Search

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.

There is a growing interest regarding the attitudes of medical students towards people with mental illness, since discrimination and stigma may affect healthcare workers and education should be aimed to improve empathy and attitudes at medical school level. A cross-sectional study was conducted at medical schools in Rome and Foggia (Italy). We recruited 339 medical students who completed an anonymous self-report questionnaire including sociodemographic data, the 40-item Community Attitudes toward the Mentally Ill scale (CAMI) and the 60-item Baron Cohen’s Empathy Quotient. The questionnaires were administered before and after the yearly academic course of psychiatry. This study shows a significant improvement in some CAMI items and total score after the yearly academic course of psychiatry among medical students, especially among those who had personal experience with mentally ill people (including the training in a psychiatric ward). Female students reported higher empathy quotient and CAMI score...

IntroductionEmpathy is the capacity to understand or feel what another person is experiencing. It is an important quality in the medical profession, since it is fundamental in interpersonal relationships with patients. Nevertheless, many studies have found that over time medical students (MS) become less empathic and more detached from patients.Objectives and aimsTo determine MS loss of empathy and to study the differences in empathy between MS and other university students who are not involved in healthcare.MethodsWe enrolled 244 MS (120 of the 1st year and 124 of the last year) and 125 other university students not involved in healthcare, in different universities in Rome and Foggia (Italy). They anonymously and voluntarily completed a socio-demographic questionnaire and Baron Cohen's empathy quotient test (EQ).ResultsWe found no differences regarding EQ total score between MS and other students, however there are few differences considering individual EQ items. In particular, MS really like taking care of others (P = 0.005) and they are sometimes considered to be rude, even if only they are only blunt (P = 0.006). We found no differences in empathy between first year and last year MS.ConclusionsIn our sample of Italian students, we have not found MS to be more or less empathetic than other university students, but there are some peculiar differences in empathy that make them better suited to the chosen course of study. Moreover, we found no differences between the different years of medical school.Disclosure of interestThe authors have not supplied their declaration of competing interest.

(Headache 2011;51:1212-1227) Background.— Medication-overuse headache (MOH) refers to headache attributed to excessive use of acute medications. The role of personality needs studies to explain the shifting from drug use to drug abuse. The main aim of this study is to study personality, according to Minnesota Multiphasic Personality Inventory, comparing MOH, episodic headache, substance addicts (SA) vs healthy controls. Methods.— Eighty-two MOH patients (mean age 44.5; 20 M, 62 F) and 35 episodic headache (mean age 40.2; 8 M, 27 F), were compared to 37 SA (mean age 32.5; 29 M, 8 F) and 37 healthy controls (mean age: 32.49; 20 M, 17 F). International Classification of Headache Disorders 2nd Edition criteria were employed. Chi-square test, Kruskal-Wallis test, and post hoc comparisons were used for statistics. Results.— MOH patients scored higher on Hypochondriasis, Depression (only females), Hysteria (only females) (P

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.

We evaluated the availability of resources and specific expertise for treating comorbidity at the Italian public Services for Drug Dependence (SerTs). A stratified sample of 100 SerTs was constructed and a specific questionnaire mailed to the clinical managers. The interview aimed at: characteristics of the respondent; theoretical knowledge of comorbidity; influence of dual diagnosis on clinical practice; general, human, and organisational resources; quality evaluation. Main results: (a) 90% of managers are medical doctors but 95% claim about inadequate education of their staff. The results were also analysed by factors of stratification: regional distribution, urban/rural location, and number of clients in care. In conclusion, the problem of comorbidity should be faced more effectively, particularly by means of improved organisational resources and continuing education of staff members.

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.

Introductionstigma in mental illness is characterized by discrimination towards people affected by mental disorder. Consequence of the paradigm “stigma-injury-discrimination” is the social exclusion of these patients and the denial of their rights. Medical students, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.ObjectivesTo study the attitudes of medical students towards psychiatric patients.AimsThe present study analyzes gender differences in a sample of Italian medical students towards mental illness.MethodsA total of 339 Italian medical students completed a cross-sectional survey, in Rome and Foggia (Italy). We used the Italian version of Community Attitude towards the Mentally Ill test (CAMI) to analyze the students’ attitudes.ResultsThere is a substantial difference among the attitudes towards mental disorders in female and male students. Female students have obtained less stigmatizing results in 9 of the CAMI test items (P < 0.05), in Benevolence (P = 0.001) and Social Restrictiveness subscales (P = 0.043) and in the total score (P = 0.013).ConclusionsThese results are in line with those achieved in scientific literature, confirming that women tend to show more humanitarian attitude towards the mentally ill. Even in the original article of the validation of the CAMI test, the authors found better attitudes in women in all subscales, with the exception of Social Restrictiveness subscale (that in our analysis also correlates with the female gender).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

BackgroundStigma towards mental illness and psychiatry have a major impact on psychiatric patients’ quality of life; in particular, prejudicial beliefs make it more difficult for future doctors to send patients to mental health services, leading to a delay of necessary care.AimsOur aim is to evaluate the stigma towards mental illness and psychiatry, in a sample of Italian medical students. We studied the differences between the first-year students who have not attended the academic course in psychiatry, compared to the senior students who have attended the psychiatric lectures.MethodsWe tested 113 medical students, using the following questionnaires:– Attitudes Towards Psychiatry (ATP 30);– Community Attitudes Towards Mental Ill (CAMI);– Perceived Discrimination Devaluation Scale (PDD), to assess the discrimination towards mental illness perceived in society;– Baron-Cohen's Empathy Quotient (EQ), to measure empathy.ResultsAmong the 113 students, 46 have already attended the academic course of psychiatry and CAMI scores were less stigmatizing as total score (P = 0.014) and in authoritarianism subscale (P = 0.049), social restriction (P = 0.022) and ideology of mental health in the community (P = 0.017). However, there were no statistically significant differences in empathy, perceived discrimination in the society and stigmatization of psychiatry.ConclusionsThe 67 students who have not attended the academic course of psychiatry are more stigmatizing, considering psychiatric patients as inferior people that require coercive attitudes, socially dangerous and that should be treated faraway from the community. Studying psychiatry is therefore useful to reduce, in the future doctors, these prejudices toward mentally ill patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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.

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.

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.

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.

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.

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.

Aims:Aims of this study were to investigate alexithymic traits and dissociative experiences in a sample of patients with Alcohol Use Disorders, the significance of this association and the possible correlation with temperamental and character personality traits.Methods:Eighty patients with diagnosis of Alcohol Use Disorder (DSM-IV) were consecutively recruited and assessed with the Toronto Alexithymia Scale-20 (TAS-20), to evaluate the alexithymic traits, the Dissociative Experience Scale II (DES II), to investigate the possible presence of dissociative experiences, and the Temperament and Character Inventory - Revised (TCI-R) in order to define a personality profile.Results:The mean scores obtained by the experimental group in both the TAS-20 and DES II do not differ from those estimated during the validation procedure. Pearson's linear correlation between scores was found statistically significant (p < .05). Significant correlations with some personality dimensions have also been found.Conclusions:According to some authors substances related disorders could be classified as “disturbs of emotional regulation”, an active process in which neurophysiological, motor-behavioural and cognitive-experiential systems are involved. The lack of connection or an inadequate development of these systems would result in the malfunction of the symbolic function and then in the inability for the subject to contain the tensions generated by internal needs and/or by environmental stimulations. Both alexithymia and dissociation may assume the form of defence mechanisms against the unbearable emotions. Finally, some personality factors may be involved both in the rise of dissociative states and in the alexithymic traits.