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Background: The new coronavirus (SARS-CoV-2) shows several similarities with previous outbreaks of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) Aim of this systematic review and meta-analysis is to provide evidence of the psychopathologic burden on health care workers (HCWs) of the first two deadly coronavirus outbreaks to get lessons for managing the current burden of COVID-19 outbreak Method: According to Cochrane Collaboration guidelines and the PRISMA Statement, the study quantified the effects of frontline work on mental health of HCWs Major databases — Pubmed, Scopus, Embase, Medline, and Web of Science — were searched for observational and case-control studies evaluating mental health indexes reported by front-line work This study computed the percentage of sample that reported clinically significant levels of psychiatric symptoms Cohen’s d was used for comparing mental health outcomes of health care workers directly involved in addressing pandemic emergency with a control group that was not directly exposed to such conditions Pooled effect sizes (dw) were estimated whenever at least three independent studies yielded data Heterogeneity of findings and bias of publication were estimated as well Findings: Fifteen studies have been selected for a total of 7,393 HCWs From 9 6% to 51% of HCWs reported symptoms of Post-Traumatic Stress Disorder (PTSD) and from 20% to 75% reported psychiatric symptoms, with a prevalence of anxiety and depression From one to the three years after outbreak, from 2% to 19% reported PTSD symptoms and from 5% to 90% psychiatric symptoms Interestingly, HWCs who were directly involved in pandemic emergency showed significantly higher depressive and anxious symptoms (dw = 66 ( 46– 85);p < 001) than ones who were not directly exposed Similarly, the direct involvement significantly affected the severity of PTSD symptoms (dw = 30 ( 21– 39);p < 001) Conclusion: Health care professionals in general and most of all frontline workers showed an association with a likely risk of developing psychiatric disorders following outbreaks and for at least three years later Mental health interventions for professionals exposed to COVID-19 need to be immediately implemented Further studies are warranted to investigate long-term consequences carefully, and to look for mediating and buffering factors as well The role of clinical psychologists and psychiatrists in delivering adequate interventions is critically important © Copyright © 2020 Galli, Pozzi, Ruggiero, Mameli, Cavicchioli, Barbieri, Canevini, Priori, Pravettoni, Sani and Ferrucci

Background Whether mindfulness and emotional intelligence may counteract psychological symptoms and whether brooding and worry may be linked to decreased psychological well-being (PWB) in individuals with generalized anxiety disorder (GAD) is still an issue. Methods The study used a cross-sectional design on a sample of 66 consecutive individuals with a diagnosis of GAD. Two hierarchical multiple regressions were conducted to determine whether PWB and anxiety symptoms were accounted for by mindfulness and emotional intelligence skills, brooding, and worry. Results Worry was negatively related to PWB and showed a tendency to be positively associated with anxiety symptoms after controlling for the other variables. Brooding was uniquely and positively related to anxiety symptoms. Different mindfulness (i.e., describing and nonjudging) and emotional intelligence (i.e., attention and repair) skills were particularly important for PWB. Repair was also negatively related to anxiety symptoms. Conclusions Repair was the variable that played a key role in the association with both PWB and GAD symptoms. Worry was the second most important variable, although it approached significance in the relationship with anxiety symptoms. Brooding was more strongly positively associated with anxiety than worry. In sum, the results suggest that an integrated and balanced focus on both positive and negative functioning will be useful in future clinical psychology research to predict, understand, and treat anxiety as well as to examine the antecedents and characteristics of positivity in individuals with GAD and promote their PWB.

Introduction Oxcarbazepine (OXC) reduces high-voltage-activated calcium currents, thus reducing glutamatergic transmission at corticostriatal synapses. This effect on NMDA glutamatergic transmission may play a role against the increased glutamatergic transmission determined by alcohol withdrawal. To investigate the efficacy and safety of OXC in relapse prevention we compared OXC at different dosages with Naltrexone (NAL) in a 90 days randomised open-label trial. Craving and psychiatric symptoms improvements were the secondary endpoints. Methods Eighty-four detoxified alcohol dependent subjects currently meeting clinical criteria for alcohol dependence were randomised into three groups: 27 patients received 50 mg of naltrexone, 29 received 1500–1800 mg of oxcarbazepine (OXC high), 28 patients 600–900 mg of oxcarbazepine (OXC low). Craving (VAS; OCDS) and withdrawal (AWRS) rating scales were applied; psychiatric symptoms were evaluated through the SCL-90-R. Results A significantly larger number of subjects remained alcohol free in the OXC high group (58.6%) with respect to both the OXC low (42.8%) and the NAL groups (40.7%). Comparing the OCDS total scores at the end of the treatment, the improvement was significantly greater for the NAL group with respect to the OXC low group. The reduction of the Hostility-Aggression subscore of the SCL-90-R was significantly greater in the OXC high group than that of the other groups. Dual diagnosis patients had a better outcome when treated with OXC high. Discussion OXC at a dosage of 1500–1800 mg/day might be beneficial in terms of alcohol relapse prevention. The low dosage formulation did not show the same trend, but it still remain in the same range as NAL. The mechanism involved in the efficacy of oxcarbazepine in relapse prevention could be less related to craving and more connected to the treatment of the comorbid psychiatric symptomatology and the alcohol protracted withdrawal syndrome. Copyright © 2007 John Wiley & Sons, Ltd.

IntroductionThe addictive behaviors can be seen as attachment disorders. In literature studies about the relationship between attachment styles and addictions are few. However, in addicted patients the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.ObjectivesTo study the relationships between different attachment styles and types of addiction (chemical or behavioral).AimsTo examine the role of attachment styles in patients with alcohol dependence (AD) or pathological gambling (PG).MaterialsWe recruited 29 with AD and 33 with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered for the study of attachment styles.ResultsPG compared to AD has higher raw scores both anxiety factor (P < 0.001) and avoidance factor (P = 0.003) at ECR. ECR ambivalent correlates with the diagnosis of PG (P = 0.010); ECR avoidant correlates with AD (P = 0.006); ECR anxiety shows a trend of correlation with the diagnosis of AD (P = 0.052). The subjects showed the following attachment styles (Table 1).ConclusionsThis is the first study that compares the attachment styles of patients AD and PG. We found differences in attachment styles of the two types of addiction, confirming the need of different approaches and then different types of treatment. Our findings need to be replicated in larger groups, also widening the target of other addictions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe addictive behaviors can be seen as attachment disorders. To our knowledge, the literature on the relationship between pathological gambling (PG) and attachment styles is still poorly represented. However, in addicted patients, the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.ObjectivesTo examine the clinical role of attachment styles in the PG patients.AimsTo study the relationships between the different attachment styles and PG and the severity of PG.MaterialsWe recruited 33 patients with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered to investigate attachment styles, the South Oaks Gambling Screen (SOGS) to investigate the severity of gambling.ResultsThe subjects showed the following attachment styles (Table 1). Ambivalent attachment style correlates with high scores to the SOGS (P < 0.001), and with a shorter period of abstinence from PG (P = 0.022). Patients with ambivalent attachment style have increased severity of PG at SOGS, correlating with higher raw score on the anxiety factor of ECR and lower raw score on avoidance factor (for both P = 0.036).ConclusionsPatients showed ambivalent attachment, and anxiety factor correlates with a greater severity of PG. Attachment style could be a severity index of PG. Our findings need to be replicated in larger groups, also widening the target of other addictions both chemical and behavioral.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Purpose The aims of the study were to evaluate the occurrence of behavioral addictions (BAs) in alcohol use disorder (AUD) subjects and to investigate the role of impulsivity, personality dimensions and craving. Methods 95 AUD outpatients (DSM-5) and 140 homogeneous controls were assessed with diagnostic criteria and specific tests for gambling disorder, compulsive buying, sexual, internet and physical exercise addictions, as well as with the Barratt Impulsiveness Scale (BIS-11) and Temperamental and Character Inventory–Revised (TCI-R). The Obsessive Compulsive Drinking Scale (OCDS) and Visual Analogue Scale for craving (VASc) were also administered to the AUD sample. Results 28.4% (n = 27) of AUD subjects had at least one BA, as compared to 15% (n = 21) of controls (χ2 = 6.27; p = .014). In AUD subjects, direct correlations between BIS-11 and Compulsive Buying Scale (CBS), Internet Addiction Disorder test (IAD), Exercise Addiction Inventory-Short Form (EAI-SF) scores (p

Background. Nowadays, adult separation anxiety disorder (ASAD) is an established diagnostic category but is little investigated in subjects with addictive behaviours.Objective. To assess the presence of ASAD among patients with addictive disorders in comparison with anxiety patients and measure the personality correlates in all these groups.Methods. 103 outpatients, meeting DSM-IV-TR criteria for anxiety disorders (38 patients), alcohol dependence (30 patients), or pathological gambling (35 patients), were assessed by the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS) and the Adult Separation Anxiety Checklist (ASA-27) for separation anxiety and by the Temperament and Character Inventory-Revised (TCI-R) for personality characteristics.Results. ASAD is detected in 34.2% of anxiety patients, 13.3% of alcoholics, and 11.4% of gamblers. Separation anxiety scores correlate positively with harm avoidance and negatively with self-directedness in all groups; further correlations are seen among addictive patients only, that is, self-transcendence for gamblers and cooperativeness for both alcoholics and gamblers.Conclusions. The prevalence of ASAD is lower among addictive patients than in those with anxiety disorders; correlations are found between separation anxiety and specific TCI-R dimensions, with some matching across the three diagnostic groups.

Introduction Adult Separation Anxiety Disorder (ASAD) is related to greater personal dysfunction and to a reduced sensitivity to conventional treatment, such as cognitive-behavioural therapy or anti-panic drugs, even considering severity of anxiety symptoms, number of co-morbid disorders, socioeconomical status, disease duration, and severity of agoraphobia. Objectives To evaluate separation anxiety, psychiatric co-morbidity, levels of anxiety, character and temperament personality traits, and global functioning, in subjects with anxiety disorders attending a tertiary-level outpatient clinic. Aims To predict the outcome and customize treatment for anxiety disorders. Methods After symptom stabilization of one month (T0) 40 patients with anxiety disorders were assessed by means of SCI- SAS, SASI, ASA -27, MINI, HAM- A, TCI-R, GAF. Prospective evaluation is planned at T60 and T180. Results According to preliminary cross-sectional data, higher scores of separation anxiety show statistically significant correlations with some domains of the TCI-R; in addition, patients with ASAD show greater psychiatric co-morbidity. No correlations were found between the presence of separation anxiety and levels of anxiety at HAM-A or GAF scores at baseline. Conclusions The prospective study of long-term response to treatment is ongoing and the sample will be expanded. The comprehension of anxiety symptoms appraisal in the framework of psychobiological personality characteristics is expected to influence the choice of both pharmacological and psychological therapeutic tools, particularly in patients showing higher levels of dysfunction.

Compulsivity in alcohol-dependent patients is a frequent cause of early relapse in the post-detoxification period. The present study is a 2-month trial on detoxified alcoholics undergoing a double-blind placebo-controlled treatment with fluoxetine (20 mg/day). The rating instruments were the Hamilton Depression and Anxiety Scales, a visual analogue scale for alcohol craving and an original scale for evaluating alcohol withdrawal. The abstinence rate for fluoxetine-treated patients was significantly higher than in the placebo group, whereas no difference between treatments was found on the rating scales. Medical problems, additional psychiatric diagnoses, and family alcoholism were negatively correlated with abstinence. Two subgroups of patients having significantly different characteristics were identified as to the outcome, by means of cluster analysis. They are likely to represent two different stages in the evolution of alcoholism. Our results show that, independently from craving, fluoxetine at antidepressant doses is able to prevent relapses in weaned alcoholics. The anticompulsive therapy can positively influence the short-term outcome, while other factors are negatively associated with abstinence.

Background The aim of our study was to assess hedonic capacity in euthymic bipolar subjects, identifying possible differences compared to remitted unipolar depressed patients and healthy controls. Methods 107 subjects with bipolar disorders, 86 with major depressive disorder and 106 healthy controls, homogeneous with respect to demographic characteristics, were enrolled. The following scales were administered: the Snaith–Hamilton pleasure scale (SHAPS), the subscale for ‘anhedonia/asociality’ of the scale for the assessment of negative symptoms (SANS) and the visual analogue scale (VAS) for hedonic capacity. Results Scores on SHAPS total, interests and social interactions, SANS ‘anhedonia/asociality’ and VAS were all significantly higher in affective disorder patients compared to healthy controls. No difference was found between clinical groups. 20.5% ( n =22) of bipolar disorder subjects and 24.5% ( n =21) of major depressed subjects showed a significant reduction in hedonic capacity (SHAPS total score ≥3), compared to 7.5% ( n =8) of healthy controls ( χ 2 =12.03; p =.002). Limitations Limitations include heterogeneity with respect to pharmacological status and longitudinal course (i.e., ‘single’ vs. ‘recurrent’ affective episodes). Conclusions The major finding of our study is that euthymic bipolar patients and remitted major depressed patients display residual anhedonic symptoms. This suggests that, in affective disorder patients, altered hedonic capacity could represent an enduring trait and that, possibly, dysfunctions in the neurobiological mechanisms underlying hedonic response and reward processing persist, irrespective of mood state.

IntroductionThe aim of this preliminary study is to assess, in a sample of patients with Coronary Heart Disease (CHD), the specific association between depressive symptoms and systemic inflammation.MethodsSixty-One inpatients with CHD, 31 Unstable Angina and 28 Myocardial Infarction, participated in the study. The plasma levels of C Reactive Protein were measured using Dade Behring’s High Sensitivity CRP assay (hs-CRP) at T0, T30 and T90.At the same timings, they were tested by an examiner, unaware of their diagnosis, with a psychometric battery (SCL90-R, HDRS, MADRS, BDI, QlesQ).ResultsThe elevation of hs-CRP occurs during the whole observation period, with maximum significance at T90 (p = 0,031).A multivariate analysis at T0 indicates a statistical correlation between SCL90-R scores and hs-CRP levels (p = 0.02).The SCL90-R is also associated with the risk of further cardiac events (p = 0.013).Also the BDI could be useful as a prognostic factor (p = 0.026).We found a trend towards correlation between CRP values and depressive symptoms, but it never reaches statistical significance for the other scales.ConclusionsThe feelings of loss and the fear of death, related to the environmental and emotional situation of the hospitalization, may prevail in the acute phase of CHDs.Some patients may overcome this reactive depression, while others may exhibit a biological depression, related to the high level of CRP and thus to an increased risk of re-infarction and other coronary events.

Aim of this randomized, double-blind, placebo-controlled study was to evaluate the efficacy of Acetyl-l-Carnitine (ALC), at different dosages, on specific anhedonic symptoms in detoxified alcohol dependent subjects. Secondary endpoints were the effect of ALC on melancholic and negative symptoms.Sixty-four anhedonic alcohol dependent patients with minor or absent withdrawal symptoms were randomized: 23 received ALC at a dosage of 3g/day, 21 received ALC at a dosage of 1g/day, and 20 were given placebo. ALC was given intravenously for 10days, followed by 80days of oral treatment plus a follow-up period of 45days. The presence of anhedonic symptoms was determined by the SHAPS (Snaith-Hamilton Pleasure Scale) and the VASa (Visual Analogue Scale for Anhedonia); negative and melancholic symptoms were evaluated by the SANS (Scale for the Assessment of Negative Symptoms), and the BRMS (Bech-Rafaelsen Melancholia Scale).The natural course of anhedonia in the placebo group showed a decline until day 30 and remains stable for the rest of the study. Intravenously ALC accelerated the improvement of anhedonia reaching constant low levels early, on day 10. At this step levels of anhedonia (SHAPS, VASa) and melancholic symptoms (BRMES) resulted significantly reduced (p0.05) in both the ALC 3g and ALC 1g groups with respect to placebo; SANS scores significantly reduced only in the ALC 1g respect to placebo (p=0.014). During oral treatment with ALC, anhedonia scores did not differ from placebo.Intravenously ALC was effective in accelerating the abstinence-associated improvement of anhedonia, melancholic and negative symptoms, whereas oral ALC treatment starting on day 10 showed no further improvements. Accordingly, in alcohol dependent subjects, ALC may be considered as a new potentially useful drug for the treatment of anhedonia.

Aim: The study aimed to evaluate the efficacy of acetyl-L-carnitine (ALC), at different doses, in relapse prevention and craving in anhedonic detoxified alcohol-dependent subjects. Method: Randomized, double-blind, placebo-controlled, pilot study in 64 alcohol-dependent anhedonic patients: 23 received ALC at a dose of 3 g/day, 21 received ALC at a dosage of 1 g/day and 20 were given placebo. Intensity of alcohol craving was evaluated by Visual Analogue Scale. Subjects were evaluated at the beginning of treatment and after 10, 30, 60 and 90 days. Results: Survival analysis showed that patients treated with ALC remained completely abstinent for longer than those treated with placebo (Z=−2.27; P < 0.05). From the 10th day onwards, a greater reduction of craving was observed in the ALC 1 g group than with placebo (P= 0.035). The two groups did not differ in the percentage of subjects remaining abstinent for the entire study period or the number of subjects who relapsed (defined as five or more standard drinks (four for women) on a single occasion or drinking on five or more days in 1 week). Conclusions: The results of this study suggest that ALC can reduce craving and the time to first drink. ALC use was safe. Further studies are needed to clarify to confirm, over longer periods, these short-term outcome benefits.

Objective In this open, prospective study we aimed to investigate the efficacy, medical safety and practicability of pregabalin in outpatient detoxification of alcohol-dependent patients with mild-to-moderate alcohol withdrawal syndrome (AWS). Craving reduction, improvement of psychiatric symptoms and quality of life were the secondary endpoints. Methods Forty alcohol dependent patients (DSM-IV) were detoxified receiving 200–450 mg of pregabalin. Withdrawal (Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)) and craving (Visual Analogue Scale (VAS); Obsessive and Compulsive Drinking Scale (OCDS)) rating scales were applied; psychiatric symptoms and quality of life were evaluated using the Symptom Check List-90 Revised (SCL-90-R) and the QL-Index, respectively. Relapsed and abstinent patients in the post-detoxification evaluation have been compared. Results Alcohol withdrawal symptoms and craving for alcohol resulted significantly reduced (p

Introduction The aim of this trial was to compare lorazepam with non-benzodiazepine medications such as pregabalin and tiapride in the treatment of alcohol withdrawal syndrome (AWS). These drugs were chosen for their inhibitorial effects on the hypersecretion of neurotransmitters usually observed in AWS. Craving reduction and improvement of psychiatric symptoms were the secondary end-points. Methods One hundred and ninety subjects affected by current alcohol dependence were considered consecutively: 111 were enrolled and divided into three groups of 37 subjects each. Within a treatment duration of 14 days, medication was given up to the following maximum doses (pregabalin 450 mg/day; tiapride 800 mg/day; lorazepam 10 mg/day). Withdrawal (CIWA-Ar), craving [visual analogue scale (VAS); Obsessive and Compulsive Drinking Scale (OCDS)], psychiatric symptoms [Symptom Check List 90 Revised (SCL-90-R)] and quality of life (QL-index) rating scales were applied. Results On the CIWA-Ar score, all the groups showed a significant reduction between times (P

Behavioural addictions (BAs) can be understood as disorders characterized by repetitive occurrence of impulsive and uncontrolled behaviours. Very few studies have investigated their association with mood disorders. The present study was undertaken to determine the prevalence of the main behavioural addictions in a sample of bipolar outpatients in euthymic phase or stabilised by medications and to investigate the role of impulsivity and temperamental and character dimensions.One-hundred-fifty-eight Bipolar Disorder (BD) (DSM-IV) outpatients were assessed with tests designed to screen the main behavioural addictions: pathological gambling (SOGS), compulsive shopping (CBS), sexual (SAST), Internet (IAD), work (WART) and physical exercise (EAI) addictions. TCI-R and BIS-11 were administered to investigate impulsivity and personality dimensions mainly associated with BAs. The clinical sample has been compared with 200 matched healthy control subjects.In bipolar patients, 33% presented at least one BA respect to the 13% of controls. Significantly higher scores at the scales for pathological gambling (p.001), compulsive buying (p.05), sexual (p.001) and work addictions (p.05) have been found. Self-Directness (p=.007) and Cooperativeness (p=.014) scores were significantly lower while impulsivity level was significantly higher (p=.007) in bipolar patients with BA than those without BA.To our knowledge, this is the first study investigating the prevalence of behavioural addictions in BD showing a significant association of these disorders. BAs are more frequent in bipolar patients than in healthy controls and are related to higher impulsivity levels and character immaturity.

Pregabalin (PRE) acts as a presynaptic inhibitor of the release of excessive levels of excitatory neurotransmitters by selectively binding to the α2-δ subunit of voltage-gated calcium channels. In this randomised, double-blind comparison trial with naltrexone (NAL), we aimed to investigate the efficacy of PRE on alcohol drinking indices. Craving reduction and improvement of psychiatric symptoms were the secondary endpoints. Seventy-one alcohol-dependent subjects were detoxified and subsequently randomised into two groups, receiving 50 mg of NAL or 150—450 mg of PRE. Craving (VAS; OCDS), withdrawal (CIWA-Ar) and psychiatric symptoms (SCL-90-R) rating scales were applied. Alcohol drinking indices and craving scores were not significantly different between groups. Compared with NAL, PRE resulted in greater improvement of specific symptoms in the areas of anxiety, hostility and psychoticism, and survival function (duration of abstinence from alcohol). PRE also resulted in better outcome in patients reporting a comorbid psychiatric disorder. Results from this study globally place PRE within the same range of efficacy as that of NAL. The mechanism involved in the efficacy of PRE in relapse prevention could be less related to alcohol craving and more associated with the treatment of the comorbid psychiatric symptomatology.

Opiate detoxification procedures aim to reduce intensity and duration of withdrawal. Ultra-rapid opiate detoxification (UROD) methods attempt to obtain this goal by administering naltrexone under deep sedation or anaesthesia. We present a case study on accidental ingestion of naltrexone in a methadone maintenance patient, which shows close methodological similarities with UROD procedures. Naltrexone was effective in reducing withdrawal duration, but not as much as UROD studies report. The administration of naloxone after detoxification did not trigger withdrawal symptoms, even in the presence of methadone, as detected by urinalyses. These results suggest the importance of further developing detoxification methods based on protocols of administration of antagonists different from UROD, in absence of anaesthesia.

Anhedonia, or the inability to experience pleasure, may be regarded either as a temperamental trait or as a state symptom of negative schizophrenia or melancholic depression. In substance use disorders, anhedonia was linked to hypoactivity of the dopaminergic mesolimbic system during protracted withdrawal. The authors investigated the influence of recent clinical and social-environmental factors on the hedonic capability and related psychopathology in a sample of 70 patients manifesting substance dependence (alcohol, opiates, multiple drugs) without severe comorbidity. Three symptom scales covering anhedonia (Snaith-Hamilton Pleasure Scale, SHAPS; Scale for the Assessment of Negative Symptoms, SANS; Bech-Rafaelsen Melancholia Scale, BRMES) were administered together with the European adaptation of the Addiction Severity Index (EuropASI). The composite scores from the seven areas of the EuropASI were introduced as independent factors in a stepwise regression analysis having symptom scores of anhedonia as dependent variables. Overall, the EuropASI composites do not explain the variability of the scores of anhedonia. Only in few cases, the regression models show a weak predictive capacity for medical status, alcohol use, and drug use composite scores, with R-square values ranging from 10 to 22%. Even if the study's limitations are noted, anhedonia appears as a psychopathological entity independent from other clinical and psychosocial features of treated addicts.

Objective: Brain-derived neurotrophic factor (BDNF) is potentially involved in the pathogenesis of anxiety. We carried out meta-analyses to evaluate the relationship between the BDNF Val66Met (valine, methionine) polymorphism and anxiety disorders (AD) or anxiety-related personality traits (ARPT). Methods: Medline, Embase and PsycINFO were searched up to December 2007. We investigated 3 outcomes related to BDNF Val66Met polymorphisms: (1) clinically diagnosed cases of AD; (2) ARPT in subjects without psychiatric diagnoses, assessed either by the Neuroticism scale of NEO-Personality Inventory forms (NEO-PI, NEO-PI-R, NEO-FFI), or by (3) the Harm Avoidance (HA) scale of Tridimensional Personality Questionnaire (TPQ) or its extended version Temperament and Character Inventory (TCI). Results: Seven case-control studies were selected for AD, including 1,092 cases and 8,394 controls, while 5 cross-sectional studies for Neuroticism (n = 1,633) and 4 for HA (n = 607). Both Met/Met and Val/Met individuals, as compared to Val/Val, showed a statistically significant lower Neuroticism score [SMD = –0.24 (95% CI: –0.44, –0.04), and –0.11 (95% CI: –0.22, –0.01), respectively]. No significant association was found between BDNF Val66Met polymorphism and AD [OR = 1.13 (95% CI: 0.85–1.52) for Met/Met versus Val/Val] or HA [SMD = 0.11 (95% CI: –0.19, 0.42) for Met/Met vs. Val/Val]. Conclusions: The low number of studies on this topic and their limited sample size, along with the inner limits in the definition of anxiety phenotypes, suggest caution in the interpretation of these results. Larger additional studies possibly investigating the interaction with other genes and environmental exposures are required to confirm these results.

Oxcarbazepine (OXC) is a keto-congener of carbamazepine, which has fewer side effects and drug interactions. However, the efficacy of OXC in treating bipolar disorder is not as well established as that of carbamazepine. This article is a systematic literature review of all studies regarding OXC and bipolar disorders, with particular attention to papers published in the last 6 years. Using the terms 'oxcarbazepine and bipolar disorder', 'oxcarbazepine and mania' or 'oxcarbazepine and bipolar depression', a computer-aided search of MEDLINE for the years 2000-2006 has been conducted. Since its introduction as an antiepileptic drug in early 2000, clinical research regarding the potential role of OXC in the treatment of bipolar disorder remains limited. There is a lack of double-blind, placebo-controlled studies. Studies recently published have small samples of patients, with insufficient follow-up periods and other methodological weaknesses. The efficacy of OXC in bipolar disorder has not been widely studied. Some authors recommend using OXC as monotherapy or as add-on therapy in refractory mania, although results are not conclusive. It is unknown whether OXC has efficacy in the maintenance treatment of bipolar disorder. OXC can be particularly useful as an add-on treatment in bipolar disorder patients for whom previous treatments have failed, or in patients who have difficulty tolerating adequate dosages of standard approved treatments.

This study prospectively examined whether continued add-on treatment with oxcarbazepine (OXC) is associated with quantitative improvement in mood and anxiety symptoms in adult patients with partial epilepsy. Depressive symptoms and anxiety were assessed by clinical interview using the Hamilton Depression Rating Scale (HDRS), the Cornell Dysthymia Rating Scale (CDRS), the Beck Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). Forty controls (patients with epilepsy treated with antiepileptic drugs other than OXC) and 40 OXC-treated patients were enrolled and completed the study. In our study, a significant improvement in affect, as measured by the CDRS, was demonstrated during the course of OXC treatment for 3 months. HDRS and BDI scores also declined in the OXC-treated group, but these decreases did not reach statistical significance. In addition, 28 of 40 OXC-treated subjects who were dysthymic by CDRS criteria on study entry (score > or =20) demonstrated affective improvement consistent with a treatment-related antidepressant effect (score

Anhedonia is a condition in which the capacity of experiencing pleasure is totally or partially lost, frequently occurring in mood disorders, as a negative symptom in schizophrenia, and in substance use disorders. In order to test a set of instruments for anhedonia in a population of detoxified opiate, alcohol and multiple substance-dependent subjects, 70 individuals were recruited from three different clinical settings. The following scales were applied: Snaith-Hamilton Pleasure Scale (SHAPS), Bech-Rafaelsen Melancholia Scale (BRMS), Scale for the Assessment of Negative Symptoms (SANS), specific withdrawal scales, and visual analogue scales (VAS) for hedonic capability and substance craving. The scales measuring anhedonia either directly (SHAPS, VAS for hedonic capability) or in some key items (SANS, BRMS) were significantly correlated with each other. The period of time since detoxification was inversely correlated with anhedonia and withdrawal symptomatology. Craving was positively correlated with anhedonia. Out of the total sample, only 18.5% could be defined as psychometrically anhedonic. The same correlations were found in this subsample. The composite instrument employed for assessing anhedonia and hedonic capability was found to be sensitive enough to detect such a dimension in the population considered, with the single scales significantly interrelated. In conclusion, we found interrelations between hedonic capability, craving and protracted withdrawal, particularly in opiate-dependent subjects. The strongest association occurred between hedonic capability and craving.

The Obsessive–Compulsive Drinking Scale (OCDS) is a quick and reliable self-rating instrument for alcohol craving. Translated and validated versions are available and all of them have confirmed the utility of the scale in clinical situations. The purpose of this study was to translate and validate the Italian version of the OCDS, to assess its psychometric properties, to compare it with the other versions, and to search for possible differences between subgroups distinguished according to socio-demographic and clinical variables. The OCDS and a visual analogue scale (VAS) for alcohol craving were given to 103 Italian-speaking alcohol-dependent patients, who were assessed for their typology of alcoholism according to Cloninger’s criteria. The reliability, the correlations between the variables and the influence of other factors were measured. Principal component analysis was performed to detect underlying dimensionality of the scale. The construct validity of the total scale and the subscales, as tested with Cronbach α analysis, was good. The r-values between total (TOT) and obsessive (OB) and compulsive (CP) subscales were comparable with those obtained in the other European studies. None of the socio-demographic parameters, nor the majority of the clinical factors significantly influenced the OCDS scores; however, there was a significant difference in total and subscale scores between Cloninger’s “type 1-like” and “type 2-like” alcoholics, with the former having lower scores than the latter ones, whereas the VAS was not able to discriminate them. Principal component analysis of the 14 OCDS items showed that the scale is better described by a three-factor solution. The Italian version of the OCDS exhibited good reliability and construct validity, confirmed its psychometric properties, showed higher scores than in other studies, showed CP consistently higher than OB score, confirmed the validity of the French method for score calculation and was able to discriminate Cloninger’s “type 1-like” and “type 2-like” alcoholics.

A chart review study of 100 consecutive AIDS patients cared for by our Home Care (HC) unit was performed. The main characteristics of the sample were: M/F ratio = 3/1; mean age = 39.7 +/- 6.6; mode of transmission = 56% intravenous drug users (IVDU); Centers For Disease Control (CDC) classification = 98% C3; mean length of HC = 5.2 months. Psychopathological evaluation led to an overall rate of morbidity during HC of 73%. The most common psychiatric diagnoses were dementia and adjustment disorders. Nearly two thirds of the patients received psychopharmacological treatment; one fifth were still on methadone. Psychological discomfort was perceived by more than half of patients. Interpersonal problems with cohabitants were noticed by caregivers in 41%. Female patients showed an increased prevalence of anxiety and depressive disorders. IVDUs had more prominent psychosocial problems. Interpersonal problems with cohabitants were correlated to substance use or other mental disorders in the family and to the patient's psychological discomfort. We conclude that mental health professional intervention for AIDS patients is strongly needed in a home-care setting.

Objectives Asylum Seekers (AS) often experience stressful situations that may lead to psychiatric disorders. Our hypothesis is that the subjective perception of stressors and the resulting psychiatric symptoms may depend on the length of staying, length of the journey, level of education and age. Methods 45 AS, guests of a reception center in Borgo Mezzanone (Foggia, Italy), were assessed by means of: Addiction Severity Index, MINI, SCL-90-R and Davidson Trauma Scale (DTS). We investigated the length of the voyage and the number of nations they passed through before reaching the final destination. Results 35,6% of the patients reported PTSD, 75,6% current Major Depressive Episode, 90,5% GAD, 2,3% psychotic symptoms, 15,6% alcohol abuse and 11,1% cannabis abuse; moreover, 26,7% attempted suicide at least once. Younger ones were less concerned about physical health and scored higher at most of SCL-90-R subscales. People who have been migrated for less time are more worried about family members left home and have higher scores at DTS subscales intrusion (p=0,02), hyperarousal, frequency, as well as total score. The number of nations they passed through or stayed in during their journey, negatively correlates with DTS hyperarousal and total gravity scores. Migrants with higher education showed lower scores in SCL somatization subscale. Conclusions younger people seems to have more severe psychiatric symptoms despite minor concerns about health and it seems that concerns about family members and various PTSD symptoms tend to decrease with time. Moreover a higher level of education may be protective from the tendency to somatize.

Objectives Asylum Seekers experience different kinds of trauma, such as tortures, threats and loss of family members in the countries of origin, but also desperate journeys and legal concerns in the accepting countries. Our aim is to investigate mental health disorders among AS and to study the importance of torture in the development of their symptoms. Methods We recruited 45 AS (males, age 29±6), guests of a reception center in Borgo Mezzanone (Foggia, Italy). The following instruments were administered: MINI, SCL-90-R and Davidson Trauma Scale (DTS). Pre-migration, migration, and post-migration stressors were assessed using a self-administered scale. Results 75,6% of our patients reported a Major Depressive Episode currently, while 20% in the past. 35,6% suffered from PTSD, 13,3% agoraphobia. and 88,9% GAD. 2,3% reported psychotic symptoms and 13,3% alcohol or drugs abuse in the last year. Torture showed a correlation with PTSD (p Conclusions most of AS showed depressive and anxious symptoms and one-third had PTSD. All of them experienced different kinds of traumas, but only torture seems to play a major role in developing PTSD, while all kinds of trauma are equally important as to the perceived symptomatology, since both torture and PTSD did not correlate with higher SCL-90-R scores.

A cross-sectional multicentre study aimed at evaluating the prevalence of DSM III-R Axis I morbidity among drug addicts seeking treatment. Consecutive outpatients of the National Health Service's treatment units (aged 18–60 years, fulfilling criteria for drug dependence and without primary diagnosis of alcohol dependence) were enrolled at intake. In the first phase of the study, professional staff members evaluated current psychiatric morbidity of 317 clients clinically. In the second phase, trained interviewers administered the Composite International Diagnostic Interview and a European adaptation of the Addiction Severity Index to 65 probands. Some current psychiatric morbidity was found in 26.2% of subjects recruited during the first phase and in 22.2% during the second; lifetime comorbidity was ascertained in 32.3% of probands recruited in the second phase. Unfortunately, remarkable rates of undetermined diagnostic assessment during the second phase are due to refusers. The distribution of categorical diagnoses is somewhat different between the two samples, but the most frequent are Anxiety and Mood disorders in both. Primary versus secondary psychiatric diagnoses were also distingushed when evaluated over a lifetime. The rates of psychiatric comorbidity are low in this study as compared with previous investigations, but suffer from a poor compliance with structured diagnostic procedures by unselected probands. Other methodological factors may also affect this kind of research. Prospective studies are needed to evaluate the validity of comorbid diagnostic constructs and their prognostic significance. Also, a concurrent assessment of Axis II disorders may be helpful to explain symptomatic polymorphism in case of multiple Axis I comorbidity.

There is increasing consensus on the notion of addiction as a brain disorder characterized by longstanding changes in cognitive functioning, especially in so-called executive functions. Recent evidences indicate that specific components of executive functions, considered the domain of the frontal lobes, including dysfunctional impulsivity, could be considered a hallmark of addiction. Aim of the present study was to explore the domain of executive functions in abstinent non comorbid alcohol dependent subjects, in comparison with matched non clinical controls. Any relationship with impulsivity and drinking behaviour (binge drinking) was also investigated. We used a selective battery of neuropsychological tests designed to assess several components of executive functions, including fluency, working memory, analogical reasoning, interference and cognitive flexibility, attention, concentration, problem solving strategy and abstract reasoning. BIS-11 was also administered to explore impulsivity levels. Significant differences in many of the domains explored between alcohol dependent patients and controls have been founded. Intriguingly, impulsivity in alcoholics seems to not inhibit cognitive performance. Data about binge drinking will be also presented. Our results show that alcohol dependent patients present a weaker performance in all the domains referable to executive functions when compared to controls. Disruptions in inhibitory control are central to many theories of addiction; the inhibitory activities of the Frontal and Prefrontal Cortex, are particularly important when an individual needs to over-ride a reflexive response, such as a craving response to drug-related cues.

There is increasing consensus on the notion of addiction as a brain disorder characterized by longstanding changes in cognitive functioning, especially in so-called executive functions. Recent evidences indicate that specific components of executive functions, considered the domain of the frontal lobes, including dysfunctional impulsivity, could be considered a hallmark of addiction. Aim of the present study was to explore the domain of executive functions in abstinent non comorbid alcohol dependent subjects in comparison with matched non clinical controls. Any relationship with impulsivity and anger was also investigated. Thirty Alcohol Dependent outpatients with diagnosis of Alcohol Dependence (DSM-IV-TR) and thirty matched control subjects participated to the study. We used a selective battery of neuropsychological tests designed to assess several components of executive functions, including fluency, working memory, analogical reasoning, interference and cognitive flexibility, attention, concentration, problem solving strategy and abstract reasoning (FAS for verbal fluency; Semantic Fluency; Digit span; Spatial span; Similarities; Stroop test; Wisconsin Card Sorting Test; TMT Making Test Parts A & B; Digit Symbol). BIS-11 and STAXI I and II were also administered to explore impulsivity and anger levels. Significant differences in many of the domains explored between alcohol dependent patients and controls have been founded. Furthermore, a correlation between the performance at neuropsychological tests and the score at the instruments designed to assess impulsivity and anger have been deducted. Alcohol dependence is associated with a significant impairment on executive domain. Impulsivity and anger levels, both dimensions linked with the executive capacity, seem to be altered as well.

Non-benzodiazepine anticonvulsant agents have been shown to be efficacious treatments for the prevention of alcohol relapse although the FDA has yet approved none of these agents. Several studies have demonstrated topiramate's efficacy in improving drinking behavior and maintaining abstinence. The objective of the present randomised, parallel, placebo-controlled trial was to compare topiramate at low dosage with placebo on alcohol drinking indices and craving in detoxified alcohol dependent subjects. Psychiatric symptomatology, quality of life and clinical global improvement have also been investigated. Sixty detoxified Alcohol Dependent (DSM-IV-TR) outpatients were recruited and randomly assigned to receive topiramate low dosage (n = 30) or placebo (n = 30). Patients have been evaluated after 30, 90 and 180 days of treatment. Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar); craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VASc) and the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptoms were evaluated with the Symptom Check List 90-Revised (SCL-90-R), quality of life with the QL-INDEX; the Clinical Global Impression (CGI) was also administered. As to our results, topiramate is more efficacy than placebo on both the improvement of withdrawal symptomatology and the reduction of relapses. Furthermore, it has resulted effective in reducing craving, the severity of global psychopathology and the quality of life. The data of this pilot study investigate and suggest a possible role for the anticonvulsants agents in the treatment of alcohol dependence. Topiramate could be an alternative option beyond the already approved agents for the treatment of alcohol dependence.

Introduction The aim of this pilot study is to assess, in a sample of patients with chemical (alcohol) and behavioural (gambling) dependence, the specifical association between core symptoms and Separation Anxiety Disorder, both in Childhood and in Adulthood. Materials and methods After a stabilization period of three months, outpatients with alcohol dependence (n = 30), patological gambling (n = 30) and a control group of anxiety disorders (n = 30) will be assessed with the following psychometric battery: • SCI-SAS (Structured Clinical Interview for Separation Anxiety) Child and Adult • SASI (Separation Anxiety Symptom Inventory) • ASA-27 (Adult Separation Anxiety Questionnaire) • TCI-R (Temperament anc Character Inventory Revised) • GAF (Global Assess of Functioning) • SCL-90-R (Symptom Checklist Revised) • SOGS (South Oaks Gambling Scale) • ADS (Alcohol Dependence Scale) • HAM-A (Hamilton Anxiety Rating Scale) Results A preliminary analisys of collected datas (n = 33) shows a strong inter-reliability of the Separation Anxiety Scales (SCI-SAS, SASI and ASA-27) with a p = 0.001 and an association between levels of functioning (GAF) and ASA-27 and SASI scores (p = 0.010 and p = 0,001). It shows a statistical correlation between ASA-27 and TCI-R: inverse proportion with Self Directness (SD) (p = 0.004) and direct relation with Self Trascendency (ST) (p = 0.003). Conclusions Even if the sample is still limited we found an interesting trend between Separation Anxiety symptoms, TCI-R dimensions and core symptoms of dependance. We should focus better, when the study will be over, on narrow and specific sub-analisys that should lead us to a better understanding of the disorders.

IntroductionThe ways of coping with problems and emotions are particularly important in anxiety disorders. It is also likely that subjective functional styles help identify the mode of presentation of these disorders, regardless of diagnosis psychopathology.ObjectivesClinical and functional investigation of outpatients attending a third-level Anxiety Disorders Unit.AimsTo identify the most employed coping strategies and investigate whether different coping styles are linked to specific expressions of psychopathology by means of a cross-correlation analysis between dimensional measures of coping and characteristics of psychopathology.MethodsWe administered a set of instruments including SCL-90-R and Brief-COPE to 172 patients; categorical diagnoses according to DSM-IV-TR were as follows: GAD 80 (46.5%), 33 PD (19.2%), other miscellaneous 59 (34.3%). The statistical analyses of correlation between COPE and SCL scores were performed by means of Spearman's Rho.ResultsThe most represented (mean score >5) coping strategies include: active coping, planning, self-blame, instrumental support, emotional support, self-distraction, acceptance, venting. Venting, denial, behavioural disengagement, and use of emotional support, show positive correlations (p ≤ 0.04) with anxiety, phobic anxiety and GSI; self-blame with anxiety and GSI. Conversely, humour correlates (p ≤ 0.04) negatively with anxiety and GSI.ConclusionsCorrelations between high scores of GSI and specific coping strategies suggest possible mechanisms of interaction between functioning styles and expressions of psychopathology. The interpretation of these findings requires further investigation of interactive mechanisms, taking into account phases of activity or remission of the clinical syndrome.

ObjectivesBehavioural addictions (BAs) can be understood as disorders characterized by repetitive occurrence of impulsive and uncontrolled behaviours. Very few studies have investigated their association with mood disorders. The present study was undertaken to determine the prevalence of the main behavioural addictions in a sample of bipolar outpatients in euthymic phase or stabilised by medications and to investigate the role of impulsivity and temperamental and character dimensions.MethodsOne-hundred-fifty-eight Bipolar Disorder (BD) (DSM-IV) outpatients were assessed with tests designed to screen the main behavioural addictions: pathological gambling (SOGS), compulsive shopping (CBS), sexual (SAST), internet (IAD), work (WART) and physical exercise (EAI) addictions. TCI-R and BIS-11 were administered to investigate impulsivity and personality dimensions mainly associated with BAs. The clinical sample has been compared with 200 matched healthy control subjects.ResultsIn bipolar patients, 33% presented at least one BA respect to the 13% of controls. Significantly higher scores at the scales for pathological gambling (p< .001), compulsive buying (p< .05), sexual (p< .001) and work addictions (p< .05) have been found. Self-Directness (p=.007) and Cooperativeness (p=.014) scores were significantly lower while impulsivity level was significantly higher (p=.007) in bipolar patients with BA than those without BA.ConclusionsTo our knowledge, this is the first study investigating the prevalence of behavioural addictions in BD showing a significant association of these disorders. BAs are more frequent in bipolar patients than in healthy controls and are related to higher impulsivity levels and character immaturity.

Introduction:In this multicenter, randomised, single-blind, parellel group, comparison trial we aimed to investigate the efficacy of lorazepam, tiapride and pregabalin in alcohol withdrawal. Craving and psychiatric symptoms improvements were the secondary endpoints.Methods:One-hundred-nine alcohol dependent subjects (DSM-IV) were detoxified and subsequently randomised into three groups, respectively receiving 200-400 mg of tiapride (TIA; mean dosage 300 mg), 2-5 mg of lorazepam (LOR; mean dosage 3 mg) and 150-450 mg of pregabalin (PRE; mean dosage 280 mg). Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), whereas the level of craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VAS) and the Italian -version of the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptomatology was evaluated by the Symptom Check List 90 Revised (SCL-90 R).Results:All the three medications have shown efficacy on reducing alcohol drinking indices, craving scores and withdrawal symptomatology. The reduction observed in the PRE group was significantly higher than those in the LOR and TIA groups. In terms of safety and tolerability, all the compounds were generally well-tolerated. Only one patient has reported an epileptic episode during the treatment with tiapride.Discussion:Results from this study globally place the three medications at the same range of efficacy, with the PRE group reporting an higher reduction of withdrawal symptoms. Another point in favour of the employment of pregabalin was represented by a better outcome in those patients reporting a comorbid psychiatric disorder.

Introduction:Aim of this randomised, parallel, placebo-controlled group trial was to compare oxcarbazepina and topiramate with placebo on alcohol drinking indices. Craving and psychiatric simptomatology have also been investigated.Methods:This randomised, parallel, placebo-controlled psychopharmacology trial studied 60 patients, consecutively recruited, meeting clinical criteria for Alcohol Dependence (DSM-IV). After detoxification, subjects were assigned to flexible doses of oxcarbazepine (n=20), or topiramate (n=20) or placebo (n=20). Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) and the level of craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VAS) and the Italian -version of the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptoms were evaluated with the Symptom Check List 90 Revised (SCL-90 R).Results:Non-benzodiazepine anticonvulsants have been shown to be efficacious treatments for the prevention of alcohol relapse although the FDA has yet approved none of these agents. During the congress the main results of this study will be presented.Conclusions:To our knowledge, this is the first randomised, parallel, placebo-controlled group study to evaluate the efficacy of oxcarbazepine and topiramate compared in alcohol dependent patients. The data of this pilot clinical study suggest and investigate a possible role for the anticonvulsants agents in the treatment of alcohol dependent patients.

Cytokines may influence brain activities especially during stressful conditions, and elevated levels of IL-6 and C-reactive protein have been pointed out in subjects with Major Depression. If pro-inflammatory cytokines play a causative role in major depressive disorders, one would expect that antidepressants may down-regulate these cytokines or interfere with their actions, leading to improvement of depressive symptoms. Accumulating evidence has been published that antidepressants modulate cytokine production and this is particularly true for Tricyclics and Selective serotonin reuptake inhibitors (SSRIs), but the influence of newer antidepressants acting on both serotonin (5-HT) and norepinephrine (NE) such as venlafaxine, duloxetine and mirtazapine on cytokine levels has not been extensively studied. However, both pre-clinical and clinical studies examined in this review have demonstrated that newer serotonin-noradrenalin antidepressants can inhibit the production and/or release of pro-inflammatory cytokines and stimulate the production of anti-inflammatory cytokines, suggesting that reductions in inflammation might contribute to treatment response. Moreover, the results of the present review support the notion that the serotonin-noradrenalin antidepressants venlafaxine and mirtazapine may influence cytokine secretion in patients affected by MD, restoring the equilibrium between their physiological and pathological levels and leading to recovery. To date, no studies have evaluated the effect of duloxetine, the newest serotonin-noradrenalin antidepressant, on cytokine levels and therefore this should be evaluated in future studies.