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New treatment options such as noninvasive brain stimulation have been recently explored in the field of substance use disorders (SUDs), including transcranial direct current stimulation (tDCS).In light of this, we have performed a review of the scientific literature to assess efficacy and technical and methodological issues resulting from applying tDCS to the field of SUDs.Our analysis highlighted the following selection criteria: clinical studies on tDCS and SUDs (alcohol, caffeine, cannabis, cocaine, heroin, methamphetamine, and nicotine). Study selection, data analysis, and reporting were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Exclusion criteria were as follows: clinical studies about tDCS among behavioral addiction; review and didactic articles; physiopathological studies; and case reports.Eighteen scientific papers were selected out of 48 articles. Among these, 16 studied the efficacy of tDCS applied to the dorsolateral prefrontal cortex, and 8 suggested the efficacy of tDCS in reducing substance craving.In light of these data, it is premature to conclude that tDCS over the dorsolateral prefrontal cortex is a very efficient technique in reducing craving. Small sample size, different stimulation protocols, and study duration were the main limitations. However, the efficacy of tDCS in treating SUDs requires further investigation.

Objective Comorbidities between psychiatric diseases and use of traditional substances of abuse are common. Nevertheless, there are few data regarding the use of novel psychoactive substances (NPS) among psychiatric patients. Aim of this multicentre survey is to investigate the consumption of a number of psychoactive substances in a young psychiatric sample. Methods Between December 2013 and September 2015, a questionnaire was administered in 10 Italian psychiatric care facilities to a sample of 671 patients, aged 18–26 (mean age 22.24; SD 2.87). Results About 8.2% of the sample declared to have used NPS at least once, and 2.2% had consumed NPS in the previous 3 months. The three psychiatric diagnoses most frequently associated with NPS use were bipolar disorder (23.1%), personality disorders (11.8%), and schizophrenia and related disorders (11.6%). In univariate regression analysis, bipolar disorder was positively associated with NPS consumption, an association that did not reach statistical significance in the multivariate analysis. Conclusions The use of NPS in a young psychiatric population appears to be frequent, and probably still underestimated. Bipolar disorder shows an association with NPS use. Careful and constant monitoring and an accurate evaluation of possible clinical effects related to NPS use are necessary.

To elucidate the relationships between alexithymia, suicide ideation and serum lipid levels in drug-naive adult outpatients with a DSM-IV diagnosis of Panic Disorder (PD), 72 patients were evaluated. Measures were the Panic Attack and Anticipatory Anxiety Scale, the Toronto Alexithymia Scale (TAS-20), the Scale of Suicide Ideation (SSI) and the Montgomery Asberg Depression Rating Scale (MADRS). Alexithymic patients showed higher scores on all rating scales and altered serum lipid levels than non-alexithymics. In the hierarchical regression model, the presence of lower HDL-C and higher VLDL-C levels and Difficulty in Identifying Feelings dimension of TAS-20 were associated with higher suicide ideation. In conclusion, alexithymic individuals with PD may show a cholesterol dysregulation that may be linked to suicide ideation. The authors discuss study limitations and future research needs.

The relationships of personal resources with symptom severity and psychosocial functioning have never been tested systematically in a large sample of people with schizophrenia. We applied structural equation models to a sample of 921 patients with schizophrenia collected in a nationwide Italian study, with the aim to identify, among a large set of personal resources, those that may have an association with symptom severity or psychosocial functioning. Several relevant demographic and clinical variables were considered concurrently. Poor service engagement and poor recovery style, as well as older age and younger age at onset, were related to greater symptom severity and poorer social functioning. Higher resilience and higher education were related to better social functioning only. Poor problem-focused coping and internalized stigma, as well as male gender and depression, were related to symptom severity only. The explored variables showed distinctive and partially independent associations with symptom severity and psychosocial functioning. A deeper understanding of these relationships may inform treatment decisions.

Major Depressive Disorder (MDD) is an extremely disabling, chronic and recurrent disease. Moreover, subthreshold depressive symptoms often persist during periods of apparent remission. Such symptoms include sleep disturbances, sexual dysfunction, weight gain, fatigue, disinterest, anxiety, and/or emotional blunting, which do not often respond to available antidepressant treatments. Agomelatine is a melatonergic agonist (at both MT1 and MT2 receptors) and serotonin 2C (5-HT2C) receptor antagonist. Agomelatine should be particularly useful in the treatment of MDD because of its unique pharmacological profile, accounting for its effective antidepressant action with a relative lack of serious adverse effects. Several clinical trials confirmed the antidepressant efficacy of agomelatine in patients with MDD, with significant efficacy even in severe manifestations of disease and on residual subtreshold symptoms. This compound showed a relative early onset of action as well as an excellent safety and tolerability profile linked to a low discontinuation rate in MDD patients. Moreover, some data suggest that agomelatine has not only antidepressant effects but also anxiolytic effects, with a potential benefit both on anxiety symptoms associated with MDD and in the treatment of generalised anxiety disorder. This review will summarise the role of the melatonergic system in MDD and will describe the characteristics of agomelatine, focusing on its efficacy and safety in the treatment of MDD.

Riassunto Introduzione I disturbi da ipersessualita si caratterizzano per pensieri e comportamenti inerenti la sessualita clinicamente eccessivi. Tale gruppo di disturbi ha come comuni denominatori: 1) agiti in relazione diretta con la sessualita; 2) modalita compulsiva degli stessi; 3) prosecuzione nonostante emergano conseguenze negative. Uno sforzo della comunita scientifica e attualmente in corso per la stesura dei criteri diagnostici e l’identificazione degli elementi nucleari di tali disturbi. Esiste una proposta per inserire tali comportamenti sessuali eccessivi non parafilici nel DSM-V, con la dizione “disturbo da ipersessualita”. Lo scopo di questo articolo e fornire una rassegna del dibattito contemporaneo riguardo i disturbi da ipersessualita, focalizzando l’attenzione sul modello dell’addiction sessuale, che rappresenta uno degli approcci piu utilizzati per studiare e trattare tali disturbi. Viene proposto, inoltre, uno schema che puo aiutare il clinico a ricercare i disturbi da ipersessualita in presenza di alcuni elementi clinici e sociorelazionali. Si presenta, infine, un accenno ai possibili interventi terapeutici, farmacologici e non farmacologici. Materiali e metodi Tale rassegna e stata attuata mediante la ricerca di pubblicazioni rilevanti nell’ambito della letteratura in lingua anglosassine indicizzata in Medine/PubMed (ultimo accesso febbraio 2010), con i termini: Hypersexuality, Hypersexual disorder, Sexual addiction, Sexually compulsive behavior, Cybersex. Pubblicazioni addizionali sono state tratte dalle bibliografie delle pubblicazioni selezionate e da libri di testo.

Purpose of the studyThe purpose of this study was to investigate cognitive functioning in Borderline Personality Disorder subjects, with particular reference to the Working Memory functioning. The Working Memory seems to be relate to core features of the disturb. The final aim was to better understand the disorder and to implement a cognitive training to improve the deficits.MethodsA literature search was conducted in April 2015. Pubmed and Scopus databases were used to find studies to include in the systematic review. The keywords used for the literature search were: “borderline personality disorder”, “borderline personality”, “working memory”, “executive functioning”. In each search, the keywords were used together with the logical operator “and”.SummaryThree studies were included in this systematic review (Table 1). In each study, the working memory was investigated using N-back test. In two of those studies significantly differences were found between patients and healthy group in N-back task. In the third study, which used more tests to investigate working memory domain, no differences were found between the two groups.ConclusionsBorderline personality disorder patients performed significantly worse on the N-back test compared to healthy controls and the impairment increased with increasing working memory load. In the third study the working memory domain was investigated using four different tests and single scores were not included therefore it was impossible to compare N-back data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Objectives: The treatment of bipolar disorder type I (BD-I) with a comorbid cocaine dependence disorder (CDD) is a challenge in current psychiatric practice. Drugs with proven efficacy in manic/mixed episodes, such as atypical antipsychotics and mood stabilizers, sometimes do not prevent depressive relapses; on the other hand, the use of antidepressants during acute depressive episodes may increase the risk of a manic switch. The aim of the present study was to investigate the short-term efficacy of bupropion augmentation in acutely depressed BD-I patients with cooccurring CDD. Methods: Twelve depressed BD-I patients, with a comorbid CDD, treated with valproate 1000 to 1500 mg/d and aripiprazole 10 mg/d, were randomly assigned to receive bupropion 150 mg/d as an open-label addon therapy (n = 5) or to continue their previous treatment (n = 7). Results: After 4 weeks of observation, patients receiving add-on therapy with bupropion have improved in terms of Hamilton Depression Rating Scale scores and Drug Abuse Screening Test scores, with respect to those of the comparison group, whereas no significant increase of Young Mania Rating Scale scores over time was observed. Conclusions: Our preliminary findings suggest that combining bupropion with mood stabilizers and atypical antipsychotics may be a good therapeutic option in short-term treatment of depressed BD-I patients with comorbid CDD.

IntroductionA certain degree of depressive symptoms is common in schizophrenic patients. The assessment and treatment of depressive symptoms in schizophrenia is clinically challenging.ObjectivesWe conducted a cross-sectional study to investigate the depressive dimension of schizophrenic patients.AimsThe aim was to evaluate the effect of pharmacotherapy on depressive symptomatology.MethodsThirty-four outpatients (18-65 years old) with stable schizophrenia in monotherapy with FGAs or SGAs. We evaluated: depressive symptoms with Calgary Depression Scale for Schizophrenia; positive and negative symptoms (with Positive and Negative Symptom Scale); neurocognition (with Matrics Cognitive Consensus Battery); social cognition (with Facial Emotional Identification Test); social functioning (with Personal and Social Performance Scale and with UCSD Performance-based Skills Assessment). Collected data underwent statistical analyses.ResultsA SGAs therapy was associated with: lower depressive symptoms (mean SGAs group = 4.0; mean FGAs group = 7.86, P < 0.05); lower mean positive symptoms (mean SGAs group = 12.65; mean FGAs group = 17.43, P < 0.05); lower negative symptoms (mean SGAs group = 21.35; mean FGAs group = 29.07, P < 0.05); lower scores on the PANSS-total (mean SGAs group = 71.05; mean FGAs group = 91.86, P < 0.01). After correction for multiple variables, the SGAs group still had significantly lower values towards the FGAs group (P < 0.05).ConclusionsOur study support the notion that switch from a FGA to a SGA could be a relatively simple first-step for the treatment of this condition. Atypical antipsychotics might exercise antidepressant effects with different potential mechanism including: remission of a FGA-induced depression and action on of 5-hydroxytryptamine, dopamine [other than postsynaptic D2], and α1-noradrenergic receptor sites.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The goal of this cross-sectional study was to evaluate the relationships between alexithymia and suicide ideation in 80 adult outpatients with a DSM-IV diagnosis of binge eating disorder (BED).Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20); suicide ideation was assessed with the Scale of Suicide Ideation (SSI); severity of BED was assessed with the Binge Eating Scale (BES); and depressive and anxiety symptoms were evaluated, respectively, with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale (Ham-A).Prevalence of current suicide ideation was 27.5% (n = 22) in this sample and 10 subjects (12.5%) had attempted suicide at some time in their lives. Subjects with alexithymia had more significant suicide ideation, a higher prevalence of current suicide ideation, and more previous suicide attempts than those without alexithymia. In a linear regression model, higher MADRS scores and higher scores on the Difficulty in Identifying Feelings/Difficulty in Describing Feelings dimensions of the TAS-20 were associated with increased suicide ideation.Suicidal behavior is no less common in BED than in other eating disorders. Individuals with BED may show increased suicide ideation, especially in the presence of alexithymia and depressive symptoms, even if these symptoms are subclinical. The authors also discuss limitations of this study and future research needs.

Introduction Polydrug use is mostly common among adolescents and young adults, often with the intention of enhancing or counteracting the effects of another drug. It significantly increases the risks, due to drug synergy and increased side effects. Objectives We investigated the prevalence of polydrug users in a population of Italian young adults using a specifically designed questionnaire. Aims We aimed to assess the prevalence of polydrug abusers in a large sample of general population, and also to identify possible associations between alcohol misuse (e.g., binge drinking behaviours) and polydrug use. Methods We administered the questionnaire to a sample of 3000 subjects, aged 18 to 26, investigating socio-economic characteristics, alcohol abuse (with a specific focus on binge drinking) and use of psychoactive substances (cannabis, cocaine and Novel Psychoactive Substances-NPS). Collected data underwent statistical analyses. Results 80.5% of the sample habitually consumed alcoholic beverages. Among alcohol consumers, 34.2% used cannabis, 5.4% cocaine, 3.7% NPS, and 79,2% had binge drinking behaviours. Among those who did not consume alcohol, 4% used cannabis, 0.4% used cocaine, and 0% used NPS. Polydrug use was more common among binge drinkers. 35.6% of cocaine abusers also used NPS, in comparison to 1.4% of non-abusers. Conclusions According to scientific literature, alcohol and cocaine are the substances most commonly involved in risky polydrug use. Binge drinking and NPS appear to ben involved in polydrug use too. The combined effects of the different drugs need to be considered in identifying an appropriate and timely intervention strategy

We report a clinical case of a patient with a manic episode after taking methylphenidate (up to 120mgr per day) and cannabis in order to improve performance during exam period. He was hospitalized for disorganized behaviour, increased aggresion, delusions, grandiosity. He was affected by attention deficit and hyperactivity during childhood and recent episods of subthreshold depression. The therapy consisted of benzodiazepine and hydratation. In conclusion clinicians shuould ha ve caution in prescribing neurostimulant in vulnerable subjects.

Purpose of the Study In the last ten years it has sought a connection between the psychoanalysis and the neuroscience. The meeting point between these two branches is the neuropsychoanalysis [1]. Methods A literature search was conducted on March 2014. PubMed and Scopus databases were used to find studies for inclusion in the systematic review. The keywords used for the literature search were: ‘psychoanalysis”, ‘psychoanalytic psychotherapy”, ‘psychodynamic”, ‘psychodynamic psychotherapy”, ‘fmri”, ‘functional neuroimaging” and ‘functional magnetic resonance”. keywords were used together with the logical operator ‘and”. Only studies wich compared functional magnetic resonance imaging results before and after psychoanalytic psychotherapy in adult subjects were taken into account. Two (n=2) potentially relevant studies were obtained for the systematic review. AUTHOR SCANNER PARTICIPANTS TYPE OF THERAPY MAIN FINDINGS Buchheim et al. 2013 3.0 Tesla A female dysthymic patient with narcissistic traits Standard long-term psychoanal­ysis with a frequency of two face-to-face sessions per week. The results show the therapy hours modulated the attivaction of the ventrolateral and the dorsolateral prefrontal cortex, the perigenual portion of the medial prefrontal cortex, the posterior cingulate and precuneus, the middle temporal gyrus, and the anterior tip of the inferior temporal gyrus, and the occipital/calcarine cortex. Fischmann et al. 2013 3.0 Tesla 16 patients with recurrent major depressive disorders and 18 healthy volunteers 3-year psychoanalytic treatment After treatment, it was found a marked reduction in activation pattern occipital, left and right hippocampus, left and right thalamus, left precuneus, left middle cingulated cortex, left inferior frontal gyrus/pars orbitalis, left precentral gyrus, vermis, left inferior frontal gyrus, right middle temporal gyrus, superior parietal lobule, cerebellum, and right and left putamen. Summary As shown in the table, Buchheim et al. study results demostrate that the therapy hours modulated the attivaction of brain areas. After treatment, Fischmann et al. found a marked reduction in activation pattern. Conlcusions The common results of the studies investigated in this systematic review is represented by a reduction, a modulation or a normalization of the activation areas before and after the psychoanalytic psychotherapy.

Introduction Orthorexia nervosa (ON) is an alleged eating disorder in which the person is excessively preoccupied with healthy food. First described by Bratman in 1997, ON entails a fixation on healthy food or a health food dependence. The term orthorexia nervosa arises from the Greek words orthos (=accurate) and orexis (=hunger) meaning obsession with healthy food and proper nutrition. Fears and worries about health, eating, and the quality of food are significant. Objectives We investigated the prevalence of ON in a a population of young Italian adults by using a validated questionnaire (ORTO-15). Aims We aimed to assess the prevalence of ON in a large sample of general population and to identify some possible specific correlation such as gender and Body Mass Index (BMI). Methods 1453 adult subjects from the general population were administered the ORTO-15 test and investigated for gender, age and BMI. Statistical analyses were performed referring to diagnostic threshold (40). Results Orthorexia had a 10,9% prevalence in our sample, with a female prevalence statistically significant (female vs male= 72,8% vs 27,2%). Moreover, age and Body Mass Index did not seem to be significant factors. Conclusions ON is not currently considered as a full-fledged and discrete mental disorder. Again, the definition and diagnostic criteria of ON remain unclear. Further studies are needed to clarify appropriate diagnostic methods and the place of ON among psychopathological categories. This should be accompanied by a vigorous research effort aimed at understanding the core nature of this condition.

Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Moreover, research indicates that far from all who suffer from depression and suicidal ideation seek treatment and the determination of suicide risk and prevention of suicide attempts is traditionally difficult. In an era of empowered public and patients awareness, internet may be a more powerful determinant of health-seeking behavior than medical opinion. Suicide information is easily accessible over the web, as are special chat rooms for discussions with likeminded people. Internet can be considered as well as efficiently exploited to help people in severe emotional distress, including those contemplating suicide. Some websites advise acutely suicidal persons to seek help. Promotion and announcement of suicide are forbidden. Some websites offer a variety of professional help, including psychological and health-related information on various troubling issues, questions and answers and professional guidance intended to promote self-help in coping with numerous psychological problems. One promising treatment is activation, two kinds of which are behavioural activation, and one solely focused on physical exercise. These two kinds of activation therapy have the potential to be administered via the Internet, which would both lower the threshold for those seeking treatment, while also providing effective treatment to a low cost.

ObjectivesThe aim of the present study was to evaluate the prevalence of alexithymia and its relationships with psychopathological features and suicide risk in a sample of adult patients with a DSM-IV diagnosis of paranoid schizophrenia.MethodA mixed male-female sample of 60 subjects (30 males and 30 females) was evaluetd with the following rating scales: Toronto Alexithymia Scale (TAS-20), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Calgary Depression Scale for Schizophrenia (CDSS), Scale for Suicidal Ideation (SSI), State-Trait Anxiety Inventory (STAI). RESULTS. 22 subjects (36.7%) were categorized as alexithymic (TAS-20 scores ≥ 61). Alexithymics showed more severe negative and depressive symptoms and increased suicide risk than nonalexithymics.However, the results of a linear regression with SSI score as dependent variable showed that Difficulty in Identifying and Describing Feelings dimensions of TAS-20 and higher CDSS scores were significantly associated with higher scores on the Scale for Suicide Ideation. Conclusions: The presence of alexithymia in schizophrenia may be related to higher risk of suicide ideation and more severe depressive symptoms, independently by the severity of positive and negative symptoms. However, results are preliminary and limitations must be considered.