Search

BackgroundCognitive dysfunction (CD) and mood disorders (MD) are among the most frequent neuropsychiatric (NP) events in Systemic Lupus Erythematosus (SLE), but their pathogenesis has not been clarified yet. Until now, an unquestionable correlation between the presence of specific autoantibodies, brain alterations and the presence of CDs and MDs in SLE is lacking.ObjectivesThe primary aim of the study was to explore the effects of anti-NR2 (anti-DWEYS) and anti-ribosomal-P (anti-P) antibodies on CDs and MDs and their relation with functional brain connectivity in patients affected by SLE.MethodsA cross-sectional study was conducted, between April 2019 and February 2020, including adult patients who fulfilled the ACR/EULAR 2019 SLE criteria.Demographics, ongoing medications, SLEDAI and SLICC/Damage Index were recorded. Serum level quantification for anti-P (normal values ResultsThirty-three SLE patients (9% male) were enrolled, mean age 43.5 (+-14) years, and median disease duration of 10.4 years (IQR 2.9-25.4) (Table 1). Anti-P were positive (range 0-255 U/ml) in 6 patients (18.2%) and anti-DWEYS (range 0-1.8 OD) in 14 (42.4%). Nineteen out of 33 patients (57.6%) showed at least a cognitive test alteration, but no significant association with antibodies was found. Depression was found in 14 (42.4%) patients using the Center for Epidemiologic Studies Depression Scale (CES-D) as screening instrument. In multiple regression backward models, after correction for age, disease duration, SLEDAI and SDI, the CES-D showed an independent association with anti-P titre (β= 0.32 per U/ml; p=0.049) and prednisone daily dose (β=0.38 per mg/day; p=0.023). The rs-fc MRI analysis revealed a statistically significant association between the titre of anti-P and many altered properties of the brain ROIs (Figure 1), but no effects of PDN daily dose on specific cerebral networks.Table 1.Demographic and clinical characteristics of the patients in total, Legend: PDN: Prednisone; LLDAS: Lupus Low Disease Activity State; OD: Optical densityDemographic and clinical characteristics of the participants(N=33)Age, years mean (DS)43.5 (14.0)Gender (M, %)3 (9%)Disease duration, months median (IQR)124.4 (34.7-305)SLEDAI-2k mediane (IQR)4 (0-14)Dose PDN mg/daily median (IQR)6.4 (3.8-13.5)LLDAS N, %12 (36,4%)SLICC-DI mediane (IQR)0 (0-1)Ongoing treatment25 (75.8%)Hydroxychloroquine30 (90.9%)Immunosuppressive9 (27.3%)BiologicsEducation less than 8 years13 (39.4%)Anti-Rib-P N, %6 (18.2%)Anti-Rib-P (U/ml) mean (DS)10.9 (5.7-13.3)Anti-DWEYS N, %14 (42.4%)Anti-DWEYS (OD) mean (DS)0.4 (0.25-0.67)Anti-phospholipids N, %11 (33.3%)anti-dsDNA N, %18 (54.5%)anti-dsDNA Titre mediane (IQR)22.5 (2.9-74.5)Figure 1.Results of rs-fc MR Analysis 1 (effects of Anti-rib-P titre) on cerebral networks. The regions with decreased and increased property are shown in blue and red nodes, respectively (p< 0.01). The node size represents the significance of the between-group differences in the nodal degree.ConclusionAnti-P antibodies are associated with depressive symptoms and changes of brain network properties in SLE patients, which add knowledge on their pathogenetic effect.Disclosure of InterestsNone declared

Bipolar disorder (BD) is a severe disorder, and it is associated with an increased risk of mortality. About 25% of patients with BD have attempted and 11% have died by suicide. All these characteristics suggest that the disorders within the bipolar spectrum are a crucial public health problem. With the development of molecular genetics in recent decades, it was possible to more easily detect risk genes associated with this disorder. This study aimed at summarizing the findings of systematic reviews and meta-analyses on the topic and assessing the quality of the available evidence.PubMed/Medline and Web of Science were searched to identify systematic reviews and meta-analyses published during 2013-2019. Standard methodology was applied to synthesize and assess the retrieved literature.This systematic review identifies a number of potential risk genes associated with bipolar disorder whose mechanism of action has yet to be confirmed. They are divided into several groups: 1) a list of the most significant susceptibility genetic factors associated with BD; 2) the implication of the ZNF804A gene in BD; 3) the role of genes involved in calcium signaling in BD; 4) DNA methylation in BD; 5) BD and risk suicide genes; 6) susceptibility genes for early-onset BD; 7) candidate genes common to both BD and schizophrenia; 8) genes involved in cognitive status in BD cases; 9) genes involved in structural alteration in BD brain tissue; 10) genes involved in lithium response in BD.Future research should concentrate on molecular mechanisms by which genetic variants play a major role in BD. Supplemental research is needed to replicate the applicable results.

Influenza virus infections (IVI) may pose a vital threat to immunocompromised patients such as those suffering from malignancies, but specific data on epidemiology and outcome in these patients are scarce. In this study, we collected data on patients with active cancer or with a history of cancer, presenting with documented IVI in eight centres in Germany. Two hundred and three patients were identified, suffering from haematological malignancies or solid tumours; 109 (54 %) patients had active malignant disease. Influenza A was detected in 155 (77 %) and Influenza B in 46 (23 %) of patients (genera not determined in two patients). Clinical symptoms were consistent with upper respiratory tract infection in 55/203 (27 %), influenza-like illness in 82/203 (40 %), and pneumonia in 67/203 (33 %). Anti-viral treatment with oseltamivir was received by 116/195 (59 %). Superinfections occurred in 37/203 (18 %), and admission on an intensive care unit was required in 26/203 (13 %). Seventeen patients (9 %) died. Independent risk factors for death were delayed diagnosis of IVI and bacterial or fungal superinfection, but not underlying malignancy or ongoing immunosuppression. In conclusion, patients with IVI show high rates of pneumonia and mortality. Early and rapid diagnosis is essential. The high rate of pneumonia and superinfections should be taken into account when managing IVI in these patients.

Objective: To explore whether the climate has played a role in the COVID-19 outbreak, we compared virus lethality in countries closer to the Equator with others. Lethality in European territories and in territories of some nations with a non-temperate climate was also compared. Materials and Methods: Lethality was calculated as the rate of deaths in a determinate moment from the outbreak of the pandemic out of the total of identified positives for COVID-19 in a given area/nation, based on the COVIDJohn Hopkins University website. Lethality of countries located within the 5th parallels North/ South on 6 April and 6 May 2020, was compared with that of all the other countries. Lethality in the European areas of The Netherlands, France and the United Kingdom was also compared to the territories of the same nations in areas with a non-temperate climate. Results: A lower lethality rate of COVID-19 was found in Equatorial countries both on April 6 (OR=0.72 CI 95% 0.66-0.80) and on May 6 (OR=0.48, CI 95% 0.47-0.51), with a strengthening over time of the protective effect. A trend of higher risk in European vs. non-temperate areas was found on April 6, but a clear difference was evident one month later: France (OR=0.13, CI 95% 0.10-0.18), The Netherlands (OR=0.5, CI 95% 0.3-0.9) and the UK (OR=0.2, CI 95% 0.01- 0.51). This result does not seem to be totally related to the differences in age distribution of different sites. Conclusions: The study does not seem to exclude that the lethality of COVID-19 may be climate sensitive. Future studies will have to confirm these clues, due to potential confounding factors, such as pollution, population age, and exposure to malaria.

Climate could influence the COVID-19 pandemic, but while no evidence has been advanced on the influence of colder climates, some studies have provided data to support a possible heat-related protective factor. The objective is to verify whether areas with a Cold Temperate Climate (TC) have a higher Case Fatality Ratio (CFR) for COVID-19 than areas with a Cold Climate (CC) or with a Mediterranean Climate (MC) in the European Union and the Enlarged European Region. Countries or regions were subdivided into 3 groups according to the Köppen climate classification system: TC (Cfa, Cfb and Cfc in the Köppen system); MC (Csa, Csb); CC (D and E in the Köppen system). The total number of cases and the total number of deaths were detected on 13 August 2020 on the COVID-19 Map - Johns Hopkins Coronavirus Resource Center-the CFR was thus calculated by area. Living in TC areas is strongly associated with risk of a high Case Fatality Ratio for COVID-19, OR for MC =0.42, IC 95% 0.41-0.43; OR for CC=0.33, IC 95% 0.33-0.35. The results are confirmed in the EU, OR per MC=0.85, CI 95% 0.84-0.87; OR per CC=0.63, IC 95% 0.61-0.65.The study found that the IC in a humid temperate climate is associated with higher CFR with respect to the coldest and warmest temperate climates in Europe. This does not appear to be the only determinant of the pandemic.

The current COVID-19 pandemic is likely to affect the physical and mental health and the well-being of people globally. The physicians and nurses on the frontline of patients care will be among the most affected in their psychosocial well-being, being exposed to trauma consequences and burnout syndrome. It is still unknown whether the COVID-19 infection will have direct neuropsychiatric consequences. The impact of the quarantine lockdown on mental health, too, has to be taken into account. The inclusion of mental health as part of national public health response to the COVID-19 pandemic is mandatory in assisting all those in need.

Facebook is notably the most widely known and used social network worldwide. It has been described as a valuable tool for leisure and communication between people all over the world. However, healthy and conscience Facebook use is contrasted by excessive use and lack of control, creating an addiction with severely impacts the everyday life of many users, mainly youths. If Facebook use seems to be related to the need to belong, affiliate with others and for self-presentation, the beginning of excessive Facebook use and addiction could be associated to reward and gratification mechanisms as well as some personality traits. Studies from several countries indicate different Facebook addiction prevalence rates, mainly due to the use of a wide-range of evaluation instruments and to the lack of a clear and valid definition of this construct. Further investigations are needed to establish if excessive Facebook use can be considered as a specific online addiction disorder or an Internet addiction subtype.

The objective of this paper is to verify if traits and symptoms defined as pathological and maladjusted in certain contexts may produce adaptive effects in other contexts, especially if they occur in sub-threshold forms.A historical examination of how the symptoms of depression have changed in front of great social changes and an analysis of Sardinian migrants' thymic profiles toward several metropolises.Mood disorders have been increasing since the "English malady" in the 17th century, and we suppose that some forms of mood disorders might have an adaptive advantage. Otherwise, the increase of such an epidemic would have been self-limited. From a sociobiological point of view, it is highly probable that the environment of a rapidly evolving society can select people who are explorers and able to support accelerated biorhythms and that the condition of social change stimulates psychological and psychopathologic changes. It is also possible that hyperthymic persons modulate and create the new environment. If this model can explain the epidemic of mood disorders, its verification should guide future research.

Human population is increasing in immense cities with millions of inhabitants, in which life is expected to run 24 hours a day for seven days a week (24/7). Noise and light pollution are the most reported consequences, with a profound impact on sleep patterns and circadian biorhythms. Disruption of sleep and biorhythms has severe consequences on many metabolic pathways. Suppression of melatonin incretion at night and the subsequent effect on DNA methylation may increase the risk of prostate and breast cancer. A negative impact of light pollution on neurosteroids may also affect mood. People who carry the genetic risk of bipolar disorder may be at greater risk of full-blown bipolar disorder because of the impact of noise and light pollution on sleep patterns and circadian biorhythms. However, living in cities may also offers opportunities and might be selective for people with hyperthymic temperament, who may find themselves advantaged by increased energy prompted by increased stimulation produced by life in big cities. This might result in the spreading of the genetic risk of bipolar disorder in the coming decades. In this perspective the burden of poor quality of life, increased disability adjusted life years and premature mortality due to the increases of mood disorders is the negative side of a phenomenon that in its globality also shows adaptive aspects. The new lifestyle also influences those who adapt and show behaviors, reactions and responses that might resemble the disorder, but are on the adaptive side.

Background:Research literature suggests that burnout, depression, and a low mental quality of life (QOL) are common among health care workers. Economic crisis might have increased the burden of burnout, depression and low QOL in health care workers.Objectives:To identify depression risk, burnout levels, and quality of life in a sample of workers of an Italian university hospital.Method:Cross sectional study with comparison with two community surveys database results (n = 2000 and 1500, respectively). Overall, 522 workers accepted to take part in the study, representing a 78% response rate (out of 669 individuals).Results:The frequency of positivity at the screener for Major Depressive Disorder among health care workers was more than double than that in the standardized community sample (33.3% vs 14.1%, pi.e.those who do not have contact with patients), showed a statistically higher frequency of positivity for depressive episodes compared to the controls. Among the medical staff, the highest risk was found in the surgeon units, while the lowest one was in the laboratories. Surgeons also were those most exposed to high risk of burnout, as measured by the Maslach Burnout Inventory.Conclusion:Since burnout is linked to patient safety and quality of patient care, and contribute to medical errors, dedicated interventions aimed at reducing poor mental health and low quality of life in medical staff are indicated.

There is enough evidence that, nowadays, the sedentary lifestyle is one of the major health problems worldwide, linked to many chronic diseases, including mental comorbidities, systemic hypertension, metabolic dysregulation, and cancer. Although health societies recommend engagement to physical activities, there is an overwhelming number of people remaining sedentary, even knowing the health benefits of regular exercises. One of the main factors that justifies this scenario is the lack of motivation, which is a barrier to people intended to start new habits for health. Considering this previous information, new alternatives for exercises may help people engage in a healthier lifestyle. Technology has contributed to this with devices that allow movements based on virtual reality approaches, including the exergames. These are games available even in commercial devices, as video-games, that allow people to work with different physical components. Furthermore, exergames add cognitive gain through its dual-task characteristic. Moreover, due to the combination of these benefits, they are feasible to acquire, and easy to use. Exergames are not only a potential strategy to reduce sedentary lifestyle but also a good method to improve health gains and rehabilitation in different populations and pathological conditions: older adults, stroke survivors, and Parkinson’s disease. In this review, we aim to demonstrate some conditions that literature supports the intervention with exergames due to its physical and cognitive benefits. Furthermore, at the end of this review, we also explore the neurobiological mechanisms behind virtual-reality based exercises.

Background: The aim of the study was to examine the efficacy of a vocational training program on renewable energy sources in reducing disabilities of people with chronic psychosis (CP). The innovative element was that the project could produce major advantages regarding the economic needs of the whole area involved. Methods: Experimental Cohort, 26 subjects with CP (EC); Control Cohort1, 130 subjects with CP following pharmacotherapy plus other rehabilitation activities (CIC); Control Cohort2, 101 subjects with CP following the usual treatment (pharmacotherapy) (CUC). Study tool: Health of the Nation Outcome Scales (HoNOS). Assessment made at the start of the study (T0) and after three months (T1). Statistical analysis made by MANOVA. Results: Improvement in HoNOS total score in both groups (F=7.574, p=0.000) with non-significant differences between groups over time (F=1.336, p=0.252) was found comparing EC vs. CIC. Greater improvement in EC vs. CIC was shown in the HoNOS “impairment" scale (F=4.910, p=0.028). EC vs. CUC: both groups improved in HoNOS total score (F=9.440, p=0.000) but the improvement was greater in EC (F = 2.273, P=0.048). Conclusions: Work inclusion, as well as other rehabilitation treatments, reduces the social needs of people with chronic psychosis. Work inclusion in a project with real relevance for the area where these people live, produces more improvement of cognitive, physical and somatic disabilities, probably related to a better outcome in self-efficacy.

Background: Antidepressant (AD) drugs are effective in the short term treatment of fibromyalgia (FM). It may be useful to study the long-term impact of AD on patients with FM. Methods: One-year follow-up study on 23 females with FM divided into groups on AD (ADg-N=7), and not taking AD (NADg-N=11). Evaluation at t1 and at the end (t2) with the Fibromyalgia Impact Questionnaire (FIQ); at t2 with: SCID-IV; Mood Disorder Questionnaire (MDQ); Short Form-12; Hamilton Depression Rating Scale (HAM-D); Functioning Assessment Short Test (FAST) Results: After a year the AD group showed a worst impact of the disease by FIQ (p=0.017), worsened quality of life by SF-12 (p Limitations: Observational research on few patients, not specifically designed to test the hypothesis. The results have a heuristic value only. Discussion: The results should be read in the light of the high prevalence of patients screened positive for Bipolar Disorders and of the well-known poor response of the mood symptoms to antidepressants in Bipolar Depression. The deterioration in the long-term management of FM patients following AD treatments suggests the need for new and robust studies.

Introduction:To measure the effectiveness on Quality of Life of adjunctive cognitive behavioral counseling in the setting of General Practitioners (GPs) along with the treatment as usual (TAU;) for the treatment of depression.Methods:Six month-controlled trial of patients who were referred to randomly assigned GPs (four for experimental group of patients and ten for the control) was done. Experimental sample had 34 patients with DSM-IV diagnosis of Depression (Depressed Episode, Dysthymia, or Adjustment Disorder with Depressed Mood) receiving the TAU supplemented with counseling. Control group had 30 patients with diagnosis of Depression receiving only the TAU.Results:The Beck Depression Inventory (BDI) score improved in both groups. Patients in the experimental group showed greater improvement compared to the control group at T2. The World Health Organization Quality OF Life Questionnaire (WHOQOL) score also improved in the experimental group but not in the control group. The improvement in the experimental group was statistically significant in terms of both BDI and WHOQOL scores.Conclusions:Adding counseling to TAU in general medical practice settings is more effective in controlling the symptoms of depression and improving the quality of life as measured over a period of six months, than TAU alone. These results while encouraging, also calls for a larger study involving a largersample size and a longer period of time.

To explore whether the increase in knowledge about the biological correlates of mental disorders over the last decades has translated into improved public understanding of mental illness, increased readiness to seek mental health care and more tolerant attitudes towards mentally ill persons.A systematic review of all studies on mental illness-related beliefs and attitudes in the general population published before 31 March 2011, examining the time trends of attitudes with a follow-up interval of at least 2 years and using national representative population samples. A subsample of methodologically homogeneous studies was further included in a meta-regression analysis of time trends.Thirty-three reports on 16 studies on national time trends met our inclusion criteria, six of which were eligible for a meta-regression analysis. Two major trends emerged: there was a coherent trend to greater mental health literacy, in particular towards a biological model of mental illness, and greater acceptance of professional help for mental health problems. In contrast, however, no changes or even changes to the worse were observed regarding the attitudes towards people with mental illness.Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness.

With the exception of bereavement, the diagnosis of major depressive disorder in the DSM-IV does not take into account the context in which the symptoms occur. Recent criticism has maintained that common sense suggests making a distinction between depression as mental disorder and sorrow as 'normal' reaction to social stress. This study sets out to investigate whether the public does in fact make this distinction.In spring 2009, a population-based survey was conducted by phone in the city of Vienna (n = 1205). A fully structured interview was carried out which began with the presentation of a vignette describing a diagnostically unlabeled case of depression, with or without provision of information about preceding stressful life events.Respondents presented with vignettes containing information on loss events were less likely to define depressive symptoms as indication of mental illness. They were also not as willing to recommend professional help. And if they were, they tended to less frequently recommend seeking help from someone with a medical background.In contrast to the conceptualization in the DSM-IV, the public tends to perceive depressive symptoms differently depending on the context in which they occur.

Tardive Dyskinesia (TD) is an adverse effect of several psychotropic drugs for long-term therapy for schizophrenia and other psychoses. TD is considered an important issue for public health for its invalidating characteristics. An extensive review of the literature on studies concerning efficacious treatments for TD has been carried out.A computer-generated search of the biomedical literature up to and including December 2002 was undertaken to identify studies.Some evidence supports the switch from typical neuroleptics to atypical antipsychotics in patients with TD (particularly clozapine and olanzapine) and supports the use of atypical antipsychotics as first choice treatments. Other than the new antipsychotics, the gabaergic compounds, the new anticolinergics and some antioxidants as melatonin seem to be clinically useful. However, their tolerability and efficacy have to be confirmed by randomized clinical trials.The recent introduction of atypical antipsychotics seems to reduce the risk of TD in patients with long-term and maintenance therapies. Available literature data show that TD is less frequent with the new antipsychotics but still remains a well-known complication. The future research sould be directed to confirm the efficacy of these new drugs and to offer other treatment opportunities for patients that cannot change typical with atypical antipsychotics or for patients where the onset of the TD appears during therapy with atypical compounds.

A survey of 5 year period activity (1995-99) of a university consultation-liaison service is reported, concerning 1556 psychiatric consultations. The majority of referrals (68%) came from internal medicine units; the reason of referral was prevalently due (approx. 50%) to the presence of psychiatric symptoms; moreover, the majority of patients (approx. 51%) for which the consultation has been requested were already under psychiatric treatment and 32% of them took psychoactive drugs. In 75% of cases a psychiatric diagnosis according to ICD-10 was formulated after consultation: "Affective syndromes" were diagnosed in 25% of cases and "Neurotic, somatoformand stress-related syndromes" in 36.6% of cases. Approx. 60% of patients were prescribed psychoactive drugs; 50% received psychological support.

The survey involved 50 centres comprising both hospital and community psychiatric care services throughout Italy. Overall, 2620 patients were recruited, and of those 2002 (76%) completed the Somatoform Disorders Schedule (SDS), a CIDI-derived interview. The NOS somatoform disorders (SDs) diagnosis appeared to be the most common (60%) (and they showed the highest number of co-morbid diagnoses), followed by pain disorders (8%). The prevalence of undifferentiated somatoform and hypochondriactal disorders was 1.6%: older age groups showed a tendency towards higher rates of the latter. In general, the study found that a significant percentage of patients with SDs are referred to psychiatric services, but mainly because of other psychopathological problems: in fact, somatic complaints are cross-sectionally present in different psychiatric nosological categories. This study also emphasizes some limitations of the current classification of SDs.

The aim of the present study is to investigate the possible clinical and symptomatological determinants of social outcome in schizophrenic patients.40 schizophrenic patients (DSMIII-R), 21 males and 19 females, mean age 4 +/- 5 years, have been evaluated in the present retrospective study. All of them had first undergone psychiatric hospitalization between 1978 and 1981. The following data have been collected: socio-anagraphic features and course of the illness (AMDP), contacts with community health centre and pharmacological compliance. Social disability has been investigated by means of a semi-structured interview developed from the "Disability Assessment Schedule" named "Accertamento Disabilità e Carico Familiare" (ADC), which has been administered to the main carer, usually a cohabitant relative. Presence and level of social support have also been evaluated. One Way Analysis of Variance (ANOVA), "t" test with Bonferroni correction and Pearson Correlation test have been used for data analysis.Patients with less severe social disability (lower scores at ADC) were mainly those with recurrent course of illness without residual symptoms or remitted ones (p = 0.0001), better pharmacological compliance (p = 0.004), more frequent and regular contacts with community health centres (p = 0.0001) and better social support (p = 0.01). On the contrary, score at ADC resulted positively correlated with number of hospitalizations (r = 0.57, p = 0.01), number of compulsory admission (r = 0.32, p = 0.01) and length of illness (r = 0.40, p = 0.01).Although in our study the influence of severity of illness on social disability has been confirmed, suggestive evidence about importance of other factors, such as compliance or social support, may be drawn.