Assessing response, remission and treatment resistance in patients with Obsessive-Compulsive Disorder with and without Tic Disorders: results from a multicenter study

Introduction

Obsessive Compulsive Disorder (OCD) and Tic Disorder (TD) are two highly disabling, comorbid and difficult-to-treat conditions. DSM-5 acknowledged a new “tic-related” specifier for OCD, i.e., Obsessive-Compulsive Tic-related Disorder (OCTD), which may show poor treatment response.

Objectives

The aim of the present study was to evaluate rates and clinical correlates of response, remission and resistance to treatment in a large multicentre sample of OCD patients with versus without tics.

Methods

398 patients with a DSM-5 diagnosis of OCD with and without comorbid TD was assessed from ten psychiatric departments across Italy. Treatment response profiles in the whole sample were analysed comparing the rates of response, remission and treatment-resistance as well as related clinical features. Multivariate logistic regressions were performed to highlight possible treatment response related factors.

Results

Later ages of onset of TD and OCD were found in the remission group. Moreover, significantly higher rates of psychiatric comorbidities, TD, and lifetime suicidal ideation and attempts were associated to the treatment-resistant group, with larger degrees of perceived worsened quality of life and family involvement.

Conclusions

While remission was related to later ages of OCD and TD onset, specific clinical factors, such as early onset and presence of psychiatric comorbidities and concomitant TD, predicted a worse treatment response, with a significant impairment in quality of life for both patients and their caregivers. These findings suggest a worse profile of treatment response for patients with OCTD.

Disclosure

No significant relationships.

Echocardiographic changes in anorexia nervosa: a pathophysiological adaptation or a disease?

Anorexia Nervosa is one of the most common form of eating disorders. Cardiac involvement occurs in approximately 80% of patients. Few reports focused on the association between body weight fluctuations and echocardiographic abnormalities, considering linear measurements. We describe echocardiographic and clinical features among male and female patients with anorexia nervosa and the effect of weight gain on these parameters. We performed a single center, retrospective study of patients followed at a dedicated multidisciplinary Unit. The study population consisted of 81 patients, mean age 25 ± 11 years, 94% female. Median body mass index was 14.4 kg/m² (25th-75th percentile 12.7-15.6 kg/m²). Patients with body mass index below the median value had more often pericardial effusion, smaller left ventricular mass and left ventricular end-diastolic volume and thinner interventricular septum. However, when indexed to body surface area, left ventricular mass and volumes were within the normal range in 90% of population. Patients with pericardial effusion showed mitral valve abnormalities and lower values of white blood cells and platelets, although within normal limits. Presence of pericardial effusion was not related to inflammatory parameters or low plasma protein levels. In 39 patients who displayed weight gain during a median follow-up of 189 days (25th-75th percentile 47-471), increased left ventricular mass, interventricular septum thickness, white blood cells and platelet count and decreased pericardial effusion were observed. Patients with anorexia nervosa have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates.

Abnormal sensory sensitivity during pregnancy, peri-partum and post-partum in mothers with high functioning autism spectrum disorder: A preliminary study

Introduction

Individuals with Autism Spectrum Disorder without intellectual disabilities (High Functioning ASD, HF-ASD) present atypical sensory sensitivity, due to the hyper-reactivity to sensory inputs.

Objectives

To retrospectively evaluate the sensory sensitivity in a sample of mothers with HF-ASD during pregnancy (pre-partum), delivery and childbirth (peri-partum) and during the three months after delivery (post-partum).

Methods

19 HF-ASD and 13 neurotypical (NT) mothers were asked to complete an ad-hoc questionnaire designed for the study, named Maternity Questionnaire, assessing sensory perception during pre-, peri- and post-partum. Moreover, they underwent the following assessment: the Autism-Spectrum Quotient (AQ), the Empathy Quotient (EQ), the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), the Edinburg Postnatal Depression Scale (EPSD), the Sensory Perception Quotient (SPQ) and the Post Partum Bonding Questionnaire (PBQ).

Results

At the Maternity Questionnaire, HF-ASD mothers showed higher sensitivity scores than NT mothers overall. Moreover, HF-ASD mothers presented lower sensitivity during the peri-partum, compared to pre- and post- partum periods, while NT mothers showed a linear decrease from pre- to post- partum. The two groups significantly differed at the AQ, the EQ, the RAADS-R, the SPQ and Factor 3 of the PBQ. Sensitivity during pre- and post-partum positively correlated with EPDS scores.

Conclusions

Mothers with HFA tend to experience pregnancy, childbirth and the post-partum period differently from neurotypical mothers, particularly in terms of hypersensitivity, although during the peri-partum the hypersensitivity decreases. Further studies investigating these aspects might give fundamental hints to provide proper help to HF-ASD mothers during pregnancy and motherhood overall.

Attachment styles, identification of feelings and psychiatric symptoms in functional neurological disorders

OBJECTIVE

The contribution of psychological and psychiatric symptoms in the development of Functional Neurological Disorders (FND) is unclear. We therefore aimed to investigate the role of different attachment styles (AS) and their relationship with psychiatric symptoms in FND patients as compared with both subjects with neurological disorders (ND) and healthy controls (HC); and the possible differences between patients with functional movement disorders (FMD) and with functional seizures.

METHODS

In this case-control study, forty-six patients with FND were compared to 34 with ND and 30 HC, by means of an extensive battery to investigate the presence of alexithymia, depression, anxiety, dissociation and to explore their AS using the Revised Experiences in Close Relationships instrument (ECR-R).

RESULTS

Patients with FND had higher depression and alexithymia as well as an avoidant pattern on the ECR-R than patients with ND. In the FND group, ECR-R avoidance was an independent predictor of psychiatric symptoms and, altogether, ECR-R avoidance, the somatic-affective component of depression and difficulty identifying feelings were independent predictors of FND. Gender, anxiety and difficulty identifying feelings predicted the presence of functional seizures.

CONCLUSION

The avoidant AS may be an important psychological factor influencing the presence of mood disorders and alexithymia. Their co-occurence might drive maladaptive responses underlying the presence of FND. Although we demonstrated a large overlap between FND phenotypes, patients with functional seizures might have higher alexithymia, which in turn could explain a defensive response less anchored to body reactions and physical symptoms.

Eating disturbances in subjects with autism spectrum disorder without intellectual disabilities

Introduction

There is a growing interest in the relationship between Autism Spectrum Disorders (ASD) and Eating Disorders (ED), two relatively common conditions lying on a spectrum from mild to severe clinical features. However, only limited data are available about pathological eating behaviours throughout adults on the autistic spectrum.

Objectives

The aim of the present study is to assess dysfunctional eating behaviours, including ED manifestations and ASD-related eating disturbances, in a population of adults with ASD with no intellectual disabilities.

Methods

We recruited 115 adults on the autistic spectrum, with no intellectual disability and 114 neurotypical adults (NA). Participants completed the “Eating Attitude Test” (EAT-26), to measure symptoms and concerns characteristic of ED, and the “Swedish Eating Assessment for Autism Spectrum Disorders” (SWEAA), to assess eating behaviours frequently seen within the autistic spectrum.

Results

Subjects with ASD scored significantly higher than NA at the EAT-26 and at the SWEAA. Women reported higher scores than men. Moreover, an interaction effect Group*Gender emerged at the EAT-26 only, with women with ASD scoring higher than men with and than NA overall. ASD subjects scored higher than NA at the EAT-26 subscales Dieting and Bulimia. Furthermore, the higher the SWEAA total score was, the more likely it was that a subject on the autistic spectrum would score above the cut-off of 20 at the EAT-26.

Conclusions

These results indicate that adults with ASD without intellectual disability presented not only a higher prevalence of eating disturbances typical of autistic spectrum, but also other ED symptoms in comparison to NA.

Disclosure

No significant relationships.

The psychological impact of COVID-19 and lockdown measures among a sample of italian patients with eating disorders: A longitudinal study

Introduction

COVID-19 pandemic and lockdown greatly impact on mental health, especially on individuals with pre-existing psychiatric conditions.

Objectives

To explore the prevalence of specific psychiatric symptoms across a sample of patients with Eating Disorder (ED), compared to a group of healthy controls (HC), during the lockdown period in Italy, and to assess whether patients’ symptoms improved, persisted or worsened with the easing of the lockdown measures.

Methods

Study 1: 59 ED patients and 43 HC were recruited and completed, at the beginning of May 2020(t0), an online survey including: the Depression, Anxiety and Stress Scale – 21 items (DASS-21), the Impact of Event Scale-Revised (IES-R), the Perceived Stress Scale (PSS), and few ad-hoc questions extracted from the Eating Disorder Examination Questionnaire (EDE-Q). Study 2: 40 ED patients from Study 1 completed the same survey two months after t0 (t1).

Results

Study 1: ED patients scored significantly higher than HC at the DASS-21 (Total Score and subscales), the IES-R (Total Score and subscales) and the PSS. Moreover, they showed higher distress specifically related to food and their body. Study 2: at t1, levels of stress, anxiety and depression were not different than at t0, but symptoms related to post-traumatic stress disorder (PTSD) improved, together with patients’ reported level of psychological wellbeing and specific ED symptomatology.

Conclusions

During lockdown, ED patients presented significantly higher levels of stress, anxiety, depression, PTSD-related symptoms, and ED-related symptoms than HC. With the easing of lockdown, PTSD-related and ED-related symptoms ameliorated, but high levels of stress, anxiety and depression persisted.

Disclosure

No significant relationships.

Telework during COVID-19 outbreak: Impact on mental health among Italian workers

Introduction

Since February 2020, the outbreak of COVID-19 has spread to several countries worldwide, including Italy, leading to an uptake of telework.

Objectives

We aim to evaluate the psychopathological impact of teleworking during the COVID-19 pandemic in Italy, identifying mental health determinants among home-based workers.

Methods

804 participants completed an online survey, including the psychometric scales “Depression, Anxiety and Stress Scale – 21 items” (DASS-21) and the “Insomnia Severity Index” (ISI). Teleworkers were also asked to provide information about their current work routine, home environment and clinical history.

Results

At the DASS-21, 30% of the participants presented pathological levels of depression, 20.8% of anxiety and 30.7% of stress. At the ISI, 5% appeared to suffer from insomnia. Respondents with psychological and physical frailties, greater social isolation or inadequate working spaces manifested higher levels of psychiatric symptoms. Moreover, we also find a correlation of these symptoms with occupations in education. Telework was broadly appreciated and 87% of respondents expressed a willingness to maintain access to this arrangement.

Conclusions

Our results document that about a third of our sample manifested psychopathological symptoms while teleworking during the COVID-19 outbreak in Italy. However, telework itself does not seem to be directly associated with increased psychiatric symptoms, which were instead exacerbated by COVID-19-related stressful circumstances, as well as by constitutional and social determinants of health. Going forward, authorities should promote adequate measures in order to guarantee a healthy approach to teleworking.

Disclosure

No significant relationships.

The effect of eight yoga sessions on interoceptive accuracy, confidence and awareness in a sample of patients with eating disorder: A preliminary study

Introduction

Previous research from our group showed that, after a single yoga class, Interoceptive Accuracy (IAc), tested through the Heartbeat Counting Task, improved in a group of Healthy Controls (HC), but not in a group of patients with Anorexia Nervosa (AN).

Objectives

To evaluate three levels of interoception (accuracy, confidence (IC) and awareness (IAw)) before and after eight sessions of Yoga in a sample of patients with Eating Disorders (ED: AN, Bulimia Nervosa (BN) and Binge Eating Disorder (BED)).

Methods

15 patients with ED were included. Before the first yoga session (T0) and 72 hours after the last session (T1), participants underwent: (i) the Heartbeat Counting Task for the evaluation of IAc, IC and IAw; (ii) a psychometric assessment evaluating depression, anxiety, body awareness, alexithymia, self-objectification and eating disorders symptomatology.

Results

At T1, ED patients’ IAc appeared higher than at T0, but not IC and IAw. A trend towards significance (p = 0.055) emerged for the interaction effect between IAc and diagnosis, with BED patients having a higher increase of IAc at T1 than AN and BN patients. Significant correlations between IAc and Alexithymia, Anxiety and Depression emerged at T0, but were not maintained at T1.

Conclusions

After a program of eight Yoga sessions, IAc in ED patients (but not IC and IAw) increases, especially in BED patients. Moreover, the improvement of IAc following the yoga course seems to be unrelated to the course of depressive, anxious and alexithymic symptoms of ED patients.

Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, italy

The ongoing Corona Virus Disease 2019 (COVID-19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms. The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalized in the first four months since lockdown in Milan. We recruited sixty-two patients hospitalized between March 8 to July 8, 2020 versus those first  hospitalized in the same period in 2019. The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes. Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse. Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019. These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.

Neuropsychiatric aspects of HIV infection: a liaison psychiatry study

All the HIV-infected patients having referred to our Liaison Psychiatry Service between October 1992 and June 1994 were considered in this study. Seventy patients underwent psychiatric assessment and medical/neurological evaluation. Forty-seven of these patients were also subjected to cognitive/neuropsychological examination by means of the Milan Overall Dementia Assessment (MODA). Depressive episodes, adjustment disorders and substance abuse were the most frequently encountered diagnoses. Taking into account neuropsychological data, we found that symptomatic patients performed worse on tests than did asymptomatic ones.

Consultation-liaison psychiatry for patients with headaches

Screening of headache patients for psychiatric disorders is needed, because of the well-known high rates of comorbidity with depression and anxiety. Screening for both depression and anxiety is highly advisable in order to identify subjects who need psychiatric consultation and therapy. Screening tools for depression and anxiety range from informal questions to self-report instruments to structured interviews and the choice is up to the clinician and the setting of the clinical evaluation. Data on psychiatric disorders and medication overuse are till now not consistent. The treatment of mood and anxiety disorders in headache patients needs to take into account the possible drug interactions with headache therapies. The collaboration between neurologists and consultation-liaison psychiatrists helps the identification of headache patients who need a psychiatric therapeutic program and follow-up.

Prevalence of depression in patients affected by subclinical hypothyroidism

AIM

The aim of this study was to estimate the prevalence of depressive symptoms in patients affected by subclinical hypothyroidism by means of Hamilton Rating Scale for Depression (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS); to assess which depressive symptoms are prevalent in our population, with references to the factorialization of HAM-D by Cleary and Guy (1977); to verify whether levothyroxine replacement therapy alone can induce total remission of depressive symptoms.

METHODS

The study enrolled 63 patients affected by subclinical hypothyroidism undergoing follow-up at the endocrinology service of San Paolo Hospital in Milan. All patients underwent an evaluation by means of HAM-D and MADRS scales and serum TSH, free T4, free T3, TPO-Ab and Tg-Ab levels were measured.

RESULTS

We estimated a prevalence of depressive symptoms in our population of 63.5%. Concerning the qualitative assessment of psychiatric disturbances in the population we considered, our results showed that the most frequent symptoms were part of four factors, according to the Cleary and Guy factorialization of HAM-D: these factors are representative of anxiety and somatisation (factor I), cognitive impairment disturbances (factor III), psychomotor retardation (factor V) and sleep disorders (factor VI). Levothyroxine replacement therapy alone wasn't effective in inducing total remission of depressive symptoms.

CONCLUSION

This study suggests the importance of a psychiatric evaluation in patients affected by subclinical hypothyroidism.

Psychiatric issues in patients with headaches

Comorbidities among headaches and psychiatric disorders have been consistently reported in several clinical studies and reviews. In this paper, we review some recent clinical studies on migraine and tension-type headaches associated with mood, anxiety and somatoform disorders, focusing on therapeutic strategies for the psychiatric disorders.

Theory of Mind in schizophrenia: First person vs third person perspective

Patients suffering from schizophrenia have an impaired meta-representation also known as Theory of Mind (ToM). Moreover, the presence of delusions or other positive symptoms of schizophrenia has been correlated to poor ToM performances. Lack of insight is a common symptom of schizophrenia and can be considered a critical manifestation of impaired ToM abilities. In particular, the present study addresses the role of perspective ToM ability in schizophrenic patients. Thirty severely delusional schizophrenic patients completely lack insight when interviewed about their delusions. Seven subsequently gain insight about their mental state when perspective is shifted from the first person to third person. These data suggest that in some delusional schizophrenic patients, it may be possible to gain access to and modify their mental states.

Clinical and serological associations of ribosomal P autoantibodies in systemic lupus erythematosus: prospective evaluation in a large cohort of Italian patients

OBJECTIVE

To verify the association of ribosomal anti-P antibodies (anti-P), as detected by a sensitive ELISA, with serological findings and clinical manifestations, including neuropsychiatric involvement evaluated according to the American College of Rheumatology (ACR) nomenclature, in a large cohort of patients with systemic lupus erythematosus (SLE).

METHODS

Anti-P were evaluated in the serum of 149 consecutive Italian SLE patients by an ELISA using a multiple antigen peptide carrying four copies of a common P0, P1 and P2 epitope. A complete laboratory evaluation and clinical examination were performed in each patient. In addition, all patients underwent an accurate neuropsychiatric and neuropsychological assessment performed by trained specialists according to the 1999 ACR suggestions.

RESULTS

Serum anti-P were detected in 18/149 patients (12.1%). The anti-P prevalence was similar (11.7%) when the analysis was performed in a larger series of sera including 82 additional SLE patients, who were not included in the clinical study. The age of anti-P-positive patients at disease onset was less than 33 yr and, in comparison with the anti-P-negative patients, these patients showed more active disease activity and a higher prevalence of photosensitivity and malar and discoid rash. A strong association between IgG anticardiolipin antibodies and anti-P was also found. However, anti-P were associated with neither neuropsychiatric syndromes nor cognitive impairment.

CONCLUSION

This study does not seem to confirm the described association of anti-P with SLE neuropsychiatric manifestations. However, it supports the anti-P association with different skin manifestations as well as the presence of anticardiolipin in a subset of patients with SLE characterized by early disease onset.

An artificial neural network that uses eye-tracking performance to identify patients with schizophrenia

Several researchers have underscored the importance of precise characterization of eye-tracking dysfunction (ETD) in patients with schizophrenia. This biological trait appears to be useful in estimating the probability of genetic recombination in an individual, so it may be helpful in linkage studies. This article describes a nonlinear computational model for using ETD to identify schizophrenia. A back-propagation neural network (BPNN) was used to classify schizophrenia patients and normal control subjects on the basis of their eye-tracking performance. Better classification results were obtained with BPNN than with a linear computational model (discriminant analysis): a priori predictions were approximately 80 percent correct. These results suggest, first, that eye-tracking patterns can be useful in distinguishing patients with schizophrenia from a normal comparison group with an accuracy of approximately 80 percent. Second, parallel distributed processing networks are able to detect higher order nonlinear relationships among predictor quantitative measurements of eye-tracking performance.

Central nervous system involvement in systemic lupus erythematosus patients without overt neuropsychiatric manifestations

OBJECTIVE

To verify whether features of CNS involvement can be detected in SLE patients without overt neuropsychiatric manifestations.

METHODS

114 SLE patients who had never received a diagnosis of neuropsychiatric lupus (never-NPSLE) were studied and compared to 65 SLE patients with known neuropsychiatric involvement (NPSLE). The study relied on evaluation of neurocognitive functions by means of a battery of neuropsychological tests, on psychiatric and neuropsychological assessments and on neuroimaging studies (computed tomography, magnetic resonance, single photon emission computed tomography (SPECT)).

RESULTS

Clinical features, including disease duration/activity and pharmacological therapy, of never-NPSLE and NPSLE patients were similar. Short-term and long-term memory, visuo-spatial and verbal information processing were similarly compromised in never-NPSLE and in NPSLE patients; only attention was significantly more compromised in NPSLE patients. Psychiatric morbidity was higher than expected in never-NPSLE patients, although less than in the control neuropsychiatric group. Ischemic lesions, multiple small high intensity lesions and cortical atrophy, detected by CT and MR scans, as well as abnormal SPECT were also frequently detected in never-NPSLE patients. Interestingly, left parietal and occipital area hypoperfusion by SPECT was significantly more frequent in the patients with impaired visuo-spatial intelligence and short-term memory.

CONCLUSIONS

Most abnormalities detected by available diagnostic tools and characteristics of neuropsychiatric SLE are also present in non-symptomatic patients. They may derive from an unexpected widespread involvement of the CNS and are not per se sufficient, in the absence of clinical manifestations, for a diagnosis of neuropsychiatric SLE.

Delusional disorder and eye tracking dysfunction: preliminary evidence of biological and clinical heterogeneity

This study used eye tracking movement tests to examine the relationships between frontal field functions and clinical features. Smooth pursuit and voluntary saccadic eye movements were recorded and analyzed in 34 delusional disorder (DD) patients and in 40 normal subjects. The DD group differed significantly from the group of normal subjects in some eye tracking performances. As reported in our previous study (Gambini et al., 1993), DD patients showed abnormalities of voluntary saccadic eye movements. In this study, we also found abnormal smooth pursuit eye movements, indicating a cerebral dysfunction similar to those detected in schizophrenic patients. Moreover, normal smooth pursuit eye movement performance in DD patients was related to remitted depressive mood and probably to benefit from antipsychotic medications, thus supporting the idea of the biological and clinical heterogeneity of DD.

Efficacy of paroxetine for the treatment of depression in the context of HIV infection

Recent studies in the literature point out that HIV-infected subjects are affected by depression with a relatively high frequency. The aim of this study was to assess the efficacy and tolerability of paroxetine for the treatment of depression in the context of HIV infection. 15 HIV-infected subjects (10 patients with a major depressive episode and 5 patients with an adjustment disorder with depressed mood, according to the DSM IV diagnostic criteria) were administered paroxetine at a daily dosage of 20 mg. Depressive symptomatology was monitored by means of the Hamilton Rating Scale for Depression (HAM-D) at the time of enrollment and 2 weeks, 4 weeks, and 6 weeks later; at the same times adverse effects were recorded. 14 patients completed the study, and all of these recovered from depression; HAM-D mean scores significantly improved from baseline to final assessment, both when all subjects were considered (ANOVA for repeated measurements: p < or = 0.0001) and when only patients with a major depressive episode were included in the statistical analysis (ANOVA for repeated measurements: p < 0.0001). No significant adverse effects were recorded. Because of its efficacy and good tolerability paroxetine seems to be suitable for the treatment of depression in the context of HIV infection.

A preliminary report of a strong genetic component for thought disorder in normals. A twin study

Several authors have investigated the presence of thought disorder in psychiatric patients using different reliable methods. Under the hypothesis of a genetic predisposition to thought disorder, the degree and quality of thought disorder have also been studied in populations at a high risk for psychosis, in particular for schizophrenia. As a result, an increasing incidence of thought disorder was detected in relatives of schizophrenics. To account for the thought disorder also found in normal subjects, researchers propose that thought disorder exists in normal subjects on a continuum with schizophrenic patients. In the following report, we evaluated the inherited component of thought disorder in normal subjects, using a sample of 25 normal twin pairs, 16 monozygotic and 9 dizygotic twin pairs. We applied the Thought Disorder Index (TDI) to assess disordered thinking, genetic estimates were made with classical methods, controlling for environmental sources of variability where possible. Our findings suggest a strong additive genetic component for the global TDI rating variable, with a heritability estimate approaching 80-90%. New approaches in neuropsychology and neuropsychiatry-based on genetic methodologies should further define the cerebral physiology responsible for disordered thinking.

Structured psychiatric interview and ambulatory sleep monitoring in young psychophysiological insomniacs

BACKGROUND

The presence of psychiatric disorders (according to DSM-III-R), the discriminating power of a psychiatric structured interview, and sleep monitoring were investigated in psychophysiological insomnia.

METHOD

Forty young (20-40 years old) patients, selected for putative psychophysiological insomnia, underwent a psychiatric structured interview and home ambulatory sleep monitoring for 2 nights. The results were compared with those of a group of nine young normal sleepers.

RESULTS

48% of the insomniacs showed some psychiatric disorders, while 52% did not meet DSM-III-R criteria for a psychiatric diagnosis. Both groups, but not the controls, showed a slight first-night effect in the sleep analysis. The sleep structure of all insomniacs was found to be disturbed, mainly in sleep continuity, but essentially the two groups showed no significant differences. When we used a stepwise logistic regression analysis, the number of sleep stage shifts (indicating sleep instability) was the best variable in discriminating the insomniacs from controls, but not the patients with psychiatric disturbances from those without psychopathologies.

CONCLUSION

The evaluation of young insomniacs with a structured psychiatric interview rather than with ambulatory sleep monitoring seems to be most useful in discriminating between patients with only psychophysiological insomnia and patients with both insomnia and an associated diagnosis of another mental disorder.

The Wisconsin Card Sorting Test (WCST) performance in normal subjects: a twin study

The aim of this study was to evaluate the WCST, a task linked to the frontal (prefrontal) cortex, in normal twins to detect an inherited component of frontal lobe function. The WCST scores of 15 monozygotic (MZ) twin pairs, 9 dizygotic (DZ) twin pairs, and 15 unrelated control pairs were used to compute genetic estimates. No significant differences were detected between MZ, DZ and control groups intrapair correlation coefficients. No significant heritability estimates different by zero were computed. The frontal lobe function measured by WCST performance in normal twins does not seem to have a high degree of genetic component, and larger samples of twins are required to detect low genetic effects. The possible implications of such results about the genetic predisposition of frontal deficit in schizophrenia have been discussed.

Notes on the use of fluvoxamine as treatment of depression in HIV-1-infected subjects

Fluvoxamine belongs to the class of selective serotonin reuptake inhibitors (SSRIs) which have recently gained large popularity as antidepressant agents essentially because they lack the most troublesome adverse effects of older antidepressants (i.e. tricyclic antidepressants) such as anticholinergic effects and cardiotoxicity. Recent studies in the literature suggest that HIV-1 infected subjects are affected by depressive episodes with a relatively high frequency, often requiring an antidepressant treatment. Due to its favorable adverse effects profile, we used fluvoxamine as first line treatment for sixteen depressed HIV-1 infected subjects. They were administered the drug at a daily dosage of 100 mg in the evening. Fluvoxamine provided a good clinical efficacy for six of these patients, whereas the other ten had to discontinue the drug because of the presence of severe adverse effects such as acute total insomnia, gastro-intestinal disturbances together with anorexia, aggressive and impulsive behavior and excessive sedation. The observed fluvoxamine side-effects are not typical or specific for this particular patient group since they are also described in seronegative subjects taking fluvoxamine; however, our findings seem to indicate that they become more frequent and more severe when the drug is administered to HIV-1 infected patients.

Smooth pursuit eye movements and saccadic eye movements in patients with delusional disorder

OBJECTIVE

This study used eye movement tests to examine whether frontal lobe dysfunction is present in delusional disorder.

METHOD

Smooth pursuit and voluntary saccadic eye movements of 15 delusional patients, 40 schizophrenic patients, and 40 normal subjects were recorded and analyzed statistically.

RESULTS

The schizophrenic patients differed significantly from the normal subjects in some smooth pursuit eye movement characteristics, whereas both the schizophrenic and the delusional patients showed more saccades than the normal subjects during the smooth pursuit test. The delusional patients and normal subjects differed significantly in some voluntary saccadic eye movement characteristics.

CONCLUSIONS

The data support the idea of a biological dysfunction in eye tracking in delusional disorder.

Smooth pursuit and saccadic eye movements and Wisconsin Card Sorting Test performance in obsessive-compulsive disorder

Smooth pursuit eye movements (SPEMs), voluntary saccadic eye movements (VSEMs), and neuropsychological test (Touluse-Pieron Test and Wisconsin Card Sorting Test) performance were studied in 23 patients with obsessive-compulsive disorder and 27 age-matched normal control subjects. The patients performed more poorly than the control subjects on the SPEM and, to a lesser degree, VSEM measures. They also showed impairment on some aspects of the neuropsychological tests. No relationship was found between eye movement performance and neuropsychological impairment.

The Wisconsin Card Sorting Test discriminates schizophrenic patients and their siblings

The following report is an evaluation of the performances of 35 schizophrenic patients and 35 of their siblings on the Wisconsin Card Sorting Test (WCST), a neuropsychological test considered sensitive to frontal lobe functioning. Thirty five normal subjects matched for age and education were the comparison group. The purpose of this study was to examine the relationship of the neurofunctional basis for schizophrenia to its familiar occurrence. Non-schizophrenic siblings of schizophrenic patients did not perform significantly different from normal subjects on the WCST; however, schizophrenic patients performed significantly worse than both their siblings and normal subjects. These results indicate that WCST dysfunction seems to be a characteristic related to the presence of the disease and that non-genetic factors could contribute to the WCST pathological profile.

Influence of education on WCST performances in schizophrenic patients

Schizophrenic patients have been widely reported to fail in performing Wisconsin Card Sorting Test (WCST). These data have been mostly interpreted as cognitive difficulties and/or neurofunctional impairment inherent to schizophrenia. Nevertheless, checking sample characteristics, the importance of variables as education appears relevant. In our study we examined schizophrenic patients and controls with low and high educational levels respectively. ANOVA results show significant differences on WCST performances for the variable diagnosis (schizophrenics and controls) and for the variable educational level (low and high educational level). It therefore seems necessary call for caution in interpreting WCST results in schizophrenic patients when educational level is not considered.

Smooth pursuit eye movements and neuropsychological tests in schizophrenic patients: possible involvement of attentional components

The relationships among different components of frontal lobe dysfunction and voluntary attention were studied. Drug-free schizophrenic patients and matched normal controls were recruited and assessed for smooth pursuit eye movements, voluntary saccadic eye movements and by means of neuropsychological tests (Toluse-Pieron test and Wisconsin Card Sorting Test). No clear-cut relationship was found between eye movement performance and neuropsychological impairment.

Frontal and callosal neuropsychological performances in schizophrenia. Further evidence of possible attention and mnesic dysfunctions

Some level of frontal and callosal dysfunction has been reported in patients with schizophrenia. In the present study 68 normal controls and 117 schizophrenic patients were administered the Wisconsin Card Sorting Test (WCST), which involves the function of the frontal areas, and the Auditory Comprehension Test (ACT) which involves the corpus callosum and to a lesser degree attention and mnesic mechanisms. WCST correctly discriminated 69.8% of schizophrenics and 74.2% of controls, ACT 86.7% of schizophrenics and 90.2% of controls. Moreover, schizophrenics correctly classified by the WCST performed more poorly than schizophrenics incorrectly classified by the WCST on the related ACT indices for the attention and mnesic mechanisms. There were no differences in present age, age at onset, duration of the illness, diagnostic subtype and course of the disease between correctly and incorrectly classified schizophrenics by the WCST and the ACT. These data indicate a prevalent malfunctioning of attention and mnesic mechanisms in schizophrenia. Finally there seems to be no relationship between these neurofunctional abnormalities and demographic and clinical characteristics of the disease.

A statistical approach to computerized EEG: preliminary data on control subjects and epileptic patients

Factor Analysis represents an important method of extracting salient features from EEG data condensing functional as well as spatial informations in a few factors and so reducing redundancy of multi-channels computerized EEG data. A 16-channel computerized frequency analysis of background brain electrical activity during 3 functional conditions (eyes closed, eyes open and hyperventilation) were performed in 2 groups, 50 healthy subjects and 14 epileptic patients with generalized seizures. The differences in each frequency band between the 2 groups have been assessed by means of factor scores. Factor scores differences between control and epileptic patients have been found in theta and alpha frequency bands. These interictal EEG abnormalities were more evident in epileptic patients. This preliminary study shows the confirmatory capability of Factor Analysis and its usefulness in managing and comparing computerized EEG data.

Delusional hypochondriasis: nosographic evaluation, clinical course and therapeutic outcome of 5 cases

Five cases of delusional hypochondriasis are reported. Their nosographic position is discussed in the light of recent literature, DSM-IIIR, Present State Examination and ICD-9 classification criteria of hypochondriacal symptomatology.

Asymmetrical distribution of beta-endorphin in cerebral hemispheres of suicides: preliminary data

The assessment of beta-endorphin levels in several symmetrical brain regions of seven suicides and seven sudden death controls reveals a decreased concentration in the left temporal cortex, the left frontal cortex, and the left caudate nucleus of suicides compared to controls. Moreover, the comparisons of beta-endorphin concentrations in the symmetrical brain regions reveals an asymmetrical concentration in suicides (left less than right) in frontal cortex and caudate nucleus. These data confirm previous reports of abnormalities of neurochemical pathways in the brains of suicides and suggest that suicidal behavior might be related to the lateralized mechanisms of mood control.

Chlorthalidone alone or in fixed combination with slow-release metoprolol in the management of arterial hypertension: a long-term study of 545 patients

In a double-blind trial, 545 out-patients with essential hypertension received 25 mg/day chlorthalidone alone (274 patients) or in fixed combination with 200 mg/day slow-release metoprolol (271 patients) for 8 weeks. Both treatments significantly (P less than 0.001) decreased systolic and diastolic blood pressure; 45.6% of patients receiving chlorthalidone and 82.5% receiving combined therapy had a diastolic blood pressure of less than 95 mmHg. Patients not controlled by chlorthalidone or chlorthalidone plus metoprolol subsequently received chlorthalidone plus metoprolol (137 patients) or chlorthalidone plus metoprolol plus a third drug (34 patients), respectively, for 8 weeks. A total of 79.5% of patients receiving chlorthalidone plus metoprolol and 61.8% receiving chlorthalidone plus metoprolol plus a third drug had a diastolic blood pressure of less than 95 mmHg. Only 5.9% of patients experienced mild to moderate side-effects. Plasma potassium levels significantly (P less than 0.01) decreased during the first 8 weeks only. It is concluded that a diuretic alone or in fixed combination with a beta-blocker is effective in the long-term treatment of arterial hypertension.

Alpha reactivity in schizophrenia and in schizophrenic spectrum disorders: demographic, clinical and hemispheric assessment

Alpha EEG reactivity was assessed in a carefully diagnosed sample of 84 schizophrenic and schizophrenic spectrum disorder patients, both under resting conditions (eyes closed and eyes open) and during two spatial-geometric cognitive tasks. The influence of the subject's demographic (sex and age), clinical (diagnostic subtypes, disease course, CT scan characteristics) and neurophysiological (hemispheric recording and different cognitive tasks) characteristics on alpha peak reactivity was analyzed by means of multivariate analysis of variance. The results indicated a significant effect of type of illness on alpha EEG reactivity, patients with a diagnosis of undifferentiated and disorganized schizophrenia having the lowest alpha reactivity levels. None of the other variables considered had any contributing effect. The results are discussed in terms of orienting responses and hemispheric CNS organization in functional psychoses.

Neuropsychological assessment of functional central nervous system disorders. I. Hemispheric functioning characteristics in schizophrenia and affective illness

The neuropsychological characteristics of a group of schizophrenic and affective patients were assessed by mean of a comprehensive neuropsychological tool, the Luria-Nebraska Neuropsychological Batter (LNNB), to determine the lateralized hemispheric neurofunctional characteristics in major functional central nervous system disorders. The results showed that schizophrenics had more right-hemisphere impairment than affectives. They do not substantiate the hypothesis of right hemisphere-lateralized malfunctioning in functional mood disorders. Psychopharmacological treatment influences neuropsychological test performance, neuroleptics having the greatest effects. Pharmacological effects other than anticholinergic ones are responsible for the negative influence on neuropsychological test performance.

Combined measure of smooth pursuit eye movements and ventricle-brain ratio in schizophrenic disorders

Smooth pursuit eye movements (SPEM) were examined in 67 schizophrenic patients and 101 control subjects. Our study confirms that eye tracking in schizophrenic patients is impaired compared to that in controls. The similar pattern of distribution of SPEM abnormalities in Italian patients as in ethnically different populations strengthens the hypothesis that these abnormalities may be a biological marker for schizophrenia. We also examined the relationship between SPEM abnormalities and the ventricle-brain ratio (VBR), which is also considered useful for differentiating schizophrenic subgroups. Our preliminary results indicate that there is an inverse correlation between abnormal SPEM performance and ventricular enlargement, suggesting that these abnormalities mark distinct subgroups of patients.

Asymmetry of lateralised hemispheric functions in schizophrenia. Influence of clinical and epidemiological characteristics on quality extinction test performance

The Quality Extinction Test was used to detect lateralised abnormalities of hemispheric functions in schizophrenic patients. Course of illness significantly affected the distribution of tactile extinctions, chronic patients showing more left-side extinctions than sub-chronic ones. Ages significantly affected the number of left extinctions, and sex the number of right extinctions. The importance of clinical and epidemiological characteristics of the patients in determining the quality and degree of hemispheric dysfunction in schizophrenia was confirmed.

Neurofunctional assessment of schizophrenia: a preliminary investigation of the presence of eye-tracking (SPEMs) and quality extinction test (QET) abnormalities in a sample of schizophrenic patients

This preliminary study evaluated the simultaneous presence of abnormalities in the regulation of eye-tracking and neuropsychological tests performance (tactile extinction) in a sample of schizophrenic patients. Both those measures of central malfunctioning appears to be quite specific to schizophrenic disorders and more related to the trait, rather than state characteristics. Even though preliminary, the results indicate a significant relationship between abnormalities in SPEM regulation and the distribution of tactile abnormalities, with more left-side extinguishing patients showing abnormal SPEMs. Some interpretations of the findings are given in the context of current hypotheses on the neurofunctional abnormalities of schizophrenics.

Neurofunctional assessment of lateralized hemispheric asymmetries in affective illness

Performances of 59 affective patients, 59 schizophrenics and 59 normal controls on the Quality Extinction Test (QET), which has been proven to be valuable for detecting abnormal hemisphere functioning in neurological and psychiatric patients, are presented. Frequencies of the left and right extinctions of the affective patients did not exceed those of normal controls. Compared to schizophrenics, fewer affective patients had left and right extinctions and the number of these extinctions was significantly lower in affective patients. These results would indicate that affective patients do not differ from controls relative to lateralized cerebral malfunctioning as measured by the QET. The differences between affective and schizophrenic patients' QET performances may be explained by differences in the course and chronicity of the disease.