11 results
A comparison between two rTMS protocols as augmentation strategies in patients with treatment-resistant depression
- L. Larini, M. Castiglioni, E. Piccoli, C. Scarpa, M. Renne, S. Torriero, M. Bosi, B. Benatti, A. Varinelli, M. Vismara, B. Dell’Osso
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S114-S115
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Introduction
Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment and rTMS protocols have been included in international guidelines for patients with treatment-resistant depression (TRD). The daily administration of standard rTMS protocols, typically over several weeks, could be a limiting factor (e.g., time off from work, commuting issues). To intensify the antidepressant response and to reduce the number of stimulation days, it has been proposed that increasing the number of rTMS sessions performed per day could be more effective and help to reduce the burden for patients and clinicians. Although there is much interest in accelerated TMS protocols, little is known about their efficacy and tolerability, and the literature on the topic is still scarce.
ObjectivesTo compare the efficacy and tolerability of two rTMS protocols (standard vs. accelerated) as augmentative strategies in patients with TRD.
MethodsIn the present ongoing, open-label, trial 14 patients meeting DSM-5 criteria for major depressive episode (either unipolar or bipolar), classified as partial responders or non-responders to adequate pharmacological treatment, were randomized to receive either standard (one session per day, five days a week, for four weeks; n= 7) or accelerated (two sessions per day, five days a week, for two weeks; n=6) rTMS treatment protocols. In both cases, rTMS was performed on the left dorsolateral prefrontal cortex, high frequency (10 Hz) at 120% of the motor threshold, 3000 pulses per sessions. Primary outcome measures included HAM-D, MADRS, and CGI-S scores at baseline (T0), at the end of rTMS treatment (T1), and after 1 month (T2), as well as tolerability based on adverse effects. Paired Samples t-Test for continuous variables was used to compare psychometric scales at each timepoint, while t-Test was used to compare differences between the two groups.
ResultsWith respect to total sample, in terms of primary outcome measures a significant reduction of HAM-D, MADRS and CGI-S total scores between T0 and T1 (t: 3.01, p<0.05; t: 1.692, p<0.5; t:3.207, p<0.05 respectively), T1 and T2 (t: 3.264, p<0.05: t:2.669, p<0.05; t:.085, p=0.437 respectively) and T0 and T2 (t:5.669, p<0.05; t=4.711, p<0.05; t:2.551, p<0.05 respectively) was found. No significant differences in terms of efficacy were found between the two groups. One patient dropped-out for reasons not related to rTMS treatment. Mild and transient headache during the stimulation was the only side effect reported (4 patients).
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ConclusionsConsistently with previous literature studies, our preliminary results supported the evidence of comparable efficacy and tolerability between accelerated and standard rTMS protocols. In the future, larger, blinded, and controlled trials might support these conclusions and further address treatment parameters of novel accelerated rTMS protocols.
Disclosure of InterestNone Declared
Criminal behaviors and substance abuse in psychiatric patients
- B. Benatti, F. Achilli, S. Leo, L. Molteni, E. Piccoli, D. Gobbo, B. M. Dell’Osso
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S536-S537
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Introduction
People with mental illness are overrepresented throughout the criminal justice system. In Italy, an ongoing process of deinstitutionalization has been enacted: the Judicial Psychiatric Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (Residenze per l’Esecuzione delle Misure di Sicurezza - REMS). Law 81/2014 prescribes that a patient cannot stay in a REMS for a period longer than a prison sentence for the same index offense. Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to outpatient psychiatric centers. Elevated risks of violent behavior are not equally shared across the spectrum of psychiatric disorders. In the past several years, multiple studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse.
ObjectivesIn order to broaden the research in this area, we analyzed sociodemographic, clinical and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, with a focus on substance abuse.
MethodsThis is a cross-sectional single center study, conducted in 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or more and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.
ResultsData were available for 76 patients, 51,3% of them had lifetime substance abuse. Lifetime substance abuse was significantly more common in patients with long-acting injectable antipsychotics therapy, >3 psychiatric hospitalizations, history of previous crimes and economic crime (Table 1). Additionally, this last potential correlation was confirmed by logistic regression.
Table 1. Lifetime substance abusers (N=39) Non-lifetime substance abusers (N=37) Proportion Difference P-value N % N % Depot administration Yes 11 (28,9%) 0 (0%) 28,9% 0,02 Hospitalizations Four or more 25 (64,1%) 5 (33,3%) 30,8% 0,04 Economic crime Yes 15 (40,5%) 1 (6,7%) 33,8% 0,02 Previous crimes Yes 17 (51,4%) 2 (13,3%) 38,1% 0,02 ConclusionsData emerging from this survey provide new information about offenders in an Italian mental health service with a focus on lifetime substance abuse in these patients. Our preliminary results should be confirmed in larger sample sizes.
Disclosure of InterestNone Declared
Clinical relevance of Paliperidone Palmitate three-month intramuscular injection formulation: an Italian Real-World, Retrospective, one-year Mirror Image Study
- S. Vanzetto, G. Cirnigliaro, V. Battini, E. Piccoli, M. Vismara, C. Viganò, B. Dell’Osso
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S346
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Introduction
Paliperidone Palmitate 3-month (PP3M) formulation, introduced in Italy since 2017, is an effective and safety therapeutic option for patients with schizophrenia, clinically stable with 1-month formulation (PP1M). Only a few “Real World” studies investigated the clinical relevance of PP3M and the long-term clinical and health resource utilization outcomes.
ObjectivesThe aim of this retrospective, mirror image study was to evaluate the efficacy of PP3M in terms of continuity of care and number of hospitalizations.
MethodsFifty outpatients treated with Paliperidone Palmitate (PP) were recruited from a Community Mental Health Centre (CMHC) in Milan. Statistical analysis were conducted with SPSS 26. Frequencies of hospitalization 6 months before and after the start of PP3M were compared using the McNemar test, setting the significance to p<0.05.
ResultsThis study involved 34 patients (68%) treated with PP1M and 16 (32%) treated with PP3M.The median time interval between PP1M and PP3M was 14 months. After the switch to PP3M, 69% of patients continued to visit the CMHC with an unchanged frequency (50% once/month, 6% more than once/month), while 31% with a decreased frequency (once/3 months). No patient increased the frequency of CMHC visits or started visiting it discontinuously. 44% of subjects had had at least one hospitalization prior to the switch and no hospitalizations after (p=0.016). Moreover, no patients showed increased hospitalizations
ConclusionsIn this study PP3M clinical relevance was confirmed comparing pre-initiation and post-initiation 6-months time intervals: hospitalizations number significantly decreased, while the continuity of care was preserved. Further studies on a greater sample are necessary to support these preliminary data.
DisclosureNo significant relationships.
Incidence and predictive factors of non adherence to therapy in young adults attending a psycho social center in Milan: a retrospective observational “Real world” study
- S. Vanzetto, G. Cirnigliaro, E. Piccoli, S. Dagoberti, M. Vismara, B. Benatti, C. Viganò, B. Dell’Osso
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S691
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Introduction
Non adherence to psychotropic drugs is associated with negative outcomes, including hospitalizations, aggressive behaviors, suicide attempts and increased premature mortality. It represents a psychiatric challenge, especially in young adults who show higher risk of non-adherence to treatment
ObjectivesFirstly this study evaluates the incidence of non-adherence to therapy in 18-24 years patients from a Psycho-Social Center in Milan; and then to analyze the predictive factors of non-adherence.
MethodsIn this retrospective “Real Life” observational study, 120 outpatients aged 18 to 24 years, from Psycho-social Center of L. Sacco University Hospital in Milan, were recruited in 2019. Non-adherence to treatment, according to the World Health Organization, was considered “a modality of assuming medications that does not correspond to healthcare professionals’ recommendations”. Statistical analysis were performed with chi-square, ANOVA and linear regression tests, setting significance to p<0.05.
Results88 of 120 outpatients (73.3%) received an indication to psychopharmacological treatment. Of these, 23 (26.1%) did not show adherence to therapy. Results showed a positive association between non-adherence and increased hospitalizations (p <.01), oral antipsychotics (p<.05) and drop-out rates (p<.001). A significant correlation was also observed between non-adherence and Intellectual Disability (p<.05), Bipolar Disorder (p<.05), psychotic symptoms (p<.05), alterations in affectivity and mood (p<.005), alterations in sleep pattern (p<.05), school dropout (p<.05) and poor family support (p<.01).
ConclusionsThis study confirms that non-adherence has a relevant incidence in young-adults psychiatric population, highlighting the importance of effective and structured assessment in clinical practice to identify predictive factors and risk profiles associated with this phenomenon.
DisclosureNo significant relationships.
Chapter 14 - Alagille Syndrome
- from Section II - Cholestatic Liver Disease
- Edited by Frederick J. Suchy, Ronald J. Sokol, William F. Balistreri
- Edited in association with Jorge A. Bezerra, Cara L. Mack, Benjamin L. Shneider
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- Book:
- Liver Disease in Children
- Published online:
- 19 January 2021
- Print publication:
- 18 March 2021, pp 222-241
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Summary
Alagille syndrome (ALGS) is an autosomal dominant, multisystem disorder which was first described in 1969 by Daniel Alagille as a constellation of clinical features in five different organ systems [1]. The diagnosis was based on the presence of intrahepatic bile duct paucity on liver biopsy in association with at least three of the major clinical features: chronic cholestasis, cardiac disease (most often peripheral pulmonary stenosis), skeletal abnormalities (typically butterfly vertebrae), ocular abnormalities (primarily posterior embryotoxon), and characteristic facial features. Advances in molecular diagnostics have enabled an appreciation of the broader disease phenotype with recognition of renal and vascular involvement [2, 3]. There is significant variability in the extent to which each of these systems is affected in an individual, if at all [4, 5]. ALGS was originally estimated to have a frequency of one in 70,000 live births, though this was based on the presence of neonatal cholestasis. However, this is clearly an underestimate as molecular testing has demonstrated that many individuals with a disease-causing mutation do not have neonatal liver disease and the true frequency is likely closer to one in 30,000 [5].
Effect of dietary lipids on circulating adiponectin: a systematic review with meta-analysis of randomised controlled trials
- Anize D. von Frankenberg, Flávia M. Silva, Jussara C. de Almeida, Vanessa Piccoli, Filipe V. do Nascimento, Mônica M. Sost, Cristiane B. Leitão, Luciana L. R. Remonti, Daniel Umpierre, André F. Reis, Luis H. Canani, Mirela J. de Azevedo, Fernando Gerchman
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- Journal:
- British Journal of Nutrition / Volume 112 / Issue 8 / 28 October 2014
- Published online by Cambridge University Press:
- 05 September 2014, pp. 1235-1250
- Print publication:
- 28 October 2014
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Different dietary interventions have been identified as potential modifiers of adiponectin concentrations, and they may be influenced by lipid intake. We identified studies investigating the effect of dietary lipids (type/amount) on adiponectin concentrations in a systematic review with meta-analysis. A literature search was conducted until July 2013 using databases such as Medline, Embase and Scopus (MeSH terms: ‘adiponectin’, ‘dietary lipid’, ‘randomized controlled trials (RCT)’). Inclusion criteria were RCT in adults analysing adiponectin concentrations with modification of dietary lipids. Among the 4930 studies retrieved, fifty-three fulfilled the inclusion criteria and were grouped as follows: (1) total dietary lipid intake; (2) dietary/supplementary n-3 PUFA; (3) conjugated linoleic acid (CLA) supplementation; (4) other dietary lipid interventions. Diets with a low fat content in comparison to diets with a high-fat content were not associated with positive changes in adiponectin concentrations (twelve studies; pooled estimate of the difference in means: − 0·04 (95 % CI − 0·82, 0·74) μg/ml). A modest increase in adiponectin concentrations with n-3 PUFA supplementation was observed (thirteen studies; 0·27 (95 % CI 0·07, 0·47) μg/ml). Publication bias was found by using Egger's test (P= 0·01) and funnel plot asymmetry. In contrast, CLA supplementation reduced the circulating concentrations of adiponectin compared with unsaturated fat supplementation (seven studies; − 0·74 (95 % CI − 1·38, − 0·10) μg/ml). However, important sources of heterogeneity were found as revealed by the meta-regression analyses of both n-3 PUFA and CLA supplementation. Results of new RCT would be necessary to confirm these findings.
Chapter 14 - Alagille syndrome
- from Section II - Cholestatic liver disease
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- By Binita M. Kamath, Department of Paediatrics, University of Toronto; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada, Nancy B. Spinner, Division of Genomic Diagnostics, and Evelyn Willing Bromley Chair of Pediatric Pathology, Department of Pathology Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Pennsylvania, Pittsburgh, PA, USA, David A. Piccoli, Division of Gastroenterology, Hepatology and Nutrition, Fred and Suzanne Biesecker Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Pennsylvania, Philadelphia, PA, USA
- Edited by Frederick J. Suchy, University of Colorado Medical Center, Ronald J. Sokol, University of Colorado Medical Center, William F. Balistreri
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- Liver Disease in Children
- Published online:
- 05 March 2014
- Print publication:
- 20 February 2014, pp 216-233
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Summary
Introduction
Alagille syndrome (ALGS) is an autosomal dominant, multisystem disorder which was first described in 1969 by Daniel Alagille as a constellation of clinical features in five different organ systems [1]. The diagnosis was based on the presence of intrahepatic bile duct paucity on liver biopsy in association with at least three of the major clinical features: chronic cholestasis, cardiac disease (most often peripheral pulmonary stenosis), skeletal abnormalities (typically butterfly vertebrae), ocular abnormalities (primarily posterior embryotoxon), and characteristic facial features. Advances in molecular diagnostics have enabled an appreciation of the broader disease phenotype with recognition of renal and vascular involvement [2,3]. There is significant variability in the extent to which each of these systems is affected in an individual, if at all [4,5]. It was originally estimated that ALGS had a frequency of 1 in 70000 live births, although this was based on the presence of neonatal cholestasis. However, this is clearly an underestimate as molecular testing has demonstrated that many individuals with a disease-causing mutation do not have neonatal liver disease and the true frequency is likely closer to 1 in 30000 [5].
Alagille syndrome is caused by mutations in JAGGED1 (JAG1), encoding a ligand Jagged1 in the Notch signaling pathway [6,7]. Mutations in JAG1 are identified in 94% of clinically defined probands [8]. Recently, mutations in NOTCH2 have been identified in a few patients with ALGS who do not have JAG1 mutations [9]. This exciting development has enhanced our understanding of the heterogeneity of this disorder, although much remains to be understood about the tremendous variability seen in affected individuals and the likely genetic modifiers involved.
Optimal distribution of traffic flows in emergency cases
- R. MANZO, B. PICCOLI, L. RARITÀ
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- Journal:
- European Journal of Applied Mathematics / Volume 23 / Issue 4 / August 2012
- Published online by Cambridge University Press:
- 12 April 2012, pp. 515-535
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The aim of this work is to present a technique for the optimisation of emergency vehicles travel times on assigned paths when critical situations, such as car accidents, occur. Using a fluid-dynamic model for the description of car density evolution, the attention is focused on a decentralised approach reducing to simple junctions with two incoming roads and two outgoing ones (junctions of 2 × 2 type). We assume the redirection of cars at junctions is possible and choose a cost functional that describes the asymptotic average velocity of emergency vehicles. Fixing an incoming road and an outgoing road for the emergency vehicle, we determine the local distribution coefficients that maximise such functional at a single junction. Then we use the local optimal coefficients at each node of the network. The overall traffic evolution is studied via simulations, both for simple junctions or cascade networks, evaluating global performances when optimal parameters on the network are used.
3 - Hybrid automata
- from Part I - Theory
- Edited by Jan Lunze, Ruhr-Universität, Bochum, Germany, Françoise Lamnabhi-Lagarrigue, Centre National de la Recherche Scientifique (CNRS), Paris
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- Book:
- Handbook of Hybrid Systems Control
- Published online:
- 21 February 2011
- Print publication:
- 15 October 2009, pp 57-86
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Summary
Hybrid automata is a modeling formalism for hybrid systems that results from an extension of finite-state machines by associating with each discrete state a continuous-state model. Conditions on the continuous evolution of the system invoke discrete state transitions. A broad set of analysis methods is available for hybrid automata including methods for the reachability analysis, stability analysis, and optimal control.
Definition
A hybrid automaton is a transition system that is extended with continuous dynamics. It consists of locations, transitions, invariants, guards, n-dimensional continuous functions, jump functions, and synchronization labels. Various definitions exist in the literature which differ only in details. The following definition covers all of the aspects needed for the purpose of this handbook. A hybrid automaton consists of:
a finite set of locations Q, q ∈ Q;
a finite transition relation ⊖ ⊆ Q × Q
for the specification of the discrete dynamics. The locations can be seen as discrete states (also called control modes), in other words as the discrete part of the hybrid state space ℋ. Transitions from one control mode to the next are often called control switches. The continuous dynamics is described by:
a finite and indexed set of continuous variables V = {x1, x2, …, xn}, often written as a vector x = (x1, …, xn);
a real-valued activity function f : Q × ℝn → ℝn, often defined by a continuous differential equation ẋ = dx/dt = f(q, x).
15 - Alagille Syndrome
- from SECTION II - CHOLESTATIC LIVER DISEASES
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- By Binita M. Kamath, M.B. B.Chir., Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Attending Physician, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, Nancy B. Spinner, Ph.D., Professor of Human Genetics in Pediatrics, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Director, Cytogenetics Laboratory, Department of Pathology and Clinical Laboratories, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, David A. Piccoli, M.D., Biesecker Professor of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Chief, Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Edited by Frederick J. Suchy, Mount Sinai School of Medicine, New York, Ronald J. Sokol, University of Colorado, Denver, William F. Balistreri, University of Cincinnati
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- Book:
- Liver Disease in Children
- Published online:
- 18 December 2009
- Print publication:
- 07 May 2007, pp 326-345
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Summary
Alagille syndrome (AGS) is a highly variable, multisystem, autosomal dominant disorder that primarily affects the liver, heart, eyes, face, and skeleton [1–3]. There is significant variability in the extent to which each of these systems is affected in an individual, if at all [4, 5]. AGS has traditionally been diagnosed based on the presence of intrahepatic bile duct paucity on liver biopsy in association with at least three of the major clinical features: chronic cholestasis, cardiac disease (most often peripheral pulmonary stenosis), skeletal abnormalities (typically butterfly vertebrae), ocular abnormalities (primarily posterior embryotoxon), and characteristic facial features [6]. It has an estimated frequency of 1 in 70,000 live births based on the presence of neonatal cholestasis. However, this is an underestimate as molecular testing has demonstrated that many individuals with a disease-causing mutation do not have neonatal liver disease.
Alagille syndrome is caused by mutations in Jagged1 (JAG1), a ligand in the Notch signaling pathway [7, 8]. JAG1 mutations are identified in more than 90% of clinically diagnosed probands [9]. Recently, mutations in Notch2 have been identified in a few patients with AGS who do not have JAG1 mutations [10]. This exciting development has enhanced our understanding of the heterogeneity of this disorder, though much remains to be understood about the tremendous variability seen in affected individuals and the likely genetic modifiers involved.
BILE DUCT PAUCITY
Bile duct paucity is present in a diverse group of metabolic, infectious, and inflammatory hepatic disorders in infancy.
Infinite time regular synthesis
- B. Piccoli
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- Journal:
- ESAIM: Control, Optimisation and Calculus of Variations / Volume 3 / 1998
- Published online by Cambridge University Press:
- 15 August 2002, pp. 381-405
- Print publication:
- 1998
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In this paper we provide a new sufficiency theorem for regular syntheses. The concept of regular synthesis is discussed in [12], where a sufficiency theorem for finite time syntheses is proved. There are interesting examples of optimal syntheses that are very regular, but whose trajectories have time domains not necessarily bounded. The regularity assumptions of the main theorem in [12] are verified by every piecewise smooth feedback control generating extremal trajectories that reach the target in finite time with a finite number of switchings. In the case of this paper the situation is even more complicate, since we admit both trajectories with finite and infinite time. We use weak differentiability assumptions on the synthesis and weak continuity assumptions on the associated value function.