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A case of 'dèlire de nègation' that suddenly appeared in a 43-year-old male is presented. No alteration in regional cerebral blood, as measured by (99m)Tc-HMPAO-SPECT, was found, but (123)I-IBZM-SPECT analysis showed reduced striatal D(2) receptor binding that further decreased after treatment.

Background: Prolactin and cortisol responses to d-fenfluramine challenge of central serotonin are reduced in depressed and suicidal patients. Low serum cholesterol levels are also reported in suicidal behavior. Thus, we examined for a relationship between serum cholesterol and fenfluramine challenge responses in patients with depression and/or attempted suicide. Methods: We studied 12 patients and six controls. Blood was drawn for baseline serum cholesterol and the d-fenfluramine challenge test performed. Results: Serum cholesterol levels were significantly lower in suicidal patients than in either non-suicidal patients or controls. However, neither the prolactin nor cortisol responses to d-fenfluramine correlated significantly with serum cholesterol levels. Conclusion: No relationship was found between serum cholesterol and these peripheral indices of serotonergic function.

Introduction The scales for the assessment of depressive symptoms, translated and validated in Italian, lacks in the recognition of the psychopathological nuances of the disorder. The Bipolar Depression Rating Scale (BDRS) is a tool specifically built to reflect the characteristics of bipolar depression. Methods Screening criteria: - aged 18–65 years - diagnosis of BD (DSM-IV-TR) (125 patients) or - diagnosis of MDD (DSM-IV-TR) (30 patients) - manifestation of depressive symptoms - no further psychiatric comorbidity on axis I and axis II (including abuse/addiction) - no serious cognitive deficits Psychometric battery: Bipolar Depression Rating Scale (BDRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS). Results The analysis of the BDRS scores, according to the Kolmogorov-Smimov method shows a normal distribution; the α Cronbach's coefficient shows that the the scale, in its Italian version, has considerable validity and reliability (r = 0.82). The factor analysis was verified using the Varimax rotational method: after several tests, we found 2 subscales, one linked to mixed/depressive symptoms and a second related to (hypo)manic symptoms. Conclusions The BDRS is a valid scale for the measurement of depression in patients with Bipolar Disorder, with a notable internal consistency (Cronbach α 0.82), a significant consistency between items/total (Cronbach α from 0.80 to 0.82) and positive correlation with other scales (MADRS r 0.67, p

AimRecent studies suggest an association of affective symptoms with striatal dopaminergic activity in Parkinson's Disease (PD). On the other hand, the psychopathological features of other common Movement Disorders (MD), such as Essential Tremor (ET) and Primary Dystonia, are less explored.We investigated striatal dopamine transporter (DAT) availability and affective symptoms in these three different MD.Materials and methods22 pts with ET, 14 pts with focal dystonia and 34 idiopathic PD pts underwent 123I-FP-CIT SPECT. A control group of 15 healthy subjects was also analyzed.Psychiatric assessment included the HAM-D scale for severity of depression, the HAM-A scale for anxiety levels, the Snaith Hamilton Pleasure Scale (SHAPS) for anhedonia.SPECT was carried out 3 hours after 111 MBq 123I-FP-CIT intravenous injection. Specific 123I-FP-CIT binding in the striatum and striatal subregions was calculated based on ROI analysis.ResultsSignificant reduction of 123I-FP-CIT binding ratios was found only in PD. Spearman's analysis showed an inverse correlation between anxiety and DAT availability in the left striatal regions of both ET and dystonic patients. On the contrary, a significant positive correlation was found in PD subjects.ConclusionThis preliminary study provided evidence for an association between pre-synaptic striatal dopaminergic function of the left hemisphere and anxiety in MD, thus confirming the “transnosologic” relevance of dopaminergic dysfunction.Unexpected findings in PD patients are in contrast with previous results. A down-regulation of DAT could be hypothesized in both ET and dystonic patients. This pattern seems to be concordant with preliminary findings in primary anxiety disorders.

An analysis of the biological mechanisms underlying both aggression and major depression (MD) shows the implication of common features. There is a well known link between MD and hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis. Moreover, the HPA axis dysfunction has been identified as a promising predictor of suicidal behaviours in mood disorders.The aim of the study was to examine the relationship between aggressive behaviour and plasma cortisol levels during a Major Depression Episode (MDE).83 patients (M/F = 43/40; mean age 47,70±14,52) with a Mood Disorder during a MDE have been recruited at the Day Clinic of Psychiatry of the Catholic University in Rome.A blood sample for the determination of plasma cortisol levels was collected before antidepressant treatment. Aggression Questionnaire (AQ) was used to evaluate aggression traits such as Verbal Aggression (VA), Physical Aggression (PA), Anger (A), Hostility (H) and total Aggression score (AQtot). No significant correlation between plasma cortisol levels and VA, A, H or AQtot was found. A positive correlation between PA scores and plasma cortisol levels was reported (r = 0.39; p = 0.007).Physical Aggression underline a risk for subsequent inner-directed violence, including suicidal thoughts and behaviours and it is also associated to a serotoninergic system dysfunction. An abnormal interaction between the HPA mechanisms and serotonergic systems has also been suggested in suicidal behaviours.Our results confirm the importance of further research with more sensitive markers to monitor HPA axis activity (e.g. Dexamethasone/CRH test), serotonergic activity and psychopathological features in depressed patients.