PubMed Health⌕ Search

Biomedical subjects

Matteo Balestrieri

Publications and source records attributed to Matteo Balestrieri.

14 recordsLinked to original sources
PubMed2007

Cerebral atrophy and white matter disruption in chronic schizophrenia.

Several magnetic resonance imaging (MRI) studies have shown cerebral atrophy in established schizophrenia, although not in all reports. Discrepancies may mostly be due to population and postprocessing differences. Recently, disruption of cortical white matter integrity has also been reported in chronic patients with schizophrenia. In this study we explored tridimensional (3D) cerebral volumes and white matter microstructure in schizophrenia with structural and diffusion magnetic resonance. Twenty-five patients with established schizophrenia and 25 1:1 matched normal controls underwent a session of MRI using a Siemens 1.5T-scanner. 3D brain volume reconstruction was performed with the semi-automatic software Amira (TGS, San Diego, CA), whereas the apparent diffusion coefficients (ADCs) of cortical white matter water molecules were obtained with in-house developed softwares written in MatLab (The Mathworks-Inc., Natick, MA). Compared to controls, patients with schizophrenia had significantly smaller gray matter intracranium and total brain volumes, increased 4th ventricle volumes, and greater temporal and occipital ADCs. Patients treated with typical antipsychotic medication (N = 9) had significantly larger right lateral and 4th ventricles compared to those on atypical antipsychotic drugs. Intracranial volumes significantly inversely correlated with left temporal ADC in patients with schizophrenia. Also, age correlated directly with right, left, and 3rd ventricle volumes and inversely with gray matter intracranium volumes in individuals with schizophrenia. This study confirmed the presence of cortical atrophy in patients with schizophrenia, especially in those on typical antipsychotic drugs, and the existence of white matter disruption. It also suggested that physiological aging effects on brain anatomy may be abnormally pronounced in schizophrenia.

Adult↗
PubMed2006

Normal pituitary volumes in chronic schizophrenia.

Pituitary volumes were shown to be abnormally large in pre- or first-psychotic episode patients and abnormally reduced in established schizophrenia by magnetic resonance imaging (MRI) studies. We present here the results of the second ever published MRI study exploring pituitary size in a large population of patients with chronic schizophrenia recruited from the geographically defined catchment area of South Verona, Italy. No significant differences for pituitary volumes were reported between 65 subjects with chronic schizophrenia and 65 normal individuals (mean age+/-S.D.=42.31+/-11.44 and 40.54+/-11.12 years). In contrast to Pariante et al. (2004), normal pituitary size was found in our population of chronic schizophrenia. Discrepancies between these two studies may partially be accounted by sample age and gender. Considering increased pituitary volumes in pre- or first-psychotic episode patients, we put forward the hypothesis that pituitary size may normalize or reduce with the progression of the illness as a result of reduced numbers of acute episodes and consequent diminished hypothalamus-pituitary-adrenal axis activity. To better test this hypothesis, future large MRI studies should investigate pituitary volumes in chronic schizophrenia longitudinally, also collecting pituitary hormones and cortisol, and comparing the effects of typical and atypical antipsychotics on pituitary size in a randomized trial.

Adult↗
PubMed2006

Management of depression relapse: re-initiation of duloxetine treatment or dose increase.

Continuation of antidepressant therapy after patients have responded to medication has been shown to greatly reduce but not eliminate relapse. We evaluated response to reinstating or increasing drug doses in patients who relapsed during a long-term, randomized, double-blind, continuation phase study of duloxetine treatment for major depressive disorder (MDD). Patients with HAMD17 scores of >18 and CGI-Severity scores of >4 received duloxetine 60 mg QD for 12 weeks, responders then received 26 weeks of duloxetine 60 mg QD or placebo. The relapsing patients who started 12 weeks of rescue treatment received duloxetine 60 mg QD (if relapsing on placebo) or duloxetine 60 mg BID (if relapsing on duloxetine). In the continuation phase, 87 patients received duloxetine 60 mg QD (n=58) or 60 mg BID (n=29) as treatment for relapse. The percentage of patients who responded to treatment after relapse was 62% of those whose dose was increased from 60 mg QD to 60 mg BID, and 74% for those who switched from placebo to duloxetine 60 mg daily. By the end of the study, 32 patients taking duloxetine 60 mg QD were in remission (57%), compared with 11 patients taking duloxetine 60 mg BID (38%). There was significant improvement in HAMD17 and CGI-Severity scores for both groups at endpoint vs. start of treatment for relapse. Significant improvements were seen for all visual analog scale parameters in the 60 mg QD group, but only Interference with Daily Activities and Back Pain parameters showed significant improvement for patients receiving 60 mg BID. Significant within-group improvement from baseline was seen for both groups in Symptom Questionnaire-Somatic Subscale total and pain subscales. Treatment-emergent adverse events were mild/moderate in severity; no clinically significant changes were noted in laboratory results or vital signs. Reinstatement of duloxetine 60 mg QD was effective for patients who relapsed after discontinuing drug. Patients relapsing on duloxetine 60 mg QD benefited from an increase to 60 mg BID. These duloxetine doses were well tolerated and effective, and appear appropriate for MDD patients requiring treatment of relapse.

Adult↗
PubMed2006

Lifetime rhythmicity and mania as correlates of suicidal ideation and attempts in mood disorders.

BACKGROUND: The aim of this study is to establish to what degree variation in lifetime experience of rhythmicity and manic-hypomanic features correlates with suicidality in individuals with mood disorders and other major psychiatric diagnoses and in a comparison group of controls. METHOD: Suicidal ideation and attempts were investigated in a clinical sample, including 77 patients with schizophrenia, 60 with borderline personality disorder, 61 with bipolar disorder, 88 with unipolar depression, and 57 with panic disorder, and in a comparison group of 102 controls. Using information derived from the diagnostic interview and a self-report assessment of mood spectrum symptoms, subjects were assigned to 3 categories according to the maximum level of suicidality achieved in the lifetime (none, ideation/plans, and suicide attempts). The association of categorical and continuous variables with suicidality levels was investigated using multinomial logistic regression models. RESULTS: Suicidal ideation and plans were more common in unipolar depression (50%) and bipolar disorder (42.4%) than in borderline personality disorder (30%), whereas the reverse was true for suicidal attempts. In each of the study groups, the number and the type of mood spectrum items endorsed, including depressive and manic-hypomanic items and rhythmicity and vegetative symptoms, were associated with increased levels of suicidality. CONCLUSIONS: Our results suggest that the assessment of lifetime rhythmicity and manic-hypomanic features may be clinically useful to identify potential suicide attempters in high-risk groups.

Adult↗
PubMed2005

Mental disorders associated with benzodiazepine use among older primary care attenders--a regional survey.

BACKGROUND: Benzodiazepines (BDZs) are among the most commonly prescribed drugs in the elderly and their use is often too prolonged according to current international guidelines. METHODS: We investigated the pattern of use of BDZs among 65- to 84-year-old attenders at 40 Italian primary care practices who answered positively in a questionnaire on the use of anxiolytic/hypnotic drugs and successfully completed the PRIME-MD questionnaire. The survey lasted 6 months, from February to July 2001. RESULTS: Of the 1,156 subjects who completed the PRIME-MD, 748 subjects were positive for at least one psychiatric diagnosis. A depressive disorder was present in 36.5% of all PRIME-MD completers and in about one-third of cases represented by major depression, whereas anxiety disorders, somatoform disorders and alcohol abuse accounted for 18.2%, 8.1% and 1.7% of all PRIME-MD completers, respectively. Most patients were first prescribed BDZs by their General Practitioners (GPs) for each diagnostic group. However, patients with pure anxiety started BDZ treatment during hospitalisation more often (19.7%) than patients with depressive disorders (13.7 %). Moreover, patients with comorbid anxiety and depressive disorders (CADD) were most likely to receive their first BDZ prescription from a psychiatrist (15.7 %). Sleep disturbances were present in at least 50% of cases (and up to 86 %) in each diagnostic group. About 75% of prescriptions concerned anxiolytic BDZ or medium/long-acting BDZ. Most patients with anxiety, CADD and depression used night-time BDZ (65.2%, 56.9 % and 60.5%, respectively). The prevalence of chronic use of BDZs was equally high in all categories of psychiatric disorder (about 90 % for each), showing that the vast majority of patients, irrespective of the diagnosis, had been using BDZs for years. CONCLUSIONS: BDZs are widely prescribed for elderly people by their GPs, often for a considerable length of time. The evidence that many BDZ consumers suffer from a depressive or an anxiety disorder, or both, could be a starting point for encouraging a rational prescription in accordance with international guidelines.

Adult↗
PubMed2005

Effects of pregnancy on eating attitudes and disorders: a prospective study.

The aim of this prospective study was to investigate the effects of pregnancy on eating disorders (ED), dietary habits and body image perception. One hundred and fifty pregnant women were interviewed between the period January 2001 and May 2003. Ninety-seven women completed the study and were divided in three subgroups: pregnant women with a positive history of dieting (n=37), pregnant women with a positive history of dieting with a complete diagnosis of a current ED (n=11) and pregnant women with a negative history either of dieting or ED (control group; n=49). Age, education and parity were equally distributed in all three groups. To verify if pregnancy exerts a specific protective effect, a battery of psychometric tests was administered to women at 12 degrees (T0), 22 degrees (T1), and 34 degrees pregnancy weeks (T2), and 2 days (T3) and 4 months (T4) after delivery, respectively. The study showed a quadratic trend for ED, subthreshold ED and body satisfaction, with a general improvement in the middle of pregnancy and a return to previous levels after delivery. Some interesting significant differences came out among the groups.

Adult↗
PubMed2005

Magnetic resonance findings in bipolar disorder.

The MR findings reviewed in this article suggest structural, chemical, and functional abnormalities in specific brain regions participating in mood and cognitive regulation, such as the DLPFC, anterior cingulate, amygdala,STG, and corpus callosum in subjects with bipolar disorder. These abnormalities would represent an altered anterior-limbic network disrupting inter- and intrahemispheric communication and underlying the expression of bipolar disorder. Available studies are limited by several confounding variables, such as small and heterogeneous patient samples, differences in clinical and medication status, and cross-sectional design. It is still unclear whether abnormalities in neurodevelopment or neurodegeneration play a major role in the pathophysiology of bipolar disorder. These processes could act together in a unitary model of the disease, with excessive neuronal pruning/apoptosis during childhood and adolescence being responsible for the onset of the disorder and subsequent neurotoxic mechanisms and impaired neuroplasticity and cellular resilience being responsible for further disease progression. Future MR studies should investigate larger samples of first-episode drug-free patients, pediatric patients, subjects at high risk for bipolar disorder, and unaffected family members longitudinally. Such a study population is crucial to examine systematically whether brain changes are present before the appearance of symptoms (eg, maldevelopment) or whether they develop afterwards, as a result of illness course (eg, neurodegeneration). These studies will also be instrumental in minimizing potentially confounding factors commonly found in adult samples, such as the effects of long-term medication, chronicity, and hospitalizations. Juvenile bipolar patients often have a strong family history of bipolar disorder. Future studies could help elucidate the relevance of brain abnormalities as reflections of genetic susceptibility to the disorder. MR studies associated with genetic, post-mortem, and neuropsychologic studies will be valuable in separating state from trait brain abnormalities and in further characterizing the genetic determinants, the neuropathologic underpinnings, and the cognitive disturbances of bipolar disorder.

Atrophy↗
PubMed2004

Factors associated with complex visual hallucinations during antidepressant treatment.

Published case reports on complex visual hallucinations (CVH) occurring during antidepressant (AD) treatment were reviewed. Thirteen cases of CVH associated with SSRI treatment, 16 cases during tricyclic drug treatment and seven cases with other AD drug treatments were found. Nine patients were taking concomitant drugs while on therapy with SSRIs and four had a neurological disease in addition to depression. The cholinergic impoverishment occurring in dementia states or during concomitant therapy with anticholinergic drugs could increase the sensitivity to serotonergic agonists, triggering the manifestation of CVH. During tricyclic drug treatment, half of the reports were of hypnopompic or hypnagogic hallucinations and this can be associated with the effects of tricyclics (TCA) on sleep architecture. It is likely that the potent anticholinergic effect of amitriptyline was potentiated in a situation of a rapidly changing state of consciousness. In general, the review supports the view that an imbalance between serotonin and acetylcholine systems is at the root of AD-induced CVH, with a profile defined by a cholinergic hypoactivity and a serotonergic hyperactivity. Caution is needed when administering a combination of serotonergic and anticholinergic AD in the treatment of the demented population and in other already compromised patients because there is a risk of precipitating CVH.

Acetylcholine↗
PubMed2004

Recognition of depression and appropriateness of antidepressant treatment in Italian primary care.

BACKGROUND: A significant proportion of primary care patients are affected by a depressive disorder and about half of these patients are undetected and undertreated. METHODS: Twenty-five primary care physicians (PCPs) were recruited in five Italian centres. All consecutive patients who attended the PCPs' clinics in a 2-week period completed the Personal Health Questionnaire (PHQ), and those scoring more than nine on the PHQ were interviewed with the Hamilton Rating Scale for Depression-17 items (HDRS-17). The appropriateness of antidepressant drug treatment was assessed according to the decision to treat, the coverage, the type of drug and the dosage prescribed. RESULTS: The adjusted prevalence for ICD-10 depression in 2093 patients was 18.7%, while the conspicuous morbidity was 10.7%. The ability of PCPs to detect a depression increased proportionally with HDRS scores. The coverage, i. e. the proportion of patients who would benefit from an antidepressant (AD) and who actually received such drugs, was 20.9%. The drugs most frequently prescribed were SSRI (36 %), followed by TCA (21%) and by other AD. Most SSRI were prescribed at therapeutic dosage, while two-thirds of TCA were at sub-therapeutic dosage. About 37% of patients started a non-pharmacological treatment. The severity of depression at the first consultation predicted the persistence of a depressive state in the longer term. CONCLUSIONS: The ability of Italian PCPs to detect depression is satisfactory when the patient's depressive state is moderate or severe. The appropriateness of antidepressant drug treatment still needs to be improved.

Adult↗
PubMed2004

Neuropathological and clinical phenotype of an Italian Alzheimer family with M239V mutation of presenilin 2 gene.

Presenilin 1 and 2 are 2 highly homologous genes involved in familial Alzheimer disease. While more than 100 mutations in presenilin 1 are known to segregate with the disease in familial Alzheimer disease, only 9 mutations of presenilin 2 have been identified to date. We report the clinical and neuropathological phenotype of FLO10, the large Italian Alzheimer kindred associated with methionine to valine substitution at residue 239 of presenilin 2. The patients showed a remarkable variability in age of onset of symptoms, disease duration, and clinical presentation. The neuropathological study of 2 patients revealed peculiar features in addition to neurofibrillary changes and A beta amyloid deposits in the neuropil and vessel wall. Ectopic neurons in the subcortical white matter, often containing neurofibrillary tangles, were found in both patients, one of whom presented with epilepsy. Furthermore, 1 patient showed an unusually high number of ghost tangles in the cerebral cortex. These observations indicate that the Alzheimer kindred FLO10 associated with M239V mutation of presenilin 2 is characterized by some peculiarities of the clinical and neuropathologic phenotype compared to sporadic Alzheimer disease.

Age of Onset↗
PubMed2001

Psychoeducation in the prevention of eating disorders: An experimental approach in adolescent schoolgirls.

The aim of this report is to analyse the impact of a psychoeducational preventive programme on the eating habits of a sample of adolescent schoolgirls. Of the 112 schoolgirls attending five classes, about 86% agreed to participate in the program. Of these, 63 participants belonged to the experimental group and 33 agreed to the control group. The psychoeducational sessions were performed once a month for each of three experimental classes. The programme involved discussions on the nature of eating disorders, on epidemiological aspects and on the importance of early detection of risk factors. The tests used to evaluate the sample were the EDI-2 and the PF-16. The results showed a significant improvement in bulimic attitudes, asceticism, feelings of ineffectiveness, and maturity fears. Anxiety traits were also better managed in the experimental group. Our conclusions suggest that correct information about eating disorders can ameliorate unhealthy attitudes towards eating behaviour.

Journal Article↗
PubMed2000

Efficacy and safety of novel antipsychotics: a critical review.

Efficacy and safety of novel antipsychotic (AP) drugs (amisulpride, olanzapine, quetiapine, ziprasidone and zotepine) have been reviewed. Data on their antipsychotic efficacy and side effects profile have been evaluated only on the basis of controlled trials so far published. Overall, all these drugs have shown an antipsychotic efficacy on positive symptoms of schizophrenia similar to that of the conventional AP drugs. On negative symptoms, all novel AP drugs, except quetiapine and ziprasidone, demonstrated a better efficacy than haloperidol. Long-term efficacy of these AP drugs in the maintenance treatment of schizophrenia needs to be explored by further, better-designed, epidemiological studies. The safety profile shows that the novel AP drugs are generally well-tolerated and induce significantly less acute extrapyramidal side effects in comparison with haloperidol. Some methodological flaws in the experimental design of the clinical trials analysed are discussed. Although these novel AP drugs have potential clinical advantages, a number of relevant questions still remain to be addressed, in order to establish the impact of these drugs in the overall treatment of schizophrenia. Copyright 2000 John Wiley & Sons, Ltd.

Journal Article↗
PubMedDate not supplied

Identification of depression by medical and surgical general hospital physicians.

Little information is available about identification of mental distress by general hospital physicians (GHPs). We compared, among patients admitted in a General Hospital, depressed patients with patients identified as depressed by the GHPs. A random sample of 1,039 patients were screened with the 12-item General Health Questionnaire. Afterwards, all high scorers and a probability sample of low scorers were interviewed with a variety of measures, including the Composite International Diagnostic Interview-Primary Care version (CIDI-PHC). GHPs recorded the presence of depression on a Physician Encounter Form. Patients were more likely to have depression detected on medical than surgical wards. Of the 195 patients who had a depression, the GHPs assessed 32.5% as depressed. A number of factors associated with CIDI diagnoses were not significantly associated with being identified by the GHPs - female gender, two or more life events in the previous year, and a previous history of depression. The identification by the GHPs was associated with a higher probability of contacts with medical professionals and of antidepressant drug prescriptions during the year which followed the first interview.

Adolescent↗