Daniela Campanella

Insight and alexithymia in adult outpatients with obsessive–compulsive disorder

AbstractObjectiveTo elucidate the relationships between insight and alexithymia in a sample of adult outpatients with obsessive–compulsive disorder (OCD).Methods112 adult outpatients with OCD were tested. Severity of OCD was assessed with the first 10–items of the Yale–Brown Obsessive Compulsive Scale (Y–BOCS) and score for item # 11 on the Y–BOCS was considered as a measure of insight. Alexithymia was measured with 20–item Toronto Alexithymia Scale (TAS–20). Additional measures were Maudsley Hospital Obsessive Compulsive Inventory (MOCI) and Montgomery Åsberg Depression Rating Scale (MADRS).ResultsOf the patients, 29.5% showed poor or no insight. Patients with poor or no insight were more alexithymic than patients with excellent, good and moderate insight. TAS–20 total score and subfactors positively correlated with score for item # 11 on the Y–BOCS, severity of OCD and MADRS scores. In stepwise regression model, MADRS scores, factor 3 of TAS–20 (Externally Oriented Thinking), somatic and hoarding–saving obsessions were significantly associated with lower insight.ConclusionsResults show a relationship between poor or absent insight and high alexithymia levels in OCD patients.

Mirtazapine treatment of Generalized Anxiety Disorder: a fixed dose, open label study

We investigated the efficacy of mirtazapine in the treatment of generalized anxiety disorder (GAD). Forty-four adult outpatients with GAD were treated openly with a fixed dose of mirtazapine (30mg) for 12 weeks. The primary outcome measure was the change from baseline in total score on the Hamilton Rating Scale for Anxiety (HAM-A). The Clinical Global Impression of Improvement (CGI-I) was rated at the endpoint. Patients with a reduction of 50% or more on the HAM-A total score and a CGI-I score of 1 or 2 at endpoint were considered responders to treatment; remission was defined as a HAM-A score 7. At 12 weeks, response was achieved by 79.5% of the patients (n 35) and remission by 36.4% of patients (n 16). This study supports the notion that mirtazapine is an efficacious and well tolerated treatment for GAD. Limitations of the present study must be considered and further placebo-controlled trials are needed.

Olanzapine augmentation in treatment-resistant panic disorder: a 12-week, fixed-dose, open-label trial.

The purpose of our study was to evaluate the efficacy and tolerability of low-dose olanzapine augmentation in selective serotonin reuptake inhibitor (SSRI)-resistant panic disorder (PD) with or without agoraphobia. In this 12-week, open-label study, 31 adult outpatients with treatment-resistant PD who had previously failed to respond to SSRI treatment were treated with fixed dose of olanzapine (5 mg/d) in addition to SSRI. Efficacy was assessed using the Panic Attack and Anticipatory Anxiety Scale (PAAAS), the Agoraphobic Cognitions Questionnaire (ACQ), the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), the Global Assessment of Functioning Scale (GAF), and the Clinical Global Impression of Improvement (CGI-I). Twenty-six patients completed the trial period with a dropout rate of 16.1%. At week 12, 21 patients were responders (81.8%), and an overall improvement on all rating scales was observed in all patients both with or without agoraphobia. Fifteen patients (57.7%) achieved remission. Olanzapine was well tolerated and the most frequent adverse effects were mild-to-moderate weight gain and drowsiness. No extrapyramidal symptoms were reported. Olanzapine appears to be effective as augmentation strategy in the treatment of SSRI-resistant PD, but study limitations must be considered and placebo-controlled studies are needed.

Evaluation of C-reactive protein and total serum cholesterol in adult patients with bipolar disorder.

The aim of the present study is to evaluate the role of CRP and Total Cholesterol (TC) in patients suffering from type I Bipolar Disorder (BD-I). Moreover, the goal is to elucidate possible CRP and TC differences in different phases of BD-I: acute mania, euthymia and bipolar depression. Medical records of 90 BD-I patients (30 patients with acute mania, 30 in euthymic state, full remission, and 30 in depressive phase) were reviewed to evaluate serum CRP and TC levels. Laboratory data of 30 healthy controls were also obtained. The scores of Young Mania Rating Scale (YMRS), Bech-Rafaelsen Manic Rating Scale (BRMRS) and Hamilton Rating Scale for Depression (HAM-D) were evaluated. CRP levels were higher in acute mania and depressive phase subgroups when compared to healthy controls. CRP was positively associated with BRMRS and YMRS scores in acute mania and with HAM-D in depressive phase subgroups. TC levels were lower in all clinical groups compared to controls. TC levels were negatively correlated to BRMRS, YMRS and HAM-D. In conclusion, the results of the present study support the notion that CRP and TC may be altered in patients with BP-I.

Update on the Adverse Effects of Clozapine: Focus on Myocarditis

Clozapine, an atypical antipsychotic, is a dibenzodiazepine derivative and its therapeutic effects are probably mediated by dopaminergic and serotonergic activity. In accordance to several studies, it appears to be the most effective antipsychotic drug for treatment-resistant schizophrenia. Moreover, clozapine appears to be particularly beneficial in patients with schizophrenia who are suicidal and in those with comorbid substance use disorder. However, despite its efficacy, the general use of clozapine in clinical practice is somewhat limited because of the risk of several serious adverse effects such as agranulocytosis and thromboembolism. Clozapine may be associated with fatal myocarditis and cardiomyopathy in physically healthy young adults. Consequently, the FDA and the drugs manufacturer have strengthened warnings to include that a potentially fatal myocarditis may occur when taking clozapine. In the present paper the literature on clozapine-related myocardis will be reviewed and practical advice will be given concerning the diagnosis and management of such potentially fatal adverse effect.

Alexithymia and Suicide Ideation in a Sample of Patients with Binge Eating Disorder

Objective. The goal of this cross-sectional study was to evaluate the relationships between alexithymia and suicide ideation in 80 adult outpatients with a DSM-IV diagnosis of binge eating disorder (BED). Methods. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20); suicide ideation was assessed with the Scale of Suicide Ideation (SSI); severity of BED was assessed with the Binge Eating Scale (BES); and depressive and anxiety symptoms were evaluated, respectively, with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale (Ham-A). Results. Prevalence of current suicide ideation was 27.5% (n=22) in this sample and 10 subjects (12.5%) had attempted suicide at some time in their lives. Subjects with alexithymia had more significant suicide ideation, a higher prevalence of current suicide ideation, and more previous suicide attempts than those without alexithymia. In a linear regression model, higher MADRS scores and higher scores on the Difficulty in Identifying Feelings/Difficulty in Describing Feelings dimensions of the TAS-20 were associated with increased suicide ideation. Discussion. Suicidal behavior is no less common in BED than in other eating disorders. Individuals with BED may show increased suicide ideation, especially in the presence of alexithymia and depressive symptoms, even if these symptoms are subclinical. The authors also discuss limitations of this study and future research needs. (Journal of Psychiatric Practice 2012;18:5–11)

Impaired sustained attention in euthymic bipolar disorder patients and non-affected relatives: an fMRI study

Sepede G, De Berardis D, Campanella D, Perrucci MG, Ferretti A, Serroni N, Moschetta FS, Del Gratta C, Salerno RM, Ferro FM, Di Giannantonio M, Onofrj M, Romani GL, Gambi F. Impaired sustained attention in euthymic bipolar disorder patients and non‐affected relatives: an fMRI study. Bipolar Disord 2012: 14: 764–779.

The role of C-reactive protein in mood disorders.

Recently, a possible relationship between C-Reactive Protein (CRP), a marker of underlying low-grade inflammation, and mood disorders has been proposed by some researchers. The aim of this review is to elucidate the current facts and views about CRP in mood disorders such as Depressive and Bipolar Disorders. Several studies have examined the relationship between affective disorders and CRP, but the majority of the studies in literature have been limited by retrospective, case-controlled study design, and very few studies have examined the relationship between depression and CRP in large study samples. In conclusion, the role of CRP in mood disorders is, to date, intriguing but somewhat unclear. Further prospective studies are needed to introduce the CRP in clinical settings as a marker of affective states and suicidability.

The Impact of Alexithymia on Anxiety Disorders: a Review of the Literature

Alexithymia is characterized by difficulties in recognizing and verbalizing feelings, a paucity of fantasy life, concrete speech, and thought closely tied to external events. The alexithymia construct, formulated from clinical investi- gations, is multifaceted and includes four distinct characteristics: 1) difficulty identifying and describing feelings; 2) diffi- culty distinguishing feelings from bodily sensations; 3) diminution of fantasy; and 4) concrete and minimally introspective thinking. An increasing body of studies indicates that alexithymic features exist not only in classic psychosomatic disor- ders but also in other severe and chronic somatic diseases and psychiatric disorders such as Major Depression, and other Axis I disorders, such as Anxiety Disorders. The aim of the present review was to elucidate the relationships between alexithymia and Anxiety Disorders, in order to investigate the possible psychopathological and therapeutic implications.

Alexithymia and Its Relationships with Dissociative Experiences, Body Dissatisfaction and Eating Disturbances in a Non-Clinical Female Sample

The purpose of the present study was to investigate, in a non-clinical sample of undergraduate women, the relationships between alexithymia, dissociative experiences and body dissatisfaction, while identifying the predictive factors associated with a potential risk of developing eating disorders (EDs). The Toronto alexithymia scale (TAS-20), dissociative experiences scale (DES), eating disorder inventory-2 (EDI-2), body shape questionnaire (BSQ), symptom checklist revised (SCL-90-R) and rosenberg self-esteem scale (RSES) were completed by 546 undergraduate females. We found that alexithymics had higher dissociative experiences and body dissatisfaction than did the nonalexithymics. In addition, alexithymics also reported a higher potential risk for ED (higher scores on EDI-2) and lower self-esteem as compared to nonalexithymics. Difficulty in the identifying and describing feelings subscales of the TAS-20, dissociative experiences as well as lower self-esteem were associated with higher risk of EDs in a linear regression analysis. Our findings suggest that a combination of alexithymia, dissociative experiences and low self-esteem may constitute a risk-factor for symptoms of EDs, in a non-clinical sample of university women. We discuss limitations of the present study and suggest opportunities for future research.