G. Minnai - Academia.edu (original) (raw)
Papers by G. Minnai
International Clinical Psychopharmacology, 2009
To compare the effectiveness of a switch from haloperidol (N = 99), olanzapine (N = 82), or rispe... more To compare the effectiveness of a switch from haloperidol (N = 99), olanzapine (N = 82), or risperidone (N = 104) to 12 weeks of treatment with 80-160 mg/day ziprasidone in patients with stable schizophrenia or schizoaffective disorder. Stable outpatients with persistent symptoms or troublesome side effects were switched using one of three 1-week taper/switch strategies as determined by the investigator. Efficacy was assessed using the Brief Psychiatric Rating Scale score, Clinical Global Impression, Positive and Negative Symptom Scale, Montgomery-Å sberg Depression Rating Scale, and the Global Assessment of Functioning Scale, and tolerability by using standard measures of weight change, extrapyramidal symptoms, and laboratory findings. Suboptimal efficacy was the primary reason for switching. The preferred switch strategy was immediate discontinuation, and the preferred dosing regimen was 120 mg/day. Completer rates were 68, 60, and 86% in the haloperidol, risperidone, and olanzapine pre-switch groups, respectively. At week 12, a switch to ziprasidone resulted in statistically significant improvement from baseline on the Brief Psychiatric Rating Scale score, Clinical Global Impression-Improvement, Positive and Negative Symptom Scale, and Global Assessment of Functioning scales, reduction in extrapyramidal symptoms and a neutral impact on metabolic parameters. Switch from olanzapine and risperidone resulted in weight reduction and from haloperidol in some weight increase. In conclusion, oral ziprasidone of 80-160 mg/day with food was a clinically valuable treatment option for stable patients with schizophrenia or schizoaffective disorder experiencing suboptimal efficacy or poor tolerability with haloperidol, olanzapine, or risperidone.
International Journal of Bipolar Disorders, 2013
Journal of Affective Disorders, 2003
Background: Recognition by the DSM-IV of rapid cyclicity as a course specifier has raised the que... more Background: Recognition by the DSM-IV of rapid cyclicity as a course specifier has raised the question of the stability and long-term outcome of rapid-cycling (RC) patients. Data on this topic is sparse and often inconsistent. To our knowledge, these are the first personally follorved patients over the long term, dealing directly with the issue of the duration of the RC course. Methods; We examined the evolution of the course of 109 RC patients (68 women and 41 men) followed for a minimum of 2 years and up to 36 years, beginning with the index episode rvhen the RC course rvas diagnosed by the authors (A.K.. G.PM., PG., L.P, D.R.). Patients rvere included in the study if they met criteria for RC as defined by>4 affective episodes per year (Dunner and Fieve. 19'74).The follow-up period varied from 2-5 years for 25 patients, 6-10 years for 2,1 patients, I l-l-5 years for 24 patients-16-20 years for l9 patients, 2l-25 years for 13 patients, 30-36 years for four patients. Results: In l3 patients (l2Eo),RC emerged spontaneously and in 96 patients (887o), it rvas associated with antidepressant and crther trcatments. In l9 r,vomen (28Vo of all rvomen) RC course started in perimenopausal age (45-54 years). The mean duration of RC during the follow-up period was 7.86 years (range 1-32) and its total duration (including RC course prior to the follorv-up period.l rvas ll years (range l-4O). The total duration of the affective disorder, from the first episode to the end of the follorv-up, rvas 21.78 years (range l-70). At the end of the follow-up, 36 patients (337o) had complete remission for at least the past year,44 (407o) stayed rapid cycling with severe episodes (six of this group committed suicide), rvhile l5 (l.lclo) rvere rapid cycling but rvith attenuated episodes. The other l4 patients (137o) became long cyclers, eight rvith severe episodes and six rvith milder ones. The main distinguishing features between those rvho remitted from and those rvho persisted in the RC course rvere: (l) the initial cycle pattern: patients with Depression-Hypomania(mania)-Free interval cl,cles (53 patients) had a worse outcome: 26.47o remitted and 52.87a persisted in the RC course through to the end of the follou, up period. The Mania/Hypomania-Depression-Fiee interval cycles (22 patients) had a significantly better outcome. rvith 507o remitted and2'7.2Va persisting RC; and (2) the occunence of the switch process from depression to hypomania/ mania and the occurrence of agitated depressions made the prognosis worse. Continuous treatment rvas more effective against mania/hypomania than against depression, yet in all persisting RC cases the mania/hypomania remitted only partially. Limitations: These data derive from clinics known for their expertise in mood disorders, and they may have
Annals of General Psychiatry, 2009
Background: Factors Influencing Depression Endpoints Research (FINDER) is a 6-month, prospective,... more Background: Factors Influencing Depression Endpoints Research (FINDER) is a 6-month, prospective, observational study carried out in 12 European countries aimed at investigating health-related quality of life (HRQoL) in outpatients receiving pharmacological treatment for a first or new depressive episode. Baseline characteristics of patients enrolled in Italy are presented. Methods: All treatment decisions were at the discretion of the investigator. Data were collected at baseline and after 3 and 6 months of treatment. Baseline evaluations included demographics, medical and psychiatric history, and medications used in the last 24 months and prescribed at enrolment. The Hospital Anxiety and Depression Scale (HADS), was adopted to evaluate depressive symptoms, while somatic and painful physical symptoms were assessed by using the Somatic Symptom Inventory (SSI) and a 0 to 100 mm visual analogue scale (VAS), HRQoL via 36-item Short Form Health Survey (SF-36), and the European Quality of Life 5-Dimensions (EQ-5D) instrument. Results: A total of 513 patients were recruited across 38 sites. The mean ± standard deviation (SD) age at first depressive episode was 38.7 ± 15.9 years, the mean duration of depression 10.6 ± 12.3 years. The most common psychiatric comorbidities in the previous 24 months were anxiety/panic (72.6%) and obsessive/compulsive disorders (13.4%), while 35.9% had functional somatic syndromes. Most patients (65.1%) reported pain from any cause. Monotherapy with selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) was prescribed at enrolment in 64.5% and 6.4% of the cases, respectively. The most commonly prescribed agents were sertraline (17.3%), escitalopram (16.2%), venlaflaxine (15.6%) and paroxetine (14.8%). The mean HADS subscores for depression and anxiety were 13.3 ± 4.2 and 12.2 ± 3.9, respectively; 76.4% of patients could be defined as being 'probable cases' for depression and 66.2% for anxiety. The mean total score of VAS-pain in the last week was 42.9 ± 27.1, with highest scores reported in the 'interference of pain with daily activities' and in 'amount of time patient was awake and had pain'. From SF-36, the worst health status was found for role limitations due to emotional problem, mental health and social functioning. A mean score < 50 (that is, below the standardised population norm) was also found in all remaining domains. The SF-36 summary scores and EQ-5D (health status and VAS) were lower in patients with moderate/severe pain than in those with no or mild pain. Conclusion: The baseline results of patients enrolled in the FINDER study in Italy show clinical and functional impairments, and poor HRQoL. The results obtained after 6 months of therapy will permit better understanding the effects of different variables on clinical outcomes and HRQoL.
Journal of Clinical Psychiatry, 1999
The widely accepted impression that substance abuse and dependence are associated with increased ... more The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was more common in nonmixed bip...
Acta Psychiatrica Scandinavica Supplementum, 1985
Eighty-five Italian and forty-nine Swedish patients consecutively admitted for compulsory treatme... more Eighty-five Italian and forty-nine Swedish patients consecutively admitted for compulsory treatment to either an Italian or a Swedish psychiatric unit in selected areas of the two countries have participated in an exploratory study aimed at assessing the main characteristics of compulsory admitted patients, and in particular, the immediate reason for admission. The two series proved to be quite similar as concerns most sociodemographic variables, and as concerns clinical diagnosis and severity of the morbid condition at admission as measured by means of a rating scale. More Swedish than Italian patients lived alone when admitted to hospital, and for more of them the request for admission was made by other people than relatives, and a larger proportion of them was accompanied to the hospital by medical or social welfare personnel. In both series the largest proportion had a low educational level and belonged to the lower social groups. The same proportion in the two series had previo...
International Pharmacopsychiatry, 1981
434 bipolar manic-depressive patients were followed longitudinally. The course of the disease cha... more 434 bipolar manic-depressive patients were followed longitudinally. The course of the disease changed in many patients over the years. 67 cases became rapid cyclers (two or more cycles per year); in 40 of these cases (12 men and 28 women) the change of the course took place after intense or protracted use of antidepressant drugs. In their previous course these patients had not received antidepressant drugs. The common feature of the transformation of the previous course to a continuous circular one was the appearance for the first time in the course of the disease of hypomanic episodes after the depressions, or the accentuation of hypomanias that had been of milder intensity in previous recurrences. The patients who developed continuous circularity under antidepressant drug treatment were of highly energetic temperament. The hypothesis is advanced that these patients have latent hypomanias, which become clinically manifest under the action of antidepressants. The intensification of ...
Minerva ginecologica, 1979
A mixed affective syndrome is described which meets the criteria for major depression but not tho... more A mixed affective syndrome is described which meets the criteria for major depression but not those of the DSM III-R for a mixed state. The clinical picture is characterized by lack of motor retardation and fluent verbalization; the facial expression is animated and sometimes dramatic. Patients suffer considerably and are often tearful. They complain of inner tension and restlessness, racing thoughts and despair. Emotional lability and momentary irritability are observed. Insomnia occurs initially or with frequent early waking. Suicidal ideation occurs and makes the syndrome of concern in view of its impulsive nature. Antidepressants increase restlessness, insomnia, aggressiveness and the impulsiveness of suicidal ideation. Low-dose neuroleptics, lithium and anticonvulsivants are highly effective. A few sessions of ECT offer rapid improvement.
1. Adv Biochem Psychopharmacol. 1995;49:127-47. The long term prophylaxis of affective disorders.... more 1. Adv Biochem Psychopharmacol. 1995;49:127-47. The long term prophylaxis of affective disorders. Koukopoulos A, Reginaldi D, Minnai G, Serra G, Pani L, Johnson FN. Centro Lucio Bini, Rome, Italy. PMID: 7653332 [PubMed - indexed for MEDLINE]. Publication Types: ...
Advances in biochemical psychopharmacology, 1982
BACKGROUND The widely accepted impression that substance abuse and dependence are associated with... more BACKGROUND The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. METHOD Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. RESULTS The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was m...
Neuroscience Letters, 2016
Electroconvulsive therapy (ECT), developed in the 30's by Bini and Cerletti, remains a ke... more Electroconvulsive therapy (ECT), developed in the 30's by Bini and Cerletti, remains a key element of the therapeutic armamentarium in psychiatry, particularly for severe and life-threatening psychiatric symptoms. However, despite its well-established clinical efficacy, the prescription of ECT has declined constantly over the years due to concerns over its safety (cognitive side effects) and an increasingly negative public perception. As for other treatments in the field of psychiatry, ECT is well suited to a personalized approach that would increment its efficacy, as well as reducing the impact of side effects. This should be based on the priori identification of sub-populations of patients sharing common clinical and biological features that predict a good response to ECT. In this review we have selectively reviewed the evidence on clinical and biological predictors of ECT response. Clinical features such as an older age, presence of psychotic and melancholic depression, a high severity of suicide behavior, and speed of response, appear to be shared by ECT good responders with depressive symptoms. In mania, a greater severity of the index episode, and a reduction of whole brain cortical blood flow are associated with ECT good response. Biological determinants of ECT response in depressive patients are the presence of pre-treatment hyperconnectivity between key areas of brain circuitry of depression, as well as of reduced glutamine/glutamate levels, particularly in the anterior cingulated cortex (ACC). Furthermore, pre ECT high plasma homovanillic acid (HVA) levels, as well as of tumor necrosis factor (TNF)-α, and low pre-ECT levels of S-100B protein, appear to predict ECT response. Finally, polymorphisms within the genes encoding for the brain-derived neurotrophic factor (BDNF), the dopamine 2 receptor gene (DRD2), the dopamine receptor 3 gene (DRD3), the cathechol-o-methyltransferase (COMT), the serotonin-transporter (5-HTT), the 5-hydroxytryptamine 2A receptor (5-HT2A), and the norepinephrine transporter (NET), appear to predict a good response to ECT. The integration of these data in specific treatment algorithm might facilitate a personalized approach in ECT.
Journal of Affective Disorders, 2016
Bipolar disorder (BD) encompasses manic and depressive episodes and an illness-free interval. Tre... more Bipolar disorder (BD) encompasses manic and depressive episodes and an illness-free interval. Treatments used in BD patients may influence the ill phases with different actions on the illness-free interval. We performed a naturalistic mirror-image retrospective study analyzing the number of episodes and admissions in 41 BD patients for the same period of time of 5 years before and after electroconvulsive therapy (ECT). Furthermore, we assessed the duration of free intervals before and after ECT as a sign of prolonged well-being. Univariate analysis with t-test was used to compare differences before and after ECT, while analysis of variance was used to compare factors possibly associated with the efficacy on free-interval of ECT. Comparing the 5-year periods before and after ECT, we found significantly longer [13.2±9.0 months before ECT to 25.1±19.1 after treatment (t=3.8; p&amp;amp;amp;lt;0.0001)] free intervals, as well as significant reductions in the number of episodes [5.9±3.0 before ECT to 1.0±1.7 after treatment (t=9.3; p&amp;amp;amp;lt;0.0001)], and in the number of admissions [2.2±1.3 before ECT to 0.2±0.5 after treatment (t=9.4; p&amp;amp;amp;lt;0.0001)]. The main limitations of this study consisted in the relatively small sample size, the mirror-image retrospective naturalistic study design and possibly patient selection bias. Electroconvulsive therapy seemed to increase free-intervals and reduced number of BD episodes and admissions. It is plausible that ECT, along with suspending antidepressant treatment, might carry intrinsic stabilizing effect on the course of BD.
Psychiatry the State of the Art, 1985
The Journal of clinical psychiatry, 1999
The widely accepted impression that substance abuse and dependence are associated with increased ... more The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was more common in nonmixed bip...
International pharmacopsychiatry, 1981
434 bipolar manic-depressive patients were followed longitudinally. The course of the disease cha... more 434 bipolar manic-depressive patients were followed longitudinally. The course of the disease changed in many patients over the years. 67 cases became rapid cyclers (two or more cycles per year); in 40 of these cases (12 men and 28 women) the change of the course took place after intense or protracted use of antidepressant drugs. In their previous course these patients had not received antidepressant drugs. The common feature of the transformation of the previous course to a continuous circular one was the appearance for the first time in the course of the disease of hypomanic episodes after the depressions, or the accentuation of hypomanias that had been of milder intensity in previous recurrences. The patients who developed continuous circularity under antidepressant drug treatment were of highly energetic temperament. The hypothesis is advanced that these patients have latent hypomanias, which become clinically manifest under the action of antidepressants. The intensification of ...
Advances in biochemical psychopharmacology, 1982
International Clinical Psychopharmacology, 2009
To compare the effectiveness of a switch from haloperidol (N = 99), olanzapine (N = 82), or rispe... more To compare the effectiveness of a switch from haloperidol (N = 99), olanzapine (N = 82), or risperidone (N = 104) to 12 weeks of treatment with 80-160 mg/day ziprasidone in patients with stable schizophrenia or schizoaffective disorder. Stable outpatients with persistent symptoms or troublesome side effects were switched using one of three 1-week taper/switch strategies as determined by the investigator. Efficacy was assessed using the Brief Psychiatric Rating Scale score, Clinical Global Impression, Positive and Negative Symptom Scale, Montgomery-Å sberg Depression Rating Scale, and the Global Assessment of Functioning Scale, and tolerability by using standard measures of weight change, extrapyramidal symptoms, and laboratory findings. Suboptimal efficacy was the primary reason for switching. The preferred switch strategy was immediate discontinuation, and the preferred dosing regimen was 120 mg/day. Completer rates were 68, 60, and 86% in the haloperidol, risperidone, and olanzapine pre-switch groups, respectively. At week 12, a switch to ziprasidone resulted in statistically significant improvement from baseline on the Brief Psychiatric Rating Scale score, Clinical Global Impression-Improvement, Positive and Negative Symptom Scale, and Global Assessment of Functioning scales, reduction in extrapyramidal symptoms and a neutral impact on metabolic parameters. Switch from olanzapine and risperidone resulted in weight reduction and from haloperidol in some weight increase. In conclusion, oral ziprasidone of 80-160 mg/day with food was a clinically valuable treatment option for stable patients with schizophrenia or schizoaffective disorder experiencing suboptimal efficacy or poor tolerability with haloperidol, olanzapine, or risperidone.
International Journal of Bipolar Disorders, 2013
Journal of Affective Disorders, 2003
Background: Recognition by the DSM-IV of rapid cyclicity as a course specifier has raised the que... more Background: Recognition by the DSM-IV of rapid cyclicity as a course specifier has raised the question of the stability and long-term outcome of rapid-cycling (RC) patients. Data on this topic is sparse and often inconsistent. To our knowledge, these are the first personally follorved patients over the long term, dealing directly with the issue of the duration of the RC course. Methods; We examined the evolution of the course of 109 RC patients (68 women and 41 men) followed for a minimum of 2 years and up to 36 years, beginning with the index episode rvhen the RC course rvas diagnosed by the authors (A.K.. G.PM., PG., L.P, D.R.). Patients rvere included in the study if they met criteria for RC as defined by>4 affective episodes per year (Dunner and Fieve. 19'74).The follow-up period varied from 2-5 years for 25 patients, 6-10 years for 2,1 patients, I l-l-5 years for 24 patients-16-20 years for l9 patients, 2l-25 years for 13 patients, 30-36 years for four patients. Results: In l3 patients (l2Eo),RC emerged spontaneously and in 96 patients (887o), it rvas associated with antidepressant and crther trcatments. In l9 r,vomen (28Vo of all rvomen) RC course started in perimenopausal age (45-54 years). The mean duration of RC during the follow-up period was 7.86 years (range 1-32) and its total duration (including RC course prior to the follorv-up period.l rvas ll years (range l-4O). The total duration of the affective disorder, from the first episode to the end of the follorv-up, rvas 21.78 years (range l-70). At the end of the follow-up, 36 patients (337o) had complete remission for at least the past year,44 (407o) stayed rapid cycling with severe episodes (six of this group committed suicide), rvhile l5 (l.lclo) rvere rapid cycling but rvith attenuated episodes. The other l4 patients (137o) became long cyclers, eight rvith severe episodes and six rvith milder ones. The main distinguishing features between those rvho remitted from and those rvho persisted in the RC course rvere: (l) the initial cycle pattern: patients with Depression-Hypomania(mania)-Free interval cl,cles (53 patients) had a worse outcome: 26.47o remitted and 52.87a persisted in the RC course through to the end of the follou, up period. The Mania/Hypomania-Depression-Fiee interval cycles (22 patients) had a significantly better outcome. rvith 507o remitted and2'7.2Va persisting RC; and (2) the occunence of the switch process from depression to hypomania/ mania and the occurrence of agitated depressions made the prognosis worse. Continuous treatment rvas more effective against mania/hypomania than against depression, yet in all persisting RC cases the mania/hypomania remitted only partially. Limitations: These data derive from clinics known for their expertise in mood disorders, and they may have
Annals of General Psychiatry, 2009
Background: Factors Influencing Depression Endpoints Research (FINDER) is a 6-month, prospective,... more Background: Factors Influencing Depression Endpoints Research (FINDER) is a 6-month, prospective, observational study carried out in 12 European countries aimed at investigating health-related quality of life (HRQoL) in outpatients receiving pharmacological treatment for a first or new depressive episode. Baseline characteristics of patients enrolled in Italy are presented. Methods: All treatment decisions were at the discretion of the investigator. Data were collected at baseline and after 3 and 6 months of treatment. Baseline evaluations included demographics, medical and psychiatric history, and medications used in the last 24 months and prescribed at enrolment. The Hospital Anxiety and Depression Scale (HADS), was adopted to evaluate depressive symptoms, while somatic and painful physical symptoms were assessed by using the Somatic Symptom Inventory (SSI) and a 0 to 100 mm visual analogue scale (VAS), HRQoL via 36-item Short Form Health Survey (SF-36), and the European Quality of Life 5-Dimensions (EQ-5D) instrument. Results: A total of 513 patients were recruited across 38 sites. The mean ± standard deviation (SD) age at first depressive episode was 38.7 ± 15.9 years, the mean duration of depression 10.6 ± 12.3 years. The most common psychiatric comorbidities in the previous 24 months were anxiety/panic (72.6%) and obsessive/compulsive disorders (13.4%), while 35.9% had functional somatic syndromes. Most patients (65.1%) reported pain from any cause. Monotherapy with selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) was prescribed at enrolment in 64.5% and 6.4% of the cases, respectively. The most commonly prescribed agents were sertraline (17.3%), escitalopram (16.2%), venlaflaxine (15.6%) and paroxetine (14.8%). The mean HADS subscores for depression and anxiety were 13.3 ± 4.2 and 12.2 ± 3.9, respectively; 76.4% of patients could be defined as being 'probable cases' for depression and 66.2% for anxiety. The mean total score of VAS-pain in the last week was 42.9 ± 27.1, with highest scores reported in the 'interference of pain with daily activities' and in 'amount of time patient was awake and had pain'. From SF-36, the worst health status was found for role limitations due to emotional problem, mental health and social functioning. A mean score < 50 (that is, below the standardised population norm) was also found in all remaining domains. The SF-36 summary scores and EQ-5D (health status and VAS) were lower in patients with moderate/severe pain than in those with no or mild pain. Conclusion: The baseline results of patients enrolled in the FINDER study in Italy show clinical and functional impairments, and poor HRQoL. The results obtained after 6 months of therapy will permit better understanding the effects of different variables on clinical outcomes and HRQoL.
Journal of Clinical Psychiatry, 1999
The widely accepted impression that substance abuse and dependence are associated with increased ... more The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was more common in nonmixed bip...
Acta Psychiatrica Scandinavica Supplementum, 1985
Eighty-five Italian and forty-nine Swedish patients consecutively admitted for compulsory treatme... more Eighty-five Italian and forty-nine Swedish patients consecutively admitted for compulsory treatment to either an Italian or a Swedish psychiatric unit in selected areas of the two countries have participated in an exploratory study aimed at assessing the main characteristics of compulsory admitted patients, and in particular, the immediate reason for admission. The two series proved to be quite similar as concerns most sociodemographic variables, and as concerns clinical diagnosis and severity of the morbid condition at admission as measured by means of a rating scale. More Swedish than Italian patients lived alone when admitted to hospital, and for more of them the request for admission was made by other people than relatives, and a larger proportion of them was accompanied to the hospital by medical or social welfare personnel. In both series the largest proportion had a low educational level and belonged to the lower social groups. The same proportion in the two series had previo...
International Pharmacopsychiatry, 1981
434 bipolar manic-depressive patients were followed longitudinally. The course of the disease cha... more 434 bipolar manic-depressive patients were followed longitudinally. The course of the disease changed in many patients over the years. 67 cases became rapid cyclers (two or more cycles per year); in 40 of these cases (12 men and 28 women) the change of the course took place after intense or protracted use of antidepressant drugs. In their previous course these patients had not received antidepressant drugs. The common feature of the transformation of the previous course to a continuous circular one was the appearance for the first time in the course of the disease of hypomanic episodes after the depressions, or the accentuation of hypomanias that had been of milder intensity in previous recurrences. The patients who developed continuous circularity under antidepressant drug treatment were of highly energetic temperament. The hypothesis is advanced that these patients have latent hypomanias, which become clinically manifest under the action of antidepressants. The intensification of ...
Minerva ginecologica, 1979
A mixed affective syndrome is described which meets the criteria for major depression but not tho... more A mixed affective syndrome is described which meets the criteria for major depression but not those of the DSM III-R for a mixed state. The clinical picture is characterized by lack of motor retardation and fluent verbalization; the facial expression is animated and sometimes dramatic. Patients suffer considerably and are often tearful. They complain of inner tension and restlessness, racing thoughts and despair. Emotional lability and momentary irritability are observed. Insomnia occurs initially or with frequent early waking. Suicidal ideation occurs and makes the syndrome of concern in view of its impulsive nature. Antidepressants increase restlessness, insomnia, aggressiveness and the impulsiveness of suicidal ideation. Low-dose neuroleptics, lithium and anticonvulsivants are highly effective. A few sessions of ECT offer rapid improvement.
1. Adv Biochem Psychopharmacol. 1995;49:127-47. The long term prophylaxis of affective disorders.... more 1. Adv Biochem Psychopharmacol. 1995;49:127-47. The long term prophylaxis of affective disorders. Koukopoulos A, Reginaldi D, Minnai G, Serra G, Pani L, Johnson FN. Centro Lucio Bini, Rome, Italy. PMID: 7653332 [PubMed - indexed for MEDLINE]. Publication Types: ...
Advances in biochemical psychopharmacology, 1982
BACKGROUND The widely accepted impression that substance abuse and dependence are associated with... more BACKGROUND The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. METHOD Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. RESULTS The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was m...
Neuroscience Letters, 2016
Electroconvulsive therapy (ECT), developed in the 30's by Bini and Cerletti, remains a ke... more Electroconvulsive therapy (ECT), developed in the 30's by Bini and Cerletti, remains a key element of the therapeutic armamentarium in psychiatry, particularly for severe and life-threatening psychiatric symptoms. However, despite its well-established clinical efficacy, the prescription of ECT has declined constantly over the years due to concerns over its safety (cognitive side effects) and an increasingly negative public perception. As for other treatments in the field of psychiatry, ECT is well suited to a personalized approach that would increment its efficacy, as well as reducing the impact of side effects. This should be based on the priori identification of sub-populations of patients sharing common clinical and biological features that predict a good response to ECT. In this review we have selectively reviewed the evidence on clinical and biological predictors of ECT response. Clinical features such as an older age, presence of psychotic and melancholic depression, a high severity of suicide behavior, and speed of response, appear to be shared by ECT good responders with depressive symptoms. In mania, a greater severity of the index episode, and a reduction of whole brain cortical blood flow are associated with ECT good response. Biological determinants of ECT response in depressive patients are the presence of pre-treatment hyperconnectivity between key areas of brain circuitry of depression, as well as of reduced glutamine/glutamate levels, particularly in the anterior cingulated cortex (ACC). Furthermore, pre ECT high plasma homovanillic acid (HVA) levels, as well as of tumor necrosis factor (TNF)-α, and low pre-ECT levels of S-100B protein, appear to predict ECT response. Finally, polymorphisms within the genes encoding for the brain-derived neurotrophic factor (BDNF), the dopamine 2 receptor gene (DRD2), the dopamine receptor 3 gene (DRD3), the cathechol-o-methyltransferase (COMT), the serotonin-transporter (5-HTT), the 5-hydroxytryptamine 2A receptor (5-HT2A), and the norepinephrine transporter (NET), appear to predict a good response to ECT. The integration of these data in specific treatment algorithm might facilitate a personalized approach in ECT.
Journal of Affective Disorders, 2016
Bipolar disorder (BD) encompasses manic and depressive episodes and an illness-free interval. Tre... more Bipolar disorder (BD) encompasses manic and depressive episodes and an illness-free interval. Treatments used in BD patients may influence the ill phases with different actions on the illness-free interval. We performed a naturalistic mirror-image retrospective study analyzing the number of episodes and admissions in 41 BD patients for the same period of time of 5 years before and after electroconvulsive therapy (ECT). Furthermore, we assessed the duration of free intervals before and after ECT as a sign of prolonged well-being. Univariate analysis with t-test was used to compare differences before and after ECT, while analysis of variance was used to compare factors possibly associated with the efficacy on free-interval of ECT. Comparing the 5-year periods before and after ECT, we found significantly longer [13.2±9.0 months before ECT to 25.1±19.1 after treatment (t=3.8; p&amp;amp;amp;lt;0.0001)] free intervals, as well as significant reductions in the number of episodes [5.9±3.0 before ECT to 1.0±1.7 after treatment (t=9.3; p&amp;amp;amp;lt;0.0001)], and in the number of admissions [2.2±1.3 before ECT to 0.2±0.5 after treatment (t=9.4; p&amp;amp;amp;lt;0.0001)]. The main limitations of this study consisted in the relatively small sample size, the mirror-image retrospective naturalistic study design and possibly patient selection bias. Electroconvulsive therapy seemed to increase free-intervals and reduced number of BD episodes and admissions. It is plausible that ECT, along with suspending antidepressant treatment, might carry intrinsic stabilizing effect on the course of BD.
Psychiatry the State of the Art, 1985
The Journal of clinical psychiatry, 1999
The widely accepted impression that substance abuse and dependence are associated with increased ... more The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was more common in nonmixed bip...
International pharmacopsychiatry, 1981
434 bipolar manic-depressive patients were followed longitudinally. The course of the disease cha... more 434 bipolar manic-depressive patients were followed longitudinally. The course of the disease changed in many patients over the years. 67 cases became rapid cyclers (two or more cycles per year); in 40 of these cases (12 men and 28 women) the change of the course took place after intense or protracted use of antidepressant drugs. In their previous course these patients had not received antidepressant drugs. The common feature of the transformation of the previous course to a continuous circular one was the appearance for the first time in the course of the disease of hypomanic episodes after the depressions, or the accentuation of hypomanias that had been of milder intensity in previous recurrences. The patients who developed continuous circularity under antidepressant drug treatment were of highly energetic temperament. The hypothesis is advanced that these patients have latent hypomanias, which become clinically manifest under the action of antidepressants. The intensification of ...
Advances in biochemical psychopharmacology, 1982