Sara Fratta - Academia.edu (original) (raw)

Papers by Sara Fratta

Research paper thumbnail of A case of deep venous thrombosis following protracted catatonic immobility recovered with electroconvulsive therapy: the relevance for an early intervention

General Hospital Psychiatry, 2012

Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to ven... more Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to venous stasis leading to life-threatening thrombosis and pulmonary embolism (PE). When this occurs, the prescription of electroconvulsive therapy (ECT), actually irreplaceable in most life-threatening cases, remains controversial essentially due to an increased risk for PE and cerebral haemorrhage, with timing clinical decisions being as crucial as difficult to take. We report the case of a catatonic patient affected by malnutrition, deep venous thrombosis, severe pressure ulcers and septic syndrome resulting from previous untimely management, successfully treated with 16 well-tolerated ECT applications upon intensive supportive care. Although anecdotal, cases like this remind the relevance of early ECT to reduce the risk for potentially life-threatening complications due to prolonged catatonic inactivity, especially to those clinicians substantially disregarding this practice.

Research paper thumbnail of Follow-up naturalistico di un campione di pazienti bipolari con depressione resistente trattati con terapia elettroconvulsivante

Il disturbo bipolare è una patologia ricorrente associata a una significativa morbilità, mortalit... more Il disturbo bipolare è una patologia ricorrente associata a una significativa morbilità, mortalità, alto rischio di suicidio e sostanziale alterazione della qualità della vita, che influisce negativamente sulle relazioni sociali dell'individuo, sulla sua sfera familiare e lavorativa. La prevenzione dell'insorgenza di nuovi episodi nei pazienti bipolari che hanno risposto ad un ciclo di Terapia Elettroconvulsivante (TEC) rappresenta una sfida particolarmente complessa. Gli autori che hanno valutato il decorso a lungo termine dei pazienti trattati con TEC non sono giunti a conclusioni univoche né sulle percentuali di ricaduta né sulle caratteristiche cliniche e sintomatologiche correlate ad una ricaduta precoce. In questa tesi viene descritto il decorso di un campione di 36 pazienti bipolari (22 bipolari I e 14 bipolari II) che hanno risposto a un ciclo di TEC somministrata per la presenza di un episodio depressivo o misto resistente alla terapia farmacologica. I pazienti sono...

Research paper thumbnail of Long-Term Naturalistic Follow-Up of Patients With Bipolar Depression and Mixed State Treated With Electroconvulsive Therapy

The Journal of ECT, 2013

The aim of the present study was to evaluate the long-term outcome in a sample of patients with b... more The aim of the present study was to evaluate the long-term outcome in a sample of patients with bipolar disorder with severe depression or mixed-state resistant to pharmacological treatment who have responded to electroconvulsive therapy (ECT). The study involved 36 patients with major depression (5 patients with bipolar I depression, and 14 patients with bipolar II depression) or mixed state (17 patients) treated with bilateral ECT delivered using a brief pulse stimulator Mecta 5000 Q on a twice-a-week schedule. The patients were evaluated before ECT (baseline) and 1 week after the ECT course (final score) using the Hamilton Depression Rating Scale, Mania Rating Scale, Brief Psychiatric Rating Scale, and Clinical Global Improvement. The Longitudinal Interval Follow-up Evaluation was administered every 16 weeks to assess time to relapse (defined as LIFE scores ≥5 for at least 2 consecutive weeks or as the need for hospitalization) and periods of response and remission. The mean duration of follow-up was 55.3 ± 30.4 weeks (range, 24-160 weeks). Thirteen patients (36.1%) showed a depressive relapse during the follow-up; the mean time (length) of depressive relapse was 20.4 ± 21.8 weeks (range, 2-60 weeks). Twenty-nine patients (80.5%) fulfilled the criteria for a full remission from depressive symptoms after 6.7 ± 7.9 weeks from the last ECT. Seventeen patients (47.2%) were in remission for more than 70% of the time. No manic episodes occurred during the follow-up, only 1 patient had a mixed episode, and 11 patients had a hypomanic episode. Electroconvulsive therapy showed a positive impact on the clinical course of severe and treatment-resistant patients with bipolar disorders, as suggested by the high number of weeks spent in remission during the follow-up period. In our study, the duration of depressive episode was related to early relapse during follow-up period.

Research paper thumbnail of Risk of Post-Traumatic Stress Disorder in 111 survivors the 2009 Viareggio (Italy) Rail Crash: The role of mood spectrum comorbidity

Results Sixty-six subjects, of the 111 who completed the SCID-I (59.5%), met criteria for PTSD. P... more Results Sixty-six subjects, of the 111 who completed the SCID-I (59.5%), met criteria for PTSD. PTSD patients showed higher comorbidity rates for Generalized Anxiety Disorder (GAD) (p < 0.001), and lifetime and current Major Depressive Disorder (MDD) (p < 0.001) than subjects who did not develop PTSD. Lifetime MOODS-SR ‘Sociability/Extraversion’ factor and the prevalence of lifetime MDD differentiated subjects with from those without PTSD, when a multiple logistic regression analysis was performed.

Research paper thumbnail of Estimates of Prevalence and Criteria Comparison in DSM-5 versus DSM-IV-TR Post-Traumatic Stress Disorder in 111 Survivors to the 2009 Railway Accident in Viareggio-Italy

International Journal of Emergency Mental Health and Human Resilience, 2015

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced... more The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced noteworthy revisions to Post-Traumatic Stress Disorder (PTSD) criteria, including a four-factor model and some new symptomatic criteria. To date, only a limited number of studies investigated the impact of such changes on the prevalence rates of the disorder. On 29 June 2009, in the railway station of Viareggio (Italy), a freight train carrying liquefied petroleum gas derailed with a subsequent fire leading to a large area of the town being damaged: 32 people died and 26 were severely injured. A total sample of 111 subjects who survived to the railway accident were assessed for PTSD according to either DSM-5 or DSM-IV-TR criteria by means of a spectrum assessment instrument: the Trauma and Loss Spectrum-Self Report (TALS-SR). A DSM-5 PTSD diagnosis emerged in 50.4% with respect to 54.7% according to DSM-IV-TR criteria. Most of the subjects fulfilling DSM-IV-TR but not DSM-5 criteria did not endorse new Criterion C (active avoidance). For what concern new DSM-5 PTSD symptoms: 1 (2.6%) survivor endorsed symptom D3; 29 (76.32%) D4; 6 (15.79%) both D3 and D4; 8 (27.59%) E2. This is the first study to report PTSD prevalence rates among survivors to the Viareggio 2009 railway accident. Our results corroborate the substantial equivalence between the DSM-5 and DSM-IV-TR algorithms for PTSD diagnosis and further suggest that avoidance and/or negative alterations in cognition and mood should alert the clinician for possible PTSD development.

Research paper thumbnail of A case of deep venous thrombosis following protracted catatonic immobility recovered with electroconvulsive therapy: the relevance for an early intervention

Research paper thumbnail of Efficacy of Electroconvulsive Therapy in Fahr Disease Associated With Bipolar Psychotic Disorder

The Journal of ECT, 2009

We report a case of a patient with Fahr disease affected by bipolar disorder type I with psychoti... more We report a case of a patient with Fahr disease affected by bipolar disorder type I with psychotic symptoms. The complex clinical picture, characterized by both neurological and psychiatric symptoms, proved to be partially or completely resistant to several pharmacological trials. On the contrary, a marked improvement of clinical picture occurred after a cycle of 10 sessions of electroconvulsive therapy, followed by a complete and sustained resolution of mood, cognitive, motor, and behavioral symptoms during the next 4 years.

Research paper thumbnail of A case of deep venous thrombosis following protracted catatonic immobility recovered with electroconvulsive therapy: The relevance for an early intervention

Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to ven... more Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to venous stasis leading to life-threatening thrombosis and pulmonary embolism (PE). When this occurs, the prescription of electroconvulsive therapy (ECT), actually irreplaceable in most life-threatening cases, remains controversial essentially due to an increased risk for PE and cerebral haemorrhage, with timing clinical decisions being as crucial as difficult to take. We report the case of a catatonic patient affected by malnutrition, deep venous thrombosis, severe pressure ulcers and septic syndrome resulting from previous untimely management, successfully treated with 16 well-tolerated ECT applications upon intensive supportive care. Although anecdotal, cases like this remind the relevance of early ECT to reduce the risk for potentially life-threatening complications due to prolonged catatonic inactivity, especially to those clinicians substantially disregarding this practice.

Research paper thumbnail of Long-Term Naturalistic Follow-Up of Patients With Bipolar Depression and Mixed State Treated With Electroconvulsive Therapy

The Journal of ECT, 2013

Objective: The aim of the present study was to evaluate the long-term outcome in a sample of pati... more Objective: The aim of the present study was to evaluate the long-term outcome in a sample of patients with bipolar disorder with severe depression or mixed-state resistant to pharmacological treatment who have responded to electroconvulsive therapy (ECT).

Research paper thumbnail of A case of deep venous thrombosis following protracted catatonic immobility recovered with electroconvulsive therapy: the relevance for an early intervention

General Hospital Psychiatry, 2012

Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to ven... more Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to venous stasis leading to life-threatening thrombosis and pulmonary embolism (PE). When this occurs, the prescription of electroconvulsive therapy (ECT), actually irreplaceable in most life-threatening cases, remains controversial essentially due to an increased risk for PE and cerebral haemorrhage, with timing clinical decisions being as crucial as difficult to take. We report the case of a catatonic patient affected by malnutrition, deep venous thrombosis, severe pressure ulcers and septic syndrome resulting from previous untimely management, successfully treated with 16 well-tolerated ECT applications upon intensive supportive care. Although anecdotal, cases like this remind the relevance of early ECT to reduce the risk for potentially life-threatening complications due to prolonged catatonic inactivity, especially to those clinicians substantially disregarding this practice.

Research paper thumbnail of Follow-up naturalistico di un campione di pazienti bipolari con depressione resistente trattati con terapia elettroconvulsivante

Il disturbo bipolare è una patologia ricorrente associata a una significativa morbilità, mortalit... more Il disturbo bipolare è una patologia ricorrente associata a una significativa morbilità, mortalità, alto rischio di suicidio e sostanziale alterazione della qualità della vita, che influisce negativamente sulle relazioni sociali dell'individuo, sulla sua sfera familiare e lavorativa. La prevenzione dell'insorgenza di nuovi episodi nei pazienti bipolari che hanno risposto ad un ciclo di Terapia Elettroconvulsivante (TEC) rappresenta una sfida particolarmente complessa. Gli autori che hanno valutato il decorso a lungo termine dei pazienti trattati con TEC non sono giunti a conclusioni univoche né sulle percentuali di ricaduta né sulle caratteristiche cliniche e sintomatologiche correlate ad una ricaduta precoce. In questa tesi viene descritto il decorso di un campione di 36 pazienti bipolari (22 bipolari I e 14 bipolari II) che hanno risposto a un ciclo di TEC somministrata per la presenza di un episodio depressivo o misto resistente alla terapia farmacologica. I pazienti sono...

Research paper thumbnail of Long-Term Naturalistic Follow-Up of Patients With Bipolar Depression and Mixed State Treated With Electroconvulsive Therapy

The Journal of ECT, 2013

The aim of the present study was to evaluate the long-term outcome in a sample of patients with b... more The aim of the present study was to evaluate the long-term outcome in a sample of patients with bipolar disorder with severe depression or mixed-state resistant to pharmacological treatment who have responded to electroconvulsive therapy (ECT). The study involved 36 patients with major depression (5 patients with bipolar I depression, and 14 patients with bipolar II depression) or mixed state (17 patients) treated with bilateral ECT delivered using a brief pulse stimulator Mecta 5000 Q on a twice-a-week schedule. The patients were evaluated before ECT (baseline) and 1 week after the ECT course (final score) using the Hamilton Depression Rating Scale, Mania Rating Scale, Brief Psychiatric Rating Scale, and Clinical Global Improvement. The Longitudinal Interval Follow-up Evaluation was administered every 16 weeks to assess time to relapse (defined as LIFE scores ≥5 for at least 2 consecutive weeks or as the need for hospitalization) and periods of response and remission. The mean duration of follow-up was 55.3 ± 30.4 weeks (range, 24-160 weeks). Thirteen patients (36.1%) showed a depressive relapse during the follow-up; the mean time (length) of depressive relapse was 20.4 ± 21.8 weeks (range, 2-60 weeks). Twenty-nine patients (80.5%) fulfilled the criteria for a full remission from depressive symptoms after 6.7 ± 7.9 weeks from the last ECT. Seventeen patients (47.2%) were in remission for more than 70% of the time. No manic episodes occurred during the follow-up, only 1 patient had a mixed episode, and 11 patients had a hypomanic episode. Electroconvulsive therapy showed a positive impact on the clinical course of severe and treatment-resistant patients with bipolar disorders, as suggested by the high number of weeks spent in remission during the follow-up period. In our study, the duration of depressive episode was related to early relapse during follow-up period.

Research paper thumbnail of Risk of Post-Traumatic Stress Disorder in 111 survivors the 2009 Viareggio (Italy) Rail Crash: The role of mood spectrum comorbidity

Results Sixty-six subjects, of the 111 who completed the SCID-I (59.5%), met criteria for PTSD. P... more Results Sixty-six subjects, of the 111 who completed the SCID-I (59.5%), met criteria for PTSD. PTSD patients showed higher comorbidity rates for Generalized Anxiety Disorder (GAD) (p < 0.001), and lifetime and current Major Depressive Disorder (MDD) (p < 0.001) than subjects who did not develop PTSD. Lifetime MOODS-SR ‘Sociability/Extraversion’ factor and the prevalence of lifetime MDD differentiated subjects with from those without PTSD, when a multiple logistic regression analysis was performed.

Research paper thumbnail of Estimates of Prevalence and Criteria Comparison in DSM-5 versus DSM-IV-TR Post-Traumatic Stress Disorder in 111 Survivors to the 2009 Railway Accident in Viareggio-Italy

International Journal of Emergency Mental Health and Human Resilience, 2015

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced... more The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced noteworthy revisions to Post-Traumatic Stress Disorder (PTSD) criteria, including a four-factor model and some new symptomatic criteria. To date, only a limited number of studies investigated the impact of such changes on the prevalence rates of the disorder. On 29 June 2009, in the railway station of Viareggio (Italy), a freight train carrying liquefied petroleum gas derailed with a subsequent fire leading to a large area of the town being damaged: 32 people died and 26 were severely injured. A total sample of 111 subjects who survived to the railway accident were assessed for PTSD according to either DSM-5 or DSM-IV-TR criteria by means of a spectrum assessment instrument: the Trauma and Loss Spectrum-Self Report (TALS-SR). A DSM-5 PTSD diagnosis emerged in 50.4% with respect to 54.7% according to DSM-IV-TR criteria. Most of the subjects fulfilling DSM-IV-TR but not DSM-5 criteria did not endorse new Criterion C (active avoidance). For what concern new DSM-5 PTSD symptoms: 1 (2.6%) survivor endorsed symptom D3; 29 (76.32%) D4; 6 (15.79%) both D3 and D4; 8 (27.59%) E2. This is the first study to report PTSD prevalence rates among survivors to the Viareggio 2009 railway accident. Our results corroborate the substantial equivalence between the DSM-5 and DSM-IV-TR algorithms for PTSD diagnosis and further suggest that avoidance and/or negative alterations in cognition and mood should alert the clinician for possible PTSD development.

Research paper thumbnail of A case of deep venous thrombosis following protracted catatonic immobility recovered with electroconvulsive therapy: the relevance for an early intervention

Research paper thumbnail of Efficacy of Electroconvulsive Therapy in Fahr Disease Associated With Bipolar Psychotic Disorder

The Journal of ECT, 2009

We report a case of a patient with Fahr disease affected by bipolar disorder type I with psychoti... more We report a case of a patient with Fahr disease affected by bipolar disorder type I with psychotic symptoms. The complex clinical picture, characterized by both neurological and psychiatric symptoms, proved to be partially or completely resistant to several pharmacological trials. On the contrary, a marked improvement of clinical picture occurred after a cycle of 10 sessions of electroconvulsive therapy, followed by a complete and sustained resolution of mood, cognitive, motor, and behavioral symptoms during the next 4 years.

Research paper thumbnail of A case of deep venous thrombosis following protracted catatonic immobility recovered with electroconvulsive therapy: The relevance for an early intervention

Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to ven... more Catatonic patients often experience prolonged inactivity and dehydration, thus being prone to venous stasis leading to life-threatening thrombosis and pulmonary embolism (PE). When this occurs, the prescription of electroconvulsive therapy (ECT), actually irreplaceable in most life-threatening cases, remains controversial essentially due to an increased risk for PE and cerebral haemorrhage, with timing clinical decisions being as crucial as difficult to take. We report the case of a catatonic patient affected by malnutrition, deep venous thrombosis, severe pressure ulcers and septic syndrome resulting from previous untimely management, successfully treated with 16 well-tolerated ECT applications upon intensive supportive care. Although anecdotal, cases like this remind the relevance of early ECT to reduce the risk for potentially life-threatening complications due to prolonged catatonic inactivity, especially to those clinicians substantially disregarding this practice.

Research paper thumbnail of Long-Term Naturalistic Follow-Up of Patients With Bipolar Depression and Mixed State Treated With Electroconvulsive Therapy

The Journal of ECT, 2013

Objective: The aim of the present study was to evaluate the long-term outcome in a sample of pati... more Objective: The aim of the present study was to evaluate the long-term outcome in a sample of patients with bipolar disorder with severe depression or mixed-state resistant to pharmacological treatment who have responded to electroconvulsive therapy (ECT).