end of treatment. Results: WS was positively correlated with body dissatisfaction in patients with AN (p 5 .005), but negatively correlated in BN (p 5 .022). In contrast, WLS was significantly inversely correlated with age and duration of illness in all ED (p < .001), and positively correlated with drive for thinness in BN (p 5 .007). After treatment, WS at intake predicted higher BMI increase in both AN and BN (p < .03), while higher WLS was significantly associated with a lower drop-out rate in patients with BN (p 5 .02), and predicted BMI increase only in restricting AN patients (p 5 .02). In the whole group, WLS significantly predicted remission status (p 5 .039). Discussion: In our study, both WS and WLS were associated with baseline "core" clinical variables and provided complementary abilities to predict weight gain and remission at the end of treatment. If replicated, our data suggest the importance of considering both WS and WLS as useful clinical variables in the baseline assessment of ED.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2010
We report about a complex case of pica in comorbidity with multiple sclerosis and binge eating di... more We report about a complex case of pica in comorbidity with multiple sclerosis and binge eating disorder. Pica is classified among the feeding and eating disorders of infancy and early childhood, but there is a debate in the literature about the psychopathology and classification of this behavior. Some authors emphasize the similarities with the obsessive-compulsive spectrum disorders, whereas others propose an interpretation of pica as an addiction or as an impulsive behavior. The clinical case that we describe provides a picture of impulsive and compulsive features that are very difficult to disentangle. It is noteworthy that hypercalcemia is reported to have a protective/therapeutic effect against multiple sclerosis and seems to increase the plasmatic levels of beta-endorphins. The nature, diagnostic classification, and functions of pica are a topic worthy of future investigation.
European Eating Disorders Review, 2020
Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the ... more Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: 1) to analyze the psychometric properties of the COVID Isolation Eating Scale (CIES), 2) to explore changes that occurred due to confinement in eating symptomatology; and 3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centers.Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patientsendorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.
European Psychiatry, 2021
IntroductionThe coronavirus disease 2019 (COVID-19) pandemic and the resulting containment measur... more IntroductionThe coronavirus disease 2019 (COVID-19) pandemic and the resulting containment measures, such as “lockdown” and “social distancing”, have had important consequences on people’s mental and physical health.ObjectivesWe aimed to study the effect of social isolation and subsequent re- exposure and eventual changes in general and ED-specific psychopathology in people with Eating Disorders (EDs).MethodsThree-hundred twelve Italian people with EDs (179 Anorexia Nervosa, 83 Bulimia Nervosa, 48 Binge Eating Disorder and 22 Other Specific Feeding Eating Disorder) were asked to fill-in an online survey to explore several dimensions such as: anxiety, depression, panic, insomnia, suicide ideation, stress, post-traumatic stress and obsessive-compulsive symptoms. Differences in ED specific and general symptoms among the 3 investigated time periods (before, during and after the end of lockdown) were assessed with a one-way ANOVA with repeated measures. Subsequently, ED diagnosis was int...
npj Schizophrenia, 2021
A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-... more A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-reporting their real-life functioning. In a large (n = 618) cohort of stable, community-dwelling schizophrenia patients we sought to: (1) examine the concordance of patients’ reports of their real-life functioning with the reports of their key caregiver; (2) identify which patient characteristics are associated to the differences between patients and informants. Patient-caregiver concordance of the ratings in three Specific Level of Functioning Scale (SLOF) domains (interpersonal relationships, everyday life skills, work skills) was evaluated with matched-pair t tests, the Lin’s concordance correlation, Somers’ D, and Bland–Altman plots with limits of agreement (LOA). Predictors of the patient-caregiver differences in SLOF ratings were assessed with a linear regression with multivariable fractional polynomials. Patients’ self-evaluation of functioning was higher than caregivers’ in all t...
European Eating Disorders Review, 2020
Brazilian Journal of Psychiatry, 2021
Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive d... more Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multidisciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring).
Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared gene... more Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa (BN) and problem alcohol use (genetic correlation [rg], twin-based=0.23-0.53). We estimated the genetic correlation between eating disorder and substance use and disorder phenotypes using data from genome-wide association studies (GWAS). Four eating disorder phenotypes (anorexia nervosa [AN], AN with binge-eating, AN without binge-eating, and a BN factor score), and eight substance-use-related phenotypes (drinks per week, alcohol use disorder [AUD], smoking initiation, current smoking, cigarettes per day, nicotine dependence, cannabis initiation, and cannabis use disorder) from eight studies were included. Significant genetic correlations were adjusted for variants associated with major depressive disorder (MDD). Total sample sizes per phenotype rang...
Brain, Behavior, and Immunity, 2018
The molecular underpinnings associated to first episode psychosis (FEP) remains to be elucidated,... more The molecular underpinnings associated to first episode psychosis (FEP) remains to be elucidated, but compelling evidence supported an association of FEP with blood alterations in biomarkers related to immune system, growth factors and metabolism regulators. Many of these studies have not been already confirmed in larger samples or have not considered the FEP diagnostic subgroups. In order to identify biochemical signatures of FEP, the serum levels of the growth factors BDNF and VEGF, the immune regulators IL-1RA, IL-6, IL-10 and IL-17, RANTES/CCL5, MIP-1b/CCL4, IL-8 and the metabolic regulators C-peptide, ghrelin, GIP, GLP-1, glucagon, insulin, leptin, PAI-1, resistin and visfatin were analysed in 260 subjects collected in the GET UP project. The results indicated an increase of MIP-1b/CCL4, VEGF, IL-6 and PAI-1, while IL-17, ghrelin, glucagon and GLP-1 were decreased in the whole sample of FEP patients (p < 0.01 for all markers except for PAI-1 p < 0.05). No differences were evidenced for these markers among the diagnostic groups that constitute the FEP sample, whereas IL-8 is increased only in patients with a diagnosis of affective psychosis. The principal component analysis (PCA) and variable importance analysis (VIA) indicated that MIP-1b/CCL4, ghrelin, glucagon, VEGF and GLP-1 were the variables mostly altered in FEP patients. On the contrary, none of the analysed markers nor a combination of them can discriminate between FEP diagnostic subgroups. These data evidence a profile of immune and metabolic alterations in FEP patients, providing new information on the molecular mechanism associated to the psychosis onset for the development of preventive strategies and innovative treatment targets.
Molecular Psychiatry, 2014
was on the SAB of Expression Analysis (Durham, NC). Cynthia Bulik was a consultant for Shire Phar... more was on the SAB of Expression Analysis (Durham, NC). Cynthia Bulik was a consultant for Shire Pharmaceuticals at the time the manuscript was written. Federica Tozzi was full time employee of GSK at the time when the study was performed. David A. Collier was employed by Eli Lilly UK for a portion of the time that this study was performed. James L. Kennedy has received honoraria from Eli Lilly and Roche. Robert D. Levitan has received honorarium from Astra-Zeneca. Supplementary information is available at Molecular Psychiatry's website.
Translational Psychiatry
Bipolar patients (BD) in the euthymic phase show almost no symptoms, nevertheless possibility of ... more Bipolar patients (BD) in the euthymic phase show almost no symptoms, nevertheless possibility of relapse is still present. We expected to find a psychobiological trace of their vulnerability by analyzing a specific network—the Language Network (LN)—connecting many high-level processes and brain regions measured at rest. According to Crow’s hypothesis on the key role of language in the origin of psychoses, we expected an altered asymmetry of the LN in euthymic BDs. Eighteen euthymic BD patients (10 females; age = 54.50 ± 11.38 years) and 16 healthy controls (HC) (8 females; age = 51.16 ± 11.44 years) underwent a functional magnetic resonance imaging scan at rest. The LN was extracted through independent component analysis. Then, LN time series was used to compute the fractional amplitude of the low-frequency fluctuation (fALFF) index, which was then correlated with clinical scales. Compared with HC, euthymic patients showed an altered LN with greater activation of Broca’s area right ...
Objective: This study evaluated sodium and fluid balance disturbances in anorexia nervosa. Method... more Objective: This study evaluated sodium and fluid balance disturbances in anorexia nervosa. Methods: Serum urea, creatinine, urea nitrogen/creatinine ratio, protein concentration, osmolality, electrolytes, hemoglobin, and hematocrit were evaluated on admission, after intravenous fluid supplementation, and at discharge in 14 patients who had anorexia nervosa and were admitted to a medical unit for severe malnutrition and/or medical complications. Diet history and physical signs of salt and water depletion were also evaluated on admission. The diagnosis of plasma volume depletion was considered confirmed if serum urea nitrogen/creatinine ratio was higher than 25. Results: Mean body mass indexes were 12.9 2.4 kg/m 2 on admission and 14.2 2.0 kg/m 2 at discharge. Mean duration of hospitalization was 24.2 11.9 d. Plasma volume depletion was found on admission in nine patients (64%), and hyponatremia was associated with hypovolemia (hypo- volemic hyponatremia) in three of them. Most of the...
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2021
Purpose Recent evidence from neuroimaging research has shown that eating disorders (EDs) are char... more Purpose Recent evidence from neuroimaging research has shown that eating disorders (EDs) are characterized by alterations in interconnected neural systems, whose characteristics can be usefully described by connectomics tools. The present paper aimed to review the neuroimaging literature in EDs employing connectomic tools, and, specifically, graph theory analysis. Methods A systematic review of the literature was conducted to identify studies employing graph theory analysis on patients with eating disorders published before the 22nd of June 2020. Results Twelve studies were included in the systematic review. Ten of them address anorexia nervosa (AN) (AN = 199; acute AN = 85, weight recovered AN with acute diagnosis = 24; fully recovered AN = 90). The remaining two articles address patients with bulimia nervosa (BN) (BN = 48). Global and regional unbalance in segregation and integration properties were described in both disorders. Discussion The literature concerning the use of conne...
Journal of Affective Disorders, 2020
Background: Evidence provides inconsistent findings on risk factors and health outcomes associate... more Background: Evidence provides inconsistent findings on risk factors and health outcomes associated with loneliness. The aim of this work was to grade the evidence on risk factors and health outcomes associated with loneliness, using an umbrella review approach. Methods: For each meta-analytic association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity, evidence for small-study effect, excess significance bias and 95% prediction intervals were calculated, and used to grade significant evidence (p<0.05) from convincing to weak. For narrative systematic reviews, findings were reported descriptively. Results: From 210 studies initially evaluated, 14 publications were included, reporting on 18 outcomes, 795 studies, and 746,706 participants. Highly suggestive evidence (class II) supported the association between loneliness and incident dementia (relative risk, RR=1.26; 95%CI: 1.14-1.40, I 2 23.6%), prevalent paranoia (odds ratio, OR=3.36; 95%CI: 2.51-4.49, I 2 92.8%) and prevalent psychotic symptoms (OR=2.33; 95%CI: 1.68-3.22, I 2 56.5%). Pooled data supported the longitudinal association between loneliness and suicide attempts and depressive symptoms. In narrative systematic reviews, factors cross-sectionally associated with loneliness were age (in a U-shape way), female sex, quality of social contacts, low competence, socioeconomic status and medical chronic conditions. Limitations: low quality of the studies included; mainly cross-sectional evidence. Conclusions: This work is the first meta-evidence synthesis showing that highly suggestive and significant evidence supports the association between loneliness and adverse mental and physical health outcomes. More cohort studies are needed to disentangle the direction of the association between risk factors for loneliness and its related health outcomes.
European Eating Disorders Review, 2019
Two hundred forty six patients with eating disorders (EDs) recruited from eight Italian specializ... more Two hundred forty six patients with eating disorders (EDs) recruited from eight Italian specialized treatment centres were administered with the World Health Organization "Encounter Form," a standardized schedule that makes it possible to characterize the clinical pathways that patients follow to reach specialized care. The median time from symptoms onset to specialized care was 114 weeks. Primary "points of access to care" were general practitioners (25%), psychiatrists (18%), and clinical nutritionists (17%), followed by various other carers. All patients received specific psychotherapy, whereas only 11% of them were given psychotropic drugs. EDs are characterized by complex care pathways, with low rates of direct access to specialized care. Although the role of general practitioners remains crucial, they tend to follow different clinical routes to refer ED patients. Educational programmes on EDs should be addressed to general practitioners and clinical nutritionists, in order to ease the transition of ED patients to a mental health care setting.
International Journal of Eating Disorders, 2018
Objective: Growing evidence suggests an impact of weight suppression (WS) on severity and course ... more Objective: Growing evidence suggests an impact of weight suppression (WS) on severity and course of symptoms in patients with eating disorders (ED), but no study explored also the role of the weight loss speed (WLS) together with WS on the same clinical variables, which is the aim of the present work. Method: A mixed cross-sectional and longitudinal cohort study was employed. Four hundred and fourteen patients with anorexia nervosa (AN 5 208) or bulimia nervosa (BN 5 206) according to DSM-5 criteria were recruited and assessed at referral by means of clinical interviews and selfreported questionnaires. Body mass index and diagnostic status were re-evaluated at the end of treatment. Results: WS was positively correlated with body dissatisfaction in patients with AN (p 5 .005), but negatively correlated in BN (p 5 .022). In contrast, WLS was significantly inversely correlated with age and duration of illness in all ED (p < .001), and positively correlated with drive for thinness in BN (p 5 .007). After treatment, WS at intake predicted higher BMI increase in both AN and BN (p < .03), while higher WLS was significantly associated with a lower drop-out rate in patients with BN (p 5 .02), and predicted BMI increase only in restricting AN patients (p 5 .02). In the whole group, WLS significantly predicted remission status (p 5 .039). Discussion: In our study, both WS and WLS were associated with baseline "core" clinical variables and provided complementary abilities to predict weight gain and remission at the end of treatment. If replicated, our data suggest the importance of considering both WS and WLS as useful clinical variables in the baseline assessment of ED.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2010
We report about a complex case of pica in comorbidity with multiple sclerosis and binge eating di... more We report about a complex case of pica in comorbidity with multiple sclerosis and binge eating disorder. Pica is classified among the feeding and eating disorders of infancy and early childhood, but there is a debate in the literature about the psychopathology and classification of this behavior. Some authors emphasize the similarities with the obsessive-compulsive spectrum disorders, whereas others propose an interpretation of pica as an addiction or as an impulsive behavior. The clinical case that we describe provides a picture of impulsive and compulsive features that are very difficult to disentangle. It is noteworthy that hypercalcemia is reported to have a protective/therapeutic effect against multiple sclerosis and seems to increase the plasmatic levels of beta-endorphins. The nature, diagnostic classification, and functions of pica are a topic worthy of future investigation.
European Eating Disorders Review, 2020
Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the ... more Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: 1) to analyze the psychometric properties of the COVID Isolation Eating Scale (CIES), 2) to explore changes that occurred due to confinement in eating symptomatology; and 3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centers.Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patientsendorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.
European Psychiatry, 2021
IntroductionThe coronavirus disease 2019 (COVID-19) pandemic and the resulting containment measur... more IntroductionThe coronavirus disease 2019 (COVID-19) pandemic and the resulting containment measures, such as “lockdown” and “social distancing”, have had important consequences on people’s mental and physical health.ObjectivesWe aimed to study the effect of social isolation and subsequent re- exposure and eventual changes in general and ED-specific psychopathology in people with Eating Disorders (EDs).MethodsThree-hundred twelve Italian people with EDs (179 Anorexia Nervosa, 83 Bulimia Nervosa, 48 Binge Eating Disorder and 22 Other Specific Feeding Eating Disorder) were asked to fill-in an online survey to explore several dimensions such as: anxiety, depression, panic, insomnia, suicide ideation, stress, post-traumatic stress and obsessive-compulsive symptoms. Differences in ED specific and general symptoms among the 3 investigated time periods (before, during and after the end of lockdown) were assessed with a one-way ANOVA with repeated measures. Subsequently, ED diagnosis was int...
npj Schizophrenia, 2021
A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-... more A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-reporting their real-life functioning. In a large (n = 618) cohort of stable, community-dwelling schizophrenia patients we sought to: (1) examine the concordance of patients’ reports of their real-life functioning with the reports of their key caregiver; (2) identify which patient characteristics are associated to the differences between patients and informants. Patient-caregiver concordance of the ratings in three Specific Level of Functioning Scale (SLOF) domains (interpersonal relationships, everyday life skills, work skills) was evaluated with matched-pair t tests, the Lin’s concordance correlation, Somers’ D, and Bland–Altman plots with limits of agreement (LOA). Predictors of the patient-caregiver differences in SLOF ratings were assessed with a linear regression with multivariable fractional polynomials. Patients’ self-evaluation of functioning was higher than caregivers’ in all t...
European Eating Disorders Review, 2020
Brazilian Journal of Psychiatry, 2021
Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive d... more Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multidisciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring).
Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared gene... more Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa (BN) and problem alcohol use (genetic correlation [rg], twin-based=0.23-0.53). We estimated the genetic correlation between eating disorder and substance use and disorder phenotypes using data from genome-wide association studies (GWAS). Four eating disorder phenotypes (anorexia nervosa [AN], AN with binge-eating, AN without binge-eating, and a BN factor score), and eight substance-use-related phenotypes (drinks per week, alcohol use disorder [AUD], smoking initiation, current smoking, cigarettes per day, nicotine dependence, cannabis initiation, and cannabis use disorder) from eight studies were included. Significant genetic correlations were adjusted for variants associated with major depressive disorder (MDD). Total sample sizes per phenotype rang...
Brain, Behavior, and Immunity, 2018
The molecular underpinnings associated to first episode psychosis (FEP) remains to be elucidated,... more The molecular underpinnings associated to first episode psychosis (FEP) remains to be elucidated, but compelling evidence supported an association of FEP with blood alterations in biomarkers related to immune system, growth factors and metabolism regulators. Many of these studies have not been already confirmed in larger samples or have not considered the FEP diagnostic subgroups. In order to identify biochemical signatures of FEP, the serum levels of the growth factors BDNF and VEGF, the immune regulators IL-1RA, IL-6, IL-10 and IL-17, RANTES/CCL5, MIP-1b/CCL4, IL-8 and the metabolic regulators C-peptide, ghrelin, GIP, GLP-1, glucagon, insulin, leptin, PAI-1, resistin and visfatin were analysed in 260 subjects collected in the GET UP project. The results indicated an increase of MIP-1b/CCL4, VEGF, IL-6 and PAI-1, while IL-17, ghrelin, glucagon and GLP-1 were decreased in the whole sample of FEP patients (p < 0.01 for all markers except for PAI-1 p < 0.05). No differences were evidenced for these markers among the diagnostic groups that constitute the FEP sample, whereas IL-8 is increased only in patients with a diagnosis of affective psychosis. The principal component analysis (PCA) and variable importance analysis (VIA) indicated that MIP-1b/CCL4, ghrelin, glucagon, VEGF and GLP-1 were the variables mostly altered in FEP patients. On the contrary, none of the analysed markers nor a combination of them can discriminate between FEP diagnostic subgroups. These data evidence a profile of immune and metabolic alterations in FEP patients, providing new information on the molecular mechanism associated to the psychosis onset for the development of preventive strategies and innovative treatment targets.