Il desiderio e l’ossessione del desiderio

<p>Desire is characterized by fluctuations in quality and quantity in most people, but sometimes these changes may result in a psychiatric condition. The spectrum of possible alterations is wide, and it may be  characterized by very different clinical pictures.</p><p>The main role of the neurobiological mechanisms that underlie desire is played by dopamine, a neurotransmitter whose concentration can be modified by use or abuse of several compounds, which may have a therapeutic role, in the case of medicines, or may lead to dysfunctional situations, in the case of substances or alcohol.</p><p>Neuroimaging studies have allowed a better knowledge of brain areas involved in mental illnesses, recording functional changes during the execution of specific tasks. The improvement of these techniques in the near future will improve the choice of the most appropriate treatment for each disease, leading to patient tailored therapies.</p><p>Different approaches to the treatment of disorders associated with an alteration of desire are currently available; often their combination, such as the one between psychophamacological drugs and psychotherapy, can lead to a better therapeutic result and to a reduction, or mitigation, of episodes<span style="text-decoration: line-through;">’</span> of severity and recurrences.</p

The association between the serotonin and dopamine neurotransmitters and personality traits

Evidence from previous studies has reported that complex traits, including psychiatric disorders, are moderately to highly heritable. Moreover, it has also been shown that specific personality traits may increase the risk to develop mental illnesses. Therefore the focus of the research shifted towards the identification of the biological mechanisms underpinning these traits by exploring the effects of a constellation of genetic polymorphisms in healthy subjects. Indeed, studying the effect of genetic variants in normal personality provides a unique means for identifying candidate genes which may increase the risk for psychiatric disorders. In this review, we discuss the impact of two of the most frequently studied genetic polymorphisms on personality in healthy subjects, the 5-HTT polymorphism of the serotonin transporter and the DRD2/DRD4 polymorphisms of the D2/D4 dopamine's receptors. The main aims are: (a) to highlight that the study of candidate genes provides a fruitful ground for the identification of the biological underpinnings of personality without, though, reaching a general consensus about the strength of this relationship; and (b) to outline that the research in personality genetics should be expanded to provide a clearer picture of the heritability of personality traits

Augmentative dopaminergic interventions for treatment-resistant bipolar depression: A focus on dopamine agonists and stimulants

Objectives: Bipolar depression is the most difficult-to-treat phase of bipolar disorder, in relation to its significant disruption of every-day life functioning and high suicidality risk. Despite the availability of several treatment options, the management of bipolar depression is still particularly challenging, with limited approved therapies. Mood stabilizers and second-generation antipsychotics may not be as effective in ameliorating depressive compared to mood elevation symptoms, and entail substantial somatic tolerability limitations. In contrast, antidepressants are widely used off-label in bipolar depression (perhaps in part due to their better somatic tolerability), but such use is controversial, as they may be associated with a higher risk of manic/hypomanic switch and rapid cycling. Among pharmacological augmentation strategies, compounds with pro-dopaminergic activity such as stimulants and stimulant-like agents (e.g., methylphenidate, modafinil and armodafinil) and dopamine agonists (e.g., pramipexole and ropinirole), have shown potential antidepressant effects, even though their use in clinical practice is still limited by the paucity of systematic evidence of efficacy and safety. The present review sought to summarize available evidence about such augmentative dopaminergic interventions for treatment-resistant bipolar depression, considering results of recent randomized controlled trials, as well as open studies, systematic reviews and guidelines indications. Methods: A systematic review of the literature was conducted. We first identified articles published in English and focused on the use of stimulants and dopamine agonists in bipolar disorder, using the keywords 'stimulant', 'psychostimulant', 'amphetamine', 'methylphenidate', 'modafinil', 'armodafinil', 'pramipexole', 'ropinirole', 'dopamine agonists', variably combined with 'bipolar disorder', 'bipolar depression', 'major depression' and 'treatmentresistant depression'. A second search was conducted about safety and tolerability, combining the keywords 'stimulant', 'psychostimulant', 'methylphenidate', 'modafinil', 'armodafinil', 'pramipexole', 'ropinirole', 'dopamine agonists' with 'tolerability', 'safety', 'side-effects', 'adverse events', 'discontinuation', 'drop out', 'mania', 'suicide', 'cycle acceleration'. Additionally, reference lists of retrieved articles and proceeding of recent scientific meetings were manually searched for relevant publications. Results: 21 reports met the inclusion criteria and were herein reviewed in detail. 11 reports described of pramipexole in adult bipolar depression, including 2 double-blind RCTs targeting depressive symptoms, 1 double-blind RCT targeting cognitive dysfunction, and 8 open reports, and one report on the use of ropinirole in bipolar depression was identified. 10 reports focused on the use of adjunctive stimulant-like agents and stimulants, including 1 double-blind armodafinil RCTs, and 1 double-blind modafinil RCT targeting depressive symptoms, 4 open uncontrolled modafinil studies, and 4 open uncontrolled methylphenidate studies. With respect to the use of stimulants in adult bipolar depression, although systematic evidence is quite limited, available data seems to support their use in at least some bipolar depressed patients, especially when they show significant drowsiness or fatigue. In contrast, the use of the stimulant-like agents modafinil and armodafinil seems to be more robust, supported by 2 RCTs as well as 4 open reports. Conclusions: Taken as a whole, findings from reviewed studies seem to suggest that pro-dopaminergic compounds agonists, such as pramipexole and stimulant-like agents, deserve consideration as potential adjunct therapeutic agents in adult bipolar depression, at least in specific subgroups of patients, although caution for supporting their use is still recommended. Future research and clinical trials on larger samples and greater follow-up periods are encouraged to extend available evidence and better clarify the potential role of these medications in bipolar depression. Copyright \ua9 2013 by Pacini Editore S.p.A

The metabolic basis of cognitive insight in psychosis : a positron emission tomography study

The purpose of this study was to investigate the relationship between cognitive insight and cerebral metabolism in patients suffering from psychosis. The Beck Cognitive Insight Scale (BCIS) was administered to 63 patients with psychosis undergoing Positron Emission Tomography investigation. The sample was divided into two groups considering the BCIS score. Data were analyzed using Statistical Parametric Mapping. Results: patients with low insight, compared to those with high insight, showed decreased metabolism in the right fusiform gyrus, left precuneus, superior temporal gyrus and insula bilaterally, as well as increased metabolism in the left orbito-frontal gyrus (all p&lt;0.005). Our results suggest that reduced posterior (occipito-temporo-insulo-parietal) and increased anterior (orbitofrontal) cerebral metabolism may sustain low cognitive insight in psychosis

Common and distinct structural features of schizophrenia and bipolar disorder: The European Network on Psychosis, Affective disorders and Cognitive Trajectory (ENPACT) study

INTRODUCTION: Although schizophrenia (SCZ) and bipolar disorder (BD) share elements of pathology, their neural underpinnings are still under investigation. Here, structural Magnetic Resonance Imaging (MRI) data collected from a large sample of BD and SCZ patients and healthy controls (HC) were analyzed in terms of gray matter volume (GMV) using both voxel based morphometry (VBM) and a region of interest (ROI) approach. METHODS: The analysis was conducted on two datasets, Dataset1 (802 subjects: 243 SCZ, 176 BD, 383 HC) and Dataset2, a homogeneous subset of Dataset1 (301 subjects: 107 HC, 85 BD and 109 SCZ). General Linear Model analyses were performed 1) at the voxel-level in the whole brain (VBM study), 2) at the regional level in the anatomical regions emerged from the VBM study (ROI study). The GMV comparison across groups was integrated with the analysis of GMV correlates of different clinical dimensions. RESULTS: The VBM results of Dataset1 showed 1) in BD compared to HC, GMV deficits in right cingulate, superior temporal and calcarine cortices, 2) in SCZ compared to HC, GMV deficits in widespread cortical and subcortical areas, 3) in SCZ compared to BD, GMV deficits in insula and thalamus (p<0.05, cluster family wise error corrected). The regions showing GMV deficits in the BD group were mostly included in the SCZ ones. The ROI analyses confirmed the VBM results at the regional level in most of the clusters from the SCZ vs. HC comparison (p<0.05, Bonferroni corrected). The VBM and ROI analyses of Dataset2 provided further evidence for the enhanced GMV deficits characterizing SCZ. Based on the clinical-neuroanatomical analyses, we cannot exclude possible confounding effects due to 1) age of onset and medication in BD patients, 2) symptoms severity in SCZ patients. CONCLUSION: Our study reported both shared and specific neuroanatomical characteristics between the two disorders, suggesting more severe and generalized GMV deficits in SCZ, with a specific role for insula and thalamus.Funding: PB was partially funded by grants from the Ministry of Health (RF-2011-02352308). Grant support of EM was provided by the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 602450 (IMAGEMEND Project). Part of the present study was conducted at the Hospital Universitario MarqueÂs de Valdecilla, University of Cantabria (Santander, Spain), under the following grant support: Carlos III Health Institute PI020499, PI050427, PI060507, Plan Nacional de Drugs Research Grant 2005- Orden sco/3246/2004, SENY Fundacio Research Grant CI 2005-0308007 and FundacioÂn MarqueÂs de Valdecilla API07/011. We wish to acknowledge IDIVAL Neuroimaging Unit for imaging acquirement and analysis. Part of the study was conducted at the Ospedale San Raffaele, Milano, supported by the European Union EU-FP7-HEALTH-F2-2008-222963 “MOODINFLAME” and by the Italian Ministry of Health RF-2011-02350980 projects. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

From &#8216;classical&#8217; antipsychotics to &#8216;multidimensional stabilizers&#8217;: do we need a new classification for novel drugs used in schizophrenia?

SUMMARY This article revisits the roots of the clinical categorical concept of schizophrenia and its biopathogenetic model (\u2018dopaminergic model\u2019), based on dopaminergic dysfunctioning in CNS, as conceived in the 1960s and 1970s. These clinical/biopathogenic concepts have been challenged by the dimensional approach and by a more complex neurochemical model of schizophrenia, arising mainly from the use of novel compounds, which involves activity on different neurotransmitters in the CNS. Moreover, new compounds used in the treatment of schizophrenia are effective not only on the psychotic dimension, but also on other dimensions, such as negative, depressive and cognitive ones. Therefore, the term \u2018antipsychotic\u2019, which refers to a class of drugs acting mainly on acute psychotic symptoms, seems obsolete, and schizophrenia should not be conceived as an acute disorder, but rather as a chronic multidimensional dysfunction. Consequently, novel compounds acting on different dimensions can better stabilize patients, avoiding the shift from positive to negative symptoms due to the D2 antagonism. Thus, a new denomination is needed considering all of the peculiarities of new compounds compared with neuroleptics for stabilizing not just psychotic symptoms in the acute phase, but also affective, negative and anergic symptoms (which are integral parts of the disorder), even in the medium\u2013long term; more appropriately, they should be considered as \u2018multidimensional stabilizers\u2019 instead of antipsychotics. Moreover, this denomination also refers to their efficacy in bipolar disorders, since their use is being increasingly proven to be effective in the treatment of this disorder as well. Finally, a change in the name of this pharmacological class may contribute to reducing the stigma that is now closely linked to antipsychotic drugs, such as chronicity, unfavorable prognosis and \u2018craziness\u2019