International Clinical Psychopharmacology最新文献

Obsessive-compulsive disorder (OCD) is a chronic illness associated with significant functional impairment. Monotherapy with serotonin reuptake inhibitors (SRIs) often leads to only partial improvement of symptoms. In such cases, a common, well established, treatment approach for most patients is the augmentation of SRI therapy with antipsychotic medications. Brexpiprazole is an atypical antipsychotic agent that acts as a partial agonist of 5-HT1A, D2, and D3 receptors. Purpose of this retrospective observational study was to evaluate the effectiveness and tolerability of brexpiprazole as augmentation to SRIs in patients with treatment-resistant OCD. This preliminary study included a sample of 10 patients diagnosed with treatment-resistant OCD who underwent a 12-week trial of augmentative brexpiprazole, starting at a dose of 1 mg/day, with dosage adjustments based on clinical judgment. Treatment response was assessed through changes in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score from baseline to the end of the 12-week observation period. Adverse events were systematically recorded. Significant improvement was observed after the 12-week period: at the endpoint, seven patients (70%) achieved a ≥25% reduction in Y-BOCS total score compared to baseline, with five of them (50% of the overall sample) showing a more robust clinical response (≥35% reduction). Mild adverse effects, such as sedation and weight gain, were reported by two participants (20% of the overall sample). These findings suggest that brexpiprazole may offer a promising effectiveness and tolerability profile in the management of treatment-resistant OCD.

Psychomotor agitation is a challenging symptom of major depressive disorder with mixed features (MDD-MF), often worsening outcomes and complicating treatment. This retrospective study assessed the efficacy and tolerability of intravenous trazodone in 97 hospitalized patients with MDE-MF. Symptom severity was evaluated using montgomery asberg depression rating Scale (MADRS), young mania rating scale, hamilton anxiety rating scale, GAD-7, and clinical global impression scale-severity of illness (CGI-S) scales, with significant reductions in agitation, anxiety, and irritability observed early during treatment. Correlation analyses revealed significant negative associations between intravenous (IV) trazodone dosage and improvements in MADRS ( r = -0.23; P < 0.05), item 5 of GAD-7 ( r = -0.27; P < 0.001), and CGI-S scores ( r = -0.22; P < 0.05). Therapy duration also correlated negatively with improvements in GAD-7 item 5 ( r = -0.29; P < 0.001) and CGI-S ( r = -0.27; P < 0.001), indicating diminishing returns with prolonged treatment. Regression analyses showed that therapy duration, but not dosage, significantly influenced improvements in GAD-7 item 5 and CGI-S. Trazodone was well-tolerated, with only mild side effects in 11.3% of patients. These findings suggest that IV trazodone effectively reduces agitation and related symptoms in MDD-MF, particularly in the early treatment phase, emphasizing the importance of optimizing treatment duration. Future studies should investigate individualized dosing strategies and explore long-term outcomes in this population.

Current treatments for schizophrenia encounter resistance, limited efficacy, and limiting complications, necessitating novel approaches. The effects of saffron on negative symptoms were investigated as it has shown neuroprotective and antipsychotic properties. Fifty-six clinically stable chronic schizophrenic outpatients were equally assigned to saffron 15 mg q12hr or placebo groups while continuing risperidone. The Positive and Negative Syndrome Scale (PANSS) was used to assess schizophrenia-related symptoms in weeks 4 and 8. Also, the patients were assessed for the Hamilton depression rating scale (HDRS) and adverse effects. The baseline characteristics of the groups were comparable ( P s > 0.05). There were significant time-treatment interaction effects on negative (  = 0.137), general psychopathology (  = 0.193), and total (  = 0.113) PANSS scores. Affirmatively, their reductions were significantly greater in the saffron group until weeks 4 (Cohen's d s = 0.922, 0.898, and 0.759, respectively) and 8 (Cohen's d s = 0.850, 1.047, and 0.705, respectively). Regarding the negative symptoms, a better 25% response rate was obtained in the saffron group until the endpoint ( P  = 0.003). The HDRS scores, extrapyramidal symptom rating scale scores, and side effect frequencies were comparable between the groups ( P s > 0.05). Saffron was beneficial for primary negative symptoms of chronic schizophrenia in a safe and tolerable manner. It also outperformed placebo in improving general psychopathology and total symptoms.

The auditory P300 wave, also known as P3b, is an event-related potential component thought to reflect central information processes involved in stimulus evaluation or categorization. It is typically elicited using the oddball paradigm, which involves mixing low-probability target items with high-probability standard stimuli. Its latency is associated with the timing of cognitive processes such as stimulus evaluation and response preparation, while its amplitude is related to the amount of attentional resources engaged during the task. Despite decades of use in research settings, its application in clinical practice has been limited. Prolongation of latencies and reduction of amplitudes in the auditory P3b have been observed in both psychiatric and neurological conditions. This includes cases where traditional neuropsychological tests are challenging due to severe motor or speech dysfunctions, or in conditions characterized by subtle cognitive deficits. Additionally, specific laterality patterns in psychoses and a loss of P300 habituation in migraines have been described. The wealth of experimental evidence supports the use of this evoked potential, which can be elicited through a relatively simple paradigm, for objectively evaluating cognition in psychiatric and neurological patients, particularly in follow-up assessments. Therefore, the auditory P300 appears to be a valuable tool for monitoring the clinical course of patients with mental and neurological disorders in certain circumstances.

Patients with obstructive sleep apnea (OSA), restless legs syndrome (RLS), or both may exhibit varied manifestations of depressive and anxiety symptomatology, reflecting the complex interplay between sleep disturbances, neurotransmitter imbalances, and psychosocial stressors in these often overlapping conditions. The aim of this study was to compare depressive and anxiety symptomatology, insomnia severity, and sleepiness in these conditions. Patients were enrolled and subdivided into those with OSA, RLS, and OSA + RLS. All were evaluated using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), Insomnia Severity Index, and Epworth Sleepiness Scale. A total of 159 patients were enrolled, with OSA ( n  = 85), RLS ( n  = 11), and OSA + RLS ( n  = 63). A significant difference was observed for PHQ-9 (higher in patients with RLS, associated or not with OSA); however, the groups also differed for age (older in RLS) and apnea-hypopnea index (AHI) (higher in OSA). The group difference in PHQ-9 persisted also after ruling out the confounding effects of age and AHI. Our study highlights the significant burden of depressive symptomatology in patients with OSA, RLS, or both. RLS patients consistently exhibited higher levels of depressive symptomatology compared with OSA patients, emphasizing the need for comprehensive assessment and tailored management strategies targeting both sleep-related and psychiatric symptoms in this population.

Prisoners constitute a group at suicide risk, showing higher relative rates of suicides than the general population. However, there is limited knowledge about the characteristics of those who die by suicide in Italian prisons. Based on the total sample of suicides of the Institute of Forensic Medicine of Milan (1993-2022), suicides in prison ( N  = 120) were matched by age and gender with cases that occurred outside prison ( N  = 300) and compared with them. The considered variables were sociodemographic, clinical, and suicide-related. Univariate analyses and logistic regression model were performed. In univariate analyses, suicides in prison showed higher rates of ethnicity different from white Caucasian, lower rates of depression, higher rates of alcoholism, addiction, respiratory system diseases, hepatitis, and amyotrophic lateral sclerosis, lower use of any medication, and in particular psychotropic medications, and a higher percentage of violent suicide method versus nonviolent compared to suicides outside prison. In the logistic regression model, ethnicity, depression, and addiction were the only features differentiating suicides in prison from ones outside prison. Particular attention should be paid to inmates with non-white ethnicity and those with addiction. Ensuring adequate access to psychiatric care and implementing comprehensive suicide prevention strategies within Italian prisons is crucial.

Deficits in social cognition may impair emotional processing and facial emotional recognition (FER) in patients with bipolar disorder (BD) and schizophrenia. FER is generally explored using photographs or images of static faces that do not fully capture the complexity of real-life facial stimuli. To overcome this limitation, we developed a set of dynamic virtual faces depicting six basic emotions (i.e. happiness, sadness, anger, fear, disgust, and surprise) and a neutral expression suitable for presentation in immersive and nonimmersive virtual realities. This study presents preliminary findings on the differences in FER accuracy from a frontal view between immersive and nonimmersive virtual realities among patients experiencing a relapse of schizophrenia ( n  = 10), a manic phase of BD ( n  = 10), and a group of healthy controls (HCs) ( n  = 10). As a secondary objective, we compare the FER accuracy across these three groups. Patients with schizophrenia and BD showed similar accuracy in recognizing emotions in immersive and nonimmersive virtual reality settings. However, patients with schizophrenia exhibited lower FER accuracy than HCs in both settings. Individuals with BD showed intermediate accuracy between those with schizophrenia and HCs, although these differences were not statistically significant. Notably, recognition of negative emotions was significantly impaired in both groups of patients.