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Introduction Executive function (EF) deficits are often associated with Autism Spectrum Disorder (ASD), even in the absence of Attention Deficit Hyperactivity Disorder (ADHD) diagnosis. To date, no approved medication treatments exist for EF deficits associated with ASD. Objectives To assess the efficacy of transcranial photobiomodulation (tPBM) on EF in adults with ASD. Methods Adults (18-59) with high-functioning (HF)-ASD received twice a week tPBM for 8 weeks in an open-label single group design. ASD and EF deficits were assessed by clinician-rated Clinical Global Impression Scale and patient-rated scales of Behavior Rating Inventory of Executive Function-Adult (BRIEF-A). Results Eleven participants were enrolled. Ten participants completed the study. Nine participants who completed the study had comorbid ADHD diagnosis. All 10 participants were included in efficacy analyses of EF deficits. Statistically significant improvements in executive function deficits were found in BRIEF-A total score and in subdomains of Inhibition, Emotional Control, Planning and Organization, Organization of Materials, Behavioral Regulation, Metacognitive Index and Global Executive Control. All participants were found to have mild to moderate improvement in their ADHD symptom severity per clinician rated CGIs. Statistically significant improvements in ADHD symptoms were noted in self-rated scales. No adverse events required changes in tPBM protocol. Conclusions tPBM is a safe and feasible treatment approach that has the potential to treat core features of ASD. Further research is necessary and warranted. Disclosure This work is funded by Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder and the MGH Pediatric Psychopharmacology Council Fund.

Background. – The cross-sectional clinical differentiation of schizophrenia or schizoaffective disorder from mood-incongruent psychotic mania or mixed mania is difficult, since pathognomonic symptoms are lacking in these conditions.Aims of the study. – To compare a series of clinical variables related to mood and cognition in patient groups with DSM-III-R diagnosis of schizophrenia, schizoaffective disorder, mood-incongruent psychotic mania and mood-incongruent psychotic mixed mania.Methods. – One hundred and fifty-one consecutive patients were evaluated in the week prior to discharge by using the structured clinical interview for DSM-III-R-patient edition (SCID-P). Severity of psychopathology was assessed by the 18-item version of the brief psychiatric rating scale (BPRS) and negative symptoms by the scale for assessment of negative symptoms (SANS). Level of insight was assessed with the scale to assess unawareness of mental disorders (SUMD).Results. – There were no differences in rates of specific types of delusions and hallucinations between subjects with schizophrenia, schizoaffective disorder, psychotic mania and psychotic mixed mania. SANS factors scores were significantly higher in patients with schizophrenia than in the bipolar groups. Patients with mixed state scored significantly higher on depression and excitement compared to schizophrenia group and, to a lesser extent, to schizoaffective group. Subjects with schizophrenia showed highest scores on the SUMD indicating that they were much more compromised on the insight dimension than subjects with psychotic mania or mixed mania.Conclusion. – Negative rather than affective symptomatology may be a useful construct to differentiate between schizophrenia or schizoaffective disorders from mood-incongruent psychotic mania or mixed mania.

In the course of the international development of tianeptine (T), depressed patients were recruited by 18 centres from Belgium, Italy, Mexico, Portugal, Spain and Switzerland in a double-blind parallel group study versus placebo (P) and imipramine (I). Efficacy and safety of tianeptine were evaluated in 187 depressed inpatients (56% female, 44% male), who fulfilled criteria for either major depression, single episode (24.6%) or recurrent (66.8%), or depressed bipolar disorder (8.6%). After a seven-day run-in placebo pre-inclusion period, patients were treated in double-blind conditions with tianeptine (37.5 mg/d) or imipramine (150 mg/d) or placebo for 14 days, including an increasing daily dose period of three days. After the fourteenth day and until the end of the sixth week of treatment, a flexible dosage was introduced in accordance with the therapeutic efficacy and/or the potential adverse events (T: 25-50 mg/d; I: 100-200 mg/d; P; 2-4 capsules). Discontinuation of treatment occurred in 57 patients (30.5%) with more inefficacy on placebo and tianeptine (P: 16/23; T: 11/17; I: 7/17), and more side-effects on imipramine (P: 1/23; T: 1/17; I: 7/17). Final MADRS scores in intention-to-treat analysis were 22.3 +/- 1.5, 17.3 +/- 1.6 and 18.4 +/- 1.5 for placebo, tianeptine and imipramine, respectively. Statistical analysis demonstrated the antidepressive efficacy of tianeptine and imipramine versus placebo (P = 0.012 and P = 0.034, respectively), and no difference between tianeptine and imipramine. In patients treated for 42 days (n = 129) the MADRS scores dropped from 62.3% on tianeptine, 54.2% on imipramine and 48.5% on placebo. These results confirmed the efficacy of tianeptine (37.5 mg/d) in the treatment of major depression and depressed bipolar disorder when compared to placebo. No difference was found between tianeptine and imipramine (150 mg/d) for the efficacy and between tianeptine and placebo for all safety criteria. The following adverse events were significantly more frequent with imipramine than with tianeptine or placebo: dry mouth (P < 0.001), constipation (P = 0.007), and hot flushes (P = 0.011). No difference in adverse events was found between tianeptine and placebo. While the usual cardiovascular signs of tricyclic antidepressants were observed in the imipramine group, no difference between tianeptine and placebo was shown in respect to heart rate or blood pressure (supine or standing). The assessment of haematological, renal, metabolic and hepatic parameters confirmed the safety of tianeptine.

SummaryThe monoamine hypothesis of depression and its direct derivation, the receptor theory, have constituted for several years a frame of reference for researchers working in the field of biological psychiatry. Although most of the data are derived from animal findings and must be considered inconclusive in view of various controversies, some guidelines may be identified: these would suggest that changes in postsynaptic beta-adrenoreceptors, presynaptic alpha 2-adrenoreceptors, as well as in type 2 serotonin receptors and dopaminergic autoreceptors may be involved in the mode of action of antidepressant drugs and, consequently, in the pathophysiology of depression. Nowadays, any attempt to correlate depression with the dysfunction of a single neurotransmitter or receptor is no longer tenable, since it is clear that depression is a heterogeneous disorder which involves abnormalities in the interactive relationships between neurotransmitters and receptors. If, on the one hand, this new model has opened up new fields of research and has led to the investigation of new systems,egthe GABAergic and GABA B receptors, on the other hand, it has been strongly limited by the lack of research tools and reliable peripheral CNS models forin vivostudies. A possible approach to this unresolved dilemma may be provided by molecular biology techniques, which have permitted the identification of the genes and sequencing of the primary structure of several membrane receptors. It is now established that receptors may be grouped into four superfamilies; in depression, there exists compelling evidence of alterations mainly in receptors belonging to the G-protein-coupled family: it is plausible that depression may be related to a disorder of the G-protein-coupled receptor superfamily. Such an hypothesis would represent an attempt to unify the different receptor abnormalities found in depression or following antidepressant treatments, and to shift from the monoamine paradigm to a new heuristic model. In addition, it would accommodate the various dysfunctions likely to be encountered and would open up new theoretical perspectives in the treatment of depression.

SummaryThe interest in social adjustment of psychiatric patients has increased since potent therapeutic strategies have become available, allowing patient treatment within their natural social habitat. DSM III has formally recognized the need to evaluate social variables for each patient, introducing Axis V into its multiaxial system. This is of particular relevance for personality disorders where the main pathology is manifested within the social context. In this study, 94 patients with a DSM III-R diagnosis of Panic Disorder, Major Depression, and Generalized Anxiety Disorder have been evaluated with PDE (Personality Disorders Examination) to detect the presence of DSM III personality disorders, and with SAS (Social Adjustment Scale) to assess social adjustment. Results have shown that both Axis I and Axis II diagnoses affect social adjustment, though in a slightly different manner.

SummaryIn an attempt to better delineate demographic and clinical characteristics of mild chronic depressions, 46 outpatients fulfilling DSM III-R criteria for dysthymia were compared with patients suffering from a chronic major depressive episode. The profile obtained from our dysthymic sample matches with those reported by other authors. The comparison between “minor” and major chronic depression was also carried out by subdividing these latter into unipolar - recurrent and single episode - and bipolar depression. Dysthymics showed a bipolar family history closer to that of bipolar chronic major depressives which was significantly higher than that recorded in the other sub-categories.

ObjectivesPerinatal depression is a particolar challenge to clinicians, and its prevalence estimates are difficult to compare across studies. Furthermore,there are no studies that systematically assessed the incidence of perinatal depression. The aim of this study is to estimate prevalence, incidence, recurrence and new onset of DSM IV minor and major depression (mMD) in an unselected population of pregnant women.Method1066 pregnant women were recruited at third month of pregnancy (T0), and minor/major depression (mMD) was assessed by the Structured Clinical Interview for DSM IV disorders (SCID I). The SCID I was administered at baseline evaluation (T0), the Edimburgh Postnatal Depression Scale (EPDS) was administered at third, 6th (T1), 8th (T2) month of pregnancy, and the SCID I Mood module was administered to confirme an eventual DSM-IV minor or major depression diagnosis when the EPDS score was≥13.ResultThe pregnancy period prevalence of mMD was 12,4%.The point prevalence of mMD decreased from 8,6% at the 3rd month of pregnancy to 1,7% at the 8th month of pregnancy.The cumulative incidence of mMD was 2,2%. The weighted incidence of new onsets during pregnancy was 1,6%. The weighted percentage of recurrences during pregnancy was 3,7%.ConclusionThe decline in the point prevalence during the second and third trimester of pregnancy found in our study may be attributed to psychological counselling and/or pharmacological treatment.Further studies about new onsets of depression during pregnancy are highly important in order to improve clinical prediction of risk in any individual woman.

ObjectDepression during pregnancy is associated to physical symptoms that can impair the functioning of women; furthermore some of the depression somatic symptoms (i.e., sleep disturbance, fatigue, weight change and appetite) are also features of pregnancy. The overlap of symptomatology can interfere with the identification and the diagnosis of the mood episode. Aim of this study is to compare the the depressive phenomenology and the presence of Axis I comorbidity between pregnant and non pregnant depressed women.MethodWe diagnosed Major Depression (MD) using the Structured Clinical Interview for Axis I Diagnosis DSM IV (SCID I) in 32 pregnant women at third month of pregnancy and 87 non pregnant women and we compared the depressive phenomenology in the two groups. Then we administered the Mood Spectrum Self Repost Last Month (MOOD SR-LM) in the two group in order to study the mood spectrum symptomatology.ResultPregnant depressed women have higher psychomotor retardation, higher levels of concentration and lower agitation than non pregnant depressed women.The severity of depression symptoms was similar in the two depressed groups.ConclusionOur results agree with current litterature about the presence of psychomotor retardation in depressed pregnant women.The higher level of concentration in pregnant women could be explained by the high comorbidity with Generalized Anxiety Disorder (GAD). In the pregnant depressed women the Obsessive-Compulsive Disorder (OCD) and Panic Disorder (PD) comorbidity are more rappresentated.

ObjectiveLiterature underlines that the Edinburgh Postnatal Depression Scale (EPDS) was the most common measure to assess pregnancy and postpartum depression worldwide and suggests that the rate of false positive cases is high. Furthermore, the EPDS measures, but not distinguish between depression and anxiety. The aim of this study was to value the ability of the Mood Spectrum Self Report Last Month (MOOD SR LM) to detect the rate of false positive obtained with EPDSMethodWe recruited 81 pregnant women at the third month of pregnancy. 32 women were affected by Major Depression (MD) assessed by Structured Clinical Interview for DSM IV Axis I Diagnosis and 49 women had EPDS score ≥ 13 but didn’t reach the diagnosis of MD by SCID I(False posivite group). Women were administered with the Postpartum Depression Predictors Inventory-Revised (PDPI-R), MOOD SR-LM, Work and Social Adjustment Scale(WSAS) at the third month of pregnancy.ResultsThe two groups wasn't different concerning the average scores using PDPI and EPDS. The WSAS average scores were higher in the depressed women group than in the false positive group. Tree factors of MOOD SR LR (“Depressive Mood”, “Psychomotor Retardation and “Drug/Illness related Depression”) had higher average scores in the depressed women group than in the false positive group.ConclusionTo our results, MOOD SR LM seem to be able to decrease the false positive cases. Further studies concerning this use of MOOD SR LM are necessary.

ObjectivesCognitive impairment in patients with eating disorders was reported by the majority of studies addressing this issue. However, heterogeneous patterns of cognitive dysfunctions were observed and, in a minority of studies, no impairment was found. The present study was 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.MethodsAttention, executive control, conditional and incidental learning were evaluated in 83 untreated female patients with BN and 77 healthy controls. Cortisol and 17β-estradiol plasma levels were assessed. Cloninger's Temperament and Character Inventory-Revised (TCI-R), the Eating Disorder Inventory-2 and the Montgomery-Asberg Depression Rating Scale were administered.ResultsNo impairment of cognitive performance was found in subjects with BN vs. healthy controls. The higher the cortisol level and “Self-directedness” scores the better the performance on conditional learning, while 17β-estradiol levels showed an opposite pattern of association; “Reward dependence” scores were associated to a worse performance on incidental learning; depressive symptomatology negatively influenced the performance on the WCST.ConclusionsNo cognitive impairment was found in untreated patients with BN in the explored cognitive domains. An influence of neuroendocrine, personality and clinical variables on neurocognitive functioning was found, which might explain discrepancies in literature findings.

IntroductionOur study aims to assess the prevalence of behavioural addictions in an adolescent populations, evaluating the effects of gender and age, and to assess the correlations and associations between different behavioural addictions.MethodsA population of 2853 students (1142 F and 1711 M, mean age 16.7± 1.9) was assessed in order to evaluate the prevalence of behavioural dependences such as Pathological Gambling (PG), Compulsive Buying (CB), Exercise Addiction (EA), Internet Addiction (IA), and Work Addiction (WA). The South Oaks Gambling Screen-Revised Adolescent, the Compulsive Buying Scale, the Exercise Addiction Inventory, the Internet Addiction Test, and the Work Addiction Risk Test, were compiled anonymously by the students.ResultsOverall prevalence was 7.0% for PG, 11.3% for CB, 1.2% for IA, 7.6% for WA, 8.5% for EA. PG, and EA were more common among boys, while gender had no effect on the other conditions. CB was more common among younger (< 18 years old) students. Each of these conditions showed a strong association with others, and the scores of all of these scales were correlated.DiscussionIn line with previous studies our results indicate that behavioural addictions are quite common among adolescents. The strong association between behavioural addictions stresses the concept that treatment for one of these conditions should involve assessment and treatment for the others.

Background and Aims:Mental disorders occurring in pregnancy need attention and specifically targeted treatments; if untreated, they may have severe consequences, for the woman, for her family, and mostly for the newborn. The woman is at higher risk for suicide; she may increase tobacco, alcohol and substances use, and may frequently develop postpartum depression (Halbreich, 2004).We aimed to describe the prevalence of Axis I disorders (DSM IV-TR criteria) at the 3rd month of pregnancy in a large non-clinical sample of women.Methods:Women between the 12th and the 15th gestational week were enrolled. A total of 1066 subjects (49.9%) of those eligible (N=2138) signed an informed consent and completed the baseline interview. Standard demographic information were collected and Axis I diagnoses were performed using the SCID-I (First et al, 1995).Results:Mean age was 32.3 years (±3.9); 280 women (26.3%) had a current Axis I Disorder. Mood and anxiety disorders were the most frequent current diagnoses: Major Depressive Episode (N=34;3.2%); Minor Depression (N=45;4.3%); Specific Phobia (N=114; 10.7%); Panic Disorder (N=43; 4%); Social Phobia (N=41; 3.8%); Obsessive-Compulsive Disorder (N=17; 1.6%); Anxiety Disorder NOS (N=29; 2.7%); Generalized Anxiety Disorder (N=20; 1.9%). Current comorbidity between depressive and anxiety disorders was present in 38 women (3.6%).Conclusions:The sample size and the administration of the SCID, that provides more complete and reliable information about lifetime and current psychiatric history, than instruments used in previous similar studies (Andersson et al., 2003; Spitzer et al., 2000), represent major strengths of the study.