COVID-19 and panic disorder: clinical considerations for the most physical of mental disorders

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Alexithymia and Suicide Risk in Psychiatric Disorders: A Mini-Review.

It is well known that alexithymic individuals may show significantly higher levels of anxiety, depression, and psychological suffering than non-alexithymics. There is an increasing evidence that alexithymia may be considered a risk factor for suicide, even simply increasing the risk of development of depressive symptoms or per se. Therefore, the purpose of this narrative mini-review was to elucidate a possible relationship between alexithymia and suicide risk. The majority of reviewed studies pointed out a relationship between alexithymia and an increased suicide risk. In several studies, this relationship was mediated by depressive symptoms. In conclusion, the importance of alexithymia screening in everyday clinical practice and the evaluation of clinical correlates of alexithymic traits should be integral parts of all disease management programs and, especially, of suicide prevention plans and interventions. However, limitations of studies are discussed and must be considered

CIGARETTE SMOKING HAS NO PRO-COGNITIVE EFFECT IN SUBJECTS WITH OBSESSIVE-COMPULSIVE DISORDER: A PRELIMINARY STUDY

Background: The prevalence of cigarette smoking in patients with different psychiatric disorders is higher than that in the general population, which is partly explained by the pro-cognitive effect of smoking on cognitive functions. In subjects with obsessive-compulsive disorder (OCD), the prevalence of smokers is lower than that in other psychiatric disorders. We hypothesized that cigarette smoking does not provide benefits and even worsen cognitive performance in OCD. Subjects and methods: We compared different executive function subdomains in 20 smoking and 20 non-smoking inpatients with OCD. At the beginning of hospitalization, we assessed visuo-spatial working memory, planning and set-shifting abilities (Cambridge Neuropsychological Test Automated Battery), smoking habits (standardized personal interviews), and the severity of obsessivecompulsive symptoms (Dimensional Yale-Brown Obsessive-Compulsive Scale). Results: The performance of smokers and non-smokers did not differ significantly in any cognitive subdomain. The smoking duration was significantly associated with poorer visuo-spatial working memory performance (P=0.001). Conclusions: Our results showed that cigarette smoking did not provide cognitive enhancement across various executive function subdomains in subjects with OCD. The lack of beneficial cognitive effects of smoking may make these subjects less prone to smoking and may partially explain the lower rate of smokers in OCD compared with other psychiatric conditions

Atypical Antipsychotics in the Treatment of Acute Bipolar Depression with Mixed Features: A Systematic Review and Exploratory Meta-Analysis of Placebo-Controlled Clinical Trials

Evidence supporting the use of second generation antipsychotics (SGAs) in the treatment of acute depression with mixed features (MFs) associated with bipolar disorder (BD) is scarce and equivocal. Therefore, we conducted a systematic review and preliminary meta-analysis investigating SGAs in the treatment of acute BD depression with MFs. Two authors independently searched major electronic databases from 1990 until September 2015 for randomized (placebo-) controlled trials (RCTs) or open-label clinical trials investigating the efficacy of SGAs in the treatment of acute bipolar depression with MFs. A random-effect meta-analysis calculating the standardized mean difference (SMD) between SGA and placebo for the mean baseline to endpoint change in depression as well as manic symptoms score was computed based on 95% confidence intervals (CI). Six RCTs and one open-label placebo-controlled studies (including post-hoc reports) representing 1023 patients were included. Participants received either ziprasidone, olanzapine, lurasidone, quetiapine or asenapine for an average of 6.5 weeks across the included studies. Meta-analysis with Duval and Tweedie adjustment for publication bias demonstrated that SGA resulted in significant improvements of (hypo-)manic symptoms of bipolar mixed depression as assessed by the means of the total scores of the Young Mania Rating Scale (YMRS) (SMD −0.74, 95% CI −1.20 to −0.28, n SGA = 907, control = 652). Meta-analysis demonstrated that participants in receipt of SGA (n = 979) experienced a large improvement in the Montgomery–Åsberg Depression Rating Scale (MADRS) scores (SMD −1.08, 95% CI −1.35 to −0.81, p < 0.001) vs. placebo (n = 678). Publication and measurement biases and relative paucity of studies. Overall, SGAs appear to offer favorable improvements in MADRS and YMRS scores vs. placebo. Nevertheless, given the preliminary nature of the present report, additional original studies are required to allow more reliable and clinically definitive conclusions

Cotard’s Syndrome: Clinical Case Presentation and Literature Review

In 1880 French neurologist Jules Cotard described a condition characterized by delusion of negation (nihilistic delusion) in a melancholia context. Recently, there has been a resurgence of interest in Cotard’s syndrome. The most prominent symptoms of Cotard’s Syndrome are depressive mood, nihilistic delusions concerning one’s own body and one’s own existence, delusions of guilt, immortality and hypochondria. The aim of the present paper is to review literature evidences concerning Cotard’s syndrome and to describe a clinical case keeping in the background the recent trends on its psychopathological implications. In the clinical study, the following sequence of stages emerged: the dissociative side, expressed as a loss of body-mind cohesion; the ‘mixed’ mood disorder, with depressive-manic episodes, and a persecutory background, all coexisting in the anguish of the idea of a body falling apart, the anguish of a descent towards the abyss of melancholia and/or an ascent to unlimited euphoria, characteristic of an “uncommon alarm” for loss of Self cohesion

Common and different neural markers in major depression and anxiety disorders: A pilot structural magnetic resonance imaging study.

Although anxiety and depression often co-occur and share some clinical features, it is still unclear if they are neurobiologically distinct or similar processes. In this study, we explored common and specific cortical morphology alterations in depression and anxiety disorders. Magnetic Resonance Imaging data were acquired from 13 Major Depressive Disorder (MDD), 11 Generalized Anxiety Disorder (GAD), 11 Panic Disorder (PD) patients and 21 healthy controls (HC). Regional cortical thickness, surface area (SA), volume and gyrification were measured and compared among groups. We found left orbitofrontal thinning in all patient groups, as well as disease-specific alterations. MDD showed volume deficits in left precentral gyrus compared to all groups, volume and area deficits in right fusiform gyrus compared to GAD and HC. GAD showed lower SA than MDD and PD in right superior parietal cortex, higher gyrification than HC in right frontal gyrus. PD showed higher gyrification in left superior parietal cortex when compared to MDD and higher SA in left postcentral gyrus compared to all groups. Our results suggest that clinical phenotypic similarities between major depression and anxiety disorders might rely on common prefrontal alterations. Frontotemporal and parietal abnormalities may represent unique biological signatures of depression and anxiety