Relazione tra le dimensioni nucleari del Typus Melancholicus di Tellenbach e i disturbi depressivi unipolari: uno studio trasversale

Tra i modelli che studiano la relazione tra personalità premorbosa e depressione, quello descritto da Tellenbach è uno dei più coerenti. Secondo questo modello, l’ordinatezza, la coscienziosità, l’iper/eteronomia e l’intolleranza alle ambiguità sono le caratteristiche principali del Typus Melancholicus (TM). Precedenti studi hanno mostrato una relazione tra depressione unipolare e TM. L’ipotesi principale di questo studio è che i pazienti affetti da disturbi depressivi unipolari presentino maggiori caratteristiche legate al TM in termini di ordinatezza e di coscienziosità, rispetto ai soggetti sani. Metodi. In questo studio trasversale e monocentrico sono stati reclutati 74 pazienti affetti da disturbi depressivi unipolari, secondo i criteri del DSM-5, e 60 controlli sani. Al fine di valutare la presenza dell’ordinatezza e della coscienziosità del TM, sono stati utilizzati i fattori della scala per la personalità di tipo malinconico di Kasahara (KIMTP) chiamati “armonia nelle relazioni personali” e “norme sociali”. Per valutare la relazione tra gli aspetti del TM e lo stress percepito è stata somministrata la scala di vulnerabilità correlata allo stress (SVS). Risultati. Il t-test ha rivelato punteggi della KIMTP significativamente più alti nel fattore “armonia nelle relazioni personali” (ordinatezza), ma non nel fattore “norme sociali” (coscienziosità) nel gruppo dei pazienti (p<0,001), rispetto al gruppo di controllo. La correlazione di Pearson ha rivelato una significativa correlazione positiva tra i punteggi di stress e la sottoscala “armonia nelle relazioni personali” della KIMTP. Discussione e conclusioni. Il fattore della KIMTP “armonia nelle relazioni personali” (ordinatezza) è stato osservato più frequentemente nei pazienti con depressione unipolare rispetto ai soggetti sani e ha mostrato una maggior associazione con lo stress percepito, mentre il fattore della KIMTP “norme sociali” (coscienziosità) ha mostrato valori simili in entrambi i gruppi e nessuna correlazione allo stress percepito. Ciò sottolinea la possibilità che, tra le caratteristiche fondamentali del TM, l’ordinatezza possa essere considerata come un fattore di personalità rilevante e potenzialmente premorboso, dei disturbi depressivi unipolar

Psychic euosmia and obsessive compulsive personality disorder

Patients with obsessive compulsive personality disorder (OCPD) often refer to a prompt mood improvement upon encountering good scents in general, or fresh laundry borax on their clothes, pillows or home settings. The Authors propose the new term psychic euosmia in the mean of an overstated psychological predisposition for a real pleasant smell that elicits an immediate sense of pleasure, order and calm. The prompt reactions to a pleasant odor might be explained by the involvement of rhinencephalon and its proximity to mood-related limbic circuits, which bypass the cognitive awareness. Cleanliness may not preclude a subject to enjoy a good smell, even if we are representing smells that resemble freshness, in other words order. A potentially even more important argument is given by the continuum of personality disorders and their variability. Not all personality characteristics led to disturbed behaviors. In evolutionary perspectives having the ability to differentiate between unpleasant and pleasant odors should have made the difference in surviving. On the other hand, psychic euosmia could be considered a normal reaction, but in our clinical experience it is over-represented among OCPD subjects with marked orderliness and disgust. Therefore, detecting psychic euosmia might vicariously confirm the relevance of disgust as a cognitive driver of OCPD. Hereby we support research to characterize psychic euosmia as a feature of orderliness and cleanliness for OCPD

Insomnia among Cancer Patients in the Real World: Optimising Treatments and Tailored Therapies

Abstract: Background: Insomnia is commonly reported by cancer patients. Its multifaceted pathophysiology makes this symptom a complex challenge for the clinician, who should bear in mind the manifold world of causes and consequences of sleep disturbances in these patients and the importance of accurate treatment that should consider the frequent co-prescription of multiple medications. With our work, we aim to provide a tool to better master the treatment of this symptom in cancer patients, considering the gap between clinical and pharmacodynamic knowledge about the efficacy of different molecules and evidence-based prescribing. Methods: A narrative review of the studies investigating the pharmacological treatment of insomnia in cancer patients was conducted. Three hundred and seventy-six randomised controlled trials (RCTs), systematic reviews and meta-analyses were identified through PubMed. Only publications that investigated the efficacy of the pharmacological treatment of insomnia symptoms in cancer patient were considered. Results: Among the 376 publications that were individuated, fifteen studies were eligible for inclusion in the review and were described. Pharmacological treatments were outlined, with a broad look at specific clinical situations. Conclusions: The management of insomnia in cancer patients should be personalised, as is already the case for the treatment of pain, taking into account both the pathophysiology and the other medical treatments prescribed to these patients

Triggers for atrial fibrillation. the role of anxiety

Atrial fibrillation (AF) is the most widely recognized arrhythmia. Systemic arterial hypertension, diabetes, obesity, heart failure, and valvular heart diseases are major risk factors for the onset and progression of AF. Various studies have emphasized the augmented anxiety rate among AF patients due to the poor quality of life; however, little information is known about the possibility of triggering atrial fibrillation by anxiety. +e present review sought to underline the possible pathophysiological association between AF and anxiety disorders and suggests that anxiety can be an independent risk factor for AF, acting as atrigger, creating an arrhythmogenic substrate, and modulating the autonomic nervous system.+e awareness of the role of anxietydisorders as a risk factor for AF may lead to the development of new clinical strategies for the management of AF

Efficacy of nicotine administration on obsessions and compulsions in OCD. a systematic review

Background: Preliminary studies have tested nicotine as a novel treatment for OCD patients who respond partially/ incompletely or not at all to frst and second-line treatment strategies, with the former represented by SSRIs or clomipramine, and the latter by switching to another SSRI, or augmentation with atypical antipsychotics, and/or combination with/switching to cognitive–behavioural therapy. Some studies found nicotine-induced reduction of obsessive thoughts and/or compulsive behaviour in OCD patients. We aimed to evaluate the efcacy of nicotine administration in OCD patients. Methods: We searched the PubMed, ScienceDirect Scopus, CINHAL, Cochrane, PsycINFO/PsycARTICLES, and EMBASE databases from inception to the present for relevant papers. The ‘Preferred Reporting Items for Systematic Review and Meta-Analyses’ (PRISMA) standards were used. We included all studies focusing on the efects of nicotine administration on OCD patients’ obsessions or compulsions. Studies could be open-label, cross-sectional, randomized controlled trials, case series or case reports. Results: A total of fve studies could be included. Nicotine administration may ameliorate behavioural features and recurrent thoughts of severe, treatment-resistant OCD patients; however, in one study it was not associated with OC symptom improvement or cognitive enhancement across various executive function subdomains. Conclusions: Although encouraging, the initial positive response from the use of nicotine in OCD needs testing in large controlled studies. This, however, raises ethical issues related to nicotine administration, due to its addiction potential, which were not addressed in the limited literature we examined. As an alternative, novel treatments with drugs able to mimic only the positive efects of nicotine could be implemented

Psychic euosmia among obsessive-compulsive personality disorder patients : a case control study

BACKGROUND: Psychic euosmia (PE) has been described as a supposed psychological predisposition for which pleasant smells elicit an immediate sense of pleasure, order and calmness in obsessive-compulsive personality disorder (OCPD). In this study we tried to verify the interpretation that PE is the counterpart of disgust that has been associated to contamination and moral purity. Disgust and morality are significantly associated in people with obsessive-compulsive personality traits. We expected that OCPD patients would experience higher levels of PE. AIM: To investigate the PE frequency in OCPD patients and healthy controls (HC) and to evaluate the relationship between PE and disgust. METHODS: A single-center, case-control study was conducted in an outpatient service for obsessive-compulsive and related disorders. The sample consisted of 129 subjects: 45 OCPD patients and 84 HC. In both groups we submitted the Disgust Scale Revised (DS-R) and the self-report Structured Clinical Interview for DSM-5 Screening Personality Questionnaire to which we added an additional yes or no question to investigate the presence of PE. In order to verify differences between groups, t-test was employed for continuous variables and t-test for categorical variable; odds ratio was employed to analyze group differences in the PE survey. Correlation was explored with Pearson r correlations. RESULTS: No differences were observed between groups in gender composition or education. A slight significant difference was found in mean age (t = 1.988; P = 0.049). The present study revealed significantly higher proportions of PE among OCPD patients when compared to HC (OR: 5.3, 2.28-12.46). Patients with OCPD were more likely to report PE (n = 36; 80%) whereas a much lower proportion endorsed PE in the HC group (n = 36; 42.9%). Interestingly, no differences were observed between groups in mean score for the Disgust Scale. There was also no difference between the two groups in any of the Disgust Scale Revised subscales. Moreover, no significant correlations were observed in the OCPD group between PE and Disgust Scale Revised subscales. CONCLUSION: Results suggested that PE might be part of the clinical spectrum of OCPD, and it does not reflect the counterpart of disgust. This could also indicate that this phenomenon is a manifestation of orderliness or incompleteness. Further studies will need to be undertaken to better understand PE and its significance in OCPD

Core Depressive Symptoms In Depressed Cancer OutpatientsB

Objective: This study aimed to estimate the prevalence of core depressive symptoms among cancer outpatients diagnosed with depressive or adjustment disorders with depressed mood. We also aimed to detect potential differences between patient self-assessment and psychiatrist evaluation in classifying the severity of depression. Methods: Fifty-two outpatients diagnosed with solid tumor malignancy and depressive or adjustment disorder with depressed mood were assessed using the Hamilton Depression Rating Scale (HAMD-17) (and its shortened version the HAMD-7) and the Zung Self-Rating Depression Scale (ZSDS) (and its shortened version BZSDS). Results: Based on HAMD-7 results, the prevalence of moderate depression was low (7.7%); using the BZSDS moderate depression was absent. Mild depression was identified in 82.3% and 73% of our subjects using the HAMD-7 and the BZSDS, respectively. The strength of agreement between psychiatrist and patients' self-evaluation for mild depression was "slight", employing the original and the abbreviated versions of both scales. Conclusion: Our findings suggest that the prevalence of core depressive symptoms is very low in cancer patients diagnosed with depressive disorder. The lack of a strong agreement between psychiatrist and patient in classifying the severity of depression highlights the importance of factors such as well-being and functional status among depressed cancer patients in their self assessment of depression. © Massimo et al

Suicidio e rischio di suicidio nelle sindromi psichiatriche e in ospedale

Il suicidio é un atto estremo non ascrivibile a una sola causa o a un motivo preciso, esso sembra, infatti, derivare da una complessa interazione di fattori biologici, genetici, psicologici, sociali, culturali e ambientali. Il suicidio è un importante problema di sanitá pubblica con un numero di morti di circa un milione ogni anno. Secondo i dati attuali, sull'analisi dei tassi di morte per suicidio nel mondo, nel 2020 le vittime per suicidio potrebbero salire a un milione e mezz

Antiglutamatergic agents for obsessive-compulsive disorder: Where are we now and what are possible future prospects?

: Recent data suggest that obsessive-compulsive disorder (OCD) is driven by an imbalance among the habit learning system and the goal-directed system. The frontostriatal loop termed cortico-striatal-thalamo-cortical (CSTC) circuitry loop is involved in habits and their dysfunction plays an important role in OCD. Glutamatergic neurotransmission is the principal neurotransmitter implicated in the CSTC model of OCD. Hyperactivity in the CSTC loop implies a high level of glutamate in the cortical-striatal pathways as well as a dysregulation of GABAergic transmission, and could represent the pathophysiology of OCD. Moreover, the dysregulation of glutamate levels can lead to neurotoxicity, acting as a neuronal excitotoxin. The hypothesis of a role of neurotoxicity in the pathophysiology of OCD clinically correlates to the importance of an early intervention for patients. Indeed, some studies have shown that a reduction of duration of untreated illness is related to an earlier onset of remission. Although robust data supporting a progression of such brain changes are not available so far, an early intervention could help interrupt damage from neurotoxicity. Moreover, agents targeting glutamate neurotransmission may represent promising therapeutical option in OCD patients