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Fibromyalgia (FM) is highly prevalent in the female gender. Scarce attention has been given to the exploration and description of this syndrome, from a psychological point of view, when occurring in males. The aim of the present study is to develop further knowledge, and to summarise the literature regarding subjective psychological experience, characteristics of symptoms presentation (both onset and development), and treatment options for FM in male patients, in order to highlight differences with FM in females.All studies published between January 1993 and February 2020 using PubMed and PsycInfo were included, provided that they met the following criteria: 1) written in English; 2) original articles on studies with a longitudinal design; 3) prospective or retrospective, observational (analytical or descriptive), experimental or quasi-experimental, controlled or non-controlled studies. Reviews and non-original articles (i.e. editorials, letters to the editor, and book chapters) were not included. We utilised the following keywords: (male), (female), (fibromyalgia), combined with Boolean operators 'AND' and 'NOT'.We found an initial number of 55 papers. Duplicated records were excluded (n=13), as well as papers not focusing on male patients or not fulfilling the inclusion criteria (n=25), thus narrowing the research to 17 papers.FM male patients consider their masculine identity as inefficiently re-negotiated after the onset of symptoms. FM males tend to endure pain for longer periods of time than females before seeking treatment; bodily symptoms are prevalent with a compromised exploration of feelings about FM. Unfortunately, there is still a paucity of evidence on clinical characterisation and treatment options when FM occurs in males. Moreover, no studies have addressed the issue of the psychopharmacological/non-pharmacological management of males with FM and comorbid psychiatric syndromes.

Objective We reviewed literature on drugs for bipolar disorders (BD), utilized in ovarian cancer (OC). Method We adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in completion of this systematic review. Results We identified 73 papers. Thirty-two studies were finally included. BD is rarely diagnosed in OC patients. Limited finding from case reports is available. Drugs used to treat BD (mainly lithium and valproic acid) have been extensively studied in add-on to chemotherapy for treatment-resistant OC cells or in animal models, with promising results in vitro but not in vivo. Conclusions The clinical underestimation of BD in OC has leaded to the almost complete absence of evidences for a soundly based clinical guidance in this field. There is a urgent need for a systematic multi-disciplinary approach to OC.

International audience; The approach to the diagnosis of acute pulmonary embolism (PE) is under constant revision with advances in technology, noninvasive approaches, and increasing awareness of the risks of ionizing radiation. Optimal approaches in some categories of patients are controversial. Data are insufficient for evidence-based recommendations. Therefore, this survey of investigators in the field was undertaken. Even among experts there were marked differences of opinion regarding the approach to the diagnosis of acute PE. Although CT pulmonary angiography was usually the imaging test of choice, the respondents were keenly aware of the dangers of ionizing radiation. In view of advances in scintigraphic diagnosis since the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trial, ventilation/perfusion (V/Q) lung scans or perfusion scans alone and single photon emission computed tomography (SPECT) V/Q lung scans are often recommended. The choice depends on the patient's age, gender, and complexity of the findings on the plain chest radiograph.

BACKGROUND: Genetic factors play a role in chronic obstructive pulmonary disease (COPD) but are poorly understood. A number of candidate genes have been proposed on the basis of the pathogenesis of COPD. These include the matrix metalloproteinase (MMP) genes which play a role in tissue remodelling and fit in with the protease--antiprotease imbalance theory for the cause of COPD. Previous genetic studies of MMPs in COPD have had inadequate coverage of the genes, and have reported conflicting associations of both single nucleotide polymorphisms (SNPs) and SNP haplotypes, plausibly due to under-powered studies. METHODS: To address these issues we genotyped 26 SNPs, providing comprehensive coverage of reported SNP variation, in MMPs- 1, 9 and 12 from 977 COPD patients and 876 non-diseased smokers of European descent and evaluated their association with disease singly and in haplotype combinations. We used logistic regression to adjust for age, gender, centre and smoking history. RESULTS: Haplotypes of two SNPs in MMP-12 (rs652438 and rs2276109), showed an association with severe/very severe disease, corresponding to GOLD Stages III and IV. CONCLUSIONS: Those with the common A-A haplotype for these two SNPs were at greater risk of developing severe/very severe disease (p = 0.0039) while possession of the minor G variants at either SNP locus had a protective effect (adjusted odds ratio of 0.76; 95% CI 0.61 - 0.94). The A-A haplotype was also associated with significantly lower predicted FEV1 (42.62% versus 44.79%; p = 0.0129). This implicates haplotypes of MMP-12 as modifiers of disease severity.

The paper describes the software developed for a numerical evaluation of CT thorax images, aiming to the characterization of the pulmonary tissue... The procedure, implemented in Microsoft Windows, consists on two programs. The program Parenchima processes the images obtained in the examination of a patient in order to detect both lungs in each image; given a photometric threshold, the program detects the blobs contained in the pulmonary areas and produces the blob list whit position and shape features. The program Estrai processes the blob list obtaining a set of global parameters that quantifies the overall area of the pulmonary tissue in the processed images, the overall area of the pixels with luminance values less than the selected threshold and the distributions of blob area and shape values. The paper report an application study where the implemented procedure has been used to process images obtained by patients affected by emphysema: the study shows that the procedure can be used as diagnostic tool in routine applications.

Objective: Interpersonal Psychotherapy (IPT) model, with its four problematic areas of grief, deficit, role transition and role dispute, provides a useful frame of reference for a quick case formulation. We aimed at applying the IPT problematic areas assessment in a sample of patients from a liaison psychiatry setting. Methods: One-hundred and twenty-nine hospitalized patients of both sexes, aged between 18 and 80 years were interviewed. The 'Interpersonal Problem Areas Rating Scale' (IPARS) was used to detect the interpersonal focuses. Results: IPARS problematic areas were identified in the 76% of the sample (n=98). Grief and role transition, interpersonal deficits and role disputes were, respectively, the most frequently (43.4 and 42.6%, respectively) and the less frequently described focuses (14 and 11.6%). Moreover, 31 patients (24%) showed no problem areas related to current symptomatology. Conclusions: The IPT model has proved to be an easy-to-use tool, able to guide the psychological interview and allowing the collection of information from an interpersonal perspective in a short time, although no specific focuses were detected as related to current psychological distress in around 25% of the sample.

In the course of pulmonary edema water accumulates in the extravascular space with a consequent increase of lung density- Therefore, the severity of the disease may be quantified and the time course followed if lung density changes can be measured. A tomographic technique was developed in order to visualize sectional chest planes by means of a collimated linear source of gamma rays and a gamma camera to detect Compton scattered photons at 90° to the primary beam. As the intensity of the Compton effect is a linear function of the scanned tissue density, the resulting image is a map of the distribution of a lung densities along the plane crossed by the incident beam. A computer processing of the original images was performed to clear the views of systematic and/or random acquisition errors. The application of this technique to the study of pulmonary edema and the comparison with x-ray findings are described.

No abstract available

Background The recognition and assessment of psychomotor retardation may have implications for better definition of the clinical phenotypes of depression. The aim of this study was to assess the clinical correlates of psychomotor retardation endorsed at any time during the patients' lifetime (LPR). Methods The study sample included 291 patients with non-psychotic major depressive disorder (MDD) participating in the clinical trial, “Depression: The Search for Treatment-Relevant Phenotypes.” Psychomotor retardation was measured using a factor derived from the Mood Spectrum Self-Report (MOODS-SR) assessment. Using a pre-defined cut-off score on the lifetime psychomotor retardation (LPR) factor of the MOODS-SR, participants were classified into high and low scorers. Logistic regression analysis was used to evaluate the relationship between LPR and subthreshold bipolarity. Results Compared to low scorers, participants with high scores on the LPR factor had greater severity of depression and more bipolarity indicators. Conclusions The MOODS-SR appears to be helpful to identify clinical phenotypes of unipolar depression and to highlight the usefulness of a lifetime approach to the assessment of psychopathology in the characterisation of patients with unipolar depression.

Background: To date, few randomized controlled trials (RCTs) of major depression have examined suicidal ideation as an outcome measure. Our aim is to determine the incidence of treatment-emergent suicidal ideation (ESI) and behaviors during the acute phase of treatment with an SSRI antidepressant or interpersonal psychotherapy (IPT) in patients with unipolar major depression. Methods: In a two-site RCT, 291 adult outpatients with nonpsychotic major depression and a Hamilton Depression Rating Scale (HDRS) score ≥15 were randomly allocated to IPT or SSRI. Participants who did not remit with monotherapy received augmentation with the other treatment. ESI was defined as a postbaseline HDRS suicidality item score ≥2 or a postbaseline Quick Inventory of Depressive Symptomatology (QIDS) score ≥2 in patients with a baseline score ≤1. Results: Of the 231 participants who had no suicidal ideation at baseline, 32 (13.8%) subsequently exhibited ESI on at least one postbaseline visit. Time to suicidal ideation was significantly longer in patients allocated to SSRI compared to those allocated to IPT (HR = 2.21, 95% CI 1.04-4.66, P = .038), even after controlling for treatment augmentation, benzodiazepine use, and comorbidity with anxiety disorders. Worsening of suicidal ideation occurred in 7/60 patients who had suicidal ideation at baseline. In the large majority of cases, suicidal ideation was successfully managed with the study protocol. Conclusions: In the context of careful monitoring and frequent contact, selective serotonin reuptake inhibitor (SSRI) was associated with a lower risk of ESI than IPT and both SSRI and IPT appeared to be safe treatments for patients with past suicide attempts, none of whom exhibited ESI during the study. Depression and Anxiety 0:1-7, 2011.© 2011 Wiley-Liss, Inc. Language: en

Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were initially randomized to IPT or SSRI and then augmented with the second treatment if they did not remit with monotherapy. Assessments included the SCID-I, the SCID-II for DSM-IV diagnoses, the HRSD, the QIDS and the Mood Spectrum Self-Report (MOODS-SR). Seventy-eight (25%) patients reported a history of EPA; 60 (76.9%) were women. Patients with a history of EPA did not differ from those without on HRSD scores at baseline, but showed an earlier age at onset of depression and a longer duration of illness. The two groups differed on several mood spectrum factors, namely: ‘depressive mood’ (15.6 ± 4.9 vs. 13.5 ± 5.4; p < 0.004), ‘psychomotor retardation’ (11.7 ± 4.5 vs. 9.6 ± 4.7; p < 0.001), ‘drug and illness-related depression’ (1.3 ± 1.3 vs. 0.6 ± 1.0; p < 0.0001), and ‘neurovegetative symptoms’ (8.3 ± 2.6 vs. 6.9 ± 2.9; p < 0.0001). Patients with EPA had also a significantly longer time to remission (89 vs. 67 days, log-rank test, p = 0.035). The need for augmentation treatment was significantly more frequent among patients with EPA than in those without. The present study suggests that patients with a history of EPA show a subtype of depression characterized by poor treatment response and more severe neurovegetative and psychomotor symptoms.

Background: Instruments that are intended to measure change over time need to emphasize sensitivity to change as a central property. The aims of this report are to test whether the MOODS-SR, a measure of mood spectrum symptomatology, is sensitive to changes during acute and continuation treatment of depression and whether residual mood spectrum symptoms predict relapse in the subsequent 6 months. Methods: The study sample includes 316 patients with nonpsychotic depression participating in the protocol ‘Depression: the search for treatment-relevant phenotypes’. Patients were initially randomized to selective serotonin reuptake inhibitors or interpersonal psychotherapy and then treated for 9 months using an algorithm-based protocol. Measures of mood symptomatology included the self-report version of the structured clinical interview for mood spectrum (MOODS-SR), the Quick Inventory for Depressive Symptomatology and the Hamilton Rating Scale for Depression. Results: Repeated-measures ANOVA indicates that during the acute phase MOODS scores decrease significantly from baseline to weeks 6 and 12. This decrease was significantly different (p < 0.001) between those who remitted and those who did not remit on the depressive, the rhythmicity component and the total score. Nonrelapsing subjects had stable scores across the continuation phase, while among relapsing subjects, a significant increase was found in the depressive component (p < 0.001), the rhythmicity component (p = 0.024) and the total score (p < 0.001), at 2 months, followed by a decrease from 2 to 6 months. Scores on the depressive component at the entry into continuation predicted relapse in the subsequent 6 months. Conclusions: Our findings suggest that the MOODS-SR is sensitive to change in depression status and may help the clinician to detect symptoms and signs not considered by established symptom severity scales.

The short (s) variant of the serotonin transporter gene linked functional polymorphic region (5-HTTLPR) is associated with depression. Stressful life events, gender, and race have been shown to moderate this association. Because features of mania/hypomania seem to constitute an indicator of higher severity of depression, we examined the relationship between 5-HTTLPR genotype and symptoms of mania-hypomania spectrum occurring over the lifetime in patients with major depression. The possible moderating role of gender in this relationship was taken into account. Two hundred twenty-two patients with unipolar major depression were genotyped for 5-HTTLPR and nine other representative polymorphisms, and were administered the Mood Spectrum Questionnaire, Lifetime Version (MOODS-SR). The manic-hypomanic (MH) component score was used for analysis. Using a linear model of the MH score as a function of genotypes and gender, controlling for age, severity of depression, and site, we found significant effects of gender (F = 8.003, df = 1, P = 0.005), of the interaction gender x genotype (F = 4.505, df = 2, P = 0.012), and of the baseline Hamilton score (F = 5.404, df = 1, P = 0.021), non-significant effects of genotype (F = 1.298, df = 2, P = 0.275), age (F = 0.310, df = 1, P = 0.578) site (F = 0.504, df = 1, P = 0.479). Significant associations were also detected at three other SNPs. The association between the manic/hypomanic component of the MOODS-SR and the polymorphisms of the 5-HTTLPR is moderated by gender. This finding is intriguing from a clinical point of view because women with unipolar disorder and the "ss" genotype seem to constitute a sub-group with higher severity of depression. These results should be considered tentative pending replication in other samples.

BACKGROUND: While previous attempts to elucidate the factor structure of depression tended to agree on a central focus on depressed mood, other factors were not replicated across studies. By examining data from a large number of items covering the range of depressive symptoms, the aim of the present study is to contribute to the identification of the structure of depression on a lifetime perspective. METHODS: The study sample consisted of 598 patients with unipolar depression who were administered the Mood Spectrum Self-Report (lifetime version) in Italian (N=415) or English (N=183). In addition to classical exploratory factor analysis using tetrachoric correlation coefficients, an IRT-based factor analysis approach was adopted to analyze the data on 74 items of the instrument that explore cognitive, mood and energy/activity features associated with depression. RESULTS: Six factors were identified, including 'Depressive Mood', 'Psychomotor Retardation', 'Suicidality', 'Drug/Illness related depression', 'Psychotic Features' and 'Neurovegetative Symptoms', accounting overall for 48.3% of the variance of items. LIMITATIONS: Clinical information on onset of depression and duration of illness is available only for 350 subjects. Therefore, differences between sites can only be partially accounted using available data. CONCLUSIONS: Our study confirms the central role of depressed mood, psychomotor retardation and suicidality and identifies the factors 'Drug/Illness related depression', 'Psychotic features' and the neurovegetative dysregulation not captured by the instruments most frequently used in previous studies. The identification of patients with specific profiles on multiple factors may be useful in achieving greater precision in neuroimaging studies and in informing treatment selection.

BACKGROUND: The observation that bipolar disorders frequently go unrecognized has prompted the development of screening instruments designed to improve the identification of bipolarity in clinical and non-clinical samples. Starting from a lifetime approach, researchers of the Spectrum Project developed the Mood Spectrum Self-Report (MOODS-SR) that assesses threshold-level manifestations of unipolar and bipolar mood psychopathology, but also atypical symptoms, behavioral traits and temperamental features. The aim of the present study is to examine the structure of mania/hypomania using 68 items of the MOODS-SR that explore cognitive, mood and energy/activity features associated with mania/hypomania. METHODS: A data pool of 617 patients with bipolar disorders, recruited at Pittsburgh and Pisa, Italy was used for this purpose. Classical exploratory factor analysis, based on a tetrachoric matrix, was carried out on the 68 items, followed by an Item Response Theory (IRT)-based factor analytic approach. RESULTS: Nine factors were initially identified, that include Psychomotor Activation, Creativity, Mixed Instability, Sociability/Extraversion, Spirituality/Mysticism/Psychoticism, Mixed Irritability, Inflated Self-esteem, Euphoria, Wastefulness/Recklessness, and account overall for 56.4% of the variance of items. In a subsequent IRT-based bi-factor analysis, only five of them (Psychomotor Activation, Mixed Instability, Spirituality/Mysticism/Psychoticism, Mixed Irritability, Euphoria) were retained. CONCLUSIONS: Our data confirm the central role of Psychomotor Activation in mania/hypomania and support the definitions of pure manic (Psychomotor Activation and Euphoria) and mixed manic (Mixed Instability and Mixed Irritability) components, bearing the opportunity to identify patients with specific profiles for a better clinical and neurobiological definition.

The phenomenon of antidepressant-induced mania/hypomania in patients with unipolar depression has been described since the introduction of the first antidepressant agents. The hypothesis was that antidepressant agents triggered manic/hypomanic symptoms by influencing the central dopamine and serotonin systems (1). The first studies in this field (1, 2) described a relatively low prevalence of treatment-emergent mania/hypomania (TEMH), probably attributable to the heterogeneity of patients and to the relatively infrequent use of antidepressants prior to 1982. Subsequent studies reported TEMH rates of 1–17% (3–8), with the highest rates observed with tricyclic antidepressants and lower rates for bupropion, paroxetine, and moclobemide. Differences in the diagnostic assessment method (clinical diagnosis versus structured interview) may have resulted in a variable proportion of patients with bipolar disorders being misdiagnosed as unipolar across studies (9–12). Indeed, the percentage of correct diagnoses increases when structured interviews are conducted (13). Recently, Goldberg and Truman (14) have tried to define a timeframe after beginning an antidepressant at a specific dose in which newly emergent mania or hypomania could be attributed to the effects of the antidepressant and not to the natural course of a bipolar disorder misdiagnosed as unipolar. They suggested that if mania or hypomania emerges after more than eight weeks of treatment, it should be considered drug induced only if a significant change in dosage preceded the switch. Of note, a recent study suggests that treatment-emergent hypomania can present in patients with chronic resistant depression even after different treatment trials (15), thus suggesting a longer time period at risk for TEMH. Some clinical characteristics seem to be related to a higher risk of TEMH among patients with unipolar depression; these include early age at onset of affective illness, a family history for bipolar disorder and suicide, severity of current episode, hypersomnia, less anxiety and physical complaints, motor retardation, mood lability, and a high rate of recurrences (13, 16–22). The probability of (hypo)mania seems to be independent of the mean doses of antidepressants, whereas a switch seems to be more frequent between two and three weeks after a dose increase (8). In the attempt to characterize patients at risk of TEMH, some studies have focused on the subtype of depression (atypical versus typical depression), temperamental traits (23–25), and on specific psychopathological aspects such as mood lability, energy-activity, and daydreaming (26). The identification of features that predict TEMH is of considerable clinical relevance as both misdiagnoses and subsequent mood destabilization induced by antidepressants may have a direct adverse impact on the course and outcome of an affective disorder. The aim of the present report is to estimate the incidence and describe the clinical characteristics of unipolar patients experiencing TEMH during treatment with a selective serotonin reuptake inhibitor (SSRI) (citalopram or escitalopram), a depression-specific psychotherapy [interpersonal psychotherapy (IPT)], or the combination. All patients were carefully diagnosed by experienced clinicians using the Structured Clinical Interview for Axis I DSM-IV Disorders (SCID) interview for DSM-IV diagnoses.

The "comet-tail" is an ultrasound sign detectable with ultrasound chest instruments; this sign consists of multiple comet-tails fanning out from the lung surface. They originate from water-thickened interlobular septa and would be ideal for nonradiologic bedside assessment of extravascular lung water. To assess the feasibility and value of ultrasonic comet signs, we studied 121 consecutive hospitalized patients (43 women and 78 men; aged 67 +/- 12 years) admitted to our combined cardiology-pneumology department (including cardiac intensive care unit); the study was conducted with commercially available echocardiographic systems including a portable unit. Transducer frequencies (range 2.5 to 3.5 MHz) were used. In each patient, the right and left chest was scanned by examining predefined locations in multiple intercostal spaces. Examiners blinded to clinical diagnoses noted the presence and numbers of lung comets at each examining site. A patient lung comet score was obtained by summing the number of comets in each of the scanning spaces. Within a few minutes, patients underwent chest x-ray, with specific assessment of extravascular lung water score by 2 pneumologist-radiologists blinded to clinical and echo findings. The chest ultrasound scan was obtained in all patients (feasibility 100%). The imaging time per examination was always