G. Rioli

N-acetylcysteine in the treatment of psychiatric disorders: current status and future prospects

ABSTRACT Introduction: N-acetylcysteine (NAC) is widely known for its role as a mucolytic and as an antidote to paracetamol overdose. There is increasing interest in the use of NAC in the treatment of several psychiatric disorders. The rationale for the administration of NAC in psychiatric conditions is based on its role as a precursor to the antioxidant glutathione, and its action as a modulating agent of glutamatergic, dopaminergic, neurotropic and inflammatory pathways. Areas covered: This study reviews the available data regarding the use of NAC in different psychiatric disorders including substance use disorders, autism, obsessive-compulsive spectrum disorders, schizophrenia, depression, bipolar disorder. Promising results were found in trials testing the use of NAC, mainly as an add-on treatment, in cannabis use disorder in young people, depression in bipolar disorder, negative symptoms in schizophrenia, and excoriation (skin-picking) disorder. Despite initial optimism, recent findings regarding NAC efficacy in autism have been disappointing. Expert opinion: These preliminary positive results require further confirmation in larger samples and with longer follow-ups. Given its high tolerability and wide availability, NAC represents an important target to investigate in the field of new adjunctive treatments for psychiatric conditions.

A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

Purpose To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. Patients and methods After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for <72 hours. We collected the demographic and clinical variables of our sample (n=135). We statistically analyzed PDI scores, performing Cronbach’s alpha coefficient and principal factor analysis, followed by orthogonal and oblique rotation. We concomitantly administered to our sample other scales (Hamilton Rating Scales for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales) to analyze the PDI concurrent validity. Results With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD) with excellent internal consistency (Cronbach’s alpha coefficient =0.93). The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser’s criterion), which explained >80% of total variance with good internal consistency: 1) “Loss of self-identity and social role”, 2) “Anxiety and uncertainty for future” and 3) “Loss of personal autonomy”. The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Conclusion Our preliminary research suggests that PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments.

Association Between Symptoms of Anxiety and Depression and BMI in Primary Care Patients: a Cross Sectional Study.

Introduction Recent research exploring the relationship between BMI and symptoms of anxiety and depression have reported conflicting results. Changes in common molecular pathways could be the basis of this association. Primary care represents an interesting setting for exploring this comorbidity, given the high prevalence of psychiatric symptoms displayed by patients. Aim To measure the association between BMI and symptoms of anxiety and depression in primary care patients. Methods Cross-sectional study. Evaluation of all consecutive women undergoing a GP consultation in a Northern Italy practice. Exclusion criteria: age 80; use of antidepressants or antipsychotics medication; previous stroke or heart attack; psychosis or major depression; obesity due to hereditary. Psychometric assessment: HADS (Hospital Anxiety and Depression Scale). Anthropometric measures: weight and height. Statistical analysis: SPSS. Whole sample stratified by age on the basis of literature data about the prevalence of obesity. Results 209 subjects examined (84 men and 125 women). Of those, 76 (36.7%) were overweight and 60 (29.1%) obese. BMI statistically correlated with anxiety (β(SE)=.54(.12), p=.00) and depressive symptoms (β(SE)=.32(.09), p=.03), also after stratification by age, especially in females. Conclusion - BMI has a critical value in predicting the presence of anxious and depressive symptoms, especially in females. Further studies could examine the pathophysiological reasons for such association.

EPA-0966 – The kynurenine pathway: a possible link between the depression and anxiety spectrum, metabolic syndrome and eating disorders

Introduction Eating Disorders (ED), including obesity, with and without Metabolic Syndrome (MetS), are associated with anxiety and depression. Increased levels of cytokines and their consequences on the pathway of kynurenine (KYN), the main metabolite of tryptophan, have been proposed to account for these associations. Aim To review the evidences suggesting biochemical connections between the Depression and Anxiety Spectrum (DAS), MetS and ED, respectively, focusing on the role of the KYN pathway. Methods Three PubMed searches of the literature conducted in October 2013 (key words:‘kynurenine’ ‘eating disorders’; ‘kynurenine’ ‘waist circumference’; ‘kynurenine’‘obesity’‘metabolic syndrome’) provided 2, 3 and 7 references, respectively. Results The metabolism of L-tryptophan through the KYN pathway depends on the following three factors: 1) NUTRITION; in underweight ED LKYN metabolites (quinolinic acid, kynurenic acid, 5-hydroxyindoleacetic acid) are significantly reduced until the restoration of normal body weight. In overweight and obesity with and without MetS, increased KYN levels and KYN/tryptophan ratio are found, with abdominal fat content as strongest factor for an increase of the KYN/TRP ratio. 2) AGE; KYN/TRP ratios are markedly increased vs. decreased in overweight and obese adults vs. juveniles, respectively. 3) INFLAMMATION; IFN-gamma induces the indoleamine 2,3- dioxygenase (IDO)-catalyzed synthesis of KYN, whose derivatives increase in diabetes (xanturenic acid), psychosis (kynurenic acid), and depression (quinolinic acid). Conclusions The KYN pathway may link DAS, MetS and ED explaining the frequent association of DAS to so many different disorders. Further studies are needed in order to understand these complex connections.