Psychoneurobiology of an earthquake: Brain-Derived Neurotrophic Factor and stress spectrum clinical correlates of a population involved in the L’Aquila (2009) earthquake

Disasters such as earthquakes are events that affect wide populations causing widespread consequences including psychosocial disruption, physical threat, massive psychological stress. Mental health professionals have been increasingly called upon to assist during these acute crises. Disasters deserve special attention among human traumas because the capacity to traumatize a great many individuals at once, being the most public of traumas, and thus offering unique opportunities to study human response to tragedy on any level. Because natural disasters are random events that expose unselected populations to trauma, they offer unique opportunities for researchers interested in studying subjects ‘triggered’ to a unique trauma, disentangling confounding issues of pre-existing risk for exposure to traumatic events. On April 6th 2009, at 3:32 am, an earthquake (Richter Magnitude 6.3) struck L’Aquila, Italy, a town with a population of 72,000 and a ‘local health’ (i.e. Azienda Sanitaria Locale) of 105,000 inhabitants. L’Aquila earthquake caused the death of 309 people, with more than 1600 individuals injured, among which 200 were severely injured and hospitalized, and 66,000 displaced. Many buildings collapsed in the town of L’Aquila: large parts of it were completely destroyed. In this thesis psychoneurobiology of stress caused by this traumatic event has been investigated through three studies on Brain-Derived Neurotrophic Factor (BDNF). The BDNF is a key mediator of neuronal plasticity, which stimulate a variety of cellular effects at the structural and functional levels that eventuate in the promotion of survival and differentiation of responsive neurons. Stress has been widely linked with alterations in the expression and functioning of BDNF in both animal and human clinical studies. The aim of the first study was to investigate plasma BDNF levels in a clinical population who survived to the L'Aquila 2009 earthquake, along with the post-traumatic spectrum that considers not only full expression of Post-Traumatic Stress Disorder (PTSD) but also subthreshold manifestations such as partial PTSD. To do so a consecutive sample of 37 outpatients referring to the National Mental Health Care Service in L’Aquila for anxiety or affective symptoms after the earthquake, was compared to 15 healthy controls matched for age and gender. Eleven patients were diagnosed as not having PTSD but a different pathological condition that justified the referral and 13 patients respectively were diagnosed as showing Full or Partial PTSD. The subjects without PTSD, but with anxiety or affective disorders, and subjects with full-blown PTSD showed lower BDNF level than subjects with partial PTSD and healthy controls. The aim of the second study was to investigate the clinical correlates of plasma BDNF levels in a clinical population showing PTSD symptomatology, along with the post-traumatic spectrum. Assessments included: Structured Clinical Interview for DSM-IV Axis-I disorders Patient Version, Trauma and Loss Spectrum-Self Report (TALS-SR) for post-traumatic spectrum symptoms and the Impact of Event Scale Revised (IES-R) for the PTSD symptomatology. Thirteen patients were diagnosed as showing Full PTSD and 13 Partial PTSD. Different relationship pattern of BDNF vs. stress symptoms has been reported in partial and full PTSD samples. In the third study BDNF modifications in subjects that did not showed psychiatric symptoms or symptoms worsening despite having suffered relevant stress event have been investigated. We hypothesized that, in so far as no stress consequences or relapse/worsening appeared in subjects who suffered relevant stress, any BDNF variation could be due to stress exposure. To do so BDNF plasma levels have been evaluated in subjects who suffered the same stress event, i.e. a clinical and non clinical population exposed to the 2009 L’Aquila earthquake, in comparison to a population not exposed to relevant stress. Statistical difference has been observed for diagnosis factor (clinical samples vs. controls). A trend toward significance was seen for exposition factor (exposed vs. not exposed subjects); exposition by diagnosis interaction did not reach statistical significance. The exposed clinical sample showed significant higher BDNF level than the not exposed. Lack of statistical difference between exposed and not exposed subjects suggests that no BDNF modification intervened after the stressful event, but: exposed samples show the highest BDNF levels and a trend toward significance was seen; possibility of a ceiling effect, with no possibility of exceed a possible maximum level in the control sample can be considered. Clinical sample shows instead room for stress related BDNF increase. If so a BDNF increase with neuroprotective adaptive aim after stress cannot be excluded. The findings of these studies add more insight on the mechanisms regulating BDNF levels in response to stress and further proofs on the utility of the distinction of PTSD into full and partial categories along the spectrum approach

Response to Cognitive impulsivity and the behavioral addiction model of obsessive–compulsive disorder: Abramovitch and McKay (2016)

In our recently published article, we investigated the behavioral addiction model of obsessive–compulsive disorder (OCD), by assessing three core dimensions of addiction in patients with OCD healthy participants. Similar to the common findings in addiction, OCD patients demonstrated increased impulsivity, risky decision-making, and biased probabilistic reasoning compared to healthy controls. Thus, we concluded that these results support the conceptualization of OCD as a disorder of behavioral addiction. Here, we answer to Abramovitch and McKay (2016) commentary on our paper and we support our conclusions by explaining how cognitive impulsivity is also a typical feature of addiction and how our results on decision-making and probabilistic reasoning tasks reflect cognitive impulsivity facets that are consistently replicated in OCD and addiction

Premorbid intelligence of inpatients with different psychiatric diagnoses does not differ

The diagnostic specificity of poor premorbid intelligence is controversial. We explored premorbid intelligence level in psychiatric patients with personality disorders, depressive disorders, bipolar disorders and schizophrenic disorders. 273 consecutively admitted patients and 81 controls were included in the study and tested with the ‘Test di Intelligenza Breve’, an Italian adaptation of the National Adult Reading Test. Significant differences between the clinical samples and the control subjects were found but not among the 4 clinical groups. The observation of premorbid IQ deficits in subjects with diagnoses other than schizophrenia suggests a common vulnerability diathesis, which is most likely to have a neurodevelopmental basis

The Community Assessment Psychic Experience (CAPE): evaluation study of the Italian version

AbstractNegli ultimi anni il modello categoriale della psicosi e della schizofrenia in particolare, è stato riconsiderato a favore di una visione dimensionale. Questa assume che I sintomi psicotici differiscono in modo quantitativo dalle normali esperienze psichiche distribuendosi lungo un continuum che va dalla popolazione clinica affetta da schizofrenia ad individui con disturbo di personalità, fino alla popolazione generale che può mostrare esperienze simil psicotiche (Hanssen et al., 2003; Johns & Phil, 2005). Tale continuità fenomenologica è suggerita da studi che mostrano che le dimensioni del fenotipo della psicosi subclinica sono molto simili a quelle identificate nei disturbi clinici (Van Os et al. 2000; Van Os & Tamminga, 2007; Rossler et al., 2007). Sono state infatti riportate dimensioni positive e negative sia in ambito clinico che subclinico, mentre più incerta appare la presenza della dimensione disorganizzazione (Vollema & Hoijtink, 2000; van Os et al., 2002). Vari studi hanno riportato che i fenotipi clinico e non clinico condividono fattori di rischio, meccanismi psicologici ed i pattern epidemiologici (Sharpley & Peters,1999; Johns & van Os, 2001; van Os et al., 2001), fornendo un'ulteriore prova che l'espressione clinica e subclinica delle psicosi fanno parte dello stesso continuum

Mental health in L'Aquila after the earthquake

INTRODUCTION: In the present work we describe the mental health condition of L'Aquila population in the aftermath of the earthquake in terms of structural, process and outcome perspectives. METHOD: Literature revision of the published reports on the L'Aquila earthquake has been performed. RESULTS: Although important psychological distress has been reported by the population, capacity of resilience can be observed. However if resilient mechanisms intervened in immediate aftermath of the earthquake, important dangers are conceivable in the current medium-long-term perspective due to the long-lasting alterations of day-to-day life and the disruption of social networks that can be well associated with mental health problems. CONCLUSIONS: In a condition such as an earthquake, the immediate physical, medical, and emergency rescue needs must be addressed initially. However training first responders to identify psychological distress symptoms would be important for mental health triage in the field

Personal values in mental disorders: an exploratory analysis

AbstractPersonal values have increasingly become central in socio-psychological research. However, the relationships between values and psychopathological variables have been scarcely investigated, with mixed results. This study aimed to explore potential differences in value orientation in a sample of people with psychotic disorders and mood disorders compared to a non-clinical sample using the Schwarz's values framework. A clinical sample of 162 subjects (92 subjects with psychotic disorders and 70 with mood disorders) and a non-clinical sample of 217 subjects completed the self-report measures of affective states (PANAS) and personal values (PVQ). Irrespective of the diagnostic group, the clinical sample showed higher expression of Conservation values (i.e., Tradition, Conformity, Security). Conservation and Self-enhancement values positively correlated with PANAS-positive affectivity in the clinical sample; in the non-clinical sample, Self-enhancement values only correlated with PANAS-positive affectivity. The expression of Conservation values in individuals with a mental disorder could reflect an orientation toward Conformity underlying fundamental affiliative goals. The complex relationship between personal values and clinical constructs should be further investigated, with important theoretical and clinical implications in mental health

Riti e costumi degli ebrei

Copia digital. Madrid : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, 2011Sign.: a12, A-Q12Port. con viñ. xil

The effect of verbalization strategy on wisconsin card sorting test performance in schizophrenic patients receiving classical or atypical antipsychotics

BACKGROUND: A number of reports showed en encouraging remediation in some patients' executive deficits thanks to the use of 'information processing strategies'. Moreover the impact of antipsychotics on cognitive functions of the schizophrenics is an important issue, especially if an integrated psychosocial treatment is needed. The aim of this paper is to evaluate different executive performance and response to verbalization, a strategy of the Wisconsin Card Sorting Test (WCST) remediation, in subjects on classical vs atypical antipsychotic (AP) treatment. METHODS: Sixty-three schizophrenic subjects undertook the WCST under standard and modified (verbalization) administration. Subjects were stratified by the kind of WCST response (i.e. good, poor and remediable) and AP treatment (i.e. atypical vs. classical). RESULTS: Subjects on atypical APs showed a better performance than those on classical ones. More poor performers who did not remediate were seen in the sample with classical Aps while subjects who remediated the performance were seen in the subgroup with atypical APs only. An increase of perseverative and total errors was seen in poor performers subjects on classical APs. CONCLUSION: Subjects on atypicals showed a better cognitive pattern in terms of WCST performance. Since the naturalistic assignment of medication we cannot draw conclusions about its effect on cognitive performance and its interaction with cognitive remediation potential. However the data lead us to hypothesize that subjects with potential room for remediation did so with the atypical APs