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Gli antipsicotici nel disturbo schizoaffettivo: sono anche stabilizzatori?

Gli antipsicotici nel disturbo schizoaffettivo: sono anche stabilizzatori?. Giuseppe Maina SCDU Psichiatria A.O.U. San Luigi Gonzaga Università degli Studi di Torino. Il Disturbo Schizoaffettivo Gli stabilizzatori dell’umore Il trattamento del Disturbo Schizoaffettivo.

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Gli antipsicotici nel disturbo schizoaffettivo: sono anche stabilizzatori?

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  1. Gli antipsicotici nel disturbo schizoaffettivo: sono anche stabilizzatori? Giuseppe Maina SCDU Psichiatria A.O.U. San Luigi Gonzaga Università degli Studi di Torino

  2. Il Disturbo Schizoaffettivo • Gli stabilizzatori dell’umore • Il trattamento del Disturbo Schizoaffettivo

  3. Theoretical modelsof schizoaffective disorder Atypical variant of schizophrenia MANIC-DEPRESSIVE ILLNESS SCHIZOPHRENIA SCHIZOAFFECTIVE DISORDER

  4. Schizoaffective disorder as a variant of schizophrenia 1. Specific symptoms of schizophrenia Bleuler (1923) Schneider (1959) 2. Hierarchical concept Jaspers (1913) Bleuler (1923) ? ”Even a trace of schizophrenia is schizophrenia” Lewis and Piatrawski,1954

  5. Theoretical modelsof schizoaffective disorder Atypical variant of schizophrenia Atypical variant of affective disorder MANIC-DEPRESSIVE ILLNESS SCHIZO PHRENIA SCHIZOAFFECTIVE DISORDER

  6. unipolar schizoaffective psychoses bipolar schizoaffective psychoses melancholia and other special types bipolar I BIPOLAR COURSE UNIPOLAR COURSE bipolar II mild depressive episode cyclothymia dysthymia hyperthymic and cyclothymic temperament depressive temperament AFFECTIVITY Bipolar and unipolar disorders Angst and Marneros, J Affect Disord 2001

  7. Theoretical modelsof schizoaffective disorder Atypical variant of schizophrenia Atypical variant of affective disorder “Third” psychosis MANIC-DEPRESSIVE ILLNESS SCHIZO PHRENIA SCHIZO AFFECTIVE DISORDER

  8. The “third psychosis” hypothesis Bouffée délirante (Magnan, 1938) Cycloid psychosis (Leonhard, 1957) Atypical psychosis (Mitsuda, 1965)

  9. MANIC-DEPRESSIVE ILLNESS SCHIZOAFFECTIVE DISORDER SCHIZOPHRENIA Theoretical modelsof schizoaffective disorder Atypical variant of schizophrenia Atypical variant of affective disorder “Third psychosis” Psychotic continuum Beck, 1967 Kendell, Gourlay, 1975

  10. SCHIZOPHRENIA MANIC-DEPRESSIVE ILLNESS Theoretical modelsof schizoaffective disorder Atypical variant of schizophrenia Atypical variant of affective disorder “Third psychosis” Psychotic continuum Overlap of affective disorder and schizophrenia SCHIZOAFFECTIVE DISORDER

  11. SCHIZOAFFECTIVE DISORDER Theoretical modelsof schizoaffective disorder Atypical variant of schizophrenia Atypical variant of affective disorder “Third psychosis” Psychotic continuum Overlap of affective disorder and schizophrenia Heterogeneous group of patients

  12. Schizophrenia Spectrum and Other Psychotic Disorders • Schizotypal (Personality) Disorder • Brief Psychotic Disorder • Schizophreniform Disorder • Schizophrenia • Schizoaffective Disorder • Substance/Medication-Induced Psychotic Disorder • Psychotic Disorder Due to Another Medical Condition • Other Specified/Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

  13. Schizoaffective Disorder in DSM-5: diagnostic criteria Uninterrupted period of illness during which there is a major mood episode concurrent with criterion A of schizophrenia A • Major Depressive Episode • Manic Episode

  14. Schizoaffective Disorder in DSM-5: diagnostic criteria Uninterrupted period of illness during which there is a major mood episode concurrent with criterion A of schizophrenia A Two (or more) of the following during a 1-month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3): Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms

  15. Schizoaffective Disorder in DSM-5: diagnostic criteria Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration B Major mood episodes are present for the majority of the total duration of the active and residual portions of the illness. C The disturbance is not attributable to the effects of a substance or another medical condition. D

  16. DSM-5 schizophrenia spectrum disorders along a continuum of severity Bhati MT, Curr Psychiatry Rep 2013

  17. Schizoaffective Disorder in DSM-5: subtypes and specifiers • Subtypes: Bipolar / Depressive type • Specifiers: • 1. With catatonia • 2. Course specifiers • (only to be used after a 1-year duration of the disorder): • First episode, currently in acute episode / partial • remission / full remission • Multiple episodes, currently in acute episode / partial • remission / full remission • Continuous • Unspecified • 3. Severity specifiers

  18. Il Disturbo Schizoaffettivo • Gli stabilizzatori dell’umore • Il trattamento del Disturbo Schizoaffettivo

  19. Stabilizzatori dell’umore: definizione 1. Trattamentodell’episodioacuto(senza aumentareilrischio di sviluppoepisodiocontropolare) 2. Prevenzionedellericorrenze

  20. N=453 % 12.2% p=.043 Switching rate Tohen et al., ArchGenPsychiatry 2003

  21. Keck et al., J Clin Psychiatry 2007

  22. Il Disturbo Schizoaffettivo • Gli stabilizzatori dell’umore • Il trattamento del Disturbo Schizoaffettivo

  23. Schizoaffective disorder treatment algorithm – SAD Working Group Nasrallah et al, Supplement to Current Psychiatry 2010

  24. Evidence-based pharmacotherapy • Bipolar type: • - SGA + MS (or AD) • - SGA monotherapy • - psychoeducation when clinically stable • Unipolar type: • - SGA + MS / AD • - psychoeducation when clinically stable • ECT if treatment resistant in both groups Vieta E, J Clin Psichiatry 2010

  25. Principi attivi indicati in Italia per il trattamento del Disturbo Schizoaffettivo

  26. N=316 Canuso et al, J Clin Psichiatry 2010

  27. Effectiveness of paliperidone palmitate in schizophrenia or schizoaffective disorder Meanmonthly dose: paliperidone:129-169 mg haloperidole: 67-83 mg n=290 McEvoy et al, JAMA 2014

  28. Fu et al., J Clin Psychiatry 2015

  29. PANSS TOTALE p < 0.01 p < 0.01 Poster presentato al XXII Congresso Nazionale SOPSI, 2018 N=28

  30. T0 vs T1: p < 0.01; T0 vsT2: p < 0.01; T1 vs T2: p ns N=28 Poster presentato al XXII Congresso Nazionale SOPSI, 2018 T0 vs T1: p<0.01; T0 vs T2: p<0.01; T1 vs T2: p ns

  31. Punteggi HAM-D N=28 Poster presentato al XXII Congresso Nazionale SOPSI, 2018

  32. Gli antipsicotici nel disturbo schizoaffettivo: sono anche stabilizzatori? Mi hanno diagnosticato il disturbo schizofrenico: la mia famiglia era disperata e lo ero anche io di conseguenza…. Paolo, 2018

  33. Gli antipsicotici nel disturbo schizoaffettivo: sono anche stabilizzatori? Mi hanno diagnosticato il disturbo schizofrenico: la mia famiglia era disperata e lo ero anche io di conseguenza…. Ora mi dicono che ho il disturbo schizoaffettivo. Ho letto che forse è più grave, ma non so… Comunque la mia famiglia mi sembra sollevata e a me il nome mi pare meno drammatico… Paolo, 2018

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