| 1 | Pharmacologic approaches to treatment resistant depression:Evidences and personal experience显示文摘AIM: To review evidence supporting pharmacological treatments for treatment-resistant depression(TRD) and to discuss them according to personal clinical experience.METHODS: Original studies, clinical trials, systematic reviews, and meta-analyses addressing pharmacological treatment for TRD in adult patients published from 1990 to 2013 were identified by data base queries(Pub Med, Google Scholar e Quertle Searches) using terms: 'treatment resistant depression', 'treatment refractory depression', 'partial response depression', 'non responder depression', 'optimization strategy', 'switching strategy', 'combination strategy', 'augmentation strategy', selective serotonin reuptake inhibitors antidepressants(SSRI), tricyclic antidepressants(TCA), serotonin norepinephrine reuptake inhibitors antidepressants, mirtazapine, mianserine, bupropione, monoamine oxidase inhibitor antidepressant(MAOI), lithium, thyroid hormones, second generation antipsychotics(SGA), dopamine agonists, lamotrigine, psychostimulants, dextromethorphan, dextrorphan, ketamine, omega-3 fatty acids, S-adenosil-L-metionine, methylfolat, pindolol, sex steroids, glucocorticoid agents. Other citations of interest were further identified from references reported in the accessed articles. Selected publications were grouped by treatment strategy:(1) switching from an ineffective antidepressant(AD) to a new AD from a similar or different class;(2) combining the current AD regimen with a second AD from a different class; and(3) augmenting the current AD regimen with a second agent not thought to be an antidepressant itself.RESULTS: Switching from a TCA to another TCA provides only a modest advantage(response rate 9%-27%), while switching from a SSRI to another SSRI is more advantageous(response rate up to 75%). Evidence supports the usefulness of switching from SSRI to venlafaxine(5 positive trials out 6), TCA(2 positive trials out 3), and MAOI(2 positive trials out 2) but not from SSRI to bupropione, duloxetine and mirtazapine. Three reviews demonstrated that the benefits of intraand cross-class switch do not significantly differ. Data on combination strategy are controversial regarding TCA-SSRI combination(positive results in old studies, negative in more recent study) and bupropion-SSRI combination(three open series studies but not three controlled trails support the useful of this combination) and positive regard mirtazapine(or its analogue mianserine) combination with ADs of different classes. As regards the augmentation strategy, available evidences supported the efficacy of TCA augmentation with lithium salts and thyroid hormone(T3), but are conflicting regard the SSRI augmentation with these two drugs(1 positive trial out of 4 for lithium and 3 out of 5 for thyroid hormone). Double-blind controlled studies showed the efficacy of AD augmentation with aripiprazole(5 positive trials out 5), quetiapine(3 positive trials out 3) and, at less extent, of fluoxetine augmentation with olanzapine(3 positive trials out 6), so these drugs received the FDA indication for the acute treatment of TRD. Results on AD augmentation with risperidone are conflicting(2 short term positive trials, 1 short-term and 1 long-term negative trials). Case series and open-label trials showed that AD augmentation with pramipexole or ropinirole, two dopamine agonists, could be an effective treatment for TRD(response rate to pramipexole 48%-74%, to ropinirole 40%-44%) although one recent double-blind placebo-controlled study does not support the superiority of pramipexole over placebo. Evidences do not justify the use of psychostimulants, omega-3 fatty acids, S-adenosil-Lmetionine, methylfolate, pindolol, lamotrigine, and sex hormone as AD augmentation for TRD. Combining the available evidences with our experience we suggest treating non-responders to one SSRI bupropion or mirtazapine trial by switching to venlafaxine, and nonresponders to one venlafaxine trial by switching to a TCA or, if TCA are not tolerated, combining mirtazapine with SSRI or venlafaxine. In non-responders to two or more ADs(including at least one TCA if tolerated) current AD regimen could be augmented with lithium salts(mainly in patients with bipolar depression or suicidality), SGAs(mostly aripiprazole) or DA-agonists(mostly pramipexole). In patients with severe TRD, i.e., non-responders to combination and augmentation strategies as well as to electroconvulsive therapy if workable, we suggest to try a combination plus augmentation strategy.CONCLUSION: Our study identifies alternative effective treatment strategies for TRD. Further studies are needed to compare the efficacy of different strategies in more homogeneous subpopulations. | Antonio Tundo Rocco de Filippis Luca Proietti | 2015 | World Journal of Psychiatry2015，5，3： | 15 |
| 2 | Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence显示文摘AIM To review available evidence on the use of cognitive behavioural therapy(CBT) for treating obsessive compulsive disorder co-occurring with psychosis.METHODS In this paper we present a detailed and comprehensive review of the current literature focusing on CBT treatment of obsessive compulsive disorder(OCD) co-occurring with schizophrenia or schizoaffective disorder. We identified relevant literature published between 2001 and May 2016 through MEDLINE/PubM ed search using as search string('obsessive compulsive disorders' or 'obsessive compulsive symptoms') and('schizophrenia' or 'schizoaffective disorder' or 'psychosis') and('cognitive behavioural therapy'). Other citations of interest were further identified from references reported in the accessed articles. The search was limited to studies written in English and carried out in adult patients. A total of 9 studies, 8 case reports and 1 case series, were found.RESULTS The reviewed evidence indicates that CBT is:(1) safe, i.e., does not worsen psychotic symptoms;(2) well accepted, with a discontinuation rate quite similar to that reported for patients with OCD without psychosis comorbidity;(3) effective, with a symptom reduction quite similar to that reported for patients with OCD without psychosis and for SRIs treatment of OCD cooccurring with psychosis; and(4) effective in patients with OCD induced by second-generation antipsychotic as well as in patients with OCD not induced by secondgeneration antipsychotic. Alcohol/substance use disorder comorbidity and OCD onset preceding that of SCH/SA was predictors of poor outcome. These results are derived only by additional studies with adequate sample size.CONCLUSION Our results support the use of CBT for OCD in patients with psychosis. | Antonio Tundo Roberta Necci | 2016 | World Journal of Psychiatry2016，6，4： | 2 |
| 3 | Boceprevir or telaprevir in hepatitis C virus chronic infection:The Italian real life experience显示文摘AIM: To check the safety and efficacy of boceprevir/telaprevir with peginterferon/ribavirin for hepatitis C virus(HCV) genotype 1 in the real-world settings. METHODS: This study was a non-randomized, observational, prospective, multicenter. This study involved 47 centers in Italy. A database was prepared for the homogenous collection of the data, was used by all of the centers for data collection, and was updated continuously. All of the patients enrolled in this study were older than 18 years of age and were diagnosed with chronic infection due to HCV genotype 1. The HCV RNA testing was performed using COBAS-Taq Man2.0(Roche, LLQ 25 IU/m L). RESULTS: All consecutively treated patients were included. Forty-seven centers enrolled 834 patients as follows: Male 64%; median age 57(range 18-78), of whom 18.3% were over 65; mean body mass index 25.6(range 16-39); genotype 1b(79.4%); diagnosis of cirrhosis(38.2%); and fibrosis F3/4(71.2%). The following drugs were used: Telaprevir(66.2%) and PEG-IFN-alpha2a(67.6%). Patients were na?ve(24.4%), relapsers(30.5%), partial responders(14.8%) and null responders(30.3%). Overall, adverse events(AEs) occurred in 617 patients(73.9%) during the treatment. Anemia was the most frequent AE(52.9% of cases), especially in cirrhotic. The therapy was stopped for 14.6% of the patients because of adverse events or virological failure(15%). Sustained virological response was achieved in 62.7% of the cases, but was 43.8% in cirrhotic patients over 65 years of age. CONCLUSION: In everyday practice, triple therapy is safe but has moderate efficacy, especially for patients over 65 years of age, with advanced fibrosis, nonresponders to peginterferon + ribavirin. | Antonio Ascione Luigi Elio Adinolfi Pietro Amoroso Angelo Andriulli Orlando Armignacco Tiziana Ascione Sergio Babudieri Giorgio Barbarini Michele Brogna Francesco Cesario Vincenzo Citro Ernesto Claar Raffaele Cozzolongo Giuseppe D’Adamo Emilio D’Amico Pellegrino Dattolo Massimo De Luca Vincenzo De Maria Massimo De Siena Giuseppe De Vita Antonio Di Giacomo Rosanna De Marco Giorgio De Stefano Giulio De Stefano Sebastiano Di Salvo Raffaele Di Sarno Nunzia Farella Laura Felicioni Basilio Fimiani Luca Fontanella Giuseppe Foti Caterina Furlan Francesca Giancotti Giancarlo Giolitto Tiziana Gravina Barbara Guerrera Roberto Gulminetti Angelo Iacobellis Michele Imparato Angelo Iodice Vincenzo Iovinella Antonio Izzi Alfonso Liberti Pietro Leo Gennaro Lettieri Ileana Luppino Aldo Marrone Ettore Mazzoni Vincenzo Messina Roberto Monarca Vincenzo Narciso Lorenzo Nosotti Adriano Maria Pellicelli Alessandro Perrella Guido Piai Antonio Picardi Paola Pierri Grazia Pietromatera Francesco Resta Luca Rinaldi Mario Romano Angelo Rossini Maurizio Russello Grazia Russo Rodolfo Sacco Vincenzo Sangiovanni Antonio Schiano Antonio Sciambra Gaetano Scifo Filomena Simeone Annarita Sullo Pierluigi Tarquini Paolo Tundo Alfredo Vallone | 2016 | World Journal of Hepatology2016，8，22： | 1 |
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