Giovanni Camardese

Dopamine transporter binding in depressed patients with anhedonia

Central dopaminergic dysfunction has been widely proposed as a common neurobiological correlate of the psychopathological expression of anhedonia. The dopamine transporter (DAT) is a predominantly presynaptic receptor that may play a critical role in the pathophysiology of dopaminergic transmission. The aim of our study was to evaluate DAT binding in a population of depressed patients with anhedonia. Single photon emission computed tomography (SPECT) with the radiotracer DATSCAN was used to evaluate DAT binding in 11 depressed patients with anhedonia and 9 healthy comparison subjects. Compared with healthy subjects, patients showed significantly lower DAT binding. No significant correlation was found between DAT binding ratios and scores on administered psychometric tests. These findings suggest an alteration in DAT density in depressed patients with anhedonia that may be a primary susceptibility factor or a secondary phenomenon to reduced dopamine concentration in the synaptic cleft.

Cholesterol and serotonin indices in depressed and suicidal patients.

BACKGROUND Prolactin and cortisol responses to d-fenfluramine challenge of central serotonin are reduced in depressed and suicidal patients. Low serum cholesterol levels are also reported in suicidal behavior. Thus, we examined for a relationship between serum cholesterol and fenfluramine challenge responses in patients with depression and/or attempted suicide. METHODS We studied 12 patients and six controls. Blood was drawn for baseline serum cholesterol and the d-fenfluramine challenge test performed. RESULTS Serum cholesterol levels were significantly lower in suicidal patients than in either non-suicidal patients or controls. However, neither the prolactin nor cortisol responses to d-fenfluramine correlated significantly with serum cholesterol levels. CONCLUSION No relationship was found between serum cholesterol and these peripheral indices of serotonergic function.

Further evidence for low serum cholesterol and suicidal behaviour

OBJECTIVE To examine for a relationship between serum cholesterol and suicidal behavior. METHODS Patients admitted after an overdose (N=120) were compared with controls (N=120) for their serum cholesterol levels. RESULTS Patients who had overdosed had significantly lower serum cholesterol levels than controls (mean+/-S.D. 171+/-31 vs. 196+/-30 mg/dl, P<0.0001). CONCLUSION These results add to a grouping literature reporting that low serum cholesterol is associated with suicidal behavior.

Dopaminergic dysfunction and psychiatric symptoms in movement disorders: a 123I-FP-CIT SPECT study.

PurposePsychiatric symptoms frequently occur in patients with movement disorders. They are not a mere reaction to chronic disability, but most likely due to a combination of psychosocial factors and biochemical dysfunction underlying the movement disorder. We assessed dopamine transporter (DAT) availability by means of 123I-FP-CIT SPECT, and motor and psychiatric features in patients with Parkinson’s disease, primary dystonia and essential tremor, exploring the association between SPECT findings and symptom severity.MethodsEnrolled in the study were 21 patients with Parkinson’s disease, 14 patients with primary dystonia and 15 patients with essential tremor. The severity of depression symptoms was assessed using the Hamilton depression rating scale, anxiety levels using the Hamilton anxiety rating scale and hedonic tone impairment using the Snaith-Hamilton pleasure scale. Specific 123I-FP-CIT binding in the caudate and putamen was calculated based on ROI analysis. The control group included 17 healthy subjects.ResultsAs expected, DAT availability was significantly decreased in patients with Parkinson’s disease, whereas in essential tremor and dystonia patients it did not differ from that observed in the control group. In Parkinson’s disease patients, an inverse correlation between severity of depression symptoms and DAT availability in the left caudate was found (r = −0.63, p = 0.002). In essential tremor patients, levels of anxiety symptoms were inversely correlated with DAT availability in the left caudate (r = −0.69, p = 0.004). In dystonia patients, the severities of both anxiety and depression symptoms were inversely associated with DAT availability in the left putamen (r = −0.71, p = 0.004, and r = −0.75, p = 0.002, respectively). There were no correlations between psychometric scores and 123I-FP-CIT uptake ratios in healthy subjects.ConclusionWe found association between presynaptic dopaminergic function and affective symptoms in different movement disorders. Interestingly, the inverse correlation was present in each group of patients, supporting the fascinating perspective that common subcortical substrates may be involved in both anxiety and depression dimensions and movement disorders.

Cognitive markers of psychotic unipolar depression: A meta-analytic study

BACKGROUND The goal of the current meta-analysis was to review and examine in detail the features of cognitive performance in psychotic (MDDP) versus non-psychotic (MDD) major depressive disorder. METHODS An electronic literature search was performed to find studies comparing cognitive performance in MDDP versus MDD. A meta-analysis of broad cognitive domains (processing speed, reasoning/problem solving, verbal learning, visual learning, attention/working memory) and individual cognitive tasks was conducted on all included studies (n=12). Demographic and clinical features were investigated via meta-regression analysis as moderators of cognitive performance. RESULTS No difference in socio-demographic and clinical variables was detected between groups. In general, a poorer cognitive performance was detected in MDDP versus MDD subjects (ES=0.38), with a greater effect size in drug-free patients (ES=0.69). MDDP patients were more impaired in verbal learning (ES=0.67), visual learning (ES=0.62) and processing speed (ES=0.71) tasks. A significantly poorer performance was also detected in MDDP patients for individual tasks as Trail Making Test A, WAIS-R digit span backward and WAIS-R digit symbol. Age resulted to have a negative effect on tasks involved in working memory performance. CONCLUSION In line with previous meta-analyses, our findings seem to support an association between psychosis and cognitive deficits in the context of affective disorders. Psychosis during the course of MDD is associated with poorer cognitive performance in some specific cognitive domains, such as visual and verbal learning and executive functions.

A role for pharmacotherapy in the treatment of "internet addiction".

AbstractThe advent of the Internet is among the most significant changes in recent decades and has greatly affected the entire range of human experience. However, it has, in turn, led to the emergence of psychopathological features of addiction linked to its use. Literature on the clinical management of the distress related to Internet use systematically measures up to an evolving nosography, with ambiguous definitions of the phenomenon and a diversity of diagnostic, prognostic, and therapeutic criteria. To date, case studies on “Internet addiction” treatment are rather limited, and no standard clinical treatment protocols exist. With regard to pharmacological treatment options, empirical or anecdotal assessments are mostly referred to. The aim of this article was to review current literature on Internet addiction treatment and assess the extent to which specific pharmacological interventions alleviate these patients’ symptomatic burden, to propose a rationale that may guide the therapeutic approach. To this end, we also explored pharmacological interventions that target patterns of comorbidity and underlying psychopathological dimensions shared with other behavioral or substance addictions.

Attachment style predict compliance, quality of life and renal function in adult patients after kidney transplant: preliminary results

Abstract Aim: Aim of this study was to evaluate the association between attachment style, compliance, quality of life and renal function in adult patients after kidney transplantation. Methods: A total of 43 adult patients who received a kidney transplant more than 3 months before were enrolled and were asked to complete two Self-Report questionnaires: Attachment Style Questionnaire (ASQ-40) and Short Form Health Survey (SF-36). Also compliance was measured using appropriate questions. Results: Linear regression analysis showed associations between the confidence in relationships (ASQ-40) and compliance [beta = −0.37; B = −0.02; t(41) = −2.51; p = 0.02]; aspects of anxious attachment style (ASQ-40) and creatinine levels [beta = 0.3; B = 0.13; t(41) = 2.03; p = 0.04]; aspects of avoidant attachment style (ASQ-40) and compliance [beta = −0.37; B = −3.15; t(41) = −2.35; p = 0.02]. Patients who exhibited avoidant attachment had a significantly better perception of their own general health than patients with anxious [F(2,37) = 6.8; p < 0.05] or secure attachment; however, they had a worse perception regarding role limitations due to emotional problems, compared to patients with anxious attachment [F(2,37) = 6.4; p < 0.05]. Discussion: The results of this study suggest that the evaluation of the attachment style in adult kidney transplant patients can contribute to plan a goal-directed psychological support program for these patients, in order to increase their compliance. The association between aspects of anxious attachment style and creatinine level needs more investigations.

Plasma magnesium levels and treatment outcome in depressed patients

Abstract Objectives High, normal, or low plasma magnesium (Mg) levels have been observed in depressed patients. The aim of our study was to investigate the relationship of Mg levels with depression severity, specific psychopathological dimensions, and treatment outcome. Methods A total of 123 outpatients during a major depressive episode were recruited. All patients showed at least two major depressive episodes and did not achieve remission in the former treatment trial. A blood sample was collected to determine total plasma Mg levels. The psychopathological status was assessed using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Depression Retardation Rating Scale for psychomotor retardation, and Snaith–Hamilton Pleasure Scale for anhedonia. Hamilton Depression Rating Scale was repeated at 3 months after treatment. Results All patients showed Mg levels mostly within the normal range. No association between Mg levels and psychopathological severity was reported. Patients who responded to antidepressant treatment showed higher Mg levels and higher retardation scores at basal evaluation in comparison with non-responders. Discussion Although further studies investigating the relationship between hypomagnesaemia, depression, and treatment outcome are certainly necessary, we have hypothesized that hypomagnesaemia could be an epiphenomenic biochemical trait in less drug-responsive depressed patients. It is also plausible that lower Mg levels and hyperactive traits identify a biological subtype of patients with increased catecholaminergic functioning and a poorer response to aminergic drugs. Moreover, Mg depletion could partly account for the correlation between low Mg levels and poor outcome and this raises the question of Mgs possible therapeutic role in depression.

A meta-analysis of cognitive performance in melancholic versus non-melancholic unipolar depression

BACKGROUND Recently there is increasing recognition of cognitive dysfunction as a core feature of Major Depressive Disorder (MDD). The goal of the current meta-analysis was to review and examine in detail the specific features of cognitive dysfunction in Melancholic (MEL) versus Non-Melancholic (NMEL) MDD. METHODS An electronic literature search was performed to find studies comparing cognitive performance in MEL versus NMEL. A meta-analysis of broad cognitive domains (processing speed, reasoning/problem solving, verbal learning, visual learning, attention/working memory) was conducted on all included studies (n=9). Sensitivity and meta-regression analyses were also conducted to detect possible effects of moderator variables (age, gender, education, symptom severity and presence of treatments). RESULTS MEL patients were older and more severly depressed than NMEL subjects. The MEL group was characterized by a worse cognitive performance in attention/working memory (ES=-0.31), visual learning (ES=-0.35) and reasoning/problem solving (ES=-0.46). No difference was detected in drug-free patients by sensitivity analyses. No effect was found for any of our moderators on the cognitive performance in MEL vs NMEL. CONCLUSION Our findings seem to support a moderate but specific effect of melancholic features in affecting the cognitive performance of MDD, in particular as regards visual learning and executive functions.

Monocytes from Depressed Patients Display an Altered Pattern of Response to Endotoxin Challenge

It is now well established that major depression is accompanied and characterized by altered responses of the immune-inflammatory system. In this study we investigated the pro-inflammatory activation of monocytes isolated from depressed patients as a parameter not influenced by such confounds as the time of day, the nutritional and exercise status or the age and gender of patients. Monocytes from depressed patients and from healthy controls were isolated in vitro; after 24-h incubation under basal conditions, cells were exposed for 24-h to 100 ng/ml of endotoxin (bacterial lipopolysaccharide, LPS). We found that monocytes from drug-free depressed patients and controls release the same amounts of prostaglandin E2 (PGE2) under basal conditions, whereas monocytes from patients are dramatically less reactive to LPS (8.62-fold increase vs previous 24 hrs) compared to healthy controls (123.3-fold increase vs previous 24 hrs). Such blunted prostanoid production was paralleled by a reduction in COX-2 gene expression, whereas other pro-inflammatory mediators, namely interleukin-1β (IL-1 β) and -6 (IL-6) showed a trend to increased gene expression. The above changes were not associated to increased levels of circulating glucocorticoids. After 8 months of antidepressive drug treatment, the increase in PGE2 production after the endotoxin challenge was partially restored, whereas the increase in IL-1 β and -6 levels observed at baseline was completely abolished. In conclusion, our findings show that the reactivity of monocytes from depressed patients might be considered as a marker of the immune-inflammatory disorders associated to depression, although the lack of paired healthy controls at follow-up does not allow to conclude that monocyte reactivity to endotoxin is also a marker of treatment outcome.