Biomedical subjects
F Schifano
Publications and source records attributed to F Schifano.
Naltrexone for heroin addiction: encouraging results from Italy.
This report provides preliminary data regarding compliance rates of naltrexone (NTX) treatment for 99 consecutive heroin addicts. NTX was administered orally after a 3-13-day drug induction period. Fifteen out of the 99 patients who underwent naloxone challenge are still being treated (having taken NTX for less than 6 months to date). Of the 52 patients who completed the drug induction period, 22 (41.31%) showed satisfactory results (in terms of treatment compliance and/or opiate-free conditions at 6-month follow-up). The 52 patients who properly started regular NTX assumption stayed with the treatment for a mean 17.04 +/- 8.2 weeks. These results would demonstrate a higher than average success with NTX treatment of randomly selected heroin addicts with respect to the literature and would seem related to particularly favorable socio-cultural conditions in northern Italy (where the study was carried out).
[Viral hypothesis of schizophrenia. Critical reflections].
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OKT4/OKT8 ratio in asymptomatic heroin addicts.
The OKT4 (helper) and OKT8 (suppressor) lymphocytic subpopulations were enumerated in a sample of 60 asymptomatic drug addicts and in 17 controls. No significant differences in the ratio could be found that could not be explained by the action of HIV. It can be concluded that heroin itself was not responsible for any alteration in the T4/T8 ratio in the population considered.
Panic attacks and major depression after discontinuation of long-term diazepam abuse.
A case is described of a patient with a history of several years of diazepam abuse (in the last 24 months at dosages of 120 mg/d). A tapering schedule was carried out during a 12-day stay in the hospital in which the diazepam dosage was reduced by a fixed quantity every day, corresponding to about ten percent of the initial dosage. Five days after discharge from the hospital the patient experienced panic attacks, for the first time, which continued until 13 days after discharge. By the 40th day, the patient was experiencing a major depressive episode, which improved after administration of clomipramine therapy. We suggest that a relatively quick withdrawal schedule (ten percent per day) is probably inadequate in preventing withdrawal reactions to long-acting benzodiazepines taken in high doses for an extended period of time.
[Prevalence of HIV infection and changes in CD4/CD8 ratio in asymptomatic drug addicts].
HIV infection prevalence and CD4/CD8 ratio alterations in asymptomatic heroin abusers. Authors evaluated HIV infection prevalence and presence of possible CD4/CD8 ratio alteration in a asymptomatic heroin abusers' sample. Drug addicts consecutively arrived to Local Health Unit No 12-Drug Addicts Advisory Unit. In this sample, there was a 41% prevalence of HIV infection and significant changes, not attributable to HIV infection, in the CD4/CD8 ratio were not found by comparison with 17 healthy controls.
[Headache and "masked" depression].
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Results of dexamethasone suppression test in early Alzheimer dementia.
The frequency of an abnormal response to the Dexamethasone Suppression Test (DST) was examined in 24 non-depressed patients in the early stages of Alzheimer dementia. Results were compared with those obtained in 51 geriatric medical inpatients: 15 with major depression, 18 with dysthymic disorder and 18 normal controls. As an abnormal lack of suppression was found in 9 demented patients, in 9 with major depression, 1 with dysthymic disorder and in 2 the normal controls, it appears that DST alone is not useful in distinguishing dementia, even in its early stages, from major depression. In our experience abnormal DST results in demented patients were unrelated to mood.
Psychological distress in geriatric and adult medical in-patients.
Psychological distress was evaluated in two groups of medical in-patients, one composed of geriatric subjects (178), the other of adults (201). The instrument used for this purpose was the SCL-90. The predominant pattern of emotional response among the geriatric patients was depression; although this pattern was also present among the adult patients, reactions of an anxious type were more common in these subjects. Women of both groups of patients scored significantly higher than men on many of the subscales of the SCL-90. No significant differences emerged in relation to the type of organic disease among the adult patients, while among the geriatric patients, subjects with disorders of the CNS, muscular-skeletal system and blood scored significantly higher than those with other diseases.
Longitudinal evaluation of psychological distress in medical geriatric in-patients.
A longitudinal evaluation of the degree and type of psychological distress was carried out in 50 geriatric medical in-patients, using the Symptom Distress Checklist. They were tested within three days of admission, after 12-15 days of hospital stay, and 20-30 days after discharge. The first two evaluations showed significantly higher distress than the third for almost all the subscales. Scores indicating a significant depressive distress decreased from 70 per cent (first evaluation) and 76 per cent (second evaluation) to 34 per cent at the third one. The number of patients with significant distress for the other SCL-90 subscales was, at the third evaluation, rather low. Our data hence seem to show that the phenomenon of psychological distress in the hospital setting is transitory, and mainly arises from the factors of 'disease' and 'hospitalization'. However, in the case of some particular aspects of psychological distress, such as depression, whilst most patients overcome it, one out of three still presents a significant degree of suffering after returning home.
[Pharmacological interactions of lithium].
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[Identification and appreciation of the psychological distress in hospitalized elderly persons].
We evaluated psychological distress in a survey of 398 geriatric medical inpatients, using the Symptom Distress Check-List (SCL-90). Predominant patterns of emotional response are depression, somatization and sleep disorders. Women scored higher than men for psychological suffering on many of the SCL-90 subscales. Those who lived alone, and those who entered the hospital with a neurological disturbance, scored higher for depression than the others. We briefly discussed the need for attention to psychological reactions in this setting.
The dexamethasone suppression test in dementia.
The dexamethasone suppression test (DST) was performed on 13 patients with multi-infarct dementia (MID), 5 patients with primary degenerative dementia (PDD) and 18 elderly controls. Abnormal lack of suppression was found in 7 demented patients (3 with PDD, 1 mild and 2 severe, and 4 with MID, 1 mild and 3 severe), and in 2 of the controls. Only one demented patient was depressed. The value of DST in the differential diagnosis of dementia from the major depressive disorders is discussed.
The dexamethasone suppression test in depressed and non-depressed geriatric medical inpatients.
The frequency of an abnormal response to the dexamethasone suppression test (DST) was examined in 38 geriatric patients hospitalized for medical illnesses and affected by depressive disorders diagnosed according to the DSM III, and in 18 medical patients (used as controls) hospitalized in the same ward. Only 11% of the controls and 11% of those affected by dysthymic disorder had an abnormal DST vs 73% of the patients with major depressive disorder (MDD). The sensitivity of the DST for MDD, in this particular setting, was found to be about 73% and the specificity 89%. The importance of this clinical adjunct in diagnosing the severe depressive disorders is discussed.