Cyberchondria as an emerging trans-diagnostic digital compulsive syndrome: An updated systematic review and clinical case report

Non peer reviewe

Is Cyberchondria a New Transdiagnostic Digital Compulsive Syndrome? A Systematic Review of the Evidence

© 2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Background. Cyberchondria (CYB) has been described relatively recently as a behaviour characterized by excessive online searching for medical information that is associated with increasing levels of health anxiety. Although CYB has received some attention from researchers, there is no consensus about many of its aspects. Aims. We describe one of the first reported cases of a treatment-seeking patient with CYB. We review the published literature on the definition of CYB, its assessment, epidemiology, cost and burden, psychological models and mechanisms associated with CYB, relationships between CYB and mental disorders and prevention and treatment strategies. Methods: Systematic review of all peer-reviewed papers published within the PubMed, PsycINFO, and Cochrane Library databases. Results. 61 articles were selected. Nearly all the studies were descriptive and cross-sectional recruiting sample mainly from the general/university student population and collecting self-report data via online surveys. Data on epidemiology, clinical features, course, comorbidity and therapeutic interventions were scarce. CYB showed a self-reported association with health anxiety, hypochondriasis and obsessive-compulsive disorder (OCD) as well as other forms of problematic usage of the internet (PUI) The psychological mechanisms associated with CYB include low self-esteem, anxiety sensitivity, intolerance of uncertainty, pain catastrophizing and certain meta-cognitive beliefs. Conclusion: A working definition of CYB includes excessive online health searches that are compulsive and may serve the purpose of seeking reassurance, whilst leading to a worsening of anxiety or distress and further negative consequences. CYB represents a clinically relevant transdiagnostic compulsive behavioural syndrome, closely related to PUI and usually presenting in association with health anxiety, hypochondriasis and/or OCD. CYB is clearly in need of further study and we identify key areas for future research.Peer reviewe

New drugs on the Internet : the case of Camfetamine

Copyright © 2014 Eduardo Cinosi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedThe number of new psychoactive substances (NPS) advertised for sale online is constantly increasing and it has become a phenomenon of global concern. Among NPS, Camfetamine has been rediscovered as recreational drug in 2011. Very little information is still available in the scientific literature on its nature and potential health risks. Methods. Data in scientific literature were integrated with a multilingual qualitative assessment of a range of online resources over the period of 32 months (May 2011–January 2014). Results. N-Methyl-3-phenyl-norbornan-2-amine (Camfetamine) may act as an indirect dopaminergic agonist in the central nervous system and may have mild-moderate opioid activity too. There are no current epidemiological data about recreational use of Camfetamine; our research shows that it is indeed used especially by individuals with a history of recreational polydrug misuse. It facilitates mental alertness, induces relaxation, and, unlike many other stimulants, seems not to be associated with severe physical effects. Valid causes for concern issued in our research may be Camfetamine intravenous or intramuscular administration as well as its use in conjunction with other psychoactive substances. Conclusions. It is here highlighted that more large-scale studies need to be carried out to confirm and better describe both the extent of Camfetamine misuse and possible psychotropic/adverse effectsPeer reviewedFinal Published versio

Transcranial Direct Current Stimulation in Obsessive Compulsive Symptoms: A Personalised Approach

Peer reviewe

25C-NBOMe: preliminary data on pharmacology, psychoactive effects and toxicity of a new potent hallucinogenic drug

Copyright © 2014 Francesco Saverio Bersani et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedIntroduction. The use of novel psychoactive substances (NPSs) has rapidly increased as well as their online availability. The aim of this paper is to provide a comprehensive review of the nature and the risks associated with 25C-NBOMe, which has recently appeared in the drug market. Methods. A systematic analysis of the scientific literature and a qualitative assessment of online and media resources (e.g., e-newsgroups, chat-rooms, and e-newsletters) in 10 languages were carried out. Results. 25C-NBOMe is sold online as legal LSD or as research chemical with different designations such as “Boom,” “Pandora,” “Holland film,” or “N-bomb.” It is a partial agonist of 5-HT2A receptors. It is usually ingested orally/sublingually and, less commonly, nasally, through injection, vaginally, rectally, and smoked. Its effects include sublingual numbing, stimulation, “body high,” hallucinations, dissociation, and anxiety. 25C-NBOMe presents high risk of overdoses; acute toxicity and fatalities have been reported. Conclusions. 25C-NBOMe consumption represents an emerging phenomenon with potential harmful effects. Its use is increased by its online availability at low costs. Health and other professionals should be informed about this new trend of substance usePeer reviewedFinal Published versio

Investigating the Acceptability and Tolerability of tDCS in Patients with OCD - A Feasibility Study

© 2021 University of Hertfordshire.Introduction: Obsessive Compulsive Disorder (OCD) is a neuropsychiatric disorder which often proves refractory to current treatment approaches1. Transcranial Direct Current Stimulation (tDCS), a non-invasive form of neurostimulation, with potential for development as a self-administered intervention, has shown potential as a safe and efficacious treatment for OCD in a small number of trials2. The two most promising stimulation sites are located above the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). The aim of this feasibility study was to inform the development of a definitive trial, focussing on the acceptability, safety of the intervention, feasibility of recruitment, adherence and tolerability to tDCS and study assessments and the size of the treatment-effect. Due to COVID-19 this study was paused in March 2020 and restarted in July 2020, consequently facing the challenges of recruiting and continuing face-to-face research during the pandemic. This abstract presents acceptability and safety of the intervention as well as the feasibility of recruitment, adherence and tolerability of tDCS in patients with OCD. Method: Potential participants were identified from OCD clinics, primary health care services (e.g. IAPTs), charity/support networks, advertisements and trust databases across two sites (Hertfordshire Partnership and Southampton). Individuals were screened, then randomised if eligible, receiving three courses of tDCS (SMA, OFC and sham), randomly allocated and given in counterbalanced order. Each course comprised four sessions of 20-minute stimulations, delivered over two consecutive days, separated by at least a four-week washout period. Participants were evaluated at baseline, 1, 2 and 4 hours after stimulation. Follow-up assessments were conducted via telephone at 24 hours, 7 and 14 days following the last stimulation of each round with a final assessment 28 days after the third round. Intervention-related adverse events (AEs) were also recorded at each time point, using a questionnaire specific to tDCS3. Results: A total of 135 individuals were identified as potentially eligible (through clinics or self-referral), of which 36 consented to eligibility screening. Four withdrew consent/were lost to follow up, so screening was completed for 32. Subsequently, 16 were excluded through ineligibility (n=9), withdrawal (n=2) or loss to follow up (n=1), with the remaining 20 randomised. One participant withdrew prior to intervention round one and another prior to round two, both due to COVID-19 anxiety. All other participants (n=18, 90% of those randomised) completed all three intervention rounds. However, one individual was unable to attend day two of round two due to unconnected ill-health. Across all tDCS types, the most commonly reported AEs were sleepiness (18.7% of sessions), trouble concentrating (13.0%) and headache (12.2%), with other AE types present at <7% of sessions. Itching (0.8%) and scalp pain (1.0%) were reported least often. Discussion: Despite the impact of COVID-19, this study successfully restarted after suspension with few adjustments, meeting the revised target sample with minimal participant drop-out. Reasons for drop-out were unrelated to the intervention itself, with some participants delayed or experiencing pandemic-related anxiety. This study presents a safe intervention which was accepted, adhered to and tolerated by OCD patients, even amid a pandemic.Peer reviewe

Substance use in the club scene of Rome : a pilot study

Date of Acceptance: 28/08/2014 Copyright © 2014 Alessandro Emiliano Vento et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedOver the last few years, a wide number of unregulated substances have been marketed on the Web and in smart and head shops; they are usually advertised as legal alternatives to commonly known drugs and are defined as “smart drugs,” “legal highs,” and “novel psychoactive substances” (NPS). Aim of our work is to describe use habits and distribution of NPS in a population of young adults in Rome club scene. Methods. A self-administered questionnaire was proposed to subjects over 18 years of age at the entrance of 5 nightclubs in Rome. Socioeconomic characteristics and substance use were investigated. Results. Preliminary results give evidence that 78% of respondents have a lifetime history of NPS use. In addition, 56% of the sample has consumed illicit drugs in the past and 39% has used psychoactive substances in the 12 hours preceding the questionnaire administration. Conclusions. A significant proportion of subjects report use of novel psychoactive substances; traditional illicit drugs consumption, particularly cocaine, appears to be very high as well in the club scene. These data highlight a serious public health challenge, since pharmacological, toxicological, and psychopathological effects linked to interactions among all these substances may be unpredictable and sometimes fatal in vulnerable individualsPeer reviewedFinal Published versio

Characterizing the building blocks of Problematic Use of the Internet (PUI): The role of obsessional impulses and impulsivity traits among Italian young adults

BACKGROUND: Problematic Use of the Internet (PUI) is a considerable issue of the modern era, but its risk factors are still poorly understood. Impulsivity and obsessive-compulsive symptoms have been associated with PUI, but this relationship is still debated. In this article we focus on the relationships of PUI with obsessive-compulsive and impulsive symptoms in a cohort of Italian young adults, in order to identify possible vulnerability factors for PUI.METHODS: A sample of 772 Italian individuals aged 18-30 (mean age 23.3±3.3years old; 38% males and 62% females) was assessed via online survey using the Internet Addiction Test (IAT), the Mini International Neuropsychiatric Interview (MINI) Screen, the Padua Inventory-Washington State University Revision (PI-WSUR) and the Barratt Impulsiveness Scale (BIS-11).RESULTS: Ninety-seven subjects (12.6% of the sample) reported IAT scores at risk for PUI. PUI participants reported higher levels of impulsivity, obsessive-compulsive symptoms and a higher burden of co-occurrent psychiatric symptoms. In a logistic regression model, obsessional impulses to harm (OR =1.108, p&lt;0.001), attentional impulsivity (OR=1.155, p&lt;0.001) and depressive symptomatology (OR=1.246, p=0.012) had significant association with PUI. Finally, higher severity of PUI has been associated with manic/psychotic symptoms and with attentional impulsivity.CONCLUSIONS: Our findings confirmed the role of impulsivity in PUI, while also underling the association of obsessional impulses with this pathological behavior. We could hypothesize a trigger role of obsessive impulses for the engagement in PUI, together with factors as negative affective states. Further research is needed with respect to more severe forms of PUI, also for establishing tailored interventions

Mapping Compulsivity in the DSM-5 Obsessive Compulsive and Related Disorders: Cognitive Domains, Neural Circuitry, and Treatment.

Compulsions are repetitive, stereotyped thoughts and behaviors designed to reduce harm. Growing evidence suggests that the neurocognitive mechanisms mediating behavioral inhibition (motor inhibition, cognitive inflexibility) reversal learning and habit formation (shift from goal-directed to habitual responding) contribute toward compulsive activity in a broad range of disorders. In obsessive compulsive disorder, distributed network perturbation appears focused around the prefrontal cortex, caudate, putamen, and associated neuro-circuitry. Obsessive compulsive disorder-related attentional set-shifting deficits correlated with reduced resting state functional connectivity between the dorsal caudate and the ventrolateral prefrontal cortex on neuroimaging. In contrast, experimental provocation of obsessive compulsive disorder symptoms reduced neural activation in brain regions implicated in goal-directed behavioral control (ventromedial prefrontal cortex, caudate) with concordant increased activation in regions implicated in habit learning (presupplementary motor area, putamen). The ventromedial prefrontal cortex plays a multifaceted role, integrating affective evaluative processes, flexible behavior, and fear learning. Findings from a neuroimaging study of Pavlovian fear reversal, in which obsessive compulsive disorder patients failed to flexibly update fear responses despite normal initial fear conditioning, suggest there is an absence of ventromedial prefrontal cortex safety signaling in obsessive compulsive disorder, which potentially undermines explicit contingency knowledge and may help to explain the link between cognitive inflexibility, fear, and anxiety processing in compulsive disorders such as obsessive compulsive disorder