Francesca Gambini

Dorsolateral prefrontal cortex and hippocampus sustain impulsivity and aggressiveness in borderline personality disorder

BACKGROUND Borderline Personality Disorder (BPD) patients are characterized by increased levels of aggressivity and reduction of impulse control, which are behavioural dimensions mainly sustained by hippocampus and dorsolateral prefrontal cortex (DLPFC). In this study we aimed at investigating whether hippocampus and DLPFC anatomy may sustain impulsive and aggressive behaviours in BPD. METHODS Fifteen DSM-IV BPD patients (11 females, 4 males) and fifteen 1:1 matched healthy controls (11 females, 4 males) were studied with a 1.5T magnetic resonance imaging (MRI) and underwent a psychopathological assessment in order to measure the severity of aggressive and impulsive traits. RESULTS Right hippocampal volumes were significantly reduced in BPD patients compared to healthy subjects (p=0.027), particularly in those with a history of childhood abuse (p=0.01). Moreover, in patients but not in controls, right hippocampal volumes significantly inversely correlated with aggressiveness and DLPFC grey matter volumes significantly inversely associated with impulsiveness (p<0.05). CONCLUSIONS Our results provide evidence that hippocampus and DLPFC play a separate and unique role in sustaining the control of impulse and aggressive behaviours in BPD patients.

Childhood abuse is associated with structural impairment in the ventrolateral prefrontal cortex and aggressiveness in patients with borderline personality disorder

Volume reduction and functional impairment in areas of the prefrontal cortex (PFC) have been found in borderline personality disorder (BPD), particularly in patients with a history of childhood abuse. These abnormalities may contribute to the expression of emotion dysregulation and aggressiveness. In this study we investigated whether the volume of the PFC is reduced in BPD patients and whether a history of childhood abuse would be associated with greater PFC structural changes. Structural MRI data were obtained from 18 BPD patients and 19 healthy individuals matched for age, sex, handedness, and education and were analyzed using voxel based morphometry. The Child Abuse Scale was used to elicit a past history of abuse; aggression was evaluated using the Buss-Durkee Hostility Inventory (BDHI). The volume of the right ventrolateral PFC (VLPFC) was significantly reduced in BPD subjects with a history of childhood abuse compared to those without this risk factor. Additionally, right VLPFC gray matter volume significantly correlated with the BDHI total score and with BDHI irritability and negativism subscale scores in patients with a history of childhood abuse. Our results suggest that a history of childhood abuse may lead to increased aggression mediated by an impairment of the right VLPFC.

Effectiveness of a Single Education and Counseling Intervention in Reducing Anxiety in Women Undergoing Hysterosalpingography: A Randomized Controlled Trial

Hysterosalpingography (HSG) is generally considered a stressful and painful procedure; we aimed to evaluate whether a single education and counseling intervention could reduce womens distress and pain after undergoing HSG for infertility. Patients were randomized into control group (n = 108) and intervention group (n = 109). All patients filled the following questionnaires before and after HSG: Zung self-rating anxiety scale (Z-SAS), Zung self-rating depression scale (Z-SDS), and an ad hoc questionnaire designed to evaluate HSG procedure knowledge. Pain was scored using a visual analog scale. The intervention consisted in a 45-minute individualised session 48 h before HSG. We observed a reduction of anxiety and depression scores in the intervention arm compared to the control group. After controlling for potential confounding variables, intervention was an independent predictor of the difference of Z-SAS score before and after HSG. This is the first randomised controlled trial to assess the potential effectiveness of a single education and counseling intervention to lower anxiety in a diagnostic setting.

Impaired working memory and normal sustained attention in borderline personality disorder

Lazzaretti M, Morandotti N, Sala M, Isola M, Frangou S, De Vidovich G, Marraffini E, Gambini F, Barale F, Zappoli F, Caverzasi E, Brambilla P. Impaired working memory and normal sustained attention in borderline personality disorder. Objective: Although reports in the literature describe deficits in working memory in borderline personality disorder (BPD), the evidence is limited and inconsistent. The aim of this study was to evaluate further this cognitive dimension and its clinical correlates in BPD. Method: We compared the performance of 15 BPD patients to 1:1 matched healthy controls on verbal working memory as determined by the sequential letter N-back test and sustained attention as measured using the continuous performance test (CPT). Results: BPD patients performed significantly worse on the N-back test compared to healthy controls (p < 0.05), but not on the CPT. The N-back deficit was more pronounced and significant in the 3-back condition and inversely correlated with impulsivity. Conclusions: These results suggest the presence of working memory deficits in BPD that may be linked to greater impulsivity and sustained by impairment in the dorsolateral prefrontal cortex.

Association between Low-Activity Allele of Cathecolamine-O-Methyl-Transferase (COMT) and Borderline Personality Disorder in an Italian Population

The objective of the present study was to test the association between Borderline Personality Disorder (BPD) and the cathecolamine-O-methyl-transferase (COMT) low-activity (Met158) single nucleotide polymorphism (SNP). In this case-control study, DNA was obtained from venous blood of 19 BPD patients and 36 healthy subjects. COMT-Val158Met single-nucleotide polymorphism was genotyped by predesigned SNP assay. The COMT Met158 allele was over-represented in patients with BPD in comparison to normal subjects (68.4% vs 44.4%, respectively; Fisher exact test, p = .02). In terms of genotype, the Met158Met subjects were more frequent in patients versus controls (47.4% vs 22.2%, respectively), whereas the high-activity genotype Val158Val was under-represented (10.5% vs 33.3%, respectively). The allele encoding for the COMT with low enzymatic efficiency was found to be over-represented in BPD, possibly resulting in excessive synaptic dopaminergic activity and ultimately affecting externalizing behaviours, such as impulsivity and aggressiveness.

Aspetti psichiatrici dell’infertilità: analisi della letteratura

L’infertilita, condizione patologica molto frequente nella popolazione occidentale, e il suo trattamento rappre-sentano un importante evento stressante e traumatico nell’esistenza di una donna determinando un peggioramento della sua qualita di vita. Il percorso di diagnosi e di cura risulta inoltre particolarmente lungo e faticoso, gli esami a cui le donne vengono sottoposte sono numerosi e le tecniche di PMA usate per il suo tratta-mento spesso risultano invasive e caratterizzate da numerosi fallimenti. Abbiamo analizzato la letteratura rela-tiva agli aspetti psichiatrici dell’infertilita e di uno degli esami eseguiti di routine per un completo inquadramento di tale condizione, l’isterosalpingografia. Da quest’analisi e emerso che l’isterosalpingografia e un esame accompagnato da un’importante componente emotiva e che l’infertilita e una condizione patologica che provoca una vera e propria crisi esistenziale e che risulta spesso associata ad ansia e depressione. Risulta dunque fondamentale che il medico, nell’ambito di una completa presa in carico di una donna con problemi di infertilita che si deve sottoporre ad isterosalpingografia, tenga in considerazione quest’importante aspetto e-motivo.

Incertezza nella determinazione del sottotipo di schizofrenia sulla base dei criteri diagnostici proposti dal DSM-IV-TR e dall’ICD-10: un caso clinico

This work focuses on a case of childhood-onset schizophrenia; the patient is now 25 years old. The patient’s clinical picture was always characterized by precocious and predominant negative schizophrenic symptoms with no evidence of positive ones and this fact was causing doubts and indecision in making diagnosis. We analyzed all schizophrenia subtypes included in DSMIV- TR and ICD-10; diagnostic criteria proposed in the two manuals seems not exhaustive enough in order to allow an exact definition of the schizophrenia subtype. The current knowledge about pathogenetic, clinical and evolutive characteristics of childhood-onset Schizophrenia are still preliminary.

Aumento della clozapinemia concomitante all'assunzione di doxiciclina: un caso clinico

In questo lavoro abbiamo presentato il caso di un paziente di 37 anni affetto da schizofrenia paranoide in cui le terapie farmacologiche con antispicotici sia tipici che atipici si sono rivelate inefficaci. A causa della scarsa risposta alle precedenti terapie, si e decisa la somministrazione di Clozapina, che e un antipsicotico atipico, la cui indicazione terapeutica e limitata ai casi di schizofrenia resistente. Durante la terapia con Clozapina comincia ad assumere una tetraciclina (Doxiciclina 100 mg x os), prescritta per un problema di acne cistica. Nell’arco di pochi giorni il paziente presenta livelli di clozapinemia (1270 ng/ml) molto superiori al range terapeutico (100-600 ng/ml). Come noto, la clozapina viene metabolizzata a livello epatico, in particolar modo dal citocromo CYP1A2 e sono note alcune interazioni con farmaci antibatterici: eritromicina e ciprofloxacina ne aumentano la concentrazione plasmatica, mentre la rifampicina la riduce. Non sono riportati, pero, in letteratura, dati sulle possibili interazioni con le tetracicline. L’analisi di questo caso suggerisce una possibile interazione farmacocinetica tra antipsicotici atipici e tetracicline, probabilmente legata a competizione dei due farmaci a livello del metabolismo epatico, prospettando la possibilita di studi osservazionali su ampie casistiche.

Lo stile di vita del paziente schizofrenico

Il rischio di mortalita legato a condizioni cardiovascolari-metaboliche e circa quattro volte piu alto nei pazienti in cura presso il servizio psichiatrico che nella popolazione generale. Per valutare lo stile di vita in questi soggetti e stato realizzato uno studio pilota su un campione di 22 pazienti schizofrenici, reclutati nel servizio psichiatrico pavese, attraverso la somministrazione del questionario inglese HALS-2 (Health and Lifestyle Survey). Dai dati raccolti si puo osservare che i pazienti esaminati hanno un’alimentazione irregolare. La maggior parte di loro, inoltre, svolge scarsa attivita fisica, fatto che, insieme all’alimentazione scorretta e all’assunzione di farmaci antipsicotici, contribuisce all’aumento di peso di molti pazienti predisponendoli a sovrappeso e obesita. Infine e emerso che la maggior parte degli intervistati e dipendente dal fumo di sigaretta, mentre solo una piccola frazione di essi consuma alcol. In generale si osserva come i pazienti esaminati abbiano uno stile di vita meno salutare rispetto alla popolazione generale che suggerisce la necessita di efficaci interventi di promozione della salute.