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Introduction: Our 15-years follow-up ReMIND project aims to re-assess an epidemiological and a clinical sample of adults (Wave 3), who were assessed in preadolescence (Wave 1) and adolescence (Wave 2), to evaluate symptoms trajectories and their relationship with genetic/epigenetic data, environmental risk factors and neuroimaging measures. Objectives: Here, we depict preliminary results regarding the epidemiological sample. Methods:Weassessed internalizing and externalizing symptoms in 40 italian subjects (25 F) from general population at three waves (W1 mean age: 12±0,82; W2 mean age: 17±0,88, W3 mean age: 28±1), through the Child Behavior Checklist (W1 and W2) or the Adult Self Report (W3), and perinatal risk factors through a socioanamnestic questionnaire, by a new online platform (MedicalBit). We analyzed symptoms trajectories and their relation with perinatal risk factors through a repeated measures multivariate analysis of variance (rm-MANOVA). Results: rm-MANOVA results show that high number of perinatal risks was significantly associated with higher internalizing symptomatology in preadolescence but not in adolescence and adult life. The mean difference was 8 T-points. The same trend is evident in adolescence but not in adult age (Graph 1). Perinatal risk factors did not have a significant effect on externalizing symptoms at any time point, despite a non-significant trend is evident (Graph 2). Conclusions: Our preliminary results suggest a trend of increased internalizing symptoms from childhood to adulthood and a significant role of perinatal risk factors in pre-adolescence. Further investigations are necessary to better understand symptoms trajectories and the role of biological and environmental factors. [ABSTRACT FROM AUTHOR]

Introduction: Epigenetics hypothesizes a crucial link between postnatal risk factors, individual response to stress, DNA methylation and psychiatric symptomatology changes during life. Objectives: We analyzed methylation within two gene exons: NR3C1 and SLC6A4, which are involved in responses to environmental stressors. We investigated the relationship between methylation, postnatal risk factors and psychopathology assessed by Child Behavior Checklist (CBCL) in our help-seeking sample evaluated in infancy (W1), preadolescence (W2) and adult life (W3). Methods: Postnatal risk factors data were collected at W1 in 205 clinical subjects (156 M, 49 F; age=9,13±1,95). The CBCL scores were collected at W1 and W2 (W2 age=14,52±2,12). Data regarding methylation were collected at W2. At W3 we are also collecting clinical scores. A Spearman correlation coefficient was calculated between methylation percentage and clinical data at W2. The externalizing and internalizing trajectories were evaluated through repeated measure ANOVA with postnatal risk factors (presence/absence) as between-groups factor. Results: Significant associations were found betweenmethylation and internalizing and total clinical scores (Table 1). The rm-ANOVA results showed a significant interaction between the CBCL internalizing score and presence/absence of postnatal risk, with higher internalizing problems in subjects that were exposed to postnatal risk factors. This effect was significant at W2 but not at W1 (Figure 1). Conclusions: Psychopathological symptoms trajectories could depend on epigenetics and early environmental risk factors. Further analyses will address a Linear Discriminant Analysis to proceed to a machine learning oriented approach. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented in response to an article about the observation that depressed patients held delusional beliefs of having AIDS.

Object: Depression 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. Method: We 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. Result: Pregnant 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. Conclusion: Our 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. [Copyright &y& Elsevier]

Objectives: Perinatal 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. Method: 1066 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. Result: The 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%. Conclusion: The 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. [Copyright &y& Elsevier]

Objective: Literature 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 EPDS Method: We 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. Results: The 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. Conclusion: To 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. [Copyright &y& Elsevier]

Introduction: Second generation antipsycotics (SGAs) represent an essential treatment for Psychotic Disorders. However SGAs cause weight gain and metabolic disorders with an unknown mechanism. Objective: The aim of this study is to investigate whether weight gain may be caused by a reduction in resting energy expenditure (REE). Methods: We recruited 34 pazients who received a clinical diagnosis of Bipolar Disorder I, Schizoaffective Disorder or Schizophrenia. Patients were in antipsychotic monotherapy (clozapine, olanzapine or aripiprazole). We measured REE by indirect calorimetry and we calculated theorical REE utilizing LARN and Harris-Benedict (H-B) equation. Results: The difference between the average value of REE measured in patients (1295Kcal/die) and the average value of REE estimated by LARN and H-B equation (1719Kcal/die and 1741Kcal/die) was respectively 423Kcal/die and 445Kcal/die: both the differences resulted statistically significative (p< 0.01). This reduction of REE results in a weight gain of 1,7 kg in a month. Conclusions: It is necessary to inform patients about the side effects of SGAs. Lifestyle counseling and pharmacological assistance, or switching to another antipsychotic are possible strategies. [Copyright &y& Elsevier]

Aims: To investigate the predictive role of any specific (DSM-IV) Anxiety Disorders (AD) on depressive symptoms and Major or Minor Depressive Disorder (MDD, mDD) during early postpartum period. Method: Women (at the 12th-15th gestational week, N=1066) were recruited in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)’. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS), and Axis-I disorders (AD, MDD, mDD) were diagnosed with the Structured Clinical Interview for Axis-I Disorders (SCID-I). Results: Any current AD at baseline (3rd month of pregnancy) was detected in 231 (21.7%). Having at least one current AD, was associated with a greater likelihood of having MDD or mDD during the early postpartum period, even after the adjustment for the confounding factor of having a lifetime history of MDD (RR=3.86 95%CI 1.58-9.42). In particular, women affected by Obsessive Compulsive Disorder (N=17; 1.6%) or Panic Disorder (N=43; 4%) had at higher risk to develop depressive symptoms (EPDS≥13) during the postpartum period than women without these AD (RR=6.9 and 6.7 respectively). As for the risk of developing PPD, the strongest association was found for women with Panic Disorder (RR=7.6 95% CI 2.62-22.0). Conclusions: AD are associated with a greater likelihood to develop depressive symptoms and MDD or mDD during the early postpartum period. Women with current PD have the strongest risk to develop both MDD or mDD and depressive symptoms during early postpartum period compared to other anxiety disorders. [Copyright &y& Elsevier]

Aims: To investigate the predictive role of any specific (DSM-IV) Anxiety Disorders (AD) on depressive symptoms and Major or Minor Depressive Disorder (MDD, mDD) during early postpartum period. Method: Women (at the 12th-15th gestational week, N=1066) were recruited in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)". Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS), and Axis-I disorders (AD, MDD, mDD) were diagnosed with the Structured Clinical Interview for Axis-I Disorders (SCID-I). Results: Any current AD at baseline (3rd month of pregnancy) was detected in 231 (21.7%). Having at least one current AD, was associated with a greater likelihood of having MDD or mDD during the early postpartum period, even after the adjustment for the confounding factor of having a lifetime history of MDD (RR=3.86 95%CI 1.58-9.42). In particular, women affected by Obsessive Compulsive Disorder (N=17; 1.6%) or Panic Disorder (N=43; 4%) had at higher risk to develop depressive symptoms (EPDS≥13) during the postpartum period than women without these AD (RR=6.9 and 6.7 respectively). As for the risk of developing PPD, the strongest association was found for women with Panic Disorder (RR=7.6 95% CI 2.62-22.0). Conclusions: AD are associated with a greater likelihood to develop depressive symptoms and MDD or mDD during the early postpartum period. Women with current PD have the strongest risk to develop both MDD or mDD and depressive symptoms during early postpartum period compared to other anxiety disorders. [Copyright &y& Elsevier]

A large, observational, multinational cross-sectional pharmacoepidemiological study was performed to determine the prevalence of diabetes and other metabolic disorders in patients with schizophrenia receiving atypical antipsychotic drugs in Europe. The study included adult outpatients with schizophrenia (DSM-IV-TR) treated for at least three months by an antipsychotic drug. Patients treated with classical or atypical antipsychotic drugs were recruited into two parallel strata (ratio of 1:3). A fasting blood sample was taken and height, weight, waist and hip circumference and blood pressure measured during a single visit. Biochemical parameters assessed included glucose, insulin, HbA1c, triglycerides, total cholesterol, HDL-cholesterol and apolipoprotein B. 2463 patients (median age: 41.0 years; 54.6% male) were included in twelve countries. Among these, 10.9% of patients were treated for hypertension, 7.1% for a lipid disorder, 0.3% for type I diabetes and 3.5% for type II diabetes. In addition, 26% of untreated patients had dysglycaemia, 67.7% dyslipidemia and 38% had hypertension. 34% of the patients presented a metabolic syndrome. No overall difference was observed in the proportion of patients with glycaemic and lipid disorders between the two treatment strata. Values for weight-related variables were slightly higher in the atypical stratum, whereas hypertension was more frequent in the classical stratum (47.3%) than in the atypical stratum (42.2%). The results of this study emphasise the need for careful follow-up of patients with schizophrenia treated with antipsychotic drugs to detect the occurrence of metabolic disorders. The proportion of patients with glycaemic or lipid disorders was very high and largely underdiagnosed. This study was funded by sanofi-aventis. [Copyright &y& Elsevier]

Introduction: Metabolic side effects of clozapine represent an important treatment limitation. Ziprasidone is a new atypical antipsychotic with low affinity to hystaminergic H1 and adrenergic alpha 1 receptors and few effects on body weight, metabolic parameters and cardiovascular system. Objectives: To confirm the efficacy and tollerability of ziprasidone as adjunctive therapy in Schizoaffective or bipolar patients partially responder to clozapine or with persisting negative symptoms, metabolic syndrome or overweight. Methods: 8 patients with psychotic Bipolar Disorder or schizoaffective disorder were tested with the BPRS, the HAM-D and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels, concomitant treatments, BMI, cholesterol and tryglicerides (in patients at cardiovascular risk) were tested at T0 and T1. Results: Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. Concomitant antipsychotics and mood stabilizers were reduced. Patients at cardiovascular risk showed a reduction of total cholesterol, Cholesterol LDL and triglycerides. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course. Discussion: The adding of ziprasidone consented a better control of metabolic parameters in patients with cardiovascular risk and a reduction of the severity of the disorder. Ziprasidone showed an efficacy on negative and depressive symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 10 to 15% of women experience a clinically significant major depressive episode during pregnancy or the early postpartum period. Objectives: The hypothesis of study is that feelings of anxiety or depression and lack of social support would be an interference issue in the development of maternal antenatal attachment. Aims: The aims of this thesis were: to assess the specific role of antenatal attachment as risk factor for depression,as anxiety symptoms, during pregnancy. Methods: Symptoms of maternal depression were assessed using the 10-item Edinburgh Postnatal Depression Scale. The Post-partum Depression Predictors Inventory-Revised (PDPI-R) was used to identify the risk factors for PPD. Prenatal maternal attachment were assessed using the Maternal Antenatal Attachment Scale (MAAS). Maternal and paternal antenatal attachment scales. Anxiety symptoms were assessed using STAI-Y. Results: Our sample is composed by 456 women: the average of the MAAS total scores at T2 was 76.95±6.3, while at T3, the average is 78.54±6.29. Considering the Quality of Attachment subscale MAAS, at T2, the average is 47.2±3.29, while the T3 is 47.71±2.98. Conclusions: Further studies are needed to replicate our findings and to clarify the role of pre/post natal attachment during pregnancy and its link with Post-Partum Depression in order to identify a specific subgroup of women. Cox, J.L., 1987. Detection of postnatal depression: development of the 10-item EPDS. Br J Psychiatry Condon, J. T, (1997). The correlates of antenatal attachment in pregnant women arranting special attention. [ABSTRACT FROM AUTHOR]

Introduction: In the perinatal period the woman is vulnerable to depression. Major and minor depression presents prevalence rates ranging respectively from 8,5 and 11% during pregnancy and between 6.5% and 12.9% in the first year post-partum. However, only a small percentage of cases are identified and treated, with negative consequences on both the mother and the baby. Objective: To compare two samples of women at the first month postpartum, the first followed since first month of pregnancy and the second evaluated the first time in the first month postpartum, about the symptoms of depression and anxiety. Methodology: We compared two groups of women in the first month postpartum: 271 women followed since 1 st month of pregnancy and 130 women evaluated for the first time in the first month postpartum. We administered: the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Postpartum Depression Predictors Inventory-Revised (PDPI-R) and the Structured Clinical Interview for the Diagnosis of Axis I psychiatric disorders (SCID-I). Results: In the first month postpartum, women followed since pregnancy have a significantly lower depressive symptoms and anxiety, as demonstrated by lower EPDS scores (t=−6,140, p<.001) and STAI scores (t=−4,800, p<.001). Conclusions: Early screening can reduce rates of perinatal psychopathology and allow to identify women most at risk, allowing earlier diagnosis and better treatment management. [ABSTRACT FROM AUTHOR]

Introduction: Psychotic disorders such as schizophrenia and bipolar disorder are complex neuropsychiatric conditions of multifactorial etiology whose diagnosis is currently based solely on clinical interview methodology. Therefore, biomarkers which could improve the current classification and in perspective stratify patients on a biological basis into more homogeneous clinically distinct subgroups, are highly needed. Objectives: We describe here the preliminary data on the application of a protein profiling investigation for the identification of peripheral markers for psychotic disorders, based on a proteomic approach. Aims: To identify serum protein biomarkers in patients with acute phase psychotic disorder compared with anxiety or depressive disorders with no history of psychosis. Methods: Patients were sampled and evaluated by means of SCID-I, PANSS, YMRS, HAM-A, HAM-D. Lymphocytes have been separeted and Two-Dimensional Electrophoresis (2-DE) was carried out on protein extracts. Analysis was performed using Progenesis Same Spot software. Result: 2-DE showed significant differences in protein patterns between the two groups, in particular some protein spots are upregulated in a statistically significant manner and are under identification by mass spectrometry. PCA underlies a clear separation between the two groups, with a t1 value for the first component of 54%. Conclusions: Preliminary analysis of a small sample shows significant differences in protein pattern between acute psychotic patients compared with non-psychotic psychiatric controls. Further work will widen the sample and will identify the single proteins. [ABSTRACT FROM AUTHOR]

Introduction: Anorexia nervosa (AN) is a mental health 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 resulting in low levels of gonadotropins and estrogens, secondary amenorrhea, bone loss and/or osteoporosis. Bone reabsorption is related with the exposure to low levels of estrogens leading to an increased risk of bone fractures as it happens in late postmenopausal period and young women with AN may develop a risk for pathological fractures comparable to that of menopausal women. Objective: In our case report series we examined the influence of AN related amenorrhea on bone mineral density (BMD). Methodology: We evaluated BMD with computerised bone mineralometry (CBM) in 10 women with diagnosis of AN, hospitalized in the Psychiatric Clinic of University of Pisa. Results: All the patients showed a lumbar and femoral bone loss or osteoporosis with an increased fracture risk in comparison with peers and comparable to that of menopausal women. Conclusions: Our data support the hypothesis that lower estrogenic levels associated with AN have an impact on BMD. Although osteoporotic complications and fracture risk are underdiagnosed, underestimated and potential cause of permanent disability is a predictable and treatable condition in AN patients. Therefore we recommend a more accurate evaluation of BMD with CBM in all patients with prolonged amenorrhoea. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence and clinical correlates of dissociative symptoms in general, and depersonalization (DP) in particular, in patients with mood disorders have received limited attention in the literature1. Thus, the aim ofour study is to evaluate the association between depersonalization symptoms and mood dimensions in a sample of unipolar (UD) and bipolar (BD) patients. Method: 185 patients (95 BD and 90 UD) in eutimic phase (evaluate with YMRS and HDRS) are assessed with: SCID-P for axis I diagnosis, HDRS, YMRS, MOOD-SR-lifetime version2 and SCI-DER. Results: through a regression analysis we underline in UD patients that the presence of depersonalization symptoms is significantly associated with the following mood dimensions: psychomotor retardation (p=0.031; B=2,197), mixed irritability (p=0.035; B=2,137) and social extroversion (p=0.028; B=-2,229). We found no significat association in the group of BD patients. Conclusion: In UD patiens, the presence of depersonalization symptoms must carefully consider. Further research are needed to identify specific clinical endophenotypes3. [ABSTRACT FROM AUTHOR]

Introduction: Impulsivity is a core feature of bipolar disorder (BD). The best definition of impulsivity is the predisposition to have rapid and unplanned reactions to internal and external stimuli without regard to the negative consequences of these actions to the impulsive individual or others. Thus, the aim of our study is to investigate the relationship between impulsivity, panic disorder (PD) comorbidity and panic spectrum symptoms in patients with BD. Method: 247 eutimic patients were assessed with SCID-P, MOOD-SR, PAS-SR. Impulsivity dimension was defined on the basis BIS Scale score (version 11). Results: A backward stepwise logistic regression in bipolar patients with PAS explained score statistically much higher for impulsivity (pas +6.09 vs pas - 3.88 p<001) and the difference is statistically significant stratifing for BD. A stepwise linear regression, corrected by age and gender, displayed significantly statistical correlation with impulsivity score and PAS-SR by cut-off 35 (OR=1.210). Conclusions: In our sample BD eutimic patients explained score statistically much higher for impulsivity. This data confirm the presence of the trait impulsivity in BD eutimic patients. BD patients with a comorbid anxiety disorder seem to display significant higher levels of impulsivity when compared to patients without an anxiety disorder. Impulsivity was linked with atypical panic like symptoms more with PD diagnosis. Results suggest the presence of specific bipolar disorder endophenotipe. Further neurobiologies studies are needed to elucidate the implications and reasons of this association. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study is to evaluate, in a sample of bipolar (BD) eutimic patients, the association between depersonalization symptoms, facial emotions expression recognition and affective temperament. Method: 95 bipolar eutimic patients (YMRS<6 and HDRS<8), are assessed with: SCID-P, TEMPS, SCI-DER1 e POFA (test of recognitionof facial emotions expression by Ekman e Friesen). Results: Throught a regression analysis we underline that, independently to panic disorder, the ipertimic temperament is associated with: major recognition of happiness (p<0.001; β=-4,483) and minor recognition of anger (p=0.005; β=3,202) in BD patients with high scores in autopsychic depersonalization domain; major recognition of sadness (p=0.001; β=-3,944) and minor recognition of anger (p=0.005; β=3,181) in BD patients with high scores in affective depersonalization domain. Moreover, the cyclotimic temperament is associated with: major recognition of surprise (p=0.004; β=-3,233) and happiness (p=0.044; β=-2,124) in BD patients with high scores in Derealization (DER-TOT); major recognition of surprise (p=0.001; β=-3,792) and happiness (p=0.018; β=-2,532) in BD patients with high scores in somatopsychic depersonalization domain. Conclusion: The presence of depersonalization and derealization symptoms is associated with a selective deficit in the recognition of several emotions. In bipolar patients this selective deficit is dependent of type of affective temperament. Further research is warranted to replicate our clinical observation. [ABSTRACT FROM AUTHOR]

Introduction: There is a strong association between depersonalization (DP) and panic disorder (PD), as documented by Roth (1960) and later by Cassano (1989)1. In the PD is shown a prevalence of 7.8% to 82.6% from the DP. The aim of our study was to evaluate the association between depersonalization symptoms and PD in a sample of patients with anxiety disorders and mood. Method: a sample of 310 patiens was assessed with: SCID-P for axis I diagnosis and SCI-DER (structured clinical interview for depersonalization and derealization symptoms, lifetime version)2. Results: Through a linear regression analysis we underline that, the presence of depersonalization symptoms, irrespective of age, gender and mood disorder, is significantly associated with the PD diagnosis (total score SCI-DER Tot p=0.001; derealization p=0.001; somatopsychic depersonalization p=0.001; autopsychic depersonalization p=0.003; affective depersonalization p=0.047). Conclusion: the presence of depersonalization symptoms must carefully assess in clinical setting and suggest the presence of panic disorder. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive 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. Methods: Attention, 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. Results: No 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. Conclusions: No 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. [Copyright &y& Elsevier]

Background: To 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., Methods: A 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)., Results: Sixty-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., Conclusions: Path 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.

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 examine the predictors of aggressive behaviours occurring before acute hospitalisation., Methods: We analysed 350 acute admissions to a psychiatric ward during a 12-month period. The diagnoses were formulated according to the DSM IV axis I and II criteria. Aggressive behaviours occurring in the week before admission were retrospectively assessed using the modified overt aggression scale. The patients' clinical and sociodemographic variables, concurrent drug or alcohol abuse, and admission status were recorded at the time of admission., Results: Aggressive and violent behaviours were highly prevalent, respectively, in 45% and 33% of the cases. Violence before admission was independently associated with drug abuse, involuntary admission status, and severe psychopathology. A diagnosis of a psychotic disorder did not increase the risk of aggression or violence, compared to the other psychiatric diagnoses. Personality disorders were significantly more associated to aggressive behaviours than psychotic disorders., Conclusion: The diagnosis of psychotic disorder is a poor predictor of aggression in a sample of psychiatric patients. Other clinical and non-clinical variables are associated to aggression before hospitalisation: they include drug abuse, involuntary admission status, general severity of symptoms, and diagnosis of personality disorder.

Objective: Research on adolescent adjustment disorder (AD) is scarce. We characterized adolescent outpatients with AD in psychosocial background and treatment received compared with patients with other non-psychotic disorders (OND). Furthermore, we explored precipitant stressors, distress symptoms and behavioral problems among males and females with AD., Method: Data were collected prospectively on 290 consecutive psychiatric outpatients, aged 12-22 yrs, at a secondary care clinic in Finland. DSM-III-R diagnoses were assigned, based on all available information, at the end of treatment., Results: AD was the second most common diagnosis among non-psychotic patients (31% of 290). Compared to OND-patients, those with AD were predominantly female and had less severe psychosocial impairment. In multivariate comparisons school-related stressors, problems with law and restlessness characterized males, and parental illness and internalizing symptoms females with AD. Intensity and duration of treatment of AD-patients varied widely., Conclusions: Adjustment disorder comprised a common clinical entity among adolescent outpatients. Psychiatric assessment and treatment should be individually targeted by taking into account gender-specific stressors and distress symptoms among young people with AD.

Social phobia (SP) has onset during early adolescence, and is associated with significant impairment in social and educational functioning of adolescents. Therefore, valid and easy-to-use tools for screening and identification of SP among adolescent community populations are needed. We investigated both construct and discriminative validity, and screening properties of the 17-item Social Phobia Inventory (SPIN) relative to SP diagnoses based on a semi-structured clinical interview (K-SADS-PL), in a sample of 752 12 to 17-year-old Finnish students from general population. The SPIN demonstrated good properties to differentiate adolescents with SP and those with sub-clinical SP symptoms (SSP), from adolescents without SP. The SPIN also differentiated adolescents with SP from those with depressive and disruptive disorders. In this sample 27% of participants scored above the previously suggested SPIN cut-off (15 points) for adolescent SP. We suggest using a somewhat higher cut-off score, 24 points, when using the SPIN as a screen for SP in general adolescent populations. This cut-off score resulted in a sensitivity of 81.2%, a specificity of 85.1%, a positive predictive value of 26.9%, and a negative predictive value of 98.6% in relation to the SP diagnosis in our sample. To screen for both SP and SSP, 19 points as a cut-off score produced satisfactory diagnostic efficiency statistics. The SPIN appears to have good properties for screening and identification of adolescent SP.

Purpose: This open label study was performed to evaluate the relationship between the plasma concentration of olanzapine and the response in acute schizophrenic inpatients., Material and Methods: A total of 54 inpatients, 38 males and 16 females, age ranging from 18 to 75 years, affected by Schizophrenia (DSM IV criteria) during an exacerbation phase were included in the study. Olanzapine (OLZ) was started at a dose of 5-20 mg/day and was increased to a mean dose of 15.27 mg +/-5.53 S.D. Patients were evaluated at baseline, and after 2 weeks, by using BPRS, PANNS, HRS-D, EPSE, and ACS., Results: BPRS and total PANSS showed a statistically significant improvement at the end of the study. Olanzapine plasma levels (PL) ranged from 5 to 120 ng/ml (mean 33.15 ng/ml +/- 28.28 S.D.) and showed a positive correlation with OLZ dosage. A significant curvilinear correlation between OLZ PL and clinical improvement (BPRS, PANSS and HRS-D percent of amelioration) was observed., Conclusion: Olanzapine plasma level determination seems to be a useful tool in optimizing acute treatment particularly for more problematic cases.

Adduction arytenopexy was designed as an innovation to arytenoid adduction, however the pragmatic issues regarding patient selection for these procedures has not been comprehensively assessed. A prospective examination was performed on 100 consecutive patients who had undergone laryngoplastic phonosurgical reconstruction for paralytic dysphonia. Seventy-seven of 100 (77 per cent) were judged pre-operatively to gain potentially significant phonatory enhancement from an arytenoid procedure. Fifty-six of 77 (73 per cent) underwent adduction arytenopexy; 17 of 77 (22 per cent) were judged pre-operatively to have inadequate respiratory abduction of the contralateral arytenoid and two out of 77 (three per cent) had athletic aerodynamic requirements. In another two out of 77 (three per cent), there was a chance of favourable reinnervation and thus it was not the preferred method. The majority of patients were judged pre-operatively to gain potentially substantial phonatory enhancement from an arytenoid procedure. However, in this series, approximately 25 per cent of the patients were considered to be unsuitable candidates for an arytenoid medializing procedure, primarily because it was deemed that the operation could result in an inadequate airway.

Twenty-four chronic schizophrenic outpatients with a mean age of 37.21 years +/- 9.96 SD were treated with risperidone (RSP) at the dosage of 2-9 mg/die (mean 4.46 mg/die +/- 1.30 SD, mean 0.06 mg/kg +/- 0.01 SD) for a year. Clinical evaluation was assessed with the Brief Psychiatric Rating Scale (BPRS), Positive and Negative Symptoms Scale (PANSS), Extrapyramidal Side Effects Rating Scale (EPSE) and a checklist for Anticholinergic Side Effects (ACS) at T0, then after 1 (T1), 2 (T2), 3 (T3), 6 (T6), 9 (T9) and 12 (T12) months. RSP and 9-hydroxy-risperidone (9OH-RSP) plasma levels were determined at T12 by the HPLC method. BPRS and PANSS mean values showed a significant improvement during the study. No correlation between RSP dosage (mg/kg) and RSP, 9OH-RSP plasma levels or active moiety resulted. A positive correlation between age and active moiety was observed. A positive correlation between RSP and 9OH-RSP plasma levels was observed. A curvilinear relationship between active moiety and PANSS improvement (%) was observed. Patients with the higher PANSS amelioration showed RSP + 9OH-RSP plasma levels ranging from 15 to 30 ng/mL. RSP seems to be quite an effective drug. It seems, however, difficult to devise appropriate dose schedules and plasma level determination seems to be necessary in some cases.