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Food addiction (FA) is characterised by the consumption of appetible foods and by addictive psychological and behavioural symptoms such as cravings, tolerance, limited control of substance intake and withdrawal symptoms. Despite previous research on FA has been hindered by the lack of a formal definition for this condition, recent global trends have stirred the interest of the scientific community towards a proper classification and construct of FA. More specifically, recent studies have pointed towards shared defective neurobiological mechanisms as well as frequent comorbidities between FA, eating disorders, mood disorders, anxiety disorders and substance-related and addictive disorders. In this review, we will provide an overview of the complex symptomatology of food addiction evaluating its relationship with mood disorders, anxiety disorders, eating disorders and substance-related and addictive disorders. We wrote a systematic review and followed a PRISMA methods. Patients with FA and substance use disorders show similar risk factors, neurobiological and hormonal correlates, personality traits and symptom profiles. The presence of FA appears to be directly proportional to the burden of symptoms of affective disorder. The comorbidity between FA and other eating disorders is associated with worse clinical conditions and symptoms. FA should be considered a sort of transnosological construct existing in different psychopathological domains that have similarities with substance-related, affective, and eating disorders. Furthermore, FA seems to be likely an important factor related to several psychopathological dimensions, but further studies are needed to clarify this view. Level V, review article.

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

Eating and Feeding Disorders are heterogeneous clinical conditions characterized by cognitive, interpersonal, and behavioural features. They might spread across a spectrum of severity, from mild or sub-threshold conditions, belonging to the realm of altered eating habits or body dysmorphic features, to severe disorders. The Anorexia-Bulimia Spectrum (ABS) aims at exploring and describing in a systematic manner this psychological/psychopathological area. The ABS model has been proposed to detect, in a lifetime perspective, signs and symptoms that might be considered as clinically relevant or not, but evenly associated with different levels of subjective impairment. To detect the eating disorder spectrum phenomenology, a structured clinical interview has been built and validated, the Anorexic-Bulimic Spectrum Clinical Interview (SCI-ABS). The paper describes its clinical significance and potential implications.

Food addiction (FA) is characterised by the consumption of appetible foods and by addictive psychological and behavioural symptoms such as cravings, tolerance, limited control of substance intake and withdrawal symptoms. Despite previous research on FA has been hindered by the lack of a formal definition for this condition, recent global trends have stirred the interest of the scientific community towards a proper classification and construct of FA. More specifically, recent studies have pointed towards shared defective neurobiological mechanisms as well as frequent comorbidities between FA, eating disorders, mood disorders, anxiety disorders and substance-related and addictive disorders.In this review, we will provide an overview of the complex symptomatology of food addiction evaluating its relationship with mood disorders, anxiety disorders, eating disorders and substance-related and addictive disorders.We wrote a systematic review and followed a PRISMA methods.Patients with FA and substance use disorders show similar risk factors, neurobiological and hormonal correlates, personality traits and symptom profiles. The presence of FA appears to be directly proportional to the burden of symptoms of affective disorder. The comorbidity between FA and other eating disorders is associated with worse clinical conditions and symptoms.FA should be considered a sort of transnosological construct existing in different psychopathological domains that have similarities with substance-related, affective, and eating disorders. Furthermore, FA seems to be likely an important factor related to several psychopathological dimensions, but further studies are needed to clarify this view.Level V, review article.

Objective To explore decision-making, impulsiveness and temperamental traits in patients suffering from eating disorders (EDs), as compared with healthy controls (HC). Method Fifty-one patients affected by ED (fourteen with anorexia restricting subtype, AN-R; fourteen with bulimia, BN; thirteen with anorexia bingeing/purging subtype, AN-BP; ten with binge-eating disorder, BED) and twenty-eight HC. The patients, recruited at the Section of Psychiatry of the University of Pisa (Italy, were evaluated with a battery of neuropsychological questionnaires, including the IOWA Gambling Task (IGT), the Barratt Impulsiveness Scale (BIS-11), the Temperament and Character Inventory (TCI), the Frontal Assessment Battery (FAB) and the Hamilton Depression Rating Scale (HAM-D). Results The results indicated that AN-R, AN-BP and BN patients showed poorer IGT performances than HC (p < .05), while BED performances were similar to those of HC. IGT scores suggested the existence of similarities in decision-making performances of AN-BP and BN patients, as they performed differently from HC starting from block 3 (F(16.2)=1.7). In addition, differences between AN-BP/BN and AN-R patients were detected, given that they performed differently starting from block 4. As far as BIS-11 is concerned, AN-BP and BN patients reached the highest BIS total scores, when compared with the other groups. Further, they shared similar temperamental and impulsiveness profiles, as demonstrated by their BIS-11 ‘motor impulsiveness’ scores, and by their TCI ‘novelty seeking’, ‘reward dependence’ and ‘persistence’ dimensions. The post-hoc analyses revealed that both AN groups (namely, AN-R and AN-BP) scored significantly lower than HC on the FAB. No patients fulfilled the criteria for the diagnosis of a current major depression. Conclusions Decision-making deficits are common in EDs. In AN-R these seem related to cognitive styles, while in AN-BP and BN patients with temperament features and impulsiveness traits.

Background Food addiction (FA) is a controversial concept, denoting the craving for certain foods. Given the little information available, the aim of this study was to evaluate the possible relationships between FA and full-blown and subthreshold psychopathology or eating behaviors in subjects consulting nutritional biologists. Materials and methods Three-hundred and fifty subjects completed the following self-questionnaires: Yale Food Addiction Scale (YFAS), Structured Clinical Interview for Mood Spectrum, Self-Report, Lifetime Version (MOOD-SR-LT), Symptom Checklist-90-Revised (SCL-90-R), Structured Clinical Interview for Anorexic-Bulimic Spectrum, Self-Report, Lifetime Version (ABS-SR-LT). Results Most of the subjects were women (n = 278) and the remaining were 72 men. A large proportion of the subjects (77.1%) had a YFAS score Conclusion Our data, while indicating that FA is related to different subthreshold psychopathological domains, in particular, with both depressive and manic symptoms, as well as with rhythmicity of mood spectrum, or with eating subthreshold symptoms, would suggest that it might be a dimension underlying different conditions or symptom clusters.

The present study investigated the validity, reliability and, as novel aspects, the temporal stability and discriminant validity of the Italian version of the Sleep Condition Indicator (SCI), a new brief tool to appraise Insomnia Disorder (ID) according to the new criteria of the DSM-5.Subjects with ID (DSM-5), Obstructive Sleep Apnea Syndrome (OSAS) (ICSD3) and a group of healthy subjects (H) were recruited. At the first evaluation (T1), SCI, the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) were administered. ID patients also completed the SCI 2months later (T2). Statistical analyses included Cronbach's alpha co-efficient calculation, Intraclass Correlation, Receiver Operating Characteristic (ROC) curves and Pearson correlations.Eighty-eight ID (n=50 F, mean age 49.9±15.1 years), 43 OSAS (n=22 F, mean age 50.2±9.1 years) and 40 H (n=22 F, 49.3±13 years) were recruited at T1. SCI, PSQI and ISI scores were significantly higher in the ID group vs H and OSAS (both p.001). ROC analysis revealed cut off of18 to correctly identify 100% of H, cut off of17 the 100% of OSAS and17 the 100% of ID. Cronbach's alpha were 0.71 at T0, 0.78 at T2 for ID, 0.76 and 0.81 respectively for H and OSAS. SCI showed a negative correlation with ISI (p.01) and PSQI (p.05).The Italian version of SCI shows good internal consistency, temporal stability and concurrent validity in insomnia, confirming data on the original version. Importantly, the present study shows that the SCI effectively discriminates insomnia from both normal sleep and OSAS.

This study evaluates the effectiveness of paliperidone ER in patients with symptomatic but not highly acute schizophrenia in terms of efficacy, safety, and patients' perception of their social functioning and well-being. This is a multicenter, open-label prospective study with a flexible-dose approach; 133 patients were enrolled and followed for 13 weeks after switching to paliperidone ER. Outcome efficacy measures were as follows: the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression-Severity (CGI-S) scale, and the Personal and Social Performance (PSP) scale; in addition, the Subjective Well-being under Neuroleptics (SWN-20) scale, the Drug Attitude Inventory (DAI-30), and the sleep evaluation scale were used. Symptom Rating Scale (ESRS), adverse events, and subjective side effects were recorded. 118/133(88.7%) patients completed the study. The mean PANSS score decreased (88.98 ± 10.09 to 66.52 ± 16.29; P0.001); 40.5% of the patients achieved improvement of at least 30%. PSP and CGI-S scores as well as DAI-30 and SWN-20 decreased (P0.001). ESRS (P0.001) decreased significantly from the baseline. Throughout the trial, no deaths occurred and only one serious adverse event was reported. Paliperidone ER has proved to be efficacious, safe, and well tolerated also with this approach more closely resembling actual clinical practice. Patient-relevant outcome parameters such as social functioning and quality of life improved, which is crucial for treatment adherence in clinical practice.

Behçet's syndrome (BS) is a systemic, chronic, relapsing vasculitis, typically characterized by recurrent orogenital ulcers, ocular inflammation and skin manifestations; articular, vascular, gastroenteric and neurological involvement may also occur. Besides the other clinical features of BS, it seems relatively frequent that patients with BS develop a neurobehavioural syndrome, characterized by euphoria, bipolar disorders and paranoid attitudes, loss of insight/disinhibition, and indifference to their disease, defined as 'neuro-psycho-BS'. To date, the pathogenetic mechanism underlying neuro-psycho-BS has not been determined. It may be secondary to organic neurological involvement, or it may be related to poor quality of life and the relapsing course of the disease. Another engaging theory suggests that it could be related to the frequent observation of psychiatric symptoms during relapses or, in some cases, in the phases preceding reactivation of the disease; these elements suggest that psychiatric disorders in BS could represent a crucial element, whether a psychiatric subset or a distinct clinical feature of the disease. Moreover, it has been reported that cognitive impairment in BS can be seen with or without central nervous system involvement. Globally, psychiatric symptoms have been described as being multifaceted, ranging from anxiety disorders to depressive-bipolar disorders or to psychotic ones. In addition, some psychological characteristics of BS patients seem to predispose them to maladaptive stress management, which may lead to stress-related disorders, including anxiety and depression. Therefore, the aims of this review are to explore the epidemiology of neuro-psycho-BS by evaluating the relationship between the stress system and the multifaceted psychiatric manifestations in BS, and to summarize the therapeutic strategy used.

Summary Eating dyscontrol constitutes a potential negative predictor for the outcome of treatment strategies for obese patients. The aim of this study was to examine the qualitative characteristics of eating dyscontrol in obese patients who engage in binge eating (BE) compared with those who do not (NBE), and to analyse the relationship between eating dyscontrol and axis-I, axis-II, spectrum psychopathology using instruments that explore mood, panic–agoraphobic, social–phobic, obsessive–compulsive and eating disorders spectrum psychopathology (SCI-MOODS-SR, SCI-PAS-SR, SCI-SHY-SR, SCI-OBS-SR, SCI-ABS-SR). This was a cross-sectional study involving a clinical sample of adult obese patients with severe obesity (average body mass index = 45 ± 8 kg m−2) and candidate to bariatric surgery who were recruited between November 2001 and November 2010 at the Obesity Center of the Endocrinology Unit, University Hospital of Pisa. All participants completed a face-to-face interview, including a diagnostic assessment of axes-I and II mental disorders (using the Structured Clinical Interview for Manual of Mental Disorders, fourth edition [SCID]-I and SCID-II) and filled out self-report spectrum instruments. Among obese patients not affected by BE, eating dyscontrol was highly represented. Indeed, 39.7% (N = 177) of subjects endorsed six or more items of the Anorexia–Bulimia Spectrum Self-Report, lifetime version domain exploring this behaviour. The cumulative probability of having axis-I, axis-II and a spectrum condition disorder increased significantly with the number of eating dyscontrol items endorsed. In both BE and NBE obese subjects, eating dyscontrol may represent an independent dimension strongly related to the spectrum psychopathology and axes I/II disorders. A systematic screening for eating dyscontrol symptoms by means of self-report spectrum instruments may be valuable to assign specific treatment strategies.

The aim of this study was to evaluate the association of maternal antenatal attachment and post-partum psychopathology, maternal-infant bonding, while checking for antenatal psychopathology, for lifetime psychiatric diagnosis and for the known risk factors for peripartum depression.One hundred and six women recruited at the first month of pregnancy (T0) were evaluated with the structured interview for DSM-IV TR (SCID-I) to assess the presence of lifetime psychiatric diagnosis and with the Perinatal Depression Predictor Inventory-Revised (PDPI-R), the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI). At the sixth month of pregnancy (T1) and at the first month post-partum (T2), all patients were evaluated with the PDPI-R, the EPDS, the STAI, at T1, with the Maternal Antenatal Attachment Scale (MAAS), and at T2 with the Maternal Postnatal Attachment Scale (MPAS).Multivariate regression analyses showed that maternal-foetal attachment was the variable most significantly associated with postnatal symptoms of depression and anxiety and with quality of maternal-infant attachment. The logistic regression analyses showed that antenatal attachment may predict postnatal depressive and anxiety symptoms (respectively, OR: 0.83 - IC [0.74 - 0.95], p = .005, OR: 0.88 - IC [0.79 - 0.98], p = .02), and the quality of maternal postnatal attachment (OR: 1.17 - IC [1.08 - 1.27], p .001), also after taking into account the known risk factors for perinatal depression, the sociodemographic variables and lifetime psychiatric diagnosis.The quality of maternal-foetal bonding may independently predict the quality of maternal-infant attachment and post-partum depressive and anxiety symptoms. A comprehensive assessment of maternal risk factors for perinatal psychopathology during pregnancy should include the evaluation of antenatal attachment that could be modifiable by specific interventions promoting the quality of maternal bonding.

Objectives Recent research indicates that Heart Rate Variability (HRV) is affected in Bipolar Disorders (BD) patients. To determine whether such alterations are a mere expression of the current mood state or rather contain longitudinal information on BD course, we examined the potential influence of states adjacent in time upon HRV features measured in a target mood state. Methods Longitudinal evaluation of HRV was obtained in eight BD patients by using a wearable monitoring system developed within the PSYCHE project. We extracted time-domain, frequency-domain and non-linear HRV-features and trained a Support Vector Machine (SVM) to classify HRV-features according to mood state. To evaluate the influence of adjacent mood states, we trained SVM with different HRV-feature sets: 1) belonging to each mood state considered alone; 2) belonging to each mood state and normalized using information from the preceding mood state; 3) belonging to each mood state and normalized using information from the preceding and subsequent mood states; 4) belonging to each mood state and normalized using information from two randomly chosen states. Results SVM classification accuracy within a target state was significantly greater when HRV-features from the previous and subsequent mood states were considered. Conclusions Although preliminary and in need of replications our results suggest for the first time that psychophysiological states in BD contain information related to the subsequent ones. Such characteristic may be used to improve clinical management and to develop algorithms to predict clinical course and mood switches in individual patients.

Short sleep duration, poor sleep quality, and insomnia frequently characterize sleep in pregnancy during all three trimesters. We aimed: (i) to review the clinical evidence of the association between conditions of sleep loss during pregnancy and adverse pregnancy outcomes; and (ii) to discuss the potential pathophysiological mechanisms that may be involved. A systematic search of cross-sectional, longitudinal studies using Medline, Embase, and PsychINFO, and MeSH headings and key words for conditions of sleep loss such as ‘insomnia’, ‘poor sleep quality’, ‘short sleep duration’, and ‘pregnancy outcome’ was made for papers published between January 1, 1960 and July 2013. Twenty studies met inclusion criteria for sleep loss and pregnancy outcome: seven studies on prenatal depression, three on gestational diabetes, three on hypertension, pre-eclampsia/eclampsia, six on length of labor/type of delivery, eight on preterm birth, and three on birth grow/birth weight. Two main results emerged: (i) conditions of chronic sleep loss are related to adverse pregnancy outcomes; and (ii) chronic sleep loss yields a stress-related hypothalamic– pituitary–adrenal axis and abnormal immune/inflammatory, reaction, which, in turn, influences pregnancy outcome negatively. Chronic sleep loss frequently characterizes sleep throughout the course of pregnancy and may contribute to adverse pregnancy outcomes. Common pathophysiological mechanisms emerged as being related to stress system activation. We propose that in accordance to the allostatic load hypothesis, chronic sleep loss during pregnancy may also be regarded as both a result of stress and a physiological stressor per se, leading to stress ‘overload’. It may account for adverse pregnancy outcomes and somatic and mental disorders in pregnancy.

Barrett's esophagus (BE) is a metaplastic lesion that may result from long-lasting gastroesophageal reflux and it is an established precursor of esophageal adenocarcinoma. There are reports of an increased prevalence of BE, and eventually esophageal adenocarcinoma, in patients with eating disorders characterized by purging behaviors like those with bulimia nervosa (BN). Among patients with eating disorders, those affected by anorexia nervosa binging purging subtype (ANBP), are behaviorally very similar to those with BN, but to our knowledge there are no data in literature about BE in patients with ANBP. We present the case of a 37-year-old female with a 20-year history of ANBP in comorbidity with bipolar disorder, who developed a BE requiring multi-specialistic intervention.

Objective Sleep disturbances are often seen in rheumatic diseases, including systemic lupus erythematosus (SLE). However, the prevalence of sleep disorders in SLE as well as the contributing factors to their occurrence remain poorly understood. The aim of this paper is to review the clinical and psychobiological data on the relationship between sleep disturbances and SLE. Method We performed a systematic search of MEDLINE, EMBASE and PsychINFO, using MeSH headings and keywords for “sleep disorders” and “SLE.” Results Nine studies reporting the relationship between sleep disorders and SLE were found. Prevalence rates of sleep disorders ranged between 55% and 85%; differences in assessment techniques appeared to be a major source of this variability. In the majority of the studies an association between sleep disorders and disease activity, pain and fatigue has been reported. Psychosocial variables, depression, steroid use, and the role that sleep disruption has on pain, inflammation and cytokines, have been hypothesized as possible psychobiological factors. Conclusions Sleep disorders appear to occur in more than half of patients with SLE and appear to be associated with disease activity. Pain and fatigue are also related to sleep disorders. Among the hypotheses on the possible mechanisms underlining the association between sleep disorders and SLE, psychosocial/psychological factors, especially depression, were the most frequently reported.

Here we report on a case series chart review conducted on nine severe and treatment-resistant patients with anorexia nervosa, body mass index < 13 kg/m(2), and a delusional body image disturbance. Patients received low doses of haloperidol during hospitalization. Haloperidol was well tolerated. The delusional body image disturbance and the drive for thinness were subjectively perceived as less intense. BMI increased from the initial 12.2 ± 0.5 to 16.0 ± 1.5 kg/m(2). Mean pulse rate and blood pressure did not change significantly from admission to discharge (66 ± 11.6 bpm; 91/56 mmHg vs 77 ± 12.0 bpm; 102/66 mmHg). Mean of QTc, available from electrocardiograms performed during hospitalization, was 413 ± 38.5 ms (range 342-469 ms). Further investigations are warranted to elucidate clinical usefulness and safety of low doses of haloperidol for patients with treatment-resistant anorexia and delusional body image disturbance.

Introduction: Anorexia nervosa (AN) is a mental disorder whose features are deliberate weight loss, disordered body image, and intrusive overvalued fears of gaining weight. Long-term consequences of AN include endocrine dysfunctions leading to secondary amenorrhea, bone loss and/or osteoporosis with an increased risk of bone fracture. Therefore young women with AN may develop a risk for bone fractures comparable to that of postmenopausal women. Methods: In this case report series Bone Mineral Density (BMD) was examined by Dual energy X-ray Absorptiometry (DXA) in 19 hospitalized patients with diagnosis of AN and prolonged amenorrhea. Results: All patients showed a lumbar/femoral bone loss or osteoporosis, with an increased fracture risk comparable to that of postmenopausal women. Conclusions: Our observation suggests that DXA evaluation of anorexic patients with prolonged amenorrhea would be helpful to prevent fracture risk in this population of patients. However, although DXA is almost routinely recommended in women over 65, it is not in young AN patients with prolonged amenorrhea.

Research into the cause of chronic insomnia has identified hyperarousal as a key factor, which is likely to have both trait and state components. Sleep-related cognition, metacognition, and sleep reactivity also play an important role in insomnia. Our aim was to investigate how these insomnia-related constructs are associated with trait predisposition and pre-sleep arousal in subjects with an insomnia disorder.Fifty-three individuals with insomnia disorder (according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (F = 33; 52 + 10)) and 30 healthy controls (F = 18; 51.8 + 12 years) were evaluated with a set of questionnaires, including the Ford Insomnia Response to Stress Test (FIRST), Metacognition Questionnaire - Insomnia (MCQI), Arousal Predisposition Scale (APS), and Pre-sleep Arousal Scale (PSAS). Statistical analyses included multiple regression to elucidate the independent determinants of APS and PSAS.Participants with insomnia presented higher FIRST, MCQI, APS, PSAS scores (p-values0.001) than healthy controls. In insomnia, APS and cognitive PSAS were best determined by MCQI (respectively, B = 0.09, p = 0.001, B = 0.08, p = 0.02), somatic PSAS by cognitive arousal (PSAS B = 0.35, p = 0.004) CONCLUSIONS: This study suggests that in insomnia disorders, trait predisposition toward hyperarousal and pre-sleep-cognitive-state-dependent arousal may be closely related to sleep-related metacognitive processes. Sleep-related metacognitive processes may be associated with trait hyperarousal within the framework of a mutual relationship, and could, in turn, modulate cognitive pre-sleep-state arousal. A broad range of cognitive and metacognitive processes should be considered when dealing with subjects with insomnia.

Objective The aim of this study is to evaluate perceived stress and coping strategies in individuals with systemic lupus erythematosus (SLE) according to the presence of insomnia symptoms, using a set of variables that include anxiety and depressive symptoms evaluation. Methods Ninety SLE women were evaluated in a cross-sectional study using the Perceived Stress Scale (PSS), Brief COPE, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI) and Self-rating Anxiety Scale (SAS). Results Individuals with insomnia symptoms ( n = 57, 66%) presented higher PSS ( p Conclusions SLE individuals with insomnia symptoms show high levels of perceived stress and more frequent use of disengaging and emotional-focused coping strategies. This body of evidence suggests that individuals with SLE and comorbid insomnia symptoms may therefore require additional interventions for insomnia.

To investigate the presence of mood spectrum signs and symptoms in patients with anorexia nervosa, restricting subtype (AN-R) or bulimia nervosa (BN). 55 consecutive female patients meeting DSM-IV criteria for eating disorders (EDs) not satisfying DSM-IV criteria for Axis I mood disorders were evaluated with the Lifetime Mood Spectrum Self-Report (MOODS-SR) and the Mini-International Neuropsychiatric Interview (MINI). The MOODS-SR explored the subthreshold comorbidity for mood spectrum symptoms in patients not reaching the threshold for a mood disorder Axis I diagnosis. MOODS-SR included 161 items. Separate factor analyses of MOODS-SR identified 6 ‘depressive factors’ and 9 ‘manic-hypomanic factors’. The mean total score of MOODS-SR was significantly higher in BN than in AN-R patients (97.5 ± 25.4 vs 61.1 ± 38.5, respectively; p = 0.0001). 63.6 % of the sample (n = 35) endorsed the threshold of ≥61 items, with a statistically significant difference between AN-R and BN (39.3 % vs 88.9 %; χ 2 = 14.6; df = 1; p = 0.0001). Patients with BN scored significantly higher than AN-R patients on several MOODS-SR factors: (a) MOODS-SR depressive component: ‘depressive mood’ (11.2 ± 7.4 vs 16.0 ± 5.8; p

The aim of this review was to summarize evidence from research on psychopharmacological options for adult patients with anorexia nervosa (AN). Database searches of MEDLINE and PsycINFO (from January 1966 to January 2014) were performed, and original articles published as full papers, brief reports, case reports, or case series were included. Forty-one papers were screened in detail, and salient characteristics of pharmacological options for AN were summarized for drug classes. The body of evidence for the efficacy of pharmacotherapy in AN was unsatisfactory, the quality of observations was questionable (eg, the majority were not blinded), and sample size was often small. More trials are needed, while considering that nonresponse and nonremission are typical of patients with AN.

Objective To preliminary investigate the link between the darkness hormone melatonin (MLT) and the pro-hypnotic effectiveness of the atypical antidepressant Trazodone (TRZ) in a group of mood disorder patients suffering of insomnia. Design and methods The study's design comprised: i) the enrolment of insomniac outpatients, ii) baseline (t 0 ) psychiatric and biochemical examinations; iii) the subsequent patients' introduction into a treatment with TRZ for 3–4 weeks, followed by post-therapy re-evaluations (t 1 ). The MLT function was investigated by t 0 /t 1 ELISA determinations of 6-hydroxy-MLT sulfate (6-OH-MLTs) levels in early-morning urines and HPLC analysis of morning MLT serum amount. Concomitantly, TRZ and its metabolite m -chloro-phenylpiperazine ( m- CPP) were measured by HPLC in serum to monitor patients' compliance/metabolism. Results Seventeen insomniac outpatients, displaying mild symptoms of depression/anxiety resistant to antidepressants, completed TRZ therapy (dose:10–20 mg/day, bedtime). Serum TRZ levels (127 ± 57 ng ml − 1 , mean ± SD) confirmed patients' compliance, while the anxiogenic metabolite m- CPP resulting almost undetectable. Moreover, the 6-OH-MLTs output was found increased at t 1 vs. baseline values (t 1 : 58.4 ± 45.02 ng ml − 1 ; t 0 : 28.6 ± 15.8 ng ml − 1 ; mean ± SD, P P 1 : 48.53 ± 50.70 ng ml − 1 ; t 0 : 49.80 ± 66.53 ng ml − 1 ). Morning MLT in serum slightly diminished at t 1 without reaching the statistical significance, not allowing therefore to define the patients' outcome. Conclusions This initial investigation encourages to explore MLT networks as possible correlates of TRZ pro-hypnotic responses.

The aim of the study was to evaluate perceived stress and coping strategies in people with hypertension, according to the presence of insomnia symptoms and by using a set of variables that included anxiety and depressive symptoms evaluation.A total of 371 hypertensive patients were enrolled during their first visit to the Hypertension Outpatient Unit. The Perceived Stress Scale (PSS), Brief-COPE, Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Self-rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI) were administered. Patients with other sleep disorders or with incomplete data (n = 41) were excluded.Data from 330 hypertensive patients were analyzed (males 51%, mean age 57 ± 13 years). Those with insomnia symptoms (n = 70, 21%) were older (p = 0.02), more frequently females (p = 0.01), and presented with higher PSS (p 0.001), BDI (p 0.0001), SAS (p = 0.0003), and STAI (p 0.0001) scores than those without insomnia symptoms. In a linear regression trait, anxiety (p 0.0001) and depressive symptoms (p 0.05) were independent predictors of high PSS. Patients with insomnia symptoms showed lower scores in coping strategies, such as positive reframing (p = 0.03) and emotional support (p = 0.04), and an increased score in behavioral disengagement (p = 0.03). Trait anxiety and insomnia severity were independent predictors of less effective coping strategies.People with hypertension and insomnia symptoms showed higher perceived stress and less effective coping strategies than non-insomniacs; psychological factors such as trait anxiety and depressive symptoms may play a modulating role in these relationships. Prevention and treatment of insomnia symptoms and psychological factors should receive high attention for people with hypertension.

Background Research has supported the role of cognitive processes in the development and maintenance of insomnia, yet a standardized characterization of mind-wandering experiences in insomniacs is lacking. Objectives The aim was to understand the quantitative nature of thoughts and feelings during mind wandering in insomniacs and healthy controls and their relationship with sleep-related parameters. Methods We used the 5-minute eyes-closed wakeful rest as an experimental model condition of mind wandering. Forty-seven individuals with insomnia disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (48.66±15.62 years; 31 women) and 29 healthy controls (50.66±15.14 years; 17 women) participated in the experiments and completed the Amsterdam Resting-State Questionnaire (ARSQ) immediately after the resting session. Participants also completed the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), the Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS). Statistical analyses included multiple regression to elucidate the independent determinants of ARSQ phenotypes. Results Participants with insomnia presented higher ISI, PSQI, and DBAS scores than did healthy controls. Insomniacs had strikingly different scores on most dimensions of the ARSQ, in particular Discontinuity of Mind, Self, Sleepiness, and Health Concern, that correlated positively with ISI and DBAS. Multiple regressions highlighted that for insomniacs, ISI was the best predictor of both Discontinuity of Mind and Health Concern. Conclusions Resting-state activity in insomnia is altered and it seems to be related to unhelpful beliefs and insomnia severity. Resting-state neuroimaging in combination with the ARSQ could reveal important associations between these aberrant cognitive scores and their underlying systems-level brain mechanisms.

Background Recent epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. Data from literature suggest that Adult Separation Anxiety Disorder (ASAD) may develop after a bereavement or threat of loss. Research has demonstrated that bereaved persons may present a clinically significant grief reaction, defined as Complicated Grief (CG) that causes a severe impairment in the quality of life. The aim of this study was to evaluate the relationship between ASAD and CG in a large cohort of outpatients with mood and anxiety disorders. Methods Study participants comprised 454 adult psychiatric outpatients with DSM-IV mood or anxiety disorders diagnoses. Diagnostic assessments were performed using the SCID-I; ASAD was assessed using an adapted version of the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS-adult). Complicated grief symptoms were assessed by the Inventory of Complicated Grief (ICG). Social and work impairments were evaluated using the Sheehan Disability Scale (SDS). Adult attachment styles were assessed by the Relationship Questionnaire (RQ). Results The overall frequency of ASAD in our sample was 43% and that of CG was 23%. Individuals with CG had a greater frequency of ASAD (56%) with respect to those without CG (40%). Subjects with CG plus ASAD reported higher scores on ICG and greater impairment on quality of life, as measured with SDS, than CG patients without ASAD. Conclusions Adult separation anxiety disorder occurs in a high proportion of adult psychiatric outpatients with complicated grief. The association between these two conditions should be further investigated in light of their clinical implications.

A number of large-scale studies have shown that there is a relationship between many psychiatric disorders and aggression or violence. As no medication is currently approved for the treatment of aggression, pharmacotherapy (often involving drug combinations) is used on a trial-and-error basis with various degrees of response.The study involved 244 in-patients aged 19-83 years (mean 41.9 ± 11.3 SD). The Modified Overt Aggression Scale (MOAS) was used to assess any aggressive or violent behaviors occurring in the week before admission and upon discharge. Psychopathology was assessed using the Brief Psychiatric Rating Scales (BPRS).All of the patients showed a significant improvement (p0.001) in mean weighted total MOAS scores at the end of the study, with no significant differences between the various drugs or combination therapies. The patients who received combination treatments including antidepressants showed a worsening in the weighted total MOAS score (18.46% ± 114.31% SD); the patients who did not receive antidepressants had an improvement (13.61% ± 257.36% SD) (p=0.0069).Multivariate testing of the variables age, gender, substance/alcohol abuse, the duration of hospitalisation, the administration of mood stabilisers, and the use of typical or atipical antipsychotics showed that the severity of the psychopathological picture correlated significantly with the presence of violence, whereas the effect of combined antidepressant treatment on violent behavior was only relative.

We present a case report of a woman hospitalized for a ventricular-peritoneal shunting replacement, who developed a manic episode with psychotic symptoms after hydrocephalus resolution. We have no knowledge of cases of manic episodes due to hydrocephalus resolution by ventricular-peritoneal shunt replacement, although previous case reports have suggested that hydrocephalus might induce rapid-onset affective episodes or mood cycles. The patient’s history revealed the lifetime presence of signs and features belonging to the subthreshold bipolar spectrum, in absence of previous full-blown episodes of a bipolar disorder. Our hypothesis is that such lifetime sub-threshold bipolar features represented precursors of the subsequent full-blown manic episode, triggered by an upregulated binding of striatum D2 receptors after the ventricular-peritoneal shunt replacement.

Objective Literature underlines that the Edinburgh Postnatal Depression Scale (EPDS) is the most common measure to assess postpartum depression (PPD) worldwide and suggests that the rate of false positives is high. Furthermore, the EPDS does not distinguish between depression and anxiety. This study describes different definitions of PPD and whether pregnancy anxiety disorders are risk factors for different PPDs at both 1 month and 1 year postpartum. Method 1066 women were recruited during pregnancy and followed until the 12th month postpartum ( N = 500). Women were administered the SCID and completed the PDPI-R during pregnancy. During the postpartum women who had an EPDS score of 13 or more were administered the SCID to distinguish minor or major depressive episodes (mMD) from false positives. Results 41.5% and 44.9% of the PPD assessed with the EPDS were false positives at the 1st month and during the 1st year postpartum respectively. The difference observed in prevalence rates estimated with EPDS and SCID was statistically significant both at the 1st month and during the 1st year postpartum. Overall the effect of anxiety diagnoses in predicting PPD was stronger at the 1st month than during the 1st year postpartum. The role of panic disorder is associated both with probable depression (ES = 0.82) and with mMD (ES = 0.87) at the 1st month postpartum, and predicted mMD during the 1st year postpartum (ES = 0.71). OCD predicted false positives at the 1st month postpartum (ES = 0.89). Conclusion An antenatal screening of specific anxiety diagnoses could be extremely useful for the prevention of possible postpartum distress outcomes.

Patients with schizophrenia present a two- to three-fold higher prevalence of diabetes, of metabolic syndrome and of cardiovascular morbidity. The reason for this increased prevalence may involve intrinsic vulnerability, lifestyle factors and iatrogenic effects of antipsychotic drugs. The objective of this multinational, cross-sectional, pharmacoepidemiological study was to determine the prevalence of diabetes, lipid disorders, obesity, hypertension and the metabolic syndrome in patients with schizophrenia treated with antipsychotic drugs. Particular attention was taken to acquire data on a wide a range as possible of demographic, clinical and lifestyle variables that may influence the risk of metabolic disorders, which were taken into account in the calculation of prevalence data by propensity scoring. The study included 2270 subjects from 16 European countries, predominantly from Central and Eastern Europe. The proportion of subjects presenting the pathologies of interest was relatively high, ranging from 28% for glycaemic disorders to 70% for lipid disorders.

Numerose alterazioni di origine biologica, psicologica e ambientale sono state evidenziate nei disturbi del comportamento alimentare (DCA). La regolazione dell’introito del cibo, il senso di sazieta e di fame sono regolati da fattori di origine centrale e periferica. In questi circuiti sono coinvolti neuropeptidi e neurotrasmettitori la cui secrezione e alterata nel corso della sintomatologia dei DCA, ma tende a normalizzarsi in gran parte dopo la remissione sintomatologica. Questo dato lascia ipotizzare che le alterazioni presenti possono essere secondarie alla malnutrizione o al calo ponderale. Le modifiche ormonali e neurotrasmettitoriali presenti nei DCA non possono essere considerate la causa del comportamento alimentare disfunzionale, poiche molte di tali alterazioni insorgono secondariamente ai DCA. Non e comunque da escludere che queste possano contribuire al perpetuarsi della sintomatologia, influenzando cosi il decorso clinico. Ad esempio, il deficit della trasmissione serotoninergica contribuisce sia alla manifestazione di un DCA sia alla sintomatologia dello spettro depressivo e ossessivo associato al DCA; oppure le modificazioni dei peptidi regolatori della fame e della sazieta possono contribuire a mantenere alterato il pattern alimentare (ridotta ghrelina e maggior numero di abbuffate, aumentata colecistochinina e maggiore sazieta, ecc.). Possiamo dunque affermare che i DCA insorgono a seguito di una complessa interazione tra fattori biologici, personologici-psicologici e ambientali. Le modificazioni endocrine indotte dagli squilibri nutrizionali possono rinforzare e favorire il mantenimento dei comportamenti disfunzionali, entrando in un circolo vizioso che si automantiene. E auspicabile pertanto programmare adeguate strategie di prevenzione e interventi terapeutici integrati in una prospettiva multidisciplinare.

BackgroundStudies investigating neurocognitive impairment in subjects with eating disorders (EDs) have reported heterogeneous patterns of impairment and, in some instances, no dysfunction. The present study aimed to define the pattern of neurocognitive impairment in a large sample of bulimia nervosa (BN) patients and to demonstrate that neuroendocrine, personality and clinical characteristics influence neurocognitive performance in BN.MethodAttention/immediate memory, set shifting, perseveration, conditional and implicit learning were evaluated in 83 untreated female patients with BN and 77 healthy controls (HC). Cortisol and 17β-estradiol plasma levels were assessed. Cloninger's Temperament and Character Inventory – Revised (TCI-R), the Bulimic Investigation Test Edinburgh (BITE) and the Montgomery–Asberg Depression Rating Scale (MADRS) were administered.ResultsNo impairment of cognitive performance was found in subjects with BN compared with HC. Cortisol and ‘Self-directedness’ were associated with better performance on conditional learning whereas 17β-estradiol had a negative influence on this domain; ‘Reward dependence’ was associated with worse performance on implicit learning; and depressive symptomatology influenced performance on the Wisconsin Card Sorting Test (WCST) negatively.ConclusionsNo cognitive impairment was found in untreated patients with BN. Neuroendocrine, personality and clinical variables do influence neurocognitive functioning and might explain discrepancies in literature findings.

Background Although the role of anxiety disorders on the development of Post-partum Depression (PPD) have already been studied in literature, that of individual anxiety disorders has not received specific attention. The aim of this study is to investigate the role of Panic Disorder (PD) and family history for PD as risk factors for PPD. Methods Six hundred women were recruited in a prospective, observational study at the 3rd month of pregnancy and followed up until the 6th month after delivery. At baseline, risk factors for PPD, Axis-I disorders and family history for psychiatric disorders were assessed. We investigated minor and major depression (mMD) occurred at 1st, 3rd and 6th months post-partum. Logistic regression models were used to estimate the association between PD, family history for PD and PPD. Results Forty women had mMD in the post-partum. PD during pregnancy (RR = 4.25; 95%CI:1.48–12.19), a history of PD (RR 2.47; 95%CI:1.11–5.49) and family history for PD (RR = 2.1; 95%CI:1.06–4.4) predicted PPD after adjusting for lifetime depression and risk factors for PPD. Limitations The response rate is moderately low, but it is similar to other studies. The drop out rate is slightly high, however the 600 women who completed the 6th month follow-up did not differ from the presence of PD at baseline. Conclusions PD is an independent risk factor for PPD, underscoring need to assess PD symptoms during pregnancy. Furthermore, PD represents an important risk factor for the development of PPD and should be routinely screened in order to develop specific preventive interventions.

Premesse La gravidanza e considerata un periodo di serenita per la donna, tuttavia essa non rappresenta un fattore protettivo per la depressione perinatale, i cui tassi di prevalenza variano tra l’8,5% e l’11,0% in gravidanza e tra il 6,5% e il 12,9% nel primo anno post partum. Solo una piccola percentuale dei casi viene identificata, sia perche alcuni sintomi vengono erroneamente attribuiti allo stato di gravidanza, sia perche molte donne, nel tentativo di evitare lo stigma, prefericono “soffrire in silenzio”. Discussione e conclusioni Dati recenti suggeriscono che uno screening precoce puo identificare le donne a piu alto rischio per la presenza di alcuni fattori, tra cui una storia personale e familiare positiva per depressione, la presenza di ansia in gravidanza, uno scarso supporto sociale. A oggi, sono stati sviluppati solo pochi interventi preventivi standardizzati per ridurre l’impatto di questa patologia. Il trattamento si basa piu sull’esperienza clinica che sulla presenza di specifiche linee guida internazionali: in caso di depressione lieve il primo intervento dovrebbe essere rappresentato dai trattamenti non farmacologici (psicoterapia di supporto, psicoterapia interpersonale breve o cognitivo-comportamentale); nei casi di depressione da moderata a grave e consigliato l’uso di antidepressivi, prevalentemente inibitori selettivi della ricaptazione della serotonina o triciclici, valutando il bilancio fra sicurezza ed efficacia e tenendo in considerazione anche la precedente risposta a una specifica molecola.

Background: Few studies, to date, have investigated the relationship between self-damaging behavior and the presence of comorbid psychiatric diagnoses in eating disorders. The aim of the present study was to investigate the axis I and II comorbidity in subjects with bulimia nervosa who report self-injurious behavior and/or suicide attempt. Methods: The subjects were 95 patients with purging type bulimia nervosa who underwent a clinical evaluation assessing the presence of self-injurious behavior and suicide attempts, comorbidity for axis I and II psychiatric disorders and temperament. Results: No axis I diagnosis was associated with any type of self-injurious behavior, whereas social phobia and bipolar disorder were linked to attempted suicide. Significant independent predictors of impulsive self-injurious behavior were the presence of childhood sexual abuse, high harm avoidance scores, and high self-transcendence scores, whereas childhood sexual abuse, the presence of a cluster B personality disorder, and a low self-directedness were predictors of suicide attempts. Compulsive self-injurious behavior was significantly associated with harm avoidance and cluster C personality disorders. Harm avoidance was also associated with skin picking. Conclusions: Personality disorders are a frequent correlate of the presence of SIB in purging bulimia nervosa. However, temperament seems to play a more important role. Further studies on larger samples are necessary to confirm our findings in bulimia nervosa and to extend them to other patient populations. (c) 2007 Elsevier B.V. All rights reserved.

Objectives: Patients with bipolar disorder (BD) on long-term maintenance treatment represent a clinical population with peculiar characteristics, for which available equations to estimate resting energy expenditure (REE) are not suitable. The aim of this study was to measure REE by means of indirect calorimetry in bipolar patients on maintenance treatment and in controls, and to estimate the agreement between measured and predicted REE in both groups. Methods: Patients diagnosed with BD I and healthy controls were assessed for height, weight and body mass index (BMI). Predicted REE was calculated using Harris–Benedict, Schofield, Recommended Nutrients Assumption Levels (LARN), and OUR equations; measurements of REE were performed using a portable indirect calorimeter. Results: Results for our sample show the most commonly used formulas give a systematic overestimation of REE with respect to measured basal metabolic rate in the patient group. The mean bias was considerably greater for bipolar subjects than for controls. Conclusions: These results suggest that patients with severe mental illness on long-term psychopharmacologic treatment may have reduced basal energy expenditure that may be a cause of weight gain.

Nell'ultimo decennio la qualita della vita ha acquisito una sempre maggiore rilevanza come misura di esito sociale e clinico (Katschnig, 1997) dei disturbi mentali. Vi e un ampio consenso sul fatto che il costrutto della qualita della vita è multidimensionale e comprende la percezione che il paziente ha delle relazioni sociali, della propria salute fisica, della capacità di svolgere le attivita quotidiane domestiche e lavorative e del proprio benessere in generale (Patrick & Erickson, 1988). Mentre le misure di funzionamento si propongono di quantificare la compromissione in modo oggettivo, le misure della qualita della vita valutano la capacita del soggetto di trarre soddisfazione e piacere da varie attivita e richiedono una valutazione soggettiva. La definizione di qualita della vita del Quality of Life Group dell'Organizzazione

To evaluate the relation between stress-related sleep reactivity and metacognitive beliefs about sleep in subjects with insomnia disorder (93) and in a group of healthy controls (30) a set of variables, including Ford Insomnia Response to Stress Test (FIRST) and Metacognition Questionnaire-Insomnia (MCQ-I), have been used. Internal consistency of the Italian version of FIRST was studied. Univariate correlation, regression analysis, and principal component analysis were also performed. The Italian version of FIRST showed good internal consistency and discriminant validity. Sleep reactivity was higher in women (p < .05) and correlates positively in both genders with metacognitive beliefs about sleep (p < .01) in insomnia. In insomnia, metacognitive beliefs may play a key role in modulating sleep reactivity. Therapeutic strategies acting selectively on metacognition to reduce stress-related sleep reactivity in insomnia may be useful.

Objectives We describe the clinical characteristics and short-term outcomes of a sample of inpatients with bipolar disorder with severe catatonic features resistant to pharmacological treatment. Methods The study involved 26 catatonic patients, resistant to a trial of benzodiazepines, and then treated with electroconvulsive therapy (ECT). All patients were evaluated prior to and one week following the ECT course using the Bush–Francis Catatonia Rating Scale (BFCRS) and the Clinical Global Impression (CGI). Results In our sample, women were over-represented (n = 23, 88.5%), the mean (± standard deviation) age was 49.5 ± 12.5 years, the mean age at onset was 28.1 ± 12.8 years, and the mean number of previous mood episodes was 5.3 ± 2.9. The mean duration of catatonic symptoms was 16.7 ± 11.8 (range: 3–50) weeks, and personal history of previous catatonic episodes was present in 10 patients (38.5%). Seventeen (65.4%) patients showed abnormalities at cerebral computerized tomography and/or magnetic resonance imaging and neurological comorbidities were observed in 15.4% of the sample. Stupor, rigidity, staring, negativism, withdrawal, and mutism were observed in more than 90% of patients. At the end of the ECT course, 21 patients (80.8%) were classified as responders. The BFCRS showed the largest percentage of improvement, with an 82% reduction of the initial score. The number of previous mood episodes was significantly lower and the use of anticholinergic and dopamine-agonist medications was significantly more frequent in non-responders than in responders. Conclusions Our patients with bipolar disorder had predominantly retarded catatonia, frequent previous catatonic episodes, indicating a recurrent course, and high rates of concomitant brain structure alterations. However, ECT was a very effective treatment for catatonia in this patient group that was resistant to benzodiazepines.

Objective Stress-related sleep reactivity, sleep-related cognitions, and psychological factors play an important role in insomnia. The aim was to investigate their possible association in Insomnia Disorder, insomnia subgroups, and healthy subjects. Methods The cross-sectional study consisted of 93 subjects who met diagnostic criteria for Insomnia Disorder according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and of 30 healthy subjects. Survey instruments included the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Ford Insomnia Response to Stress Test (FIRST), Dysfunctional Beliefs about Sleep scale (DBAS), Beck Depression Inventory (BDI), and Zung Self-Rating Anxiety Scale (SAS). Descriptive statistics, Pearson correlations, χ 2 -test, and multiple linear regression were performed. Results FIRST and SAS best determined the insomnia subjects vs good sleepers (FIRST χ 2 = 109.6, p 0.001, SAS χ 2 = 120.3, p 0.001). FIRST was best predicted by DBAS ( p 0.001), PSQI ( p 0.001), and SAS by PSQI ( p 0.001), ISI ( p 0.05), BDI ( p 0.001). In the sleep onset subgroup FIRST was related to ISI, PSQI, and DBAS and in the combined subgroup with DBAS. In both subgroups SAS was related to PSQI, ISI, and BDI. Conclusions Findings suggest potential implications: (1) among the factors that may contribute to insomnia, stress-related sleep reactivity, and psychological factors, such as anxiety symptoms, may distinguish insomnia subjects from good sleepers; (2) sleep reactivity and sleep-related cognitions seem interrelated, unhelpful beliefs may affect the stress reactivity; (3) psychological factors may influence sleep quality and the severity of insomnia; (4) these important sleep-related variables may have similar associations in insomnia subgroups; they may constitute the core factors for insomnia development and maintenance.

This work would give an overall and up-to-date vision of psychopharmacological and physical strategies of treatment for resistant depression.A PubMed search was done using the keywords "resistant depression treatment", "electroconvulsive therapy", "antidepressants", and the inclusion criteria of adult samples, English, French or Italian languages.Lots of psycho-pharmacological and physical treatment strategies for resistant depression exist; anyway there is no consensus about their indications and efficacy, which appears still unsatisfactory.Further research should move towards the identification of specific clinical picture of treatment resistant depression to develop more efficacious and selective treatment protocols.

Night-time sleep related cognitions have been shown to play a perpetuating role in insomnia. According to the cognitive model of insomnia day time cognitions (i.e. worry, rumination, etc.) may also contribute to it. The aim of this study was to investigate the possible role of daytime sleep-related rumination in Insomnia Disorder (n= 55, mean age 49.7±16.7 years), Obstructive Sleep Apnea Syndrome (OSAS) (n=33, mean age 58.1±10.2 years) and healthy subjects (n=33, mean age 49.8±13.9), using a set of sleep related variables which included the Daytime Insomnia Symptom Response Scale (DISRS), the Dysfunctional Beliefs about Sleep Scale (DBAS), the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Daytime sleep related rumination was higher in insomnia when compared to both OSAS (p