Papers by Marco Bortolomasi
The Journal of ECT, 2016
Objectives: Electroconvulsive therapy (ECT) is the most effective therapy for patients with treat... more Objectives: Electroconvulsive therapy (ECT) is the most effective therapy for patients with treatment-resistant depression; however, some patients do not respond or relapse in a short time. Electroconvulsive therapy stimulus parameters may be related to the outcome. We carried out a retrospective study review to investigate various ECT parameters in relation to the outcome, clinical variables, and pharmacological treatments. Our aim was to understand which factors could be considered putative seizure quality markers and which are relevant to clinical practice. Methods: Two physicians evaluated the seizure length, the postictal suppression index, the wave amplitude, tachycardia, and hemispheric brain wave synchronicity in a double-blind manner for 45 treatment-resistant depression patients receiving ECT. Results: The analysis showed a significant association between the outcome and the ECT seizure quality measured by the parameters (P = 9.9 Â 10 −5). Among patients with poor-quality seizures, 61.5% relapsed after approximately 1 month from the last ECT session. Particularly, there was an association between higher symptomatology decrease and higher quality of hemispheric brain wave synchronicity (P = 5.0 Â 10 −6), as well as a higher wave amplitude (P = 0.01). Conclusions: Our results confirm that ECT seizure quality was strongly correlated with the decrease of depressive symptomatology.
Archives of Physical Medicine and Rehabilitation, 2014
INTRODUCTION: Disorders of consciousness (DOC) range from Unresponsive Wakefulness Syndrome (UWS,... more INTRODUCTION: Disorders of consciousness (DOC) range from Unresponsive Wakefulness Syndrome (UWS, formerly known as Vegetative State) where patients show no signs of conscious/purposeful interaction with the environment, to Minimally Conscious State (MCS) where reproducible but not consistent interaction is apparent, and may last for months, years, or even a lifetime. To date, there is no therapeutic intervention for these patients who are expected to either recover spontaneously or not recover at all. Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique that applies small electrical currents through the brain that depolarize or hyperpolarize the underlying neural cell membrane depending on its polarity. Effects of tDCS include cognitive improvement in healthy volunteers as well as clinical improvement in several neurological disorders, like stroke-induced aphasia, motor and visual deficits, cognitive deficits due to TBI or Parkinson's Disease. Multiple sessions of tDCS are considered to affect LTP and LTD mechanisms. MATERIAL-METHOD: Patients with DOC were treated with anodal tDCS (25 cm2 sponge electrode, 2 mA) over the left primary motor area of the hand while they received verbal movement commands. tDCS was applied for 30 minutes daily with a mean number of 33 sessions totally (range: 14-59). Patients were assessed with the JFK Coma Recovery Scale-Revised (CRS-R). All patients had been stable with no signs of clinical improvement at least for the last 2 months before participation. RESULTS: At the end of participation some patients improved their cognitive status, some showing signs of consciousness that were not present before treatment, while others regained full consciousness. CONCLUSIONS: A significant number of patients that were not improving clinically for at least two months prior to tDCS showed clinical improvement after 10-20 sessions. This case series study shows that tDCS holds promise in the rehabilitation of DOC. Its non-invasive and side-effect-free nature, together with the portable and inexpensive equipment makes tDCS an excellent candidate for large longitudinal controlled studies for the rehabilitation of DOC.
BMJ, 1997
Objective: To determine the properties of the alcohol use disorders identification test in screen... more Objective: To determine the properties of the alcohol use disorders identification test in screening primary care attenders for alcohol problems. Design: A validity study among consecutive primary care attenders aged 18-65 years. Every third subject completed the alcohol use disorders identification test (a 10 item self report questionnaire on alcohol intake and related problems) and was interviewed by an investigator with the composite international diagnostic interview alcohol use module (a standardised interview for the independent assessment of alcohol intake and related disorders). Setting: 10 primary care clinics in Verona, north eastern Italy. Patients: 500 subjects were approached and 482 (96.4%) completed evaluation. Results: When the alcohol use disorders identification test was used to detect subjects with alcohol problems the area under the receiver operating characteristic curve was 0.95. The cut off score of 5 was associated with a sensitivity of 0.84, a specificity of 0.90, and a positive predictive value of 0.60. The screening ability of the total score derived from summing the responses to the five items minimising the probability of misclassification between subjects with and without alcohol problems provided an area under the receiver operating characteristic curve of 0.93. A score of 5 or more on the five items was associated with a sensitivity of 0.79, a specificity of 0.95, and a positive predictive value of 0.73. Conclusions: The alcohol use disorders identification test performs well in detecting subjects with formal alcohol disorders and those with hazardous alcohol intake. Using five of the 10 items on the questionnaire gives reasonable accuracy, and these are recommended as questions of choice to screen patients for alcohol problems.
Psychiatry research, 2007
The majority of previous clinical studies have indicated that repetitive transcranial magnetic st... more The majority of previous clinical studies have indicated that repetitive transcranial magnetic stimulation (rTMS) may have antidepressant effects. Herein, we investigated the longitudinal, long-term antidepressant efficacy of daily left prefrontal cortex (PFC) rTMS for ...
Background: To identify risk factors for suicide using data from a large, 3-year, multinational f... more Background: To identify risk factors for suicide using data from a large, 3-year, multinational follow-up study of schizophrenia (SOHO study). Methods: Baseline characteristics of 8,871 adult patients with schizophrenia were included in a logistic regression post-hoc analysis comparing patients who attempted and/or committed suicide during the study with those who did not. Results: 384 (4.3%) patients attempted or committed suicide. Completed suicides were 27 (0.3%). The significant risk factors for suicide behaviors were previous suicidality, depressive symptoms, prolactin-related adverse events, male gender and history of hospitalization for schizophrenia. Conclusions: In view of the observational design of the study and the post-hoc nature of the analysis, the identified risk factors should be confirmed by ad-hoc specifically designed studies.
European …, 2006
Major depression is a severe and life-threatening illness which represents one of the most import... more Major depression is a severe and life-threatening illness which represents one of the most important causes of disability world-wide. In particular, about 50% of the affected patients experience a chronic course and up to 20% of them shows an insufficient response to drug treatments ( ...
Journal of Affective Disorders, 2015
Background: Methylenetetrahydrofolate reductase (MTHFR) genetic variations have been widely studi... more Background: Methylenetetrahydrofolate reductase (MTHFR) genetic variations have been widely studied in major depressive disorder (MDD) and antidepressants outcome. An interaction with catechol-Omethyltransferase (COMT) has also been proved affecting depression. The aim of this study was to clarify the role of the most commonly studied single nucleotide polymorphisms (SNPs) of MTHFR gene in MDD and in treatment response mechanisms, along with the impact of the interaction with COMT. Methods: A total of 613 MDD patients, of whom 389 were classified as having treatment resistant depression (TRD), and 463 controls were enrolled. The A1298C, C677T and COMT Val158Met were genotyped. Genetic data were integrated with a transcriptional level analysis in peripheral blood cells (PBCs) and fibroblasts. Results: The A1298C CC homozygotes were more frequent in MDD patients compared to controls in women, increasing twice the genetic risk to develop depression. Moreover this genotype resulted in epistasis with COMT Met carriers in association with MDD. No significant effects were obtained concerning response to treatment. Transcriptional analyses highlighted a strong correlation between the mRNA levels of MTHFR in fibroblasts and COMT genotypes whereas no significant association with MDD was found. PBCs results revealed relevant influences of environmental factors. Limitation: We did not measure folate and homocisteine levels.
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Papers by Marco Bortolomasi