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BackgroundTo identify demographic and clinical characteristics of bipolar depressed patients who require antidepressant (AD) augmentation, and to evaluate the short- and long-term effectiveness and safety of this therapeutic strategy.MethodsOne hundred twenty-two bipolar depressed patients were consecutively recruited, 71.7% of them received mood stabilizers (MS)/second-generation antipsychotics (SGA) with AD-augmentation and 28.3% did not. Patients were evaluated at baseline, and after 12 weeks and 15 months of treatment.ResultsThe AD-augmentation was significantly higher in patients with bipolar II compared with bipolar I diagnosis. Patients with MS/SGA + AD had often a seasonal pattern, depressive polarity onset, depressive index episode with anxious features, a low number of previous psychotic and (hypo)manic episodes and of switch. They had a low irritable premorbid temperament, a low risk of suicide attempts, and a low number of manic symptoms at baseline. After 12 weeks of treatment, 82% of patients receiving ADs improved, 58% responded and 51% remitted, 3.8% had suicidal thoughts or projects, 6.1% had (hypo)manic switch, and 4.1% needed hospitalization. During the following 12 months, 92% of them remitted from index episode, 25.5% did not relapse, and 11% needed hospitalization. Although at the start advantaged, patients with AD-augmentation, compared with those without AD-augmentation, did not significantly differ on any outcome as well on adverse events in the short- and long-term treatment.ConclusionOur findings indicate that ADs, combined with MS and/or SGA, are short and long term effective and safe in a specific subgroup for bipolar depressed patients.

ObjectiveTo provide evidence to the link between serotonin (5-HT), energy metabolism, and the human obese phenotype, the present study investigated the binding and function of the platelet 5-HT transporter (SERT), in relation to circulating insulin, leptin, and glycolipid metabolic parameters.MethodsSeventy-four drug-free subjects were recruited on the basis of divergent body mass index (BMIs) (16.5-54.8 Kg/m2). All subjects were tested for their blood glycolipid profile together with platelet [3H]-paroxetine ([3H]-Par) binding and [3H]-5-HT reuptake measurements from April 1st to June 30th, 2019.ResultsThe [3H]-Par Bmax (fmol/mg proteins) was progressively reduced with increasing BMIs (P Bmax was negatively correlated with BMI, waist/hip circumferences (W/HC), triglycerides (TD), glucose, insulin, and leptin, while positively with high-density lipoprotein (HDL) cholesterol (P Vmax, pmol/min/109 platelets) among BMI groups was not statistically significant, but Vmax negatively correlated with leptin and uptake affinity values (P 3H]-Par affinity values positively correlated with glycemia and TD, while [3H]-5-HT reuptake affinity with glycemia only (P P = .006) resulting negatively related to Bmax independently from BMI.ConclusionsPresent findings suggest the presence of a possible alteration of insulin/5-HT/leptin axis in obesity, differentially impinging the density, function, and/or affinity of the platelet SERT, as a result of complex appetite/reward-related interactions between the brain, gut, pancreatic islets, and adipose tissue. Furthermore, they support the foremost cooperation of peptides and 5-HT in maintaining energy homeostasis.

BackgroundTo explore relationships among post-traumatic stress disorder (PTSD), depressive spectrum symptoms, and intrusiveness in subjects who survived the crash of a train derailed carrying liquefied petroleum gas and exploded causing a fire.MethodsA sample of 111 subjects was enrolled in Viareggio, Italy. AMOS version 21 (IBM Corp, 2012) was utilized for a structural equation model-path analysis to model the direct and indirect links between the exposure to the traumatic event, the occurrence of depressive symptoms, and intrusiveness. Subjects were administered with the SCID-IV (Structured Clinical Interview for DSM-IV), the Questionnaire for Mood Spectrum (MOODS-SR)-Last Month version, the Trauma and Loss Spectrum Questionnaire (TALS-SR), and the Impact of Event Scale-Revised version (IES-R).ResultsSixty-six (66/111; 59.4%) subjects met SCID-IV criteria for PTSD. Indices of goodness of fit were as followed: χ2/df = 0.2 P = .6; comparative fit index = 1 and root mean square error of approximation = 0.0001. A significant path coefficient for direct effect of potential traumatic events on depressive symptoms (β = 0.25; P < .04) and from depressive symptoms to intrusiveness (β = 0.34; P < .003) was found. An indirect effect was also observed: standardized value of potential traumatic events on intrusiveness was 0.86. The mediating factor of this indirect effect path was represented by depressive symptoms. Potential traumatic events explained 6.2% of the variance of depressive symptoms; 11.8% of the variance of intrusiveness was accounted for traumatic event and depressive symptoms.ConclusionsPath analysis led us to speculate that depression symptoms might have mediated the relationship between the exposure to potential traumatic events and intrusiveness for the onset of PTSD.

ObjectiveIncreasing evidence confirms a strict relationship between mental disorders and physical health. Particularly, stressful life events and post-traumatic stress disorder (PTSD) have been closely correlated with various physical disorders and somatic symptoms, such as chronic pain, gastrointestinal disorders, and headaches. The aim of this study was to investigate the emergence of somatic symptoms in a sample of young adult survivors 21 months after exposure to the L’Aquila 2009 earthquake, with particular attention to PTSD and gender impact.MethodsFour hundred and fifty high-school senior students (253 male and 197 female) exposed to the 2009 L’Aquila earthquake, 21 months earlier, were enrolled and evaluated by the Trauma and Loss Spectrum Self-Report (TALS-SR), for symptomatological PTSD, and the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR) “rhythmicity and vegetative functions” domain, for somatic symptoms.ResultsSignificantly higher rates of endorsement of the MOODS-SR somatic symptoms emerged in survivors with PTSD compared to those without. Females reported higher rates of endorsement of at least one MOODS-SR somatic symptom compared to males; however, a Decision Tree model and a two-way analysis of variance model confirmed a significant effect of PTSD only. A multivariate logistical regression showed a significant association between the presence of at least one MOOD-SR somatic symptom and re-experiencing and maladaptive coping TALS-SR domains.ConclusionThis study corroborates a relevant impact of symptomatological PTSD, across both the genders, on somatic symptoms occurring in young adults after months from exposure to a massive earthquake.

Ethnic differences may significantly influence the outcome of psychopharmacological treatment, in terms of prescription, adherence, clinical response, emergence of side effects, as well as pharmacokinetics and pharmacodynamics. The purpose of this review was to explore the available literature in order to provide general suggestions to help clinicians in choosing the best therapeutic option for patients, taking into account ethnicity. Although findings are sometimes controversial, the overall published studies suggest that ethnicities other than Caucasians tend to show a lower response to antidepressants and a reduced compliance. Africans tend to be more prescribed with antipsychotics, probably due to cultural stereotypes, except with clozapine, probably for their chronic benign neutropenia. Asians usually require less antipsychotic dosages than Caucasians. The differential response and side effect profile of antidepressants and antipsychotics have been related to individual intrinsic factors, to genetic make-up, but also to cultural and contextual variables. Interestingly, albeit limited data suggest ethnic-related genetic heterogeneity at the level of the serotonin transporters, the cytochromes and some neuroreceptors. Taken together, no conclusive findings are available about the role and impact of ethnicity in psychopharmacology. One of the main problems is that the majority of the studies in psychopharmacology have been conducted on Caucasians, so that there is an urgent need to have data in other populations. Furthermore, in the era of precision medicine, the role of ethnicity may be also supported by genetic analysis.

Background.While the literature frequently highlighted an association between social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD), few studies investigated the overlapping features of these conditions. The presented work evaluated the relationship between SAD and OCD spectrum in a clinical population and in healthy controls (HC).Methods.Fifty-six patients with OCD, 51 with SAD, 43 with major depressive disorder (MDD), and 59 HC (N = 209) were assessed using the Mini International Neuropsychiatric Interview, the Social Phobia Spectrum (SCI-SHY), and the Obsessive-Compulsive Spectrum (SCI-OBS).Results.SAD patients scored significantly higher than other groups on all SCI-SHY domains and total score; OCD patients scored significantly higher than HC. MDD patients scored significantly higher than HC on the SCI-SHY total, Behavioral inhibition, andInterpersonal sensitivitydomains. OCD patients scored significantly higher than other groups on all SCI-OBS domains exceptDoubt, for which OCD and SAD scored equally high. SAD patients scored significantly higher than HC on the SCI-OBS total,Childhood/adolescence,Doubt, andHypercontroldomains. MDD patients scored significantly higher than HC on theHypercontroldomain. SCI-OBS and SCI-SHY were widely correlated among groups, although lower correlations were found among OCD patients. Stronger correlations were observed between SCI-SHYInterpersonal sensitivityand SCI-OBSDoubt, Obsessive-compulsive themes,andHypercontrol; between SCI-SHYSpecific anxieties/phobic featuresand SCI-OBSObsessive-compulsive themes;and between SCI-SHYBehavioral inhibitionand SCI-OBSDoubt, with slightly different patterns among groups.Conclusion.OCD and SAD spectrums widely overlap in clinical samples and in the general population. Interpersonal sensitivity and obsessive doubts might represent a common cognitive core for these conditions.

This study aimed at comparing neuropsychological test scores in 83 cardiologists and nurses (exposed group, EG) working in the cardiac catheterization laboratory, and 83 control participants (non exposed group, nEG), to explore possible cognitive impairments. The neuropsychological assessment was carried out by means of a battery called “Esame Neuropsicologico Breve.” EG participants showed significantly lower scores on the delayed recall, visual short-term memory, and semantic lexical access ability than the nEG ones. No dose response could be detected. EG participants showed lower memory and verbal fluency performances, as compared with nEG. These reduced skills suggest alterations of some left hemisphere structures that are more exposed to IR in interventional cardiology staff. On the basis of these findings, therefore, head protection would be a mandatory good practice to reduce effects of head exposure to ionizing radiation among invasive cardiology personnel (and among other exposed professionals). (JINS, 2015,21, 670–676)

Although addictive syndromes have been traditionally related to substance-use disorders, during the last few decades a novel addictive group, including the so-called “behavioral or no-drug addictions,” has been recognized and has attracted increasing attention for its relevant social impact. This group includes pathological gambling, compulsive shopping, TV/Internet/social network/videogame addictions, workaholism, sex and relationship addictions, orthorexia, and overtraining syndrome. Substance and behavioral addictions show similar phenomenological features, such as craving, dependence, tolerance, and abstinence, and perhaps they share a common possible pathophysiology. It is, however, controversial whether all or at least some of them should be considered real disorders or just normal, albeit extreme, behaviors. The aim of this article is to review current data on pharmacological treatment of behavioral addictions. As no specific and validated treatment algorithms are currently available, only an improved knowledge on their psychopathological, clinical, and neurobiological features may have relevant implications for more focused preventive and therapeutic strategies.

Autism spectrum disorders (ASDs) include a heterogeneous group of neurodevelopmental disorders with early onset in childhood. ASDs should be considered lifelong clinical entities, although there is a certain variability in developmental trajectories, and therefore should be considered of great interest also for adulthood psychiatrists. A few studies have been carried out to explore the clinical picture and course development of these disorders during adulthood, or their relationship with other mental disorders. Indeed, ASDs often share overlapping features with other disorders, such as schizophrenia and obsessive-compulsive, mood, and personality disorders, and as a result misdiagnoses often occur. The aim of this review is to summarize the available literature on ASDs in adulthood with a specific focus on the clinical picture, course, and psychiatric comorbidity. It is proposed that a careful diagnostic screening for ASDs in adults would contribute to clarifying the relationship with comorbid psychiatric disorders, while improving the possibility of treatment and outcome of such conditions.

IntroductionThe aim of the present study was to explore the relationship between subthreshold mood symptoms and suicidality in patients with complicated grief (CG).MethodsFifty patients with CG were included in the study and evaluated by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis-I disorders, the Inventory of Complicated Grief, and the Mood Spectrum Self Report (MOODS-SR) lifetime version, to evaluate the subthreshold mood symptoms.ResultsTwenty-eight patients (56%) reported lifetime suicidal ideation and 11 patients (22%) reported suicide attempts. Subthreshold depressive and rhythmicity/vegetative functions items of the MOODS-SR were significantly associated with increased suicidal ideation and attempts, while subthreshold manic items were associated with suicidal ideation only. Relationships were confirmed after controlling for Axis-I disorders comorbidity.ConclusionThe results of the present study suggest the usefulness of exploring lifetime subthreshold mood symptoms in CG patients, in order to promptly identify those who may be more prone to suicidality.

ResumenObjetivo.– La diferenciación clínica transversal de la esquizofrenia o el trastorno esquizoafectivo de la manía psicótica incongruente con el estado de ánimo o la manía mixta es difícil, ya que faltan síntomas patognomónicos en estos trastornos.Propósitos del estudio.– Comparar una serie de variables clínicas relacionadas con el estado de ánimo y la cognición en grupos de pacientes con diagnóstico del DSM-III-R de esquizofrenia, trastorno esquizoafectivo, manía psicótica incongruente con el estado de ánimo y manía mixta psicótica incongruente con el estado de ánimo.Métodos.– Se evaluó a 151 pacientes consecutivos en la semana anterior al alta utilizando la Entrevista Clínica Estructurada para el DSM-III-R, edición del paciente (SCID-P). La gravedad del trastorno psicopatológico se evaluó por la versión de 18 elementos de la Escala de Evaluación Psiquiátrica Breve (BPRS) y los síntomas negativos, por la Escala para la Evaluación de los Síntomas Negativos (SANS). El nivel de insight se evaluó con la Escala para Evaluar el Desconocimiento de los Trastornos Mentales (SUMD).Resultados.– No hubo diferencias en las tasas de tipos específicos de ideas delirantes y alucinaciones entre los sujetos con esquizofrenia, trastorno esquizoafectivo, manía psicótica y manía mixta psicótica. Las puntuaciones de los factores de la SANS fueron significativamente más altas en los pacientes con esquizofrenia que en los grupos bipolares. Los pacientes con estado mixto puntuaron significativamente más alto en depresión y excitación comparado con el grupo de esquizofrenia y, en menor medida, el grupo esquizoafectivo. Los sujetos con esquizofrenia mostraron puntuaciones más altas en la SUMD, indicando que su compromiso en la dimensión de insight era mucho mayor que el de los sujetos con manía psicótica o manía mixta.Conclusión.– Los síntomas negativos más bien que los afectivos pueden ser un constructo útil para diferenciar entre la esquizofrenia o los trastornos esquizoafectivos y la manía psicótica o la mixta incongruente con el estado de ánimo.

Background. – The cross-sectional clinical differentiation of schizophrenia or schizoaffective disorder from mood-incongruent psychotic mania or mixed mania is difficult, since pathognomonic symptoms are lacking in these conditions.Aims of the study. – To compare a series of clinical variables related to mood and cognition in patient groups with DSM-III-R diagnosis of schizophrenia, schizoaffective disorder, mood-incongruent psychotic mania and mood-incongruent psychotic mixed mania.Methods. – One hundred and fifty-one consecutive patients were evaluated in the week prior to discharge by using the structured clinical interview for DSM-III-R-patient edition (SCID-P). Severity of psychopathology was assessed by the 18-item version of the brief psychiatric rating scale (BPRS) and negative symptoms by the scale for assessment of negative symptoms (SANS). Level of insight was assessed with the scale to assess unawareness of mental disorders (SUMD).Results. – There were no differences in rates of specific types of delusions and hallucinations between subjects with schizophrenia, schizoaffective disorder, psychotic mania and psychotic mixed mania. SANS factors scores were significantly higher in patients with schizophrenia than in the bipolar groups. Patients with mixed state scored significantly higher on depression and excitement compared to schizophrenia group and, to a lesser extent, to schizoaffective group. Subjects with schizophrenia showed highest scores on the SUMD indicating that they were much more compromised on the insight dimension than subjects with psychotic mania or mixed mania.Conclusion. – Negative rather than affective symptomatology may be a useful construct to differentiate between schizophrenia or schizoaffective disorders from mood-incongruent psychotic mania or mixed mania.

ResumenEl insight es un fenómeno complejo que se puede interpretar según un modelo dimensional. Dados los polémicos datos del insight en el trastorno obsesivo-compulsivo (TOC), nuestro estudio tenía el propósito de investigar este fenómeno en una muestra italiana de pacientes con TOC por medio del elemento específico en la Escala de Obsesión-Compulsión de Yale-Brown (Y-BOCS) y explorar las posibles correlaciones entre el insight y los rasgos clínicos. Se incluyó en el estudio a 117 pacientes ambulatorios con un diagnóstico del DSM IV de TOC y diferentes trastornos psiquiátricos comórbidos y se los evaluó por medio de la Y-BOCS, la Escala de Depresión de Hamilton (HRSD) y la Impresión Clínica Global. Los resultados mostraron que casi el 50% de los pacientes tenía un nivel excelente de insight y el 15% tenía poco o ningún insight. No se observó correlación entre los niveles de insight y los rasgos clínicos, excepto una tendencia negativa con la presencia de obsesiones somáticas. Además, se observó una tendencia hacia un nivel inferior de insight en los pacientes bipolares con antecedentes positivos de episodios maníacos o hipomaníacos repetidos. Parecen necesarios estudios adicionales para establecer si los pacientes de TOC con mal insight representan o no un subgrupo distinto de pacientes.

IntroductionAutism spectrum disorders (ASD) are highly heritable and first degree relatives (especially fathers) of autistic probands have been shown to often manifest a set of subthreshold autistic features. It is not known, however, the clinical significance of this subthreshold autism spectrum.Objectives– to evaluate the prevalence of a subthreshold autism spectrum respectively in fathers and mothers of children with ASD;– to describe clinical correlates of parents with and without a subthreshold autism spectrum respectively.Methods36 fathers and 39 mothers of preschoolers with ASD were administered the autism-spectrum quotient (AQ), the adult autism subthreshold spectrum (AdAS spectrum), the trauma and loss spectrum (TALS), the SCID-5 and the social and occupational functioning assessment scale (SOFAS).ResultsFathers and mothers did not differ for both AQ and AdAS spectrum total and subscale scores. Overall, 13 parents (17.3%) scored higher than 45 on the AdAS spectrum, as indicative of the presence of a subthreshold autism spectrum. This group showed greater prevalence of mood, anxiety and feeding/eating disorders, greater utilization of antidepressants and higher scores on the TALS and the SOFAS than the group scoring lower than 45 (all P < 0.05).ConclusionsFathers and mothers of children with ASD show autistic traits in equal measure. The presence of a subthreshold autism spectrum is associated to greater prevalence of mood, anxiety and feeding/eating disorders, to greater susceptibility to traumatic events and to lower levels of functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Panic disorder occurs frequently with different forms of cardiovascular disease and hypertension. The 13 panic symptoms described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) often overlap with manifestations of cardiovascular disorders, raising problems in the differential diagnosis. In order to explore in greater detail the phenomenology of panic symptoms in cardiovascular patients, the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS) was administered to 111 patients with hypertension and 29 patients with a recent myocardial infarction.With regard to the frequency of endorsement of many of the symptoms assessed on the SCI-PAS, more than 40% of the cardiovascular patients who failed to meet the DSM-IV criteria for panic disorder did not significantly differ from the 10% of cardiovascular patients who did fulfill the criteria for panic disorder. A third distinct subgroup comprising 48.6% of the cardiovascular patients reported a significantly smaller number of SCI-PAS symptoms than the other two groups.These preliminary findings suggest the existence of a relatively large proportion of cardiovascular patients who present with physical and psychological symptoms that are potentially related to panic disorder and that may provoke considerable subjective distress. Further studies are needed to clarify the nature of these symptoms and their potential interference with treatment and symptomatology of cardiovascular disease.

Available data from the literature supporting the hypothesis that partial manifestations of the panic-agoraphobic spectrum may be as clinically relevant as a full-fledged syndrome were reviewed. These partial expressions of disorder may occur singly or in connection with other mental disorders. In particular, we have examined evidences indicating relationships of panic-agoraphobic spectrum with other mental disorders in childhood and adolescence and with psychotic disorders. Their importance in childhood and adolescence is significant because we believe that these symptoms influence adult behavior and are viewed, at a later time, as atypical symptoms. Panic-agoraphobic spectrum syndromes, both in their full-fledged and partial manifestations frequently co-occur with other mental disorders and are likely to be associated with significant impairment either when occurring singly, partially, or comorbidly. Several conditions typical of childhood, such as separation anxiety, school phobia, and other symptoms related to the concept of “behavioral inhibition” seem to be connected with the panic-agoraphobic spectrum and deserve attention in relation to the development of different anxiety and mood disorders in subsequent phases of the life cycle. Identification of panic-agoraphobic spectrum features is also important within the realm of psychoses where they may substantially affect phenomenology, course of illness, and treatment response.

Panic disorder is the most common anxiety disorder and panic attacks are the most common expression of panic disorder. Panic attacks are characterized with sudden attacks of anxiety with numerous somatic symptoms, such as palpitations, tachycardia, tachypnea, nausea, vertigo (cardiovascular, gastro-enterological, respiratory and neurootological symptoms). Sometimes in clinical practice panic disorder show itself with isolated gastroenteric or cardiovascular symptoms, that request other clinical visit and after psychiatric intervention. The SSRIs are preferred treatment for anxiety disorders and in particular panic disorder. However these drugs may cause some adverse effects such as sexual disfunction (Serretti A et al., 2011), increased bodyweight (Serretti A et al., 2010), abnormal bleending (Andrade C et al., 2010) and others, that may be problematic for some patients.We hereby describe the case of G.V., a 29-year-old Caucasican young woman affected by panic disorder with agoraphobia, referred to our clinic for of the re-occurrence of panic gastroenteric symptoms. With SSRIs the patients feelt an improvement in every anxiety symptoms and panic attacks, but not in the gastric somatic concern, then we decided to enter duloxetine. After six months treatment the patient presented complete remission of gastric sypmtoms and panic related symptoms, and suspended every tree different gastric treatment. Others author like Simon NM et al., hypothesized and confirm the duloxetine a serotonin-norepinephrine inhibitor (SNRI) that has greater initial noradrenergic effects than venlafaxine, would have broad efficacy for individuals with panic disorder. Our case report underlines the possibility of tailored therapeutic strategies for gastroenteric expression of panic disorder.

ObjectivesCompare quetiapine+antidepressant (AD) with lithium+AD, and quetiapine monotherapy with lithium+AD in open, rater-blinded treatment.MethodsPatients with treatment resistant depression (Thase et al 1997 stage 1 and 2) with severity of MADRS ≥25 received: quetiapine XR 300mg/day plus AD (SSRIs or venlafaxine) (n=229), lithium (monitored to between 0.6 to 1.0 meq/l) plus AD (n=221) or quetiapine XR alone (300mg/day) (n=225) for 6 weeks. Primary efficacy measure was change from baseline in MADRS total score. The pre-specified non-inferiority limit was 3 points on the MADRS.ResultsFewer patients discontinued on quetiapine+AD (15.2%) than lithium+AD (20.5%) and quetiapine monotherapy (21.5%). Quetiapine+AD and quetiapine monotherapy, were not inferior to lithium+AD in the primary (per protocol) analysis with a mean difference (97.5%CI) on the MADRS of -2.32 (-4.6 to -0.05) favouring add-on quetiapine and -0.97 (-3.24 to 1.31) favouring quetiapine monotherapy. This mandated superiority testing on the modified ITT population showing no significant difference at endpoint.In a post hoc analysis discounting multiplicity, quetiapine+AD was significantly more effective than lithium+AD on the MADRS change from baseline, p=0.046. The advantage was observed at day 4 (p=0.007) and persisted throughout. Efficacy was supported by CGI-I (p=0.07). Quetiapine+AD showed a numerically greater advantage over lithium+AD in those with two failed treatments (Stage 2) rather than one (Stage 1).ConclusionsQuetiapine+AD and quetiapine monotherapy, were non-inferior to lithium+AD in treatment resistant depression. There was an early significant and persistent efficacy advantage on MADRS for quetiapine augmentation compared with lithium augmentation of SSRI or venlafaxine treatment.