Lithium from mood stabilizer to putative cognitive enhancer

This study is the first to have demonstrated, by means of a highly sensitive test of visual memory, a potential hippocampus neuroprotective effect of lithium in patients with BD. Undoubtedly, other studies are needed to finally recognize lithium as a potential cognitive enhancer. Future studies should include, apart from highly sensitive cognitive tests, specific neurotrophic biomarkers, such as BDNF, NGF, etc. Finally, it will be of outmost importance to evaluate the minimal length of treatment and the optimum serum level in order to combine potential clinical benefit and, particularly for older patients, clinical safety

Nerve growth factor, brain-derived neurotrophic factor, and the chronobiology of mood: a new insight into the "neurotrophic hypothesis"

The light information pathways and their relationship with the body rhythms have generated a new insight into the neurobiology and the neurobehavioral sciences, as well as into the clinical approaches to human diseases associated with disruption of circadian cycles. Light-based strategies and/or drugs acting on the circadian rhythms have widely been used in psychiatric patients characterized by mood-related disorders, but the timing and dosage use of the various treatments, although based on international guidelines, are mainly dependent on the psychiatric experiences. Further, many efforts have been made to identify biomarkers able to disclose the circadian-related aspect of diseases, and therefore serve as diagnostic, prognostic, and therapeutic tools in clinic to assess the different mood-related symptoms, including pain, fatigue, sleep disturbance, loss of interest or pleasure, appetite, psychomotor changes, and cognitive impairments. Among the endogenous factors suggested to be involved in mood regulation, the neurotrophins, nerve growth factor, and brain-derived neurotrophic factor show anatomical and functional link with the circadian system and mediate some of light-induced effects in brain. In addition, in humans, both nerve growth factor and brain-derived neurotrophic factor have showed a daily rhythm, which correlate with the morningness–eveningness dimensions, and are influenced by light, suggesting their potential role as biomarkers for chronotypes and/or chronotherapy. The evidences of the relationship between the diverse mood-related disorders, with a specific focus on depression, and neurotrophins are reviewed and discussed herein in terms of their circadian significance, and potential translation into clinical practice

La legalizzazione della cannabis. Tra irresponsabilità politica e deresponsabilizzazione degli psichiatri

In Italy a political parliamentary majority, recognized by all the press as "cross party", is going to approve the law that will legalize the use of cannabis. As diversified in different Countries, it is a phenomenon which affects substantially homogeneous many European nations, as well as several states of the USA and other Countries of the world. The authors, after listing the main harmful effects of cannabis, especially in young people, on cognitive functions and on the onset of several psychotic disorders, express the need for reflection by the mental health experts on a problem of extreme relevance and urgency care

The assisted suicide of Italians in Switzerland and the silence of psychiatry

The debate on different forms of request of death has taken on a broad dimension in public opinion over last years, often referring on profoundly differentiated and often opposing positions of principle. Beyond cultural, political or ideal positions, a further critical issue, often underestimated or quite not considered, concerns a person’s ability to express a valid consent to the request of death, according to the same criteria of validity of the informed consent to any medical act. This assumes particular importance in the case of assisted suicide. Assisted suicide represents a phenomenon in sharp growth in Western world. It is legal in many nations, and in Switzerland it is also allowed for foreign citizens, thus increasing the phenomenon of the so-called “tourism of suicide”. In addition to neoplastic and neurological diseases, depression has also been accepted as a disease that makes assisted suicide possible. This imposes profound clinical and ethical considerations, since depression is unanimously recognized as a treatable disease and since in its most serious forms, such as those in which suicidal ideation dominates, it can compromise the patient’s ability to express a valid consent to any medical act, including the assisted suicide. Furthermore, it is often overlooked that any serious and disabling somatic disease, source of intense and chronic suffering, carries the very high risk of the onset of unrecognized depressive conditions, able in turn to negatively influence the ability to express valid consent. Faced with this situation, which has involved a large number of Italian citizens in recent years, the personal and official voice of psychiatry is absolutely lacking, contrasting its silence with the opinions of those who do not want to take into account its potentially fundamental considerations

Acute stimulation of vagus nerve modulates brain neurotrophins, and stimulates neuronal plasticity in the hippocampus of adult male rats

The present study was aimed at evaluating whether single intermittent acute cervical vagus nerve stimulation (ACVS), pro-vided at a frequency which exhibits a clinical efficacy, may influence brain neurotrophins and hippocampal plasticity. With this purpose, the brain of adult male rats undergoing ACVS was used to analyze the expression of Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF) in brain areas known to synthetize these growth factors, and the expression the neural cell adhesion molecule (NCAM), the synaptophysin (SYP) and biosynthetic GABA (GAD67) in the hippocampus.The effects of ACVS on NGF and BDNF protein and mRNA in hippocampus, hypothalamus and cortex two hours after stimulation were shown to be dependent on the frequencies of ACVS stimulation. Prolonged (three days post stimulation) modifications of NGF and BDNF were also observed in the hippocampus of ACVS rats. An early enhancement of the plasticity markers NCAM, SYP and GAD67 was also found in ACVS hippocampus. Three days after stimulation, NCAM and GAD67 levels were still higher than controls. Immunohistochemistry confirms the stimulatory effects of ACVS on GABA showing an increase in GAD67-positive cells in the dentate gyrus and CA3 hippocampal areas. This study shows that ACVS affects brain NGF and BDNF synthesis in a frequency-dependent manner. Neurotrophins changes are associated with increased hippocampal plasticity, as demonstrated by the observed molecular and morphological modifications. These findings support the role of brain neurotrophins in the ACVS mechanism of action

TNF-a and IL-10 modulation induced by polyphenols extracted by olive pomace in a mouse model of paw inflammation

Polyphenols from olive are known to possess antioxidant and anti-inflammatory properties. The aim of this study was to study whether or not administration of olive (Olea europaeaL.) polyphenols could have an effect on cytokines as TNF-a and IL-10 in the mouse paw following inflammation induced by carrageenan injection. TNF-a and IL-10 were measured by enzyme-linked immunosorbent assay. Carrageenan decreased IL-10 in the paws, however, this reduction appeared to be less evident in mice treated with carrageenan but administered with polyphenols. As for TNF-a, our findings did not reveal differences between groups but an increase in polyphenol and carrageenan groups if compared to the carrageenan only group. No differences between groups in the serum Glutathione were found. Altogether, this investigation shows that olive polyphenols in the mouse may modulate the levels of cytokines having a role in the process of inflammation as TNF-a and IL-10

The Shanti De Corte case. Euthanasia for mental disorder between clinic and bioethics, between law and medico-legal implications

Introduction. In recent months, a great uproar has been aroused by the case of a 23-year -old Belgian woman who requested and obtained euthanasia because she was suffering from a mental disorder, in the absence of any somatic pathology. The news raises some questions and stimulates some reflections both on the general theme of euthanasia carried out for the simple presence of a mental disorder, and for the indefiniteness of the clinical information on the case in question, as well as on the ethical and medico-legal questions connected to such indefiniteness. Case presentation. The information on the case was derived essentially from the press and from websites, with no specific access to actual clinical documentation and without in-depth knowledge of case details. One wonders what the real clinical diagnosis of the patient was, only hypothetically identifiable in a Post-traumatic Stress Disorder associated with Major or Chronic De-pressive Disorder, probably on the basis of a possible Personality Disorder. One wonders if all the necessary therapeutic interventions had been implemented, in a clinical case that did not theoretically have the characteristics of incurability. One wonders why the death request was considered valid, in a subject perhaps suffering from a mental disorder of such severity as to alter the ability to express valid consent to medical treatment. One wonders why the death request was not considered as an indicator of the severity of the disease, rather than simply being considered as a free choice of a subject capable of self-determination. One wonders why the negative opinion of the patient's family members was not considered. Conclusions. Belgian legislation provides for euthanasia for patients suffering from mental disorders who, like those suffering from somatic disorders, experience a condition of constant, unbearable and incurable suffering. But the case in question raises numerous perplexities both on the clinical and ethical coherence of Belgian legislation and on the ways in which the rules of this legislation have been observed in this specific situation

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