Edoardo Giuseppe Ostinelli

• MD
• Fellow at University of Oxford

Background: Haloperidol used alone is recommended to help calm situations of aggression or agitation for people with psychosis. It is widely accessible and may be the only antipsychotic medication available in limited-resource areas. Objectives: To examine whether haloperidol alone is an effective treatment for psychosis-induced aggression or ag...

Introduction Psychotherapy is a complex intervention, consisting of various components and being implemented flexibly in consideration of individual patient’s characteristics. It is then of utmost importance to know which of the various components or combinations thereof are more efficacious, what their specific effect sizes are and which types of...

Introduction Depressive disorders are the most common, burdensome and costly mental disorders. Their treatments have developed through the past decades and we now have more than a dozen new generation antidepressants, while a series of guidelines have been published to provide recommendations over the years. However, there still may exist important...

Introduction Pharmacotherapy plays an important role in the treatment of major depression. At the initiation of antidepressant treatment, both improvement of symptoms in the short term and relapse prevention in the long term should be taken into account. However, there is insufficient evidence regarding the efficacy and the acceptability of continu...

Citation-based metrics are increasingly used as a proxy to define representative, considerable, or significant papers. We challenge this belief by taking into account factors that may play a role in providing citations to a manuscript and whether/how those highly cited studies could shape a scientific field. A different approach to summarisation of...

Background Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We Included controlled human and non-human studies in...

Aim To identify sleep abnormalities in individuals at clinical high risk for psychosis (CHR-P) or with schizophrenia spectrum disorders (SSDs) compared with healthy controls (HCs) using wrist actigraphy, and to assess potential differences in the direction of effect with self-reported assessments of sleep. Methods We conducted a systematic review...

Background Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We Included controlled human and non-human studies in...

Background Exercise can play an important role in reducing symptom severity and improving functional impairment in patients with posttraumatic stress disorder (PTSD). However, the precise mechanisms underpinning the effect of exercise in PTSD management are not fully understood. This living systematic review aims to synthesize and triangulate the e...

Background Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We Included controlled human and non-human studies in...

Objective To compare all licensed drug interventions as oral monotherapy for the acute treatment of migraine episodes in adults. Design Systematic review and network meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, ClinicalTrials.gov, EU Clinical Trials Register, WHO International Clinical Trials Regist...

Background Adverse events (AEs) are commonly reported in clinical studies using the Medical Dictionary for Regulatory Activities (MedDRA), an international standard for drug safety monitoring. However, the technical language of MedDRA makes it challenging for patients and clinicians to share understanding and therefore to make shared decisions abou...

Background New National Institute for Health and Care Excellence (NICE) guidance endorses the prescription of statins in larger population groups for the prevention of cardiovascular and cerebrovascular morbidity and mortality, especially in people with severe mental illness. However, the evidence base for their safety and risk/benefit balance in d...

When studies use different scales to measure continuous outcomes, standardised mean differences (SMD) are required to meta‐analyse the data. However, outcomes are often reported as endpoint or change from baseline scores. Combining corresponding SMDs can be problematic and available guidance advises against this practice. We aimed to examine the im...

Background Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). Objective An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the...

Background Trace amine-associated receptor 1 (TAAR1) agonism shows promise for treating psychosis, prompting us to synthesise data from human and non-human studies. Methods We co-produced a living systematic review of controlled studies examining TAAR1 agonists in individuals (with or without psychosis/schizophrenia) and relevant animal models. Two...

Background: Major depressive disorder (MDD) is a heterogeneous mental disorder. International guidelines present overall symptom severity as the key dimension for clinical characterisation. However, additional layers of individual differences may reside within severity levels related to how symptoms interact with one-another in a patient, called sy...

Background ‘Early Intervention in Psychosis’ (EIP) services have been associated with improved outcomes for early psychosis. However, these services are heterogeneous and many provide different components of treatment. The impact of this variation on the sustained treatment effects is unknown. Methods We performed a systematic review and component...

BACKGROUND Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). OBJECTIVE An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the...

Importance Chronic insomnia disorder is highly prevalent, disabling, and costly. Cognitive behavioral therapy for insomnia (CBT-I), comprising various educational, cognitive, and behavioral strategies delivered in various formats, is the recommended first-line treatment, but the effect of each component and delivery method remains unclear. Objecti...

Antipsychotic medications are widely prescribed in psychotic illnesses and other mental disorders. Effectiveness is well-established, particularly for reducing symptoms such as delusions and hallucinations, but can be impacted by tolerability. Adverse effects are wide-ranging, and vary between antipsychotics, which is clinically important. This umb...

Background Exercise can play an important role in reducing symptom severity and improving functional impairment in patients with posttraumatic stress disorder (PTSD). However, the precise mechanisms underpinning the effect of exercise in PTSD management are not fully understood. This living systematic review aims to synthesize and triangulate the e...

Background: Anhedonia is a key symptom of depression, and it has been suggested as a potential target for future individualised treatments. However, much is unknown about how interventions enhancing dopaminergic pathways may affect anhedonia symptoms in the context of depression. Methods: We will perform independent searches in multiple electronic...

BACKGROUND Globally, the needs of those with mental health illness were particularly acute during the COVID-19 pandemic, and pre-existing disparities in health care were also highlighted. However, guidelines specifically for mental health were often limited or difficult to find, particularly in the early phases. During the COVID-19 pandemic, the Ox...

Background During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in t...

Background: There is an urgent need to develop more effective and safer antipsychotics beyond dopamine 2 receptor antagonists. An emerging and promising approach is TAAR1 agonism. Therefore, we will conduct a living systematic review and meta-analysis to synthesize and triangulate the evidence from preclinical animal experiments and clinical studie...

Objective When developing prediction models, researchers commonly employ a single model which uses all the available data ( end-to-end approach). Alternatively, a similarity-based approach has been previously proposed, in which patients with similar clinical characteristics are first grouped into clusters, then prediction models are developed withi...

In anxiety, depression and psychosis, there has been frustratingly slow progress in developing novel therapies that make a substantial difference in practice, as well as in predicting which treatments will work for whom and in what contexts. To intervene early in the process and deliver optimal care to patients, we need to understand the underlying...

Objectives To find the optimal treatment duration with antibiotics for community-acquired pneumonia (CAP) in adults. Design Systematic review and duration-effect meta-analysis. Data sources MEDLINE, Embase and CENTRAL through 25 August 2021. Eligibility criteria All randomised controlled trials comparing the same antibiotics used at the same dai...

Background: To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear. Purpose: To assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose–response relations with characteristics of the pandemic and its containment. Data Sour...

Background Internationally, the impact of continued exposure to workplace environmental and psychological stressors on health care professionals’ mental health is associated with increased depression, substance misuse, sleep disorders, and posttraumatic stress. This can lead to staff burnout, poor quality health care, and reduced patient safety out...

Introduction Insomnia is highly prevalent and disabling. Clinical practice guidelines recommend cognitive-behavioral therapy for insomnia (CBTI) as the first-line treatment. However, CBTI includes various combinations of many different components and its clinical benefits have been shown as a package, whereas the effect of each component remains un...

Background: Brexpiprazole augmentation is an effective treatment strategy for antidepressant-refractory depression, but its optimal dosage remains unclear. Aims: To find the optimal dosage of brexpiprazole as augmentation of other antidepressants. Methods: We searched multiple electronic databases (from inception to September 16th, 2021) to id...

Introduction: Information on the off-label use of Long-Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on- vs off-label LAIs and predictors of off-label First- or Second-Generation Antipsychotic (FGA vs. SGA) LAI choice in e...

Objective A network meta-analysis (NMA) usually assesses multiple outcomes across several treatment comparisons. The Vitruvian plot aims to facilitate communication of multiple outcomes from NMAs to patients and clinicians. Methods We developed this tool following the recommendations on the communication of benefit–risk information from the availa...

Background The debate of whether machine learning models offer advantages over standard statistical methods when making predictions is ongoing. We discuss the use of a meta-learner model combining both approaches as an alternative. Methods To illustrate the development of a meta-learner, we used a dataset of 187,757 people with depression. Using 3...

BACKGROUND The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contacts became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what exten...

Background People with substance use disorders may be at a greater risk of contracting COVID-19 infection and developing medical complications. Several institutional and governmental health agencies across the world developed ad hoc guidance for substance use disorder services and care of individuals misusing substances. We aimed to synthesise the...

Background: Tiapride is an atypical antipsychotic used to treat alcohol withdrawal, aggressiveness and agitation, headache, dyskinesias, tic and Tourette's disorder. More recently, it has been proposed for the treatment of delirium and agitation in hospitalised patients with COVID-19. Although its safety profile makes it suitable for use in vulner...

Importance Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality globally. The optimal duration of antimicrobial therapy remains unclear and controversial. Objective To find the optimal treatment duration with antibiotics for CAP in adults. Data Sources MEDLINE, Embase and CENTRAL from inception to present (25 August, 2...

IntroductionNeighbourhood composition is considered a social determinant of mental health that can be addressed by policymakers to improve outcomes. Deprived neighbourhoods typically lack resources such as leisure and park facilities but also daycare centres. However, the study of specific needs and resource distribution tailored to the clinical-de...

Background Aripiprazole augmentation is proven effective for antidepressant-refractory depression, but its licensed dose range is wide and optimal dosage remains unclear. Aims To find the optimal dosage of aripiprazole augmentation. Method Multiple electronic databases were searched (from inception to 16 February 2021) to identify all assessor-ma...

In this study, we aimed to identify the current trend of novel psychoactive substance (NPS) consumption in Italy and the level of knowledge about NPS in the general population and to explore the presence of risk factors for a lifetime NPS misuse. We conducted an anonymous online survey, administered to a large sample of people of any age living in...

Background: Provider-evaluated substance use treatment completion and client-reported substance use improvement are standards in determining treatment success. The relationship between these two outcomes is anecdotally understood in practice. However, the relationship has not been empirically determined and factors related to provider/client confli...

Major depression is often a relapsing disorder. It is therefore important to start its treatment with therapies that maximize the chance of not only getting the patients well but also keeping them well. We examined the associations between initial treatments and sustained response by conducting a network meta-analysis of randomized controlled trial...

Background Depressive symptoms occur in several psychiatric disorders, often in the absence of a formal diagnosis of depression. We aimed to evaluate the efficacy and the tolerability of amisulpride, both alone and as augmentation therapy, in the treatment of depressive symptoms in individuals with any major psychiatric disorder. Methods We search...

Top‐tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour­nal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter­ventions and brain stimulation techniques are treatment...

Background Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. Methods We did a systematic revi...

Background Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses.Objective Our objective was to...

Background: Although depression has frequently been associated with Internet Gaming Disorder (IGD), its epidemiological impact on this emerging condition has not been systematically assessed. In this study, we aimed to synthesise the available evidence focusing on depression and depressive symptoms in individuals with IGD. Methods: We searched Pub...

Background No consistent first-option psychological interventions for adult outpatients with anorexia nervosa emerges from guidelines. We aimed to compare stand-alone psychological interventions for adult outpatients with anorexia nervosa with a specific focus on body-mass index, eating disorder symptoms, and all-cause dropout rate. Methods In thi...

Objective This study compares three major elements of evidence-based medicine (EBM) practices, namely evidence synthesis, clinical practice guidelines (CPGs) and real-world prescriptions in the US, regarding antidepressant treatments of major depression over the past three decades. Study design and setting We conducted network meta-analyses (NMAs)...

Objective Control conditions’ influence on effect estimates of active psychotherapeutic interventions for depression has not been fully elucidated. We used network meta-analysis to estimate the differences between control conditions. Study design We have conducted a comprehensive literature search of randomized trials of psychotherapies for adults...

The patho-etiology of mental disorders with onset in childhood or adolescence other than autism spectrum disorder and attention-deficit/hyperactivity disorder remains largely unknown. We conducted an umbrella review of meta-analyses (MAs) on environmental factors associated with mental disorders with onset in childhood/adolescence. We searched Pubm...

This study, based on the ‘Servizi Territoriali Associati per la Ricerca’ (STAR) Network Depot Study nationwide baseline data, explored whether individual symptoms severity and clusters might influence the prescription of paliperidone palmitate 1-month (PP1M) vs. aripiprazole monohydrate. The Brief Psychiatric Rating Scale (BPRS) was used to assess...

Background Given the strong relationship between circadian rhythm disruption and mood regulation, combined chronotherapeutic approaches have been proposed for mood disorders. However, a comprehensive review of the available evidence on the efficacy of such interventions for depression is lacking. Aim To systematically review available literature o...

BACKGROUND COVID-19 presents unique challenges in healthcare, including mental health care provision. Telepsychiatry can provide an alternative to face to face assessment and also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working. OBJECTIVE Using...

Background: COVID-19 presents unique challenges in healthcare, including mental health care provision. Telepsychiatry can provide an alternative to face to face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working. Objective:...

Mental disorders frequently begin in childhood or adolescence. Psychotropic medications have various indications for the treatment of mental dis­orders in this age group and are used not infrequently off‐label. However, the adverse effects of these medications require special attention during developmentally sensitive periods of life. For this meta...

Background: Evidence provides inconsistent findings on risk factors and health outcomes associated with loneliness. The aim of this work was to grade the evidence on risk factors and health outcomes associated with loneliness, using an umbrella review approach. Methods: For each meta-analytic association, random-effects summary effect size, 95% con...

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Few studies have delineated the real-world, long-term trends of prescription patterns of antidepressants for patients with major depressive disorder (MDD). This study aims to describe their vicissitudes in the nationally representative sample of the US from 1996 to 2015 and explore their characteristics. We used the Medical Expenditure Panel Survey...

Background: Depressive disorders are a relevant burden for public health due to their prevalence and high levels of associated disability and mortality. Recent studies suggest that the combination of multiple chronotherapuetic interventions may reveal effective in the rapid improvement of depressive symptoms. Objectives: This paper describes the...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To examine whether clozapine is an effective treatment for the management of aggression behaviour in people with schizophrenia (i.e. not for rapid tranquillisation). Specifically, this review will focus on the efficacy on aggression, self-harm, and serious adver...

Aim: We aimed to characterize youth hospitalization trends in a psychiatric inpatient unit from a large, public university hospital with a broad catchment area in Milan, Italy. Methods: Hospitalization data of patients with an age at admission ≤ 35 were retrospectively retrieved over a time span of 15 years. The sample was comprised of 1982 admi...

Introduction Individuals with psychosis may access emergency services due to aggression and agitation. When the de-escalation technique fails to achieve tranquillisation, several pharmacological options are available. However, evidence on which intervention to prefer in terms of efficacy and tolerability to achieve resolution of the acute episode (...

Risperidone for psychosis-induced aggression or agitation (rapid tranquillisation) - Volume 24 Issue 6 - Edoardo G. Ostinelli, Mohsin Hussein, Uzair Ahmed, Faiz-ur Rehman, Krista Miramontes, Clive E. Adams

Background: Overviews are a relatively new phenomenon borne out of the need to combine a number of systematic reviews for clinical decision making and policy development. Even though great strides have been made in overview methodology, considerable heterogeneity pertains to this form of evidence synthesis. For example, when to conduct a network me...

Background For many years, long-acting intramuscular (LAI) antipsychotics have been prescribed predominantly to chronic and severe patients, as a last resort when other treatments failed. Recently, a broader and earlier use of LAIs, particularly second-generation LAIs, has been emphasized. To date, few studies attempted to frame how this change in...

Background: Aggressive, agitated or violent behaviour due to psychosis constitutes an emergency psychiatric treatment where fast-acting interventions are required. Risperidone is a widely accessible antipsychotic that can be used to manage psychosis-induced aggression or agitation. Objectives: To examine whether oral risperidone alone is an effe...

Background: People experiencing psychosis may become aggressive. Antipsychotics, such as aripiprazole in intramuscular form, can be used in such situations. Objectives: To evaluate the effects of intramuscular aripiprazole in the treatment of psychosis-induced aggression or agitation (rapid tranquillisation). Search methods: On 11 December 201...

Although central to any exhaustive theory of human subjectivity, the relationship between dream and waking consciousness remains uncertain. Some findings suggest that dream consciousness can be influenced by severe disorders of thought content. The suppression of unwanted thoughts has been shown to influence dream content in healthy individuals. In...

Introduction Intervention in the early-stages of psychosis may be able to shape the clinical course; critical period (CP) is best represented by the first 5 years from first admission (FA). Objectives To investigate the effectiveness of pharmacological intervention within and beyond the CP. Aims (1) To compare hospitalization rates of patients st...

Asenapine is a second-generation antipsychotic with a unique pharmacological profile that was recently approved for the treatment of moderate/severe manic episodes. Real-world data on rapidity of action in inpatient settings are lacking.The aims of the current real-world observational study were to evaluate: (i) short-term efficacy of asenapine aft...

Walking presentation; EPA 2015, Wien.

Introduction Asenapine (ASE) is a second-generation antipsychotic with a unique pharmacological profile, that was recently approved for the treatment of moderate/severe manic episodes (ME). Real-world data on rapidity of action in inpatient settings are lacking. Objectives 1) rating scale variation after 7 days (T0-T1) of treatment with ASE in pat...

Introduction Experimental evidence indicates that patients with severe mental illness such as schizophrenia or mood disorders have a higher incidence of overweight and obesity (Daumit et al., 2003). Objectives This review describes the neuropsychological functioning and therapeutical approaches (psychotherapeutic, pharmacological, surgical) in obe...