Effects of therapeutic alliance on patients with major depressive disorder: a literature review Giovanni Videtta, Silvia Busilacchi, Giulia Bartoccioni, Luisa Cirella, Ylenia Barone, et al. Frontiers in Psychology, 2024 Therapeutic alliance refers to the collaborative relationship between a therapist and a patient, a concept widely explored in clinical research. It has emerged as a crucial component of effective psychotherapeutic interventions, particularly in the treatment of major depressive disorder (MDD), where its role appears to be multifaceted. In this context, we reviewed the main literature on the role of therapeutic alliance in MDD. The record search was conducted across three databases: PubMed, Web of Science, and PsychInfo. Seven of the reviewed studies highlighted that therapeutic alliance is a strong predictor of clinical outcomes, contributing to symptom improvement, relapse prevention, and more adaptive functioning in patients with MDD. However, three studies supported the hypothesis that clinical improvement itself might influence the therapeutic alliance between a therapist and a patient at different stages of treatment. Overall, the results suggest a bidirectional relationship between therapeutic alliance and symptom improvement, indicating that a stronger alliance often predicts better outcomes and symptom reduction can further enhance the alliance. However, the interpretation of these results must consider certain methodological limitations. These include the use of different approaches, measurements, and clinical outcomes to assess therapeutic alliance, as well as insufficient exploration of the temporal precedence between therapeutic alliance and clinical outcomes. In conclusion, future studies are warranted to address these limitations and further clarify the role of therapeutic alliance in MDD, along with its potential implications for clinical practice.
Brain-heart interaction: an ECG-fMRI integrated study in physiology and major depressive disorder Convegno Nazionale Di Bioingegneria, 2023
Anxiety disorders Ylenia Barone, Francesco Cuniberti, Giampaolo Perna Key Topics in Perinatal Mental Health, 2022
Inflammatory markers of perinatal depression in women with and without history of trauma E. Bianciardi, Y. Barone, V. Lo Serro, A. De Stefano, N. Giacchetti, et al. Rivista Di Psichiatria, 2021 PURPOSE Increased inflammation has been described as consistently associated with depression. Moreover, the pro-inflammatory pattern was found in women with a history of trauma irrespective of major depression diagnosis. In this study, we explored the possible association of inflammatory markers with perinatal depression (PND), measuring serum levels of cytokines (IL-6, TNF-a, IFN-γ), acute phase proteins (CRP), erythrocyte sedimentation rate (ESR), cortisol and brain-derived neurotrophic factor (BDNF) in women at the second trimester of pregnancy. Moreover, we tested whether the biological markers were correlated with the severity of PND, trauma history and resilience level. METHODS Seventy-nine women including two groups of patients (women with PND at the second trimester of pregnancy with and without history of trauma) and two healthy control groups (inside and outside the peripartum) were enrolled. Blood sampling were collected for measuring putative biological markers. Clinical interview, Edinburgh Postnatal Depression Scale (EPDS), Inventory of Traumatic experiences (TEC), Connor-Davidson Resilience Scale (CD-RISC) were administered. RESULTS Women with PND and trauma reported a higher EPDS (p=0.004) and lower CD-RISC scores compared to other groups (F=34.77; p<0.001). The one-way ANOVA analysis showed lower ERS (F=2.87; p=0.040), CRP (F42=4.05; p=0.010) mean values among PND women without trauma and higher TNF-α mean values (F=6.07; p=0.001) among PND women with trauma history compared to other groups. CONCLUSIONS History of trauma was associated with a more severe clinical phenotype of PND and decreased resilience level. The increase of acute phase proteins in women with PND and higher TNF-a level in those with trauma exposure validated the inflammatory theory of PND. Our findings substantiated the need of implementing the screening of pregnant women with the assessment of trauma history. Properly, resilience-enhancing interventions are recommended with the aim of support mothers and mitigate the possible transgenerational transmission of pathology. The biological results are compelling although preliminary.
Prevalence and correlates of QTc prolongation in Italian psychiatric care: Cross-sectional multicentre study M. Nosè, I. Bighelli, M. Castellazzi, G. Martinotti, G. Carrà, et al. Epidemiology and Psychiatric Sciences, 2016 Aims.In recent years several warnings have been issued by regulatory authorities on the risk of electrocardiogram abnormalities in individuals exposed to psychotropic drugs. As a consequence of these warnings, monitoring of the QT interval corrected for heart rate (QTc) has become increasingly common. This study was conducted to measure the frequency of QTc prolongation in unselected psychiatric patients, and to document the associated factors using a cross-sectional approach.Method.The study was carried out in 35 Italian psychiatric services that are part of the STAR (Servizi Territoriali Associati per la Ricerca) Network, a research group established to produce scientific knowledge by collecting data under ordinary circumstances. During a three-month period, a consecutive unselected series of both in- and out-patients were enrolled if they performed an ECG during the recruitment period and were receiving psychotropic drugs on the day ECG was recorded.Results.During the recruitment period a total of 2411 patients were included in the study. The prevalence of QTc prolongation ranged from 14.7% (men) and 18.6% (women) for the cut-off of 450 ms, to 1.26% (men) and 1.01% (women) for the cut-off of 500 ms. In the multivariate model conducted in the whole sample of patients exposed to psychotropic drugs, female sex, age, heart rate, alcohol and/or substance abuse, cardiovascular diseases and cardiovascular drug treatment, and drug overdose were significantly associated with QTc prolongation. In patients exposed to antipsychotic drugs, polypharmacy was positively associated with QTc prolongation, whereas use of aripiprazole decreased the risk. In patients exposed to antidepressant drugs, use of citalopram, citalopram dose and use of haloperidol in addition to antidepressant drugs, were all positively associated with QTc prolongation.Conclusions.The confirmation of a link between antipsychotic polypharmacy and QTc prolongation supports the current guidelines that recommend avoiding the concurrent use of two or more antipsychotic drugs, and the confirmation of a link between citalopram and QTc prolongation supports the need for routine QTc monitoring. The relatively low proportion of patients with QTc prolongation not only suggests compliance with current safety warnings issued by regulatory authorities, but also casts some doubts on the clinical relevance of QTc prolongation related to some psychotropic drugs.
