Ernestina Politi

Functional promoter polymorphism of the human serotonin transporter: lack of association with panic disorder.

To probe the hypothesis of a role for a functionally relevant 44 bp insertion/deletion of the serotonin transporter promoter in the aetiopathogenesis of panic disorder, we determined the allele frequency of the variant in two samples (combined n = 158) of panic disorder patients (DSMIII-R) and compared it with its allele frequency in two ethnically matched control samples (combined n = 169). The fact that no difference could be observed (x 2 analysis) argues against a major role for this serotonin transporter promoter polymorphism in the aetiopathogenesis of panic disorder.

Daily Sessions of Transcranial Magnetic Stimulation to the Left Prefrontal Cortex Gradually Reduce Cocaine Craving

In recent years, an increasing number of studies have contributed in advancing our understanding of the neurobiology of cocaine addiction. Consequentially, efforts have been made toward the development of new therapies. There is now considerable evidence provided by animal models, and more recently by humans, that all drugs of abuse converge on a common circuitry in the brain’s limbic system.1,2 Most attention has been dedicated to the mesolimbic dopamine pathway, which includes the ventral tegmental area (VTA) of the midbrain and their targets in the limbic forebrain, especially nucleus accumbens (NAc). This VTA-NAc pathway is one of the most important substrates for the acute rewarding effects of all drugs of abuse and each drug, regardless of its distinct mechanism, converges on the VTA and NAc with common functional effects. The DLPFC (dorsolateral prefrontal cortex) contributes to regulatory processing under conditions requiring the integration of cognitive and motivationally relevant information.3 Repetitive transcranial magnetic stimulation (rTMS) at high frequency has the potential to activate directly the immediately underlying cortex, and neural activity in other areas (orbitofrontal and anterior cingulare cortex) is inhibited.4 Craving is an uncontrollable impulse to consume substances of abuse, and is often accompanied by intense anxiety, dysphoria, irritability, nervousness, impulsive or explosive behavior, as well as by somatic symptoms such as cefalea and astenia. Craving determines a serious suffering for the addicted subject who is afraid of being unable to maintain self-control. In this respect, craving can frequently lead to relapse and loss of control concerning the manner of resumption, such as, for example, quantity and duration of the abuse behavior. Craving

Asthma and panic attacks

Panic disorder (PD) and asthma share many common characteristics and have been found in epidemiological studies to be significantly comorbid. To investigate possible reasons for this overlapping, the authors evaluated 51 patients with asthma, assessing the prevalence of PD and sporadic panic attacks, the temporal relationship between these two disorders, and the familial risk for PD in the families of asthmatics. The results showed significantly higher prevalences of PD, sporadic panic attacks, and social phobia in asthmatics than those reported for the general population. In 9 (90%) of the asthmatics with PD, asthma appeared first. Finally, the morbidity risk for PD in families of asthmatics with PD (13.5%) was significantly higher than in families of asthmatics without evidence of panic (2%). Our results suggest that the high prevalence of PD in asthmatics might be related to a facilitating effect of asthma on the development of PD in subjects with familial predisposition to PD.

Modification of 35% carbon dioxide hypersensitivity across one week of treatment with clomipramine and fluvoxamine: a double-blind, randomized, placebo-controlled study.

The effects of short treatments (7 days) with clomipramine and fluvoxamine on the reactivity to inhalations of 35% CO2/65% O2 were compared in 39 panic patients who had positive responses to 35% CO2 inhalations. A double-blind, randomized, placebo-controlled design was applied. Each patient was given the 35% CO2 challenge on days 0 (before starting treatment), 3, and 7. Patients on placebo did not report any significant changes in their reactivity to 35% CO2 across the three sessions, whereas patients on clomipramine and fluvoxamine reported a significant attenuation of the reactivity on day 7. These results indicate that treatments with clomipramine and fluvoxamine decrease hypersensitivity to 35% CO2 after a few days, suggesting a relevant role of the modulation of CO2 sensitivity by the serotonergic system in antipanic properties of these compounds.

An investigation of the co-occurrence of panic and somatization disorders through temperamental variables.

Objective The relation of temperamental dimensions to somatization and panic disorders in women was investigated. Method Eighteen patients with both panic and somatization disorders, 41 patients with panic disorder only, and 22 control subjects were compared on the Tridimensional Personality Questionnaire. Results The patients with somatization and panic disorders had significantly higher Novelty Seeking values than both the patients with panic only and the control subjects. The only significant correlation was between the number of symptoms of somatization disorder and Novelty Seeking. The presence of other psychiatric conditions, comorbid with panic disorder in the patient group, did not affect significantly the temperamental variables. Conclusions A temperamental disposition characterized by extraversion, impulsivity, as well as frequent exploratory activity and pursuit of novel and pleasurable activities may help differentiate women with both somatization and panic disorders from women with panic disorder only.

Artificial neural networks: a study in clinical psychopharmacology

Controlled trials in clinical psychopharmacology may fail to provide reliable information about the benefit of treatment when the patient is viewed in a real-life setting rather than as part of a well-defined sampling procedure. A viewpoint, rooted in systems theory, is proposed based on the identification of complex relationships among such dimensions as clinicians reasoning, drug properties, and patients condition. Artificial Neural Network (ANN) technology provides efficient tools for data analysis within a systems-oriented approach. This study proposes a way to predict the outcome of psychopharmacological treatment. Analysis was conducted on retrospective data from clinical records of psychiatric patients treated with moclobemide. Twelve pharmacological, diagnostic, and topological variables were identified as the decisional items considered by six clinicians: age at onset, sex, previous treatment, duration and dose of moclobemide treatment, other drugs, psychiatric diagnosis and other clinical features. Data were binarily coded and transformed into observed frequencies in the sampling space; treatment outcome was binarily scored as the models target. A Back-Propagation ANN based on the Delta rule with logistic transfer function was used. ANN correctly classified all cases of successful treatment (n = 51, 100%) but only half of the unsuccessful cases (n = 14, 52%). Patterns of response and areas of uncertainty were analyzed in a topological approach.

Comorbidity of panic and somatization disorder: A genetic-epidemiological approach

Although recent diagnostic systems support the distinctiveness of panic disorder (PD) and somatization disorder, a high level of comorbidity of these two diagnoses has been reported, indicating a need for investigations with external validators. One hundred fifty-nine outpatients with DSM-III-R PD and 76 surgical controls were screened for lifetime presence of DSM-III-R somatization disorder, and the risks for some types of psychiatric disorders in their families were computed. In our sample, 23% of women and 5% of men with PD also had DSM-III-R somatization disorder did not differ from women with PD only in age at onset of panic, agoraphobia, childhood history of separation anxiety, or lifetime diagnoses of other disorders. Familial risks for PD, PD-agoraphobia, and alcohol dependence were significantly higher for families of women with PD and women with PD plus somatization disorder than for controls. The familial risks for antisocial personality (ASP) disorder (a familial indicator for the somatization disorder spectrum of liability, phenomenologically independent from both PD and somatization disorder) were significantly higher for families of women with PD plus somatization disorder than for families of women with PD only or for controls. Application of DSM-IV criteria for somatization disorder substantially decreased the comorbidity with PD. Our data suggest that somatization disorder is not simply a form of PD, and that the two disorders may coexist in the same subject without sharing a common genetic diathesis. Compared with DSM-III-R, DSM-IV criteria for somatization disorder appear to be simpler in structure and of less complicated application.

Polymorphic MAO-A and 5-HT-Transporter Genes: Analysis of Interactions in Panic Disorder

Summary: Recurrent panic attacks, anticipatory anxiety and phobic avoidance characterise panic disorder. The influence of genetic factors on liability to the disease has been the object of several linkage and association studies and appears to relate to an oligo-or polygenic rather than a monogenic mode of inheritance. Recently, an excess of high activity monoamine oxidase A (MAO-A) gene promoter alleles was found in female patients with panic disorder. An analysis of possible synergistic effects of the MAO-A gene promoter variant and the short serotonin transporter (5-HTT) gene promoter variant in panic disorder was performed in a German and an Italian sample (combined panic disorder n = 144, combined controls n = 175). There was no significant difference in odds ratios, suggesting that the observed increase of genetic liability by the long MAO-A gene promoter allele is not modified by the 5-HTT gene promoter polymorphism.

Addiction and empathy: a preliminary analysis

Addicted patients show impaired social functioning. Chronic drug consumption may lead to impairments in decoding empathic cues. The aim of the study is to explore empathy abilities in addicted patients and the hypothesis of a differential impairment between affective and cognitive empathy. 62 addicted patients and 40 healthy volunteers were evaluated using the empathy quotient (EQ) and its subscales cognitive empathy (factor 1), emotional empathy (factor 2), social skills (factor 3). Patients scored statistically significantly lower than controls in EQ total score, in particular in factor 2. No difference was found in factor 1 and in factor 3. Consistent with previous findings, our study suggests specific impairment in emotional empathy combined with preserved cognitive empathy. These findings show important clinical implication in the development of specific rehabilitative programmes for the empowerment of empathy abilities and interpersonal skills that constitute important components in the prevention of relapse.

A neural network approach to the outcome definition on first treatment with sertraline in a psychiatric population

Therapy decision is one of the most important tasks clinicians have to perform in their clinical practice. The decision process requires taking into account many different factors. The Authors have proposed a neural computing approach for supporting clinical decision analysis. The mathematical model of artificial neural network (ANN) has been applied on a pool of clinical information gathered through case description freely filled by senior psychiatrists into 416 clinical charts. Sertraline, as drug for treatment, has been chosen since its clinical uses range from treatment of depression to that of many other psychiatric clinical conditions so that it has been thought to be a good candidate to this type of study. The ANN performance in forecasting successful and unsuccessful treatment cases showed an overall accuracy of classification of 97.35%. This result suggests a possible future application of this method to obtain a reliable prediction of a given psychiatric patient outcome during a specific psychopharmacological therapy, optimising the decisional making process.