Correlazione tra sintomi di spettro psicotico e suicidalità in un campione di 147 pazienti con disturbi dell'umore

Introduzione: Il suicidio rappresenta la 15° causa di morte nel mondo con più di 800.000 morti nel 2012. Se a questo numero si aggiunge il dato dei tentati suicidi, stimato essere dieci volte superiore, si capisce il motivo per cui il suicidio, e la suicidalità in generale, sono da considerarsi importanti problemi di sanità pubblica. La prevenzione del suicidio si basa sul riconoscimento dei fattori di rischio, sulla diagnosi precoce di malattia mentale e sul tempestivo intervento terapeutico. I disturbi dell’umore sono i principali fattori di rischio per il suicidio. C’è un’ampia letteratura sulla correlazione tra disturbi dell’umore, sintomi psicotici e suicidio con conclusioni contraddittorie. Lo scopo di questo studio è quello di valutare la relazione tra suicidalità e le dimensioni minori dello spettro psicotico in soggetti con disturbi dell’umore e vedere se questo rappresenta un vantaggio nella valutazione del rischio di suicidio. Metodo: 147 pazienti con disturbi dell’umore consecutivamente afferenti agli ambulatori o ai reparti di ricovero di 11 Dipartimenti italiani di Psichiatria sono stati sottoposti a una intervista clinica strutturata per i disturbi di Asse I secondo il DSM-IV, alla intervista clinica strutturata per lo Spettro Psicotico (SCI-PSY) e all’auto-valutazione dello Spettro dell’umore (MOODS-SR). I partecipanti sono stati divisi in categorie come aventi disturbi dell’umore psicotici (PM) o non psicotici (NPM) rispetto alla presenza di delirio o allucinazioni. Risultati: Soggetti con suicidalità lifetime non mostravano una significativa più alta frequenza di PM. Tuttavia, mostravano punteggi significativamente più alti nello SCI-PSY totale (p<0.001) e ai domini Sensitività Interpersonale (p<0.001), Paranoide (p=0.002), Schizoide (p=0.005) e Sintomi Tipici (p=0.031). Controllando per età e sesso, il punteggio nel dominio Sensitività Interpersonale prediceva la suicidalità lifetime indipendentemente in entrambi, sia nei soggetti con PM (p=0.002) sia in quelli con NPM (p=0.001) mentre il punteggio nel dominio Paranoide prevedeva significativamente la suicidalità solo nei soggetti con PM (p=0.019) e il punteggio nel dominio Schizoide solo in pazienti con NPM (p=0.029). Limiti: Manca la valutazione dei disturbi di Asse II. La valutazione lifetime non permette di stabilire una sequenza temporale tra sintomi dello spettro psicotico e suicidalità. L’esclusione di soggetti con gravi malattie o abuso di sostanze può portare a sottostimare la suicidalità. Conclusioni: I tratti psicotici, valutati come presenza di delirio e allucinazioni, non sono associati con la suicidalità. Tuttavia, dimensioni più sottili dello spettro psicotico come la Sensitività Interpersonale, le dimensioni Paronoide e Schizoide mostrano una significativa relazione con la suicidalità. I nostri dati mettono in rilievo il vantaggio potenziale di un approccio di spettro nella valutazione del rischio di suicidio

Cerebellar Transcranial Direct Current Stimulation (ctDCS) Effect in Perception and Modulation of Pain

Transcranial direct stimulation (tDCS) in the treatment of intractable or marginally tractable pain is experiencing an increasing diffusion in many fields worldwide. Recently, new modality of tDCS application has been proposed and applied, as cerebellar transcranial direct current stimulation (ctDCS). Indeed, the cerebellum has been proved to play a role in pain processing and to be involved in a wide number of integrative functions. In this chapter, we encompass the history of the technique, analysis of principles, a general description, including the methodological procedures of ctDCS; then, main clinical applications and their main effects in perceptive threshold of pain and other sensation, pain intensity, and laser evoked potentials (LEPs) changes

differences in motor unit loss and axonal regeneration rate between sporadic and familiar amyotrophic lateral sclerosis an undervalued field of research

Amyotrophic Lateral Sclerosis (ALS) is a clinically and genetically heterogeneous, late-onset, neurodegenerative disorder of the motor system [1]. Five to ten percent of cases are familial and about 20% of these cases have point mutations in the Cu/Zn superoxide dismutase 1 (SOD-1) gene. Since its discovery, mutations in Cu/Zn superoxide dismutase (SOD-1) have stimulated a huge amount of interest [2], but the pathogenic mechanisms underlying disease's induction in familiar cases are still elusive. The most accepted hypothesis is that familiar ALS, SOD-1 positive could be caused by a neuronal damage, due to a gradual accumulation of a toxic product SOD-1 this cumulative damage leads to a disruption of the cytoskeleton and organelle trafficking within motor neuron dendrites. Aggregates do not exclusively occur in neurons, but also in glial cells, raising the question of whether mutant SOD-1 expression in neurons is sufficient per se to induce pyramidal degeneration and sustain disease evolution over time [3]. The familial form is clinically indistinguishable from the sporadic one and to date only few studies have tried to highlight electromyographic differences between sporadic and familiar ALS forms

Unilateral Application of Cathodal tDCS Reduces Transcallosal Inhibition and Improves Visual Acuity in Amblyopic Patients

Objective: Amblyopia is a neurodevelopmental disorder characterized by visual acuity and contrast sensitivity loss, refractory to pharmacological and optical treatments in adulthood. In animals, the corpus callosum (CC) contributes to suppression of visual responses of the amblyopic eye. To investigate the role of interhemispheric pathways in amblyopic patients, we studied the response of the visual cortex to transcranial Direct Current Stimulation (tDCS) applied over the primary visual area (V1) contralateral to the "lazy eye." Methods: Visual acuity (logMAR) was assessed before (T0), immediately after (T1) and 60' following the application of cathodal tDCS (2.0 mA, 20') in 12 amblyopic patients. At each time point, Visual Evoked Potentials (VEPs) triggered by grating stimuli of different contrasts (K90%, K20%) were recorded in both hemispheres and compared to those obtained in healthy volunteers. Results: Cathodal tDCS improved visual acuity respect to baseline (p &lt; 0.0001), whereas sham polarization had no significant effect. At T1, tDCS induced an inhibitory effect on VEPs amplitudes at all contrasts in the targeted side and a facilitation of responses in the hemisphere ipsilateral to the amblyopic eye; compared with controls, the facilitation persisted at T2 for high contrasts (K90%; Holm-Sidak post hoc method, p &lt; 0.001), while the stimulated hemisphere recovered more quickly from inhibition (Holm-Sidak post hoc method, p &lt; 0.001). Conclusions: tDCS is a promising treatment for amblyopia in adults. The rapid recovery of excitability and the concurrent transcallosal disinhibition following perturbation of cortical activity may support a critical role of interhemispheric balance in the pathophysiology of amblyopia

Transcutaneous Spinal Direct Current Stimulation (tsDCS) Modulates Human Corticospinal System Excitability

This study aimed to assess the effects of thoracic anodal and cathodal transcutaneous spinal direct current stimulation (tsDCS) on upper- and lower-limb corticospinal excitability. Yet, despite studies assessing thoracic tsDCS influences the spinal ascending tract and reflexes, none assessed the effects of this technique over upper- and lower-limb corticomotorneuronal connections. In 14 healthy subjects we recorded motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) from abductor hallucis (AH) and hand abductor digiti minimi (ADM) muscles before (baseline, B), and at a different time-points (0 and 30 minutes) after anodal or cathodal tsDCS (2.5 mA, 20 minutes, T9-T11 level). In 8 of the 14 subjects we also tested the soleus H-reflex, the F-waves from AH and ADM before and after tsDCS. Both anodal and cathodal tsDCS left the upper-limb MEPs and F-wave unchanged. Conversely, while leaving lower-limb H-reflex unchanged, they oppositely affected lower-limb MEPs: whereas anodal tsDCS increased resting motor threshold (mean\ub1SEM 107.33 \ub1 3.3%, increase immediately after tsDCS, and 108.37 \ub1 3.2% increase 30 min after tsDCS compared to baseline), and had no effects on MEP area and latency, cathodal tsDCS increased MEP area (139.71 \ub1 12.9% increase immediately after tsDCS and 132.74 \ub122.0% increase 30 min after tsDCS compared to baseline) without affecting resting motor threshold and MEP latency. Our results show that tsDCS induces polarity specific changes in corticospinal excitability that last for more than 30 min after tsDCS offset and selectively affect responses in lower-limb muscles innervated by lumbar and sacral motorneurons

Iatrogenic Rhabdomyolisis and Guillain-Barre’ Syndrome: a Dangerous Association.

Guillan-Barré Syndrome (GBS) is an acute, symmetrical polyneuropathy with a clinical manifestation of flaccid paralysis with areflexia and variable sensory disturbance. GBS has an incidence of 1-2 cases/100.000 inhabitants for year. The pathological spectrum of GBS includes Acute Inflammatory Demyelinating Polyneuropathy (AIDP), Acute Motor Axonal Neuropathy (AMAN) and Acute Motor Sensory Axonal Neuropathy (AMSAN). We report a case of an 81-year-old man with GBS (subtype AMSAN), secondary to a previous Micoplasma Pneumoniae infection, who presented with an elevation of Creatin Kinase (CK) serum levels, and worsened by a co-administration of statins and clarithromycin. By our knowledge there are few cases in the literature in which the association of these drugs contributed to worsening GBS

Epilepsy and phenylketonuria: a case description and EEG-fMRI findings.

Phenylketonuria (PKU) is characterized by phenylalanine accumulation due to phenylalanine hydroxylase deficiency. Up to 50% of PKU patients experience seizures. We evaluated an adult PKU patient who suffered from absences and primarily generalized tonicclonic seizures, associated with generalized spikeand-wave discharges (GSWs) on EEG. An analysis of blood oxygenation level-dependent (BOLD) signal changes during interictal epileptiform discharges showed early activation of the left perirolandic cortex followed by a BOLD signal decrease within cortical regions belonging to the default mode network and left frontoparietal cortex. Moreover, deactivation of the head of the right caudate nucleus and the left thalamus was observed. The fMRI pattern observed in our patient during GSWs is similar but not identical to that observed in idiopathic generalized epilepsy, suggesting different neurophysiological mechanisms. This is the first description of BOLD-fMRI patterns in a PKU patient with epilepsy. Similar studies in more patients might help to uncover the pathophysiology of seizures in this disease