Gemma Battagliese

Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies

BACKGROUND In many patients with depression, symptoms of insomnia herald the onset of the disorder and may persist into remission or recovery, even after adequate treatment. Several studies have raised the question whether insomniac symptoms may constitute an independent clinical predictor of depression. This meta-analysis is aimed at evaluating quantitatively if insomnia constitutes a predictor of depression. METHODS PubMed, Medline, PsycInfo, and PsycArticles databases were searched from 1980 until 2010 to identify longitudinal epidemiological studies simultaneously investigating insomniac complaints and depressed psychopathology. Effects were summarized using the logarithms of the odds ratios for insomnia at baseline to predict depression at follow-up. Studies were pooled with both fixed- and random-effects meta-analytic models in order to evaluate the concordance. Heterogeneity test and sensitivity analysis were computed. RESULTS Twenty-one studies met inclusion criteria. Considering all studies together, heterogeneity was found. The random-effects model showed an overall odds ratio for insomnia to predict depression of 2.60 (confidence interval [CI]: 1.98-3.42). When the analysis was adjusted for outliers, the studies were not longer heterogeneous. The fixed-effects model showed an overall odds ratio of 2.10 (CI: 1.86-2.38). LIMITATIONS The main limit is that included studies did not always consider the role of other intervening variables. CONCLUSIONS Non-depressed people with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties. Thus, early treatment programs for insomnia might reduce the risk for developing depression in the general population and be considered a helpful general preventive strategy in the area of mental health care.

Persistence of poor sleep predicts the severity of the clinical condition after 6months of standard treatment in patients with eating disorders.

Clinical evidence suggests that eating disorder (ED) patients experience poor sleep even if they rarely complain of it. However, direct empirical evidence supporting this relationship is still sparse. In order to provide direct evidence, poor sleep, severity of the ED symptoms and depression were obtained in 562 ED patients at treatment admission (T0). For 271 patients out of them, data were also available after 6months of standard treatment (T1). Results evidence that at T0 poor sleep predicts severity of ED symptoms through the mediation of depression. Persistence of poor sleep at T1 directly predicts the severity of the ED symptoms both directly and through the mediation of depression. These findings suggest that the treatment of ED may benefit from addressing poor sleep since its presence and persistence increase comorbidity and attrition to the standard treatment.

Body dissatisfaction among pre-adolescent girls is predicted by their involvement in aesthetic sports and by personal characteristics of their mothers

Empirical evidence indicates that the dissatisfaction with one’s body is widely present in the general population even at very early ages, and that it is predictive of future eating disorders. The family seem particularly influent for the development of body dissatisfaction while sports practice is associated to a higher prevalence of disordered eating. However the role of sports practice in the development of body dissatisfaction is still under debate and only few studies have evaluated together the influences of family and sport practice on body dissatisfaction. The present study aimed at evaluating both the singular and conjoint role of the type of sport and maternal influences in young female children. The sport influence was assessed comparing aesthetic and non-aesthetic disciplines; the mother’s influence was evaluated considering her personal characteristics and her desire to have a thinner child. Results evidence that children involved in aesthetic sports, although thinner than those involved in non-aesthetic sports, report higher desire to be much thinner and have mothers who pressure them toward a greater thinness. Furthermore, children’s body dissatisfaction in the sport groups is predicted by maternal characteristic like her habit to restrict her own eating and her perfectionism.

Ethylglucuronide in the urine as a marker of alcohol consumption during pregnancy: Comparison with four alcohol screening questionnaires

Ethyl glucuronide (EtG) is an ethanol metabolite and EtG is used as a biomarker of alcohol drinking. EtG can be detected in the blood and in several biological matrices including urine, hair and nails. Alcohol consumption during pregnancy is a strong risk factor for fetus health so in the recent years different strategies to reveal alcohol use have been planning including the use of screening questionnaires as the AUDIT-C, T-ACE and TWEAK. The present study aims to investigate in pregnant women the specificity and predictive value of the AUDIT-C, T-ACE and TWEAK plus a food diary in use in Sapienza University Hospital compared with the results of urine EtG measurement. Seventy pregnant women were enrolled and examined. Urine samples were provided by pregnant women immediately after the interviews. EtG determinations were performed by Enzyme Immunoassay with a cut-off established at 100ng/mL. Data show that 34.28% of the enrolled pregnant women overcame the EtG cut off. No direct correlation was found between EtG data and the alcohol screening interviews showing lower levels of alcohol consumption, although T-ACE revealed the same at risk percentage. However, a significant concordance was observed with food diary data and T-ACE only in patients with higher EtG urinary concentration. This study provides clinical evidence that the diagnosis of maternal alcohol consumption during pregnancy only based on indirect methods, such as questionnaires and food diary, may significantly underestimate alcohol use.

Neurophysiological Measures and Alcohol Use Disorder (AUD): Hypothesizing Links between Clinical Severity Index and Molecular Neurobiological Patterns

Background In 1987, Cloninger proposed a clinical description and classification of different personality traits genetically defined and independent from each other. Moreover, he elaborated a specific test the TCI to investigate these traits/states. The study of craving in Alcohol Use Disorder (AUD) assumed a greater significance, since ever more data seems to suggest a direct correlation between high levels of craving and a higher risk of relapse in alcoholics. Thus, our study aim is to explore the possible correlations among TCI linked molecular neurobiological pattern (s), craving and alcohol addiction severity measures in a sample of Italian alcoholics. Materials and Methods 191 alcoholics were recruited in a Day Hospital (DH) setting at the Alcohol Addiction Program Latium Region Referral Center, Sapienza University of Rome. After 7 days detoxification treatment a psychodiagnostic protocol was administered, including TCI, VAS-C, ASI and SADQ. All patients signed an Institutional Review Board (IRB) approved informed consent. Results Principally, we detected a significant positive correlation between HA-scale scores and the VAS scale: increasing in HA-scale corresponds to an increase in craving perception for both intensity (r=0.310; p ≤ 0.001) and frequency (r=0.246; p ≤ 0.001). Moreover, perception of dependence severity, measured with SADQ was also found to be significantly associated positively to both HA-scale (r=0.246; p ≤ 0.001) and NS-scale (r=0.224; p ≤ 0.01). While, for character scales, Persistence (r=−0.195; p=.008) and Self-directedness (r=−0.294; p ≤ 0.001) was negatively associated with ASI linked to alcohol problems. Self-directedness was also negatively correlated with ASI linked to family and social problems (r=−0.349; p ≤ 0.001), employment and support problems (r=−0.220; p=0.003) and psychiatric problems (r=−0.358; p ≤ 0.001). Cooperativeness was a negative correlate with Legal Problems (r=−0.173; p=0.019). and Self-Transcendence was positive correlated with Medical Problems (r=0.276; p ≤ 0.001) Conclusions In view of recent addiction neurobiological theories, such as the “Reward Deficiency Syndrome (RDS)” and the Koob model, our data could suggest that our cohort of patients could possibly be in a particular stage of the course of their addiction history. Thus, if our hypothesis will be confirmed, the TCI-based assessment of alcoholics would allow an optimization of the treatment. Clinicians understanding these newer concepts will be able to translate this information to their patients and potentially enhance clinical outcome (s), because it could suggest a functional hypothesis of neurotransmitter circuits that helps to frame the patient in his/her history of addiction.

I disturbi alimentari in adolescenza: assessment, trattamenti evidence-based e dati relativi al funzionamento psicologico in un campione di adolescenti romani

I disturbi alimentari rappresentano uno dei disturbi piu seri in adolescenza a causa del loro decorso cronico e delle gravi conseguenze mediche e psichiatriche ad essi associate. Tra i trattamenti evidence-based indicati per i disturbi alimentari troviamo il Family-Based Treatment, indicato come trattamento di prima scelta per l’anoressia, l’Adolescent-Focused Therapy e la CBT-E che permette di lavorare sugli aspetti del funzionamento psicologico che possono ostacolare il trattamento, quali perfezionismo, bassa autostima e difficolta interpersonali. Gli obiettivi del presente lavoro sono: fornire una panoramica sugli aspetti di diagnosi, valutazione, eziologia e trattamento dei disturbi alimentari in adolescenza e portare un contributo empirico circa la presenza di comportamenti alimentari disfunzionali in un campione di adolescenti italiani romani di eta compresa fra 14 e 19 anni. I risultati dello studio dimostrano che il 4% (6,4% femmine; 1% maschi) degli adolescenti esaminati riferisce sintomi di disturbi alimentari clinicamente rilevanti Relativamente alle caratteristiche psicologiche associate, gli adolescenti che riportano una maggiore intensita sintomatologica riportano anche una piu bassa autostima, maggiori problemi personali e interpersonali, una maggiore disregolazione emotiva, maggiore percezione di inadeguatezza, e disadattamento psicologico generale. Inoltre, nelle femmine una maggiore intensita dei sintomi si associa ad alti livelli di perfezionismo e ipercontrollo. E importante, quindi, che i clinici che si confrontano con questo spettro di disturbi in eta adolescenziale conducano un’adeguata valutazione, intervenendo con trattamenti basati sulle evidenze che tengano conto anche delle caratteristiche di funzionamento psicologico associate al disturbo.

New Insight into Alcohol and Nicotine Addiction: Neurobiological Findings and Therapeutical Perspectives

Alcohol and nicotine dependence are the most serious public health problems worldwide in terms of health care costs, social impact, morbidity, and mortality rates. In this chapter, we review the latest theories on the neurobiology of addiction, with an emphasis on alcohol and nicotine co-occurrence, focusing specifically on nicotinic cholinergic mechanisms and their interaction with other critical neurochemical systems. Finally, we discuss the role of the partial nicotinic agonist, varenicline, in the treatment of nicotine dependence and its potential utility in the treatment of alcohol dependence.

Efficacia di un trattamento cognitivo comportamentale online per l’insonnia: risultati preliminari

L’insonnia e uno dei problemi piu diffusi nella popolazione generale. Coloro che ne soffrono riferiscono un peggioramento della qualita della vita e sono a maggior rischio di sviluppare disturbi a livello medico e psicologico. Studi meta-analitici hanno dimostrato che il trattamento di elezione per questo problema e quello cognitivo-comportamentale (CBT-I). Nonostante cio, questo tipo di trattamento rimane poco accessibile. Recentemente, sono stati valutati gli effetti del CBT-I amministrato attraverso internet. Gli studi condotti finora ne hanno dimostrato l’efficacia riscontrando nei pazienti miglioramenti significativi sia dei sintomi notturni sia delle conseguenze diurne. Tuttavia, nessuno studio ad oggi ha valutato l’efficacia di un programma online di CBTI-I rispetto agli stati emotivi associati al disturbo. Lo scopo di questo studio e quello di valutare l’efficacia di un trattamento CBT-I, condotto online, sia sui sintomi autoriferiti che sugli stati emotivi. Hanno partecipato allo studio 10 pazienti con disturbo d’insonnia, assegnati casualmente a un gruppo sperimentale e a un gruppo in lista di attesa. I parametri del sonno e gli stati emotivi associati sono stati misurati attraverso diari giornalieri. I risultati preliminari evidenziano che il gruppo sperimentale riporta una minore durata della veglia notturna, una maggiore efficienza del sonno e una riduzione delle emozioni negative riferite al mattino, rispetto al gruppo in lista di attesa e alla settimana di osservazione prima del trattamento. I risultati suggeriscono che il CBT-I condotto tramite internet potrebbe essere un’opzione di trattamento valida ed efficace sia per la sintomatologia notturna che per gli stati emotivi alterati associati al disturbo.

Efficacia dei programmi di intervento cognitivo-comportamentali per i disturbi esternalizzanti in età evolutiva: una metanalisi

I disturbi esternalizzanti rappresentano la piu comune e persistente forma di disadattamento nell’infanzia. Proprio per questo motivo lo sviluppo di trattamenti basati sull’evidenza costituisce un’urgenza sociale. L’obiettivo del presente studio e quello di condurre una metaanalisi sistematica e quantitativa di studi randomizzati controllati finalizzati a valutare l’efficacia di programmi di intervento psicologico sui disturbi esternalizzanti in eta evolutiva. La ricerca bibliografica e stata condotta sulle banche dati PsycInfo e PsycArticles, Medline, PubMed ed EBSCO. Gli articoli sono stati selezionati e valutatati da giudici indipendenti. Dai risultati si evince che i trattamenti cognitivo comportamentali sono efficaci nel trattamento delle condotte esternalizzanti, quando invece si prendono in considerazione i comportamenti internalizzanti e la depressione materna non si evincono differenze significative tra il gruppo sperimentale trattato con interventi cognitivo-comportamentali ed il gruppo di controllo. Al fine di produrre un miglioramento del funzionamento globale i trattamenti per le condotte esternalizzanti potrebbero beneficiare di interventi diretti ai sintomi internalizzanti del bambino e alla depressione genitoriale.