Temperament and Depression After a First Acute Coronary Syndrome

Few studies assess the role of personality styles in predicting the onset of depression among cardiac patients. This study evaluates whether temperament and character can represent a risk factor for the development of incident first-ever depressive episodes in patients at their first acute coronary syndrome (ACS). Two hundred sixty-seven (72.1%) subjects (male) completed the Temperament and Character Inventory (TCI) a few days after the cardiac event. At baseline and after 1, 2, 4, 6, 9, 12, and 24 months of follow-up, the participants completed the Primary Care Evaluation of Mental Disorder (PRIME-MD) and the Hospital Anxiety and Depression Scale to establish the presence of a depressive episode and its severity. During the follow-up, 61 (22.8%) participants developed a depressive episode. Temperamental risk factors for incident depression were scored high on novelty seeking and harm avoidance at the TCI. Given the detrimental effect of depression on cardiac prognosis, clinicians should take temperament variables into account when determining the treatment plans of their patients with ACS

Insight in cognitive impairment assessed with the Cognitive Assessment Interview in a large sample of patients with schizophrenia

The Cognitive Assessment Interview (CAI) is an interview-based scale measuring cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). The present study aimed at assessing, in a large sample of SCZ (n = 601), the agreement between patients and their informants on CAI ratings, to explore patients' insight in their cognitive deficits and its relationships with clinical and functional indices. Agreement between patient- and informant-based ratings was assessed by the Gwet's agreement coefficient. Predictors of insight in cognitive deficits were explored by stepwise multiple regression analyses. Patients reported lower severity of cognitive impairment vs. informants. A substantial to almost perfect agreement was observed between patients' and informants' ratings. Lower insight in cognitive deficits was associated to greater severity of neurocognitive impairment and positive symptoms, lower severity of depressive symptoms, and older age. Worse real-life functioning was associated to lower insight in cognitive deficit, worse neurocognitive performance, and worse functional capacity. Our findings indicate that the CAI is a valid co-primary measure with the interview to patients providing a reliable assessment of their cognitive deficits. In the absence of informants with good knowledge of the subject, the interview to the patient may represent a valid alternative

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia

CUORE DI VETRO: VULNERABILITA’ AUTONOMICA CARDIACA ALL’INTERAZIONE SOCIALE E PSICOPATOLOGIA

Questa ricerca si propone di studiare i correlati neuro-autonomici delle alterazioni del funzionamento sociale che caratterizzano il Disturbo Borderline di Personalità (DBP) e la Schizofrenia. Nel DBP tali difficoltà riflettono un’organizzazione disfunzionale del sé; nella Schizofrenia, invece, sembrano dipendere dalla sintomatologia difettuale. La teoria polivagale fornisce una cornice teorica per comprendere se tali alterazioni si associno a strategie di regolazione autonomica che favoriscono comportamenti difensivi. Secondo la teoria polivagale, la reattività alle “sfide” ambientali dipende, a livello cardiaco, da tre branche del Sistema Nervoso Autonomo, sviluppate consecutivamente nel corso dell’evoluzione, alternativamente attivabili: (1) il sistema vagale non mielinizzato, responsabile della riduzione della frequenza cardiaca e di comportamenti di immobilizzazione, (2) il sistema nervoso simpatico, che determina tachicardia e risposte di “attacco-fuga”, e (3) il sistema vagale mielinizzato, che si attiva in modo flessibile in base alla presenza di minacce nell’ambiente e favorisce un coinvolgimento sociale adattivo. L’impatto dinamico delle fibre vagali mielinizzate sul cuore può essere misurato con l’Aritmia Sinusale Respiratoria (ASR), un’oscillazione spontanea del ritmo cardiaco in base agli atti respiratori. Nel primo studio, usando il paradigma sperimentale Cyberball, sono stati valutati i cambiamenti di ASR in condizioni di inclusione sociale ed ostracismo nei pazienti affetti da DBP, confrontandoli con un gruppo di Controlli Sani (CS) e con pazienti affetti da Disturbo Depressivo Maggiore Ricorrente in fase di remissione, inclusi come gruppo clinico di controllo. I pazienti affetti da DBP presentavano una ridotta ARS, indice di uno stato fisiologico che predispone a comportamenti difensivi già nell’approccio all’interazione sociale. Durante il gioco i pazienti affetti da DBP hanno presentato un’ulteriore riduzione dei livelli di ARS, che indica uno stato di allarme persistente, indipendente dal tipo di interazione, associato a maggiori sentimenti di minaccia anche in contesti sociali favorevoli. Nel secondo studio le risposte autonomiche ed emotive al gioco Cyberball sono state valutate in un gruppo di pazienti affetti da Schizofrenia, confrontandoli con un gruppo di CS. I pazienti, in condizioni di riposo, mostravano ridotti livelli di ARS, espressione di una ridotta flessibilità fisiologica in potenziali interazioni sociali. Nella condizione di ostracismo hanno riportato una minore percezione di minaccia rispetto ai CS e non hanno sviluppato tendenze aggressive verso i partecipanti da cui erano stati esclusi. In entrambi i gruppi non è stata rilevata alcuna modulazione nell’ARS, ad indicare che nel corso dell’interazione sociale il “freno vagale” ha soppresso l’attivazione di potenziali risposte di attacco/fuga. Tali risultati confermano che ridotti livelli di ARS a riposo si osservano in modo trans-diagnostico in diversi disturbi psichici. I cambiamenti in ARS in risposta all’interazione sociale sembrano essere distintivi del DBP. Il terzo studio riguarda l’enterocezione, intesa come la percezione delle sensazioni interne al corpo. Il processamento dei segnali enterocettivi è stato correlato a funzioni psicologiche superiori quali il senso di sé e la regolazione emotiva. Un recente studio ha mostrato come tali processi siano associati alla capacità di regolazione autonomica nei contesti sociali. L’Accuratezza Enterocettiva (AE) è stata misurata con il task di detenzione dei battiti cardiaci, sul campione aggregato. I risultati hanno mostrato una ridotta AE nei pazienti affetti da DBP e Schizofrenia, suggerendo un possibile effetto di mediazione dei processi enterocettivi nelle alterazioni del funzionamento sociale.This research aims to study the neuro-autonomic correlates of the impairment in social functioning, found as a core component of at least two psychiatric disorders, namely Borderline Personality Disorder (BPD) and Schizophrenia. Whereas in the former the impairment in social functioning reflects a disturbed psychological self-organization, in the latter it seems to be most related with deficit syndrome symptoms. The polyvagal theory provides a theoretical framework to explore whether these compromised social functioning would be associated with autonomic regulation strategies that foster defensive and non-social behaviours. According to the polyvagal theory the physiological reactivity in response to environmental “challenges” depends, at the cardiac level, on three branches of the Autonomic Nervous System. These could be alternatively dominant and have consecutively developed during evolution as follow: (1) the un-myelinated vagal system, associated with cardiac slowing and “freezing” conducts, (2) the sympathetic nervous system, responsible for tachycardia and “fight or flight” responses, and (3) the myelinated vagal system, that acts in different ways according to the estimated threat in the environments and fosters adaptive social engagement. The dynamic impact of the myelinated vagal fibers on the heart is reflected by the amplitude of the Respiratory Sinus Arrhythmia (RSA), a naturally occurring rhythm in the cardiac cycle at approximately the frequency of spontaneous breathing. In the first study, using the Cyberball experiment, we investigated whether BPD patients display a peculiar pattern of changes in RSA after conditions of social inclusion and ostracism, compared with Healthy Controls (HC) and remitted Major Depressive Disorder patients, as a clinical control group. We found that, before the task, BPD patients showed reduced resting RSA, indicating stable difficulties in social predisposition. During the task, BPD patients responded with greater physiological arousal to any social situation and with greater feelings of ostracism after actually benign social scenarios, i.e., following social inclusion and when the ostracism experience is over. In the second study, we measured the autonomic and psychological response to Cyberball in a sample of patients with Schizophrenia, compared with HC. At baseline, we observed a reduced resting RSA, index of impaired social flexibility. During the task, the patients with Schizophrenia showed a blunted perception of threat and did not report aggressive tendencies, compared to HC, in response to the condition of ostracism. In both samples, a parasympathetic withdrawal was not observed, showing that the experience of being excluded did not induce propensities toward fight/flight responding. Overall, these findings confirmed low resting RSA that was observed across a variety of trans-diagnostic psychiatric conditions. Moreover, our results suggest that phasic changes in RSA in response to social interaction could be a trait marker of BPD. Finally, in the third study, we investigated the interoception, conceptualized as the sense of the internal physiological condition of the body. The processing of afferent bodily signals has been linked to higher-order psychological functions such as the sense of self and emotions regulation. Specifically, recent evidence suggested that interoceptive processes might predict the autonomic regulation in a social setting. Interoceptive Accuracy (IA) was measured with a heart beat detection task in the aggregated sample. Our results showed a reduced IA among patients with both BPD and Schizophrenia, confirming how interoceptive processes are altered in clinical samples and should be considered as potential mediator in patients' psychosocial difficulties

Early parent-child interactions and substance use disorder: An attachment perspective on a biopsychosocial entanglement

This review aims to elucidate environmental and genetic factors, as well as their epigenetic and neuroendocrine moderators, that may underlie the association between early childhood experiences and Substance Use Disorders (SUD), through the lens of parental attachment. Here we review those attachment-related studies that examined the monoaminergic systems, the hypothalamic pituitary adrenal stress response system, the oxytoninergic system, and the endogenous opioid system from a genetic, epigenetic, and neuroendocrine perspective. Overall, the selected studies point to a moderating effect of insecure attachment between genetic vulnerability and SUD, reasonably through epigenetic modifications. Preliminary evidence suggests that vulnerability to SUDs is related with hypo-methylation (e.g. hyper-expression) of high-risk polymorphisms on the monoaminergic and hypothalamic pituitary adrenal system and hyper-methylation (e.g. hypo-expressions) of protective polymorphisms on the opioid and oxytocin system. These epigenetic modifications may induce a cascade of neuroendocrine changes contributing to the subclinical and behavioural manifestations that precede the clinical onset of SUD. Protective and supportive parenting could hence represent a key therapeutic target to prevent addiction and moderate insecure attachment

Alcohol use disorders among adult children of alcoholics (ACOAs):Gene-environment resilience factors

Both genetic and early environmental factors contribute to the pathogenesis of Alcohol Use Disorder (AUD). Gender and psychopathology symptoms might further moderate this association, resulting in an impairment of both the dopaminergic and serotoninergic pathways that sustain the binge, withdrawal and craving cycle. In a sample of of adult children of alcoholic parents (ACOAs) (n = 107) we compared those with and without an AUD, on socio-demographic variables, adverse childhood experiences, psychopathology symptoms and two polymorphisms associated with an impaired serotoninergic and dopaminergic neurotransmission (5HTTLPR and Taq1A/DRD2). A logistic regression revealed that an early caring environment might lower the risk of developing an AUD. When controlling for the actual psychopathology symptoms, being male and having the genotype associated with an impaired dopaminergic neurotransmission were still associated with AUD. Results were confirmed by an unsupervised approach that showed how the clusters characterised by being male and having the high risk genotypes were still associated with AUD compared to being female without the unfavourable dopamine genotype.Our results point to the need for implementing prevention strategies aimed at creating a caring environment especially in those families with an alcoholic parent. We further suggest that psycho-education as a symptom recognition and avoiding self-medication could improve the outcome in those subjects at higher risk, especially males

Anxiety, depression, and cardiac outcomes after a first diagnosis of acute coronary syndrome

Depression is an established risk factor for acute coronary syndrome (ACS), with an impact on cardiac prognosis; nonetheless, the literature disagrees on the role played by anxiety. No study has evaluated this relationship in a cardiac population with no history of depression and after their first diagnosis of ACS. The aim of this study is to explore these associations without the confounding role of long-lasting heart disease or psychiatric illnesses

Anxiety, depression, and birth outcomes in a cohort of unmedicated women

Background: Even though most of the systematic reviews suggest that depression and anxiety are related to poor neonatal outcomes, it is not yet clear whether a dose-response effect exists. Aim: The aim of the present study is to evaluate the amount of depressive and anxiety symptoms in a cohort of pregnant women and its effect on their newborns. Methods: Two hundred ninety-nine women were assessed for anxiety and depressive disorders and anxious and depressive symptoms at near monthly intervals throughout pregnancy. At the time of delivery, we collected the newborns' gestational age, birth weight and the Apgar score at 1 and 5 min. Results: Sixty-seven women were diagnosed as depressed and 43 had an anxious disorder. After controlling for confounding variables only the overall levels of anxiety during pregnancy were negatively associated with birth weight (B = -5.76; 95% CI = -10.96, -2.81), suggesting the existence of a "dose-response" effect. The birth outcomes in mildly depressed pregnant women were similar to those of nondepressed women. Conclusion: Anxiety symptoms, beyond a categorical diagnosis, are associated with low birth weight and should be recognized and properly treated during pregnancy