Functional neural correlates of first-episode psychoses during sensory, cognitive, language, and emotional processing

Background. Numerosi studi hanno evidenziato che i pazienti affetti da esordi sindromici dello spettro schizofrenico presentano alterazioni neurofunzionali durante l’esecuzione di compiti che coinvolgono le funzioni sensoriali, cognitive, linguistiche ed emotive. Obiettivo. Paragonare pazienti con esordio psicotico a individui sani al fine di studiare il network neurale coinvolto nelle risposte a compiti sensoriali, cognitive, linguistiche ed emotive, identificando le similarità e le differenze nelle attivazioni cerebrali correlate all’esecuzione degli stessi compiti. Metodo. Abbiamo eseguito una meta-analisi ALE utilizzando il database costruito su ventisei studi di risonanza magnetica funzionale condotti su 516 pazienti con esordio e 546 soggetti sani durante l’esecuzione di task sensoriali, cognitivi, linguistici ed emotivi. Risultati. Le analisi within-group hanno dimostrato che i controlli sani manifestavano in risposta a tutti i task attivazioni significative in un circuito bilaterale fronto-parietale, mentre i pazienti in un circuito bilaterale parietale-precentrale. Le analisi between-groups hanno evidenziato iperattivazioni del lobulo parietale inferiore di destra, del giro medio frontale sinistro e della corteccia temporale destra nei sani e del cingolo di destra nei pazienti. L’analisi condotta separatamente per gruppi di compiti ha evidenziato che la performance di task attentivo-mnestici si correlava ad attivazione di aree prefrontali nei sani e parietali bilaterali negli esordi; l’esecuzione di task emotivi si correlava ad attivazione della corteccia dorsolaterale prefrontale (DLPFC) bilaterale, della corteccia parietale destra, del cingolo di sinistra e dell’amigdala di destra nei sani e del giro fusiforme di destra nei pazienti; solo i sani hanno evidenziato attivazioni in aree corticali di sinistra incentrate sull’insula, la DLPFC e la corteccia temporale in correlazione a compiti linguistici. Conclusioni. Il risultato principale di questa meta-analisi è l’evidenza di deficit funzionale della DLPFC di sinistra in pazienti con esordio psicotico durante l’esecuzione di task sensoriali, cognitivi, linguistici ed emotivi. Il giro del cingolo di destra, le cortecce parietali e la temporale di destra hanno anch’esse un ruolo importante nella neurofisiopatologia degli esordi. Questo studio ha anche evidenziato che i pazienti attivano circuiti cerebrali diversi rispetto ai sani in risposta a compiti attentivo-mnestici (attivazione predominante in aree parietali bilaterali), emotivi (attivazione predominante nel giro fusiforme destro) e linguistici (mancata attivazione di aree corticali di sinistra).Background: Several studies reported neural functional alterations in patients with schizophrenia spectrum first-episode psychosis (FEP) during performance of tasks that involve sensory, attentional memory, language, and emotional (SAMLE) processing. Aim: To compare meta-analytically FEP and healthy control (CTR) samples regarding the circuitries engaged in responding to a set of SAMLE tasks and identifying commonalities and differences in task-related brain activations. Method: We performed an activation likelihood estimation (ALE) meta-analysis using a database built on 26 fMRI studies, conducted on 516 FEP patients and 546 CTRs during SAMLE task performance. Results: Within-Group analyses showed that the CTR group has significant SAMLE task-related cortical activations in the context of a bilateral fronto-parietal network; FEP patients showed taskrelated activations of a bilateral parietal-precentral network. Between-Groups analyses showed hyperactivation of the right inferior parietal lobule, left middle frontal gyrus, and right temporal cortex in CTRs, and hyperactivation of the right cingulate gyrus in FEP. Segregated analyses of tasks showed that brain activations to attentional and memory-related tasks mainly occurred in prefrontal areas in CTRs, and in bilateral parietal areas in FEP; emotional task-related activations concerned the bilateral dorsolateral prefrontal cortex (DLPFC), right parietal cortex, left cingulate cortex and right amygdala in CTRs, whereas in FEP the activation concerned the right fusiform gyrus; we found significant left-sided language task-related activations only in the CTR group, centred on the insula, DLPFC, and temporal cortex. Conclusions: The major finding of this study is the evidence of a functional deficit of the left DLPFC in FEP during the SAMLE task performance. A prominent role in the neuropathophysiology of FEP appears also to be played by the right dorsal anterior cingulate, bilateral parietal, and right temporal cortices. This study also underlined that FEP patients activate different circuits than CTRs in response to attentional- and memory-tasks (predominant activation of bilateral parietal areas), emotional (predominant activation of the right fusiform gyrus), and language (lack of activation of left-sided cortical areas) tasks

Clinical Aspects of Manic Episodes After SARS-CoV-2 Contagion or COVID-19

As COVID-19 pandemic spread all over the world, it brought serious health consequences in every medical field, including mental health. Not only healthcare professionals were more prone to develop anxiety, depression, and stress, but the general population suffered as well. Some of those who had no prior history of a psychiatric disease developed peculiar symptoms following infection with SARS-CoV-2, mostly because of psychological and social issues triggered by the pandemic. People developed traumatic memories, and hypochondria, probably triggered by social isolation and stress. Infection with SARS-CoV-2 has influenced the mental health of psychiatric patients as well, exacerbating prior psychiatric conditions. In this review, we focus on analyzing those cases of mania in the context of bipolar disorder (BD) reported after COVID-19 disease, both in people with no prior psychiatric history and in psychiatric patients who suffered an exacerbation of the disease. Results have shown that COVID-19 may trigger a pre-existing BD or unmask an unknown BD, due to social and psychological influences (decreased social interaction, change in sleep patterns) and through biological pathways both (neuroinflammation and neuroinvasion through ACE-2 receptors expressed in the peripheral and central nervous systems (PNS and CNS respectively). No direct correlation was found between the severity of COVID-19 disease and manic symptoms. All cases presenting severe symptoms of both diseases needed specific medical treatment, meaning that they concur but are separate in the treatment strategy needed. This review highlights the importance of a now widespread viral disease as a potential agent unmasking and exacerbating bipolar mood disorder, and it can hopefully help physicians in establishing a rapid diagnosis and treatment, and pave the road for future research on neuroinflammation triggered by SARS-CoV-2

Evolution of International Psychiatry

International psychiatry is currently facing serious challenges triggered by the global economic crisis and the COVID-19 pandemic. These global events lead to the need to broaden our nosographic and therapeutic horizons, and to make use of the newest psychological approaches and the latest neuroscience acquisitions. The focus should be on the psychological consequences of the pandemic, not only on people suffering from mental disorders, but also on the general population, for which the risk of developing psychic symptoms appears to be increased. A population that needs special attention is that of health workers involved in the management of the pandemic. In facing these problems, psychiatry today can use numerous new clinical applications and technologies in the fields of precision medicine. These include genomics, neuroimaging, and microbiomics, which can also be integrated with each other through machine learning systems. They can provide new contributions both in treatment personalization and in the evolution of nosographic systems. Besides this, the contribution of psychotherapies and dynamic and clinical psychology appears to be indispensable for a complete understanding of the clinical and personological aspects of patients. This journal aims to include innovative studies deriving from original, clinical, and basic research in the fields of mental health, precision psychiatry, genomics, neuroimaging, neuropsychopharmacology, and dynamic and clinical psychology

Maintenance deep transcranial magnetic stimulation sessions are associated with reduced depressive relapses in patients with unipolar or bipolar depression

Introduction: Deep transcranial magnetic stimulation (dTMS) is a new form of TMS allowing safe stimulation of deep brain regions. The objective of this preliminary study was to assess the role of dTMS maintenance sessions in protecting patients with bipolar disorder (BD) or recurrent major depressive disorder (MDD) from developing depressive or manic relapses in a 12-month follow-up period. Methods: Twenty-four drug-resistant patients with a current depressive episode and a diagnosis of MDD or BD have been enrolled in the study. All the participants underwent daily dTMS sessions for 4 weeks. One group (maintenance - M group) received additional maintenance dTMS sessions weekly or twice a week. Results: After the first dTMS cycle, a significant reduction of Hamilton Depression Rating Scale (HDRS) scores was observed in all participants. Subsequently, the HDRS mean scores did not significantly change over time in the M group, while it significantly increased in the non-M-group after 6 and 12 months. Discussion: This study confirms previous evidence of a positive therapeutic effect of dTMS on depressive symptoms and suggests that, after recovery from acute episodes, maintenance dTMS sessions may be helpful in maintaining euthymia in a 12-month follow-up period

Pandemic experiences and psychopathological aspects in individuals with mood disorders and other mental disorders

Individuals with different personality traits, temperaments, and psychological symptoms have different attitudes toward the pandemic experiences and restrictive measures. The aim of the present study was to evaluate the associations between the psychological factors and the attitudes toward COVID-19, experienced during the third pandemic wave in Italy, in a sample of individuals with psychiatric disorders. Between March and September 2021, 53 patients with mood disorders and other mental disorders completed a survey composed of self-report questionnaires that assessed sleep quality, depressive and hypomanic symptoms, and temperament and personality traits. Positive and negative attitudes toward the pandemic experience were assessed using an ad hoc questionnaire. The results showed that individuals with more severe depressive symptoms were less prone to adhere to government guidelines, and were more convinced that the pandemic was not a real problem. Reduced sleep quality was associated with increased skepticism toward official explanations concerning the causes of COVID-19. Lastly, negative affect and cyclothymic temperament predicted the disposition toward COVID-19 vaccines. In conclusion, these findings highlighted that some psychological aspects and psychiatric symptoms could influence the beliefs about COVID-19 and compliance with government recommendations. Further research is needed to provide indications on how to improve the current healthcare policies

Decisional capacity to consent to treatment and research in patients affected by Mild Cognitive Impairment. A systematic review and meta-analysis.

ABSTRACTObjectives:To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer's disease (AD), and healthy comparisons (HCs).Design:A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases.Setting:The United States, France, Japan, and China.Participants:Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included.Measurements:The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC).Results:We identified 109 potentially eligible studies from 1672 records, and 7 papers were included in the meta-analysis. The meta-analysis showed that there was significant impairment in a decision-making capacity in MCI patients compared to the HCs group in terms of Understanding (SMD = −1.04, 95% CI: −1.31 to −0.77, P < 0.001; I2 = 52%, P = 0.07), Appreciation (SMD = −0.51, 95% CI: −0.66 to −0.36, P < 0.001; I2 = 0%, P = 0.97), and Reasoning (SMD = −0.62, 95% CI: −0.77, −0.47, P < 0.001; I2=0%, P =0.46). MCI patients scored significantly higher in Understanding (SMD = 1.50, 95% CI: 0.91, 2.09, P = 0.01, I2 = 78%, P = 0.00001) compared to patients affected by AD.Conclusions:Patients affected by MCI are at higher risk of impaired capacity to consent to treatment and research compared to HCs, despite being at lower risk compared to patients affected by AD. Clinicians and researchers need to carefully evaluate decisional capacity in MCI patients providing informed consent

EFFECTIVENESS OF SWITCHING FROM ORAL ZIPRASIDONE TO RISPERIDONE IN A PATIENT WITH COMORBID AUTISTIC DISORDER, PROFOUND INTELLECTUAL DISABILITY, GILBERT SYNDROME, AND EXACERBATION OF PSYCHOSIS

Autism and intellectual disability may hinder any other coexisting psychiatric diagnosis. Diagnoses are often based on behavioral observations, directly ob- tained or reported by family members or operators in frequent contact with the patient, and non-verbal communications, as well as on the psychological and physical symptoms manifested by the patient. We describe the case of a 28-year-old Italian man, hospitalized in one of our long-term care wards for comorbid profound intellectual disability (IQ&lt;25), autistic and psychotic disorders, and Gilbert syndrome, who manifested a severe exacerbation of psychosis, for which ziprasidone was prescribed. This condition para- doxically further deteriorated after the introduction of this drug. A subsequent switch to risperidone greatly and rapidly improved both psychosis-related and symp- toms emerging after the introduction of ziprasidone

Mitochondrial myopathy and comorbid major depressive disorder. effectiveness of dTMS on gait and mood symptoms

Background: Mitochondrial myopathies (MMs) often present with leukoencephalopathy and psychiatric symptoms, which do not respond to or worsen with psychiatric drugs. Case report: A 67-year-old woman with a 10-year history of probable chronic progressive external ophthalmoplegia, an MM, had drug-resistant, anxious-depressive symptoms. Since she had never had seizures, we proposed 20 sessions of deep transcranial magnetic stimulation (dTMS) for her depression. Surprisingly, besides the expected improvement of depression, we observed marked improvement of movement disorder that lasted as long as the patient was undergoing dTMS. She also improved her performance on neuropsychological tests of executive function and cognitive speed. Depressive symptom improvement was persistent, while anxiety symptoms recurred after the end of the sessions. Conclusions: dTMSmay be an alternative antidepressant strategy in patients withMMs, provided that they are free from seizures. The mechanism of improvement of motor disturbance may relate to dorsolateral prefrontal cortex stimulation and improved executive function and needs further investigation

STRUCTURAL NEUROIMAGING IN PATIENTS WITH PANIC DISORDER: FINDINGS AND LIMITATIONS OF RECENT STUDIES

Background: Panic disorder, a relatively common anxiety disorder, is often associated to agoraphobia and may be disabling. Its neurobiological underpinnings are unknown, despite the proliferation of models and hypotheses concerning it; investigating its correlates could provide the means for better understanding its pathophysiology. Recent structural neuroimaging techniques may contribute to the identification of possible brain morphological alterations that could be possibly related to the clinical expression of panic disorder. Methods: Through careful major database searches, using terms keen to panic, agoraphobia, structural magnetic neuroimaging and the like, we identified papers published in peer-review journals and reporting data on the brain structure of patients with panic disorder. Included papers were used comparatively to speculate about the nature of reported brain structural alterations. Results: Anxiety, which is the core feature of the disorder, correlates with the function of the amygdala, which showed a smaller volume in patients, as compared to healthy subjects. Data also showed a volumetric decrease of the anterior cingulate along with increased fractional anisotropy, and increase of some brainstem nuclei, particularly of the rostral pons. Other structures with reported volumetric correlates of panic disorder are the hippocampus and the parahippocampal cortices, the insula, the putamen, and the pituitary gland. Volumetric changes in the anterior cingulate, frontal, orbitofrontal, insular, and temporal cortices have also been described in structural neuroimaging studies. Major methodological limitations are considered in context. Conclusions: Several data point to the existence of structural neuroanatomical alterations in panic disorder, consisting in significant volumetric reductions or increases in different brain areas. White matter alterations were shown also in the only diffusion tensor imaging study performed to date. Available data do not allow us to conclude about the possible progression of these alterations