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Papers by Filippo Dragogna

Research paper thumbnail of Number of episodes and duration of illness associated with hypertension and 10-year cardiovascular risk in patients with bipolar disorder type I

Psychiatry Research-neuroimaging, Feb 1, 2022

Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened wi... more Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened with an increased mortality and a significantly reduced life expectancy than general population, and cardiovascular diseases (CVD) are considered the most contributing conditions. The aim of the present study is to evaluate 10-year CV risk and the associated clinical characteristics in patients with SCZ, BD type I and II. Patients were consecutively recruited from two Italian psychiatric acute units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Three hundred patients were included. Patients with BD type I showed a higher prevalence of hypertension and 10-year CV risk score compared to the other groups. In subjects with BD type I, we found a significant correlation between duration of illness and number of mood episodes and both hypertension and 10-year CV risk score. Several preventive strategies should be provided to these vulnerable populations, such as correcting unhealthy lifestyles, prescribing medications at lower CV and metabolic risk, enhancing access to care.

Research paper thumbnail of Should the term ‘antipsychotic’ be changed to ‘multidimensional stabiliser’ in bipolar disorder? Towards a new denomination for ‘atypical antipsychotics’

Australian and New Zealand Journal of Psychiatry, May 31, 2013

The treatment of bipolar disorder (BD) has evolved significantly with the introduction of the ‘at... more The treatment of bipolar disorder (BD) has evolved significantly with the introduction of the ‘atypical’ antipsychotics. Prior to this, for approximately 40 years, the treatment of BD was based on mood stabilisers and anticonvulsants, such as lithium or carbamazepine, for both acute episodes and prophylaxis. Depressive states were managed by combining antidepressants (AD) and mood stabilisers, but unfortunately AD use has been associated with switching to hypomania or mania, or with an increase of rapid cycling in the long term, particularly with tricyclic antidepressants (TCAs) (Mundo et al., 2006). ‘Classical’ antipsychotics were used for patients experiencing acute manic episodes, alone or in combination with mood stabilisers (Sachs et al., 2002). In the last 15 years, however, new compounds such as olanzapine, quetiapine, aripiprazole, risperidone and ziprasidone have been approved by the Food and Drug Administration (FDA) and, with few exceptions, by the European Medicines Agency (EMEA), for the treatment of BD. The emergence of these compounds has drastically changed the landscape of BD treatment, since these novel molecules show good efficacy in both acute and maintenance phases, almost comparable to that of mood stabilisers (Altamura et al., 2011; Malhi et al., 2011). They have little in common with ‘classical’ antipsychotics and offer an alternative to established treatments, both as monotherapy and in combination, in both acute and long-term therapy. This broad action suggests that the term ‘antipsychotic’ may be outdated, ill-suited and misleading as a definition of the activity of ‘atypical’ compounds in BD. This finding parallels our experience in schizophrenia, where the ‘atypical’ antipsychotics have both led to new and innovative neurochemical hypotheses (beside the dopaminergic model) and proven to be effective in different psychopathological dimensions (Altamura, 1996, 2011). Their broad spectrum of activity on different dimensions of schizophrenia (psychotic, negative, affective, disorganised and impulsive) seems to be linked to their broader pharmacodynamic profile, in stark contrast to the dominant D2 antagonism (and predominantly antipsychotic effect) of the drugs introduced in the 1950s, 60s and 70s. Accordingly, in BD they also act on different psychopathological dimensions and help in reaching an optimal clinical response, particularly when combined with other agents. We will briefly review these novel antipsychotics and their therapeutic activity, both in monotherapy and in combination with mood stabilisers, in the different phases of BD.

Research paper thumbnail of Emergency Psychiatric Consultations During and after the COVID-19 Lockdown in Italy. A Multicentre Study

Social Science Research Network, 2021

The aim was to analyse the psychiatric consultations in nine Italian hospital emergency departmen... more The aim was to analyse the psychiatric consultations in nine Italian hospital emergency departments, by comparing the lockdown and post-lockdown periods of 2020 with the equivalent periods of 2019. Conclusions: We observed a decrease of psychiatric consultations during and after the lockdown. There was an increase in consultations for manic episodes and suicidality after the lockdown. The focus of psychiatric services must remain high particularly in this latter period.

Research paper thumbnail of Haloperidol and atipical antypsychotics in the long-term treatment of psychotic disorders : preliminary data from a naturalistic study

Research paper thumbnail of Trends in Consultations for Schizophrenia and Non-affective Psychoses in Italian Emergency Departments During and After the 2020 COVID-19 Lockdown

Schizophrenia bulletin open, 2021

To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum disor... more To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum disorders in nine Italian hospitals during the 2020 lockdown and postlockdown periods, compared to the equivalent periods in 2019. Methods: Characteristics of consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations. Results: During the 2020 lockdown the overall number of HED consultations for schizophrenia decreased by 40.7% and after the lockdown by 12.2% compared with 2019. No difference was found in the proportion of consultations that led to GHPU admissions or compulsory admissions. Suicidality rates did not differ across the two years, with the exception of ideations and plans (+5.9%) during the postlockdown period. We found an increase in benzodiazepine prescriptions in 2020 during the lockdown and postlockdown periods (+10.6% and +20.8%, respectively), and a decrease of prescriptions for short-acting sedative agents in the postlockdown period (-7.9%). An increase in the weekly trend of consultations occurred from March 11 to 17 (week 11) till June 26 to 30 (week 26). As a result, the initial gap in the number of consultations between the 2 years canceled out at the end of June. Conclusions: HED consultation rate for schizophrenia-spectrum disorders declined consistent with that of other psychiatric disorders. In the postlockdown period, the growth of suicidal ideation/planning and increase in the prescriptions of anxiolytic-sedating drugs may foreshadow that for some schizophrenia patients the exit from the lockdown period is not liberating, but rather a source of agitation or perturbation.

Research paper thumbnail of How Did COVID-19 Affect Suicidality? Data from a Multicentric Study in Lombardy

Journal of Clinical Medicine, May 29, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Hallucinatory disorder: A clinical entity?

Research paper thumbnail of Haloperidol and atipical antypsychotics in the long-term treatment of psychotic disorders : preliminary data from a naturalistic study

World Congress of Biological Psychiatry (WFSBP), 2009

Research paper thumbnail of How Did COVID-19 Affect Suicidality? Data from a Multicentric Study in Lombardy

Journal of Clinical Medicine, 2021

The aim of the study was to describe the characteristics of subjects accessing the emergency room... more The aim of the study was to describe the characteristics of subjects accessing the emergency rooms for suicidal behavior during the first epidemic wave of COVID-19 in three Emergency Departments (EDs) in Lombardy (Italy). A retrospective chart review was conducted for the period 8 March–3 June 2020, and during the same time frame in 2019. For all subjects accessing for suicidality, socio-demographic and clinical data were collected and compared between the two years. The proportion of subjects accessing for suicidality was significantly higher in 2020 than in 2019 (13.0 vs. 17.2%, p = 0.03). No differences between the two years were found for sex, triage priority level, history of substance abuse, factor triggering suicidality and discharge diagnosis. During 2020 a greater proportion of subjects did not show any mental disorders and were psychotropic drug-free. Women were more likely than men to receive inpatient psychiatric treatment, while men were more likely to be discharged wit...

Research paper thumbnail of The impact of COVID-19 on the psychiatric emergency departments of two Italian hospitals in Milan

Psychiatry Research, 2022

During the first wave of the SARS-CoV-2 contagion in Italy, mental health care services continuit... more During the first wave of the SARS-CoV-2 contagion in Italy, mental health care services continuity has been granted to the general population. Emergent and urgent conditions, however, are managed in collaboration with Emergency Departments (EDs). However, this collaboration may have suffered from the overload of the EDs due to the high number of SARS-CoV-2 positive patients. In this perspective, we analysed the possible impact of COVID-19 on the EDs accesses of psychiatric patients in two of the main hospitals of Milan, the “Luigi Sacco” Hospital and the “Fatebenefratelli” Hospital, comparing their admissions between the periods of March, April and May 2019 and 2020. We found a significant reduction in the number of evaluated patients in 2020 in both EDs. Emergency Medical Services (EMSs) brought a significant lower number of patients to the ED of Sacco Hospital during 2020, while this number increased for the ED of Fatebenefratelli Hospital, confirming the hypothesis that the overload of the Sacco Hospital ED significantly influenced the possibility to receive a psychiatric evaluation there. Moreover, we found a significant difference between diagnosis at discharge of the different samples.

Research paper thumbnail of Number of episodes and duration of illness associated with hypertension and 10-year cardiovascular risk in patients with bipolar disorder type I

Psychiatry Research, 2021

Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened wi... more Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened with an increased mortality and a significantly reduced life expectancy than general population, and cardiovascular diseases (CVD) are considered the most contributing conditions. The aim of the present study is to evaluate 10-year CV risk and the associated clinical characteristics in patients with SCZ, BD type I and II. Patients were consecutively recruited from two Italian psychiatric acute units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Three hundred patients were included. Patients with BD type I showed a higher prevalence of hypertension and 10-year CV risk score compared to the other groups. In subjects with BD type I, we found a significant correlation between duration of illness and number of mood episodes and both hypertension and 10-year CV risk score. Several preventive strategies should be provided to these vulnerable populations, such as correcting unhealthy lifestyles, prescribing medications at lower CV and metabolic risk, enhancing access to care.

Research paper thumbnail of Studio di correlazione tra variabilisintomatologiche, alessitimia e decorso clinico in pazienti con disturbo di panico in terapia integrata

Introduzione : numerosi studi si sono occupati di verificare l\u2019efficacia della terapia integ... more Introduzione : numerosi studi si sono occupati di verificare l\u2019efficacia della terapia integrata, farmacologica e psicoterapeutica breve (PB) o cognitivo-comportamentale (CBT), nel disturbo di panico (DAP) per evidenziare quali tecniche possano favorire un migliore outcome clinico a lungo termine. Scopo del nostro studio \ue8 verificare eventuali correlazioni tra sintomatologia clinica, funzionamento mentale e decorso di malattia. Metodi : sono stati reclutati 20 pazienti all\u2019esordio di un DAP, diagnosticato secondo i criteri DSM-IV-TR. Tutti i pazienti sono stati trattati con SSRI e assegnati alla PB o CBT attraverso la \u201cblocking randomization\u201d(Consort, 2001). Sono state somministrate Panic Attack and Anticipatory Anxiety Scale (PAAAS), Hamilton Ansia e Depressione (HAM-A, D) per la valutazione sintomatologica, Mark-Sheehan Phobia Scale (MSPS) per il grado di evitamento e Toronto Alexithymia Scale-20 item (TAS-20) per l\u2019alessitimia. Risultati : l\u2019analisi bivariata (Spearman\u2019s correlations) ha evidenziato una correlazione tra il fattore F3 della TAS-20 (Pensiero orientato verso l\u2019esterno) e il punteggio totale alla PAAAS (r = 0,888, p = 0,044). Conclusioni : il nostro studio evidenzia come la presenza di una disregolazione nell\u2019elaborazione delle esperienze emotive e dei correlati cognitivi e somatici del DAP sia predittiva di una maggiore gravit\ue0 sintomatologica. Tale funzionamento mentale potrebbe quindi contribuire alla persistenza di una vulnerabilit\ue0 alla sintomatologia nel temp

Research paper thumbnail of Clinical pharmacology of atypical antipsychotics: an update

EXCLI Journal, 2014

This review will concentrate on the clinical pharmacology, in particular pharmacodynamic data, re... more This review will concentrate on the clinical pharmacology, in particular pharmacodynamic data, related to atypical antipsychotics, clozapine, risperidone, paliperidone, olanzapine, que¬tiapine, amisulpride, ziprasidone, aripiprazole, asenapine, iloperidone, lurasidone and cariprazine. A summary of their acute pharmacokinetics properties are also reported. Four new second-generation antipsychotics are available: iloperidone, asenapine, lurasidone and in the next future cariprazine. Similar to ziprasidone and aripiprazole, these new agents are advisable for the lower propensity to give weight gain and metabolic abnormalities in comparison with older second-generation antipsychotics such as olanzapine or clozapine. Actually lurasidone seems to be best in terms of minimizing unwanted alterations in body weight and metabolic variables. Therapeutic drug monitoring is not strictly necessary for all of the new antipsychotic drugs because there are no unequivocal data supporting a relationsh...

Research paper thumbnail of Hallucinatory disorder: A clinical entity?

Research paper thumbnail of Trends in Consultations for Schizophrenia and Non-affective Psychoses in Italian Emergency Departments During and After the 2020 COVID-19 Lockdown

Schizophrenia Bulletin Open, 2021

Aims To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum ... more Aims To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum disorders in nine Italian hospitals during the 2020 lockdown and postlockdown periods, compared to the equivalent periods in 2019. Methods Characteristics of consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations. Results During the 2020 lockdown the overall number of HED consultations for schizophrenia decreased by 40.7% and after the lockdown by 12.2% compared with 2019. No difference was found in the proportion of consultations that led to GHPU admissions or compulsory admissions. Suicidality rates did not differ across the two years, with the exception of ideations and plans (+5.9%) during the postlockdown period. We found an increase in benzodiazepine prescriptions in 2020 during the lockdown and postlockdown periods (+10.6% and +20.8%, respectively), and a decrease of prescriptions for short...

Research paper thumbnail of Emergency Psychiatric Consultations During and After the COVID-19 Lockdown in Italy. A Multicentre Study

Frontiers in Psychiatry, 2021

Aims:The aim was to analyse the psychiatric consultations in nine Italian hospital emergency depa... more Aims:The aim was to analyse the psychiatric consultations in nine Italian hospital emergency departments, by comparing the lockdown and post-lockdown periods of 2020 with the equivalent periods of 2019.Methods:Characteristics of psychiatric consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations.Results:A 37.5% decrease in the number of consultations was seen during the lockdown period and 17.9% after the lockdown. The number of individual patients seen decreased by 34.9% during the lockdown and 11.2% after the lockdown. A significant change in the number of consultations from week 11 to week 18 occurred, followed by a gradual increase. There was a higher percentage of patients with previous psychiatric hospitalizations during the lockdown period (61.1 vs. 56.3%) and a lower percentage after the lockdown (59.7 vs. 64.7%). During the lockdown there was a large increase in psychiatric consultati...

Research paper thumbnail of Cardiovascular risk in patients with severe mental illness in Italy

European Psychiatry, 2020

Background Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders,... more Background Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders, are more frequently affected by metabolic syndrome and cardiovascular (CV) diseases than the general population, with a significant reduction in life expectancy. Beyond metabolic syndrome, quantifying the risk of CV morbidity in the long-term may help clinicians to put in place preventive strategies. In this study, we assessed 10-year CV risk in patients with SMI and healthy individuals using an algorithm validated on the Italian general population. Methods Patients aged 35–69 years diagnosed with SMI were consecutively recruited from psychiatric acute care units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Patients’ data ...

Research paper thumbnail of Contents Vol. 70, 2014

Research paper thumbnail of White matter metabolism differentiates schizophrenia and bipolar disorder: a preliminary PET study

Psychiatry Research: Neuroimaging, 2013

Fluorodeoxyglucose-F18 positron emission tomography studies (FDG-PET) have shown similar corticol... more Fluorodeoxyglucose-F18 positron emission tomography studies (FDG-PET) have shown similar corticolimbic metabolic dysregulation in bipolar disorder and schizophrenia, with hypoactive prefrontal cortex coupled with hyperactive anterior limbic areas. However, it is not clear whether white matter metabolism connecting these regions is differently affected in the two disorders. Twenty-six patients with schizophrenia (mean age ± S.D.=30.23 ± 9.7 year-old; 19 males; mean weight ± S.D.=71 ± 3 kg) and 26 patients with bipolar disorder (mean age ± S.D.=48.73 ± 13 year-old; 18 males; mean weight ± S.D.=75 ± 15 kg) underwent an FDG-PET scan. Normalized datasets the two groups of patients were compared on a voxel-by-voxel basis using a two-sample t statistic test as implemented in SPM8, and adding age as covariate. Group differences were assessed applying a threshold of p<0.0005. White matter metabolic rates significantly differed between schizophrenia and bipolar disorder, whereas no differences were shown for cortical activity. This is the first FDG-PET, to our best knowledge, directly comparing subjects with schizophrenia to those with bipolar disorder. It reports decreased activity in the center of large fronto-temporal and cerebellar white matter tracts in patients with schizophrenia in respect to those with bipolar disorder. This feature may characterize and differentiate the regional brain metabolism of the two illnesses.

Research paper thumbnail of Hallucinatory disorder, an original clinical picture? Clinical and imaging data

Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2008

Objective: The aim of this study was to verify the existence of areas of clinical and neurofuncti... more Objective: The aim of this study was to verify the existence of areas of clinical and neurofunctional homogeneity in a group of patients with auditory verbal hallucinations (AVHs) as an isolated symptom, attributable to what we have called "Hallucinatory Disorder" (HD) in an attempt to propose a clinical picture that is distinct from Schizophrenia. Method: Nine patients clinically characterised by chronic AVHs were compared with nine schizophrenic patients using the Structured Clinical Interview for DSM-III-R, BPRS, PANSS, SAPS, SANS, HRS-A, HRS-D, CDSS, MMSE, CGI and PSYRATS. Both groups of patients and nine healthy subjects underwent EEG and SPECT examinations. Results: Considering the psychopathological dimensions of Schizophrenia, in the HD patients clinical evaluations revealed a mono-dimensional clinical profile, whereas all these dimensions contributed to the clinical picture of the schizophrenic patients. The SPECT data showed that the schizophrenic patients had a reduced rCBF in some areas of the right frontal lobe, while the HD patients did not show any area of hypoperfusion. The SPECT hyperperfusion data showed an activation pattern in the HD patients that was characterised by the involvement of various cortical and subcortical cerebral areas, similar to those found in studies of inner speech and auditory verbal imagery. Conclusions: The two groups of patients present significant differences that seem capable of supporting the proposed hypothesis that HD may be an independent nosographical entity.

Research paper thumbnail of Number of episodes and duration of illness associated with hypertension and 10-year cardiovascular risk in patients with bipolar disorder type I

Psychiatry Research-neuroimaging, Feb 1, 2022

Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened wi... more Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened with an increased mortality and a significantly reduced life expectancy than general population, and cardiovascular diseases (CVD) are considered the most contributing conditions. The aim of the present study is to evaluate 10-year CV risk and the associated clinical characteristics in patients with SCZ, BD type I and II. Patients were consecutively recruited from two Italian psychiatric acute units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Three hundred patients were included. Patients with BD type I showed a higher prevalence of hypertension and 10-year CV risk score compared to the other groups. In subjects with BD type I, we found a significant correlation between duration of illness and number of mood episodes and both hypertension and 10-year CV risk score. Several preventive strategies should be provided to these vulnerable populations, such as correcting unhealthy lifestyles, prescribing medications at lower CV and metabolic risk, enhancing access to care.

Research paper thumbnail of Should the term ‘antipsychotic’ be changed to ‘multidimensional stabiliser’ in bipolar disorder? Towards a new denomination for ‘atypical antipsychotics’

Australian and New Zealand Journal of Psychiatry, May 31, 2013

The treatment of bipolar disorder (BD) has evolved significantly with the introduction of the ‘at... more The treatment of bipolar disorder (BD) has evolved significantly with the introduction of the ‘atypical’ antipsychotics. Prior to this, for approximately 40 years, the treatment of BD was based on mood stabilisers and anticonvulsants, such as lithium or carbamazepine, for both acute episodes and prophylaxis. Depressive states were managed by combining antidepressants (AD) and mood stabilisers, but unfortunately AD use has been associated with switching to hypomania or mania, or with an increase of rapid cycling in the long term, particularly with tricyclic antidepressants (TCAs) (Mundo et al., 2006). ‘Classical’ antipsychotics were used for patients experiencing acute manic episodes, alone or in combination with mood stabilisers (Sachs et al., 2002). In the last 15 years, however, new compounds such as olanzapine, quetiapine, aripiprazole, risperidone and ziprasidone have been approved by the Food and Drug Administration (FDA) and, with few exceptions, by the European Medicines Agency (EMEA), for the treatment of BD. The emergence of these compounds has drastically changed the landscape of BD treatment, since these novel molecules show good efficacy in both acute and maintenance phases, almost comparable to that of mood stabilisers (Altamura et al., 2011; Malhi et al., 2011). They have little in common with ‘classical’ antipsychotics and offer an alternative to established treatments, both as monotherapy and in combination, in both acute and long-term therapy. This broad action suggests that the term ‘antipsychotic’ may be outdated, ill-suited and misleading as a definition of the activity of ‘atypical’ compounds in BD. This finding parallels our experience in schizophrenia, where the ‘atypical’ antipsychotics have both led to new and innovative neurochemical hypotheses (beside the dopaminergic model) and proven to be effective in different psychopathological dimensions (Altamura, 1996, 2011). Their broad spectrum of activity on different dimensions of schizophrenia (psychotic, negative, affective, disorganised and impulsive) seems to be linked to their broader pharmacodynamic profile, in stark contrast to the dominant D2 antagonism (and predominantly antipsychotic effect) of the drugs introduced in the 1950s, 60s and 70s. Accordingly, in BD they also act on different psychopathological dimensions and help in reaching an optimal clinical response, particularly when combined with other agents. We will briefly review these novel antipsychotics and their therapeutic activity, both in monotherapy and in combination with mood stabilisers, in the different phases of BD.

Research paper thumbnail of Emergency Psychiatric Consultations During and after the COVID-19 Lockdown in Italy. A Multicentre Study

Social Science Research Network, 2021

The aim was to analyse the psychiatric consultations in nine Italian hospital emergency departmen... more The aim was to analyse the psychiatric consultations in nine Italian hospital emergency departments, by comparing the lockdown and post-lockdown periods of 2020 with the equivalent periods of 2019. Conclusions: We observed a decrease of psychiatric consultations during and after the lockdown. There was an increase in consultations for manic episodes and suicidality after the lockdown. The focus of psychiatric services must remain high particularly in this latter period.

Research paper thumbnail of Haloperidol and atipical antypsychotics in the long-term treatment of psychotic disorders : preliminary data from a naturalistic study

Research paper thumbnail of Trends in Consultations for Schizophrenia and Non-affective Psychoses in Italian Emergency Departments During and After the 2020 COVID-19 Lockdown

Schizophrenia bulletin open, 2021

To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum disor... more To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum disorders in nine Italian hospitals during the 2020 lockdown and postlockdown periods, compared to the equivalent periods in 2019. Methods: Characteristics of consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations. Results: During the 2020 lockdown the overall number of HED consultations for schizophrenia decreased by 40.7% and after the lockdown by 12.2% compared with 2019. No difference was found in the proportion of consultations that led to GHPU admissions or compulsory admissions. Suicidality rates did not differ across the two years, with the exception of ideations and plans (+5.9%) during the postlockdown period. We found an increase in benzodiazepine prescriptions in 2020 during the lockdown and postlockdown periods (+10.6% and +20.8%, respectively), and a decrease of prescriptions for short-acting sedative agents in the postlockdown period (-7.9%). An increase in the weekly trend of consultations occurred from March 11 to 17 (week 11) till June 26 to 30 (week 26). As a result, the initial gap in the number of consultations between the 2 years canceled out at the end of June. Conclusions: HED consultation rate for schizophrenia-spectrum disorders declined consistent with that of other psychiatric disorders. In the postlockdown period, the growth of suicidal ideation/planning and increase in the prescriptions of anxiolytic-sedating drugs may foreshadow that for some schizophrenia patients the exit from the lockdown period is not liberating, but rather a source of agitation or perturbation.

Research paper thumbnail of How Did COVID-19 Affect Suicidality? Data from a Multicentric Study in Lombardy

Journal of Clinical Medicine, May 29, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Hallucinatory disorder: A clinical entity?

Research paper thumbnail of Haloperidol and atipical antypsychotics in the long-term treatment of psychotic disorders : preliminary data from a naturalistic study

World Congress of Biological Psychiatry (WFSBP), 2009

Research paper thumbnail of How Did COVID-19 Affect Suicidality? Data from a Multicentric Study in Lombardy

Journal of Clinical Medicine, 2021

The aim of the study was to describe the characteristics of subjects accessing the emergency room... more The aim of the study was to describe the characteristics of subjects accessing the emergency rooms for suicidal behavior during the first epidemic wave of COVID-19 in three Emergency Departments (EDs) in Lombardy (Italy). A retrospective chart review was conducted for the period 8 March–3 June 2020, and during the same time frame in 2019. For all subjects accessing for suicidality, socio-demographic and clinical data were collected and compared between the two years. The proportion of subjects accessing for suicidality was significantly higher in 2020 than in 2019 (13.0 vs. 17.2%, p = 0.03). No differences between the two years were found for sex, triage priority level, history of substance abuse, factor triggering suicidality and discharge diagnosis. During 2020 a greater proportion of subjects did not show any mental disorders and were psychotropic drug-free. Women were more likely than men to receive inpatient psychiatric treatment, while men were more likely to be discharged wit...

Research paper thumbnail of The impact of COVID-19 on the psychiatric emergency departments of two Italian hospitals in Milan

Psychiatry Research, 2022

During the first wave of the SARS-CoV-2 contagion in Italy, mental health care services continuit... more During the first wave of the SARS-CoV-2 contagion in Italy, mental health care services continuity has been granted to the general population. Emergent and urgent conditions, however, are managed in collaboration with Emergency Departments (EDs). However, this collaboration may have suffered from the overload of the EDs due to the high number of SARS-CoV-2 positive patients. In this perspective, we analysed the possible impact of COVID-19 on the EDs accesses of psychiatric patients in two of the main hospitals of Milan, the “Luigi Sacco” Hospital and the “Fatebenefratelli” Hospital, comparing their admissions between the periods of March, April and May 2019 and 2020. We found a significant reduction in the number of evaluated patients in 2020 in both EDs. Emergency Medical Services (EMSs) brought a significant lower number of patients to the ED of Sacco Hospital during 2020, while this number increased for the ED of Fatebenefratelli Hospital, confirming the hypothesis that the overload of the Sacco Hospital ED significantly influenced the possibility to receive a psychiatric evaluation there. Moreover, we found a significant difference between diagnosis at discharge of the different samples.

Research paper thumbnail of Number of episodes and duration of illness associated with hypertension and 10-year cardiovascular risk in patients with bipolar disorder type I

Psychiatry Research, 2021

Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened wi... more Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened with an increased mortality and a significantly reduced life expectancy than general population, and cardiovascular diseases (CVD) are considered the most contributing conditions. The aim of the present study is to evaluate 10-year CV risk and the associated clinical characteristics in patients with SCZ, BD type I and II. Patients were consecutively recruited from two Italian psychiatric acute units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Three hundred patients were included. Patients with BD type I showed a higher prevalence of hypertension and 10-year CV risk score compared to the other groups. In subjects with BD type I, we found a significant correlation between duration of illness and number of mood episodes and both hypertension and 10-year CV risk score. Several preventive strategies should be provided to these vulnerable populations, such as correcting unhealthy lifestyles, prescribing medications at lower CV and metabolic risk, enhancing access to care.

Research paper thumbnail of Studio di correlazione tra variabilisintomatologiche, alessitimia e decorso clinico in pazienti con disturbo di panico in terapia integrata

Introduzione : numerosi studi si sono occupati di verificare l\u2019efficacia della terapia integ... more Introduzione : numerosi studi si sono occupati di verificare l\u2019efficacia della terapia integrata, farmacologica e psicoterapeutica breve (PB) o cognitivo-comportamentale (CBT), nel disturbo di panico (DAP) per evidenziare quali tecniche possano favorire un migliore outcome clinico a lungo termine. Scopo del nostro studio \ue8 verificare eventuali correlazioni tra sintomatologia clinica, funzionamento mentale e decorso di malattia. Metodi : sono stati reclutati 20 pazienti all\u2019esordio di un DAP, diagnosticato secondo i criteri DSM-IV-TR. Tutti i pazienti sono stati trattati con SSRI e assegnati alla PB o CBT attraverso la \u201cblocking randomization\u201d(Consort, 2001). Sono state somministrate Panic Attack and Anticipatory Anxiety Scale (PAAAS), Hamilton Ansia e Depressione (HAM-A, D) per la valutazione sintomatologica, Mark-Sheehan Phobia Scale (MSPS) per il grado di evitamento e Toronto Alexithymia Scale-20 item (TAS-20) per l\u2019alessitimia. Risultati : l\u2019analisi bivariata (Spearman\u2019s correlations) ha evidenziato una correlazione tra il fattore F3 della TAS-20 (Pensiero orientato verso l\u2019esterno) e il punteggio totale alla PAAAS (r = 0,888, p = 0,044). Conclusioni : il nostro studio evidenzia come la presenza di una disregolazione nell\u2019elaborazione delle esperienze emotive e dei correlati cognitivi e somatici del DAP sia predittiva di una maggiore gravit\ue0 sintomatologica. Tale funzionamento mentale potrebbe quindi contribuire alla persistenza di una vulnerabilit\ue0 alla sintomatologia nel temp

Research paper thumbnail of Clinical pharmacology of atypical antipsychotics: an update

EXCLI Journal, 2014

This review will concentrate on the clinical pharmacology, in particular pharmacodynamic data, re... more This review will concentrate on the clinical pharmacology, in particular pharmacodynamic data, related to atypical antipsychotics, clozapine, risperidone, paliperidone, olanzapine, que¬tiapine, amisulpride, ziprasidone, aripiprazole, asenapine, iloperidone, lurasidone and cariprazine. A summary of their acute pharmacokinetics properties are also reported. Four new second-generation antipsychotics are available: iloperidone, asenapine, lurasidone and in the next future cariprazine. Similar to ziprasidone and aripiprazole, these new agents are advisable for the lower propensity to give weight gain and metabolic abnormalities in comparison with older second-generation antipsychotics such as olanzapine or clozapine. Actually lurasidone seems to be best in terms of minimizing unwanted alterations in body weight and metabolic variables. Therapeutic drug monitoring is not strictly necessary for all of the new antipsychotic drugs because there are no unequivocal data supporting a relationsh...

Research paper thumbnail of Hallucinatory disorder: A clinical entity?

Research paper thumbnail of Trends in Consultations for Schizophrenia and Non-affective Psychoses in Italian Emergency Departments During and After the 2020 COVID-19 Lockdown

Schizophrenia Bulletin Open, 2021

Aims To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum ... more Aims To analyze the hospital emergency department (HED) consultations for schizophrenia-spectrum disorders in nine Italian hospitals during the 2020 lockdown and postlockdown periods, compared to the equivalent periods in 2019. Methods Characteristics of consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations. Results During the 2020 lockdown the overall number of HED consultations for schizophrenia decreased by 40.7% and after the lockdown by 12.2% compared with 2019. No difference was found in the proportion of consultations that led to GHPU admissions or compulsory admissions. Suicidality rates did not differ across the two years, with the exception of ideations and plans (+5.9%) during the postlockdown period. We found an increase in benzodiazepine prescriptions in 2020 during the lockdown and postlockdown periods (+10.6% and +20.8%, respectively), and a decrease of prescriptions for short...

Research paper thumbnail of Emergency Psychiatric Consultations During and After the COVID-19 Lockdown in Italy. A Multicentre Study

Frontiers in Psychiatry, 2021

Aims:The aim was to analyse the psychiatric consultations in nine Italian hospital emergency depa... more Aims:The aim was to analyse the psychiatric consultations in nine Italian hospital emergency departments, by comparing the lockdown and post-lockdown periods of 2020 with the equivalent periods of 2019.Methods:Characteristics of psychiatric consultations, patients, and drug prescriptions were analyzed. Joinpoint models were used to identify changes in the weekly trend of consultations.Results:A 37.5% decrease in the number of consultations was seen during the lockdown period and 17.9% after the lockdown. The number of individual patients seen decreased by 34.9% during the lockdown and 11.2% after the lockdown. A significant change in the number of consultations from week 11 to week 18 occurred, followed by a gradual increase. There was a higher percentage of patients with previous psychiatric hospitalizations during the lockdown period (61.1 vs. 56.3%) and a lower percentage after the lockdown (59.7 vs. 64.7%). During the lockdown there was a large increase in psychiatric consultati...

Research paper thumbnail of Cardiovascular risk in patients with severe mental illness in Italy

European Psychiatry, 2020

Background Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders,... more Background Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders, are more frequently affected by metabolic syndrome and cardiovascular (CV) diseases than the general population, with a significant reduction in life expectancy. Beyond metabolic syndrome, quantifying the risk of CV morbidity in the long-term may help clinicians to put in place preventive strategies. In this study, we assessed 10-year CV risk in patients with SMI and healthy individuals using an algorithm validated on the Italian general population. Methods Patients aged 35–69 years diagnosed with SMI were consecutively recruited from psychiatric acute care units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Patients’ data ...

Research paper thumbnail of Contents Vol. 70, 2014

Research paper thumbnail of White matter metabolism differentiates schizophrenia and bipolar disorder: a preliminary PET study

Psychiatry Research: Neuroimaging, 2013

Fluorodeoxyglucose-F18 positron emission tomography studies (FDG-PET) have shown similar corticol... more Fluorodeoxyglucose-F18 positron emission tomography studies (FDG-PET) have shown similar corticolimbic metabolic dysregulation in bipolar disorder and schizophrenia, with hypoactive prefrontal cortex coupled with hyperactive anterior limbic areas. However, it is not clear whether white matter metabolism connecting these regions is differently affected in the two disorders. Twenty-six patients with schizophrenia (mean age ± S.D.=30.23 ± 9.7 year-old; 19 males; mean weight ± S.D.=71 ± 3 kg) and 26 patients with bipolar disorder (mean age ± S.D.=48.73 ± 13 year-old; 18 males; mean weight ± S.D.=75 ± 15 kg) underwent an FDG-PET scan. Normalized datasets the two groups of patients were compared on a voxel-by-voxel basis using a two-sample t statistic test as implemented in SPM8, and adding age as covariate. Group differences were assessed applying a threshold of p<0.0005. White matter metabolic rates significantly differed between schizophrenia and bipolar disorder, whereas no differences were shown for cortical activity. This is the first FDG-PET, to our best knowledge, directly comparing subjects with schizophrenia to those with bipolar disorder. It reports decreased activity in the center of large fronto-temporal and cerebellar white matter tracts in patients with schizophrenia in respect to those with bipolar disorder. This feature may characterize and differentiate the regional brain metabolism of the two illnesses.

Research paper thumbnail of Hallucinatory disorder, an original clinical picture? Clinical and imaging data

Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2008

Objective: The aim of this study was to verify the existence of areas of clinical and neurofuncti... more Objective: The aim of this study was to verify the existence of areas of clinical and neurofunctional homogeneity in a group of patients with auditory verbal hallucinations (AVHs) as an isolated symptom, attributable to what we have called "Hallucinatory Disorder" (HD) in an attempt to propose a clinical picture that is distinct from Schizophrenia. Method: Nine patients clinically characterised by chronic AVHs were compared with nine schizophrenic patients using the Structured Clinical Interview for DSM-III-R, BPRS, PANSS, SAPS, SANS, HRS-A, HRS-D, CDSS, MMSE, CGI and PSYRATS. Both groups of patients and nine healthy subjects underwent EEG and SPECT examinations. Results: Considering the psychopathological dimensions of Schizophrenia, in the HD patients clinical evaluations revealed a mono-dimensional clinical profile, whereas all these dimensions contributed to the clinical picture of the schizophrenic patients. The SPECT data showed that the schizophrenic patients had a reduced rCBF in some areas of the right frontal lobe, while the HD patients did not show any area of hypoperfusion. The SPECT hyperperfusion data showed an activation pattern in the HD patients that was characterised by the involvement of various cortical and subcortical cerebral areas, similar to those found in studies of inner speech and auditory verbal imagery. Conclusions: The two groups of patients present significant differences that seem capable of supporting the proposed hypothesis that HD may be an independent nosographical entity.