Giulia Zelda De vidovich

Electrophysiological changes of cardiac function during antidepressant treatment

Some antidepressant agents can cause electrophysiological changes of cardiac function leading to ventricular arrhythmias and sudden death. However, antidepressants have also protective effects on the heart through their capacity to modulate cardiac autonomic-mediated physiological responses. Heart rate variability and QTc length are two strictly linked parameters that allow us to appreciate the effects of different drugs on cardiac physiology. Heart rate variability reflects functioning of the autonomic nervous system and possibly also regulation by the limbic system. Autonomic regulation of cardiac activity influences also cardiac repolarization and QT length, both directly and via its effects on heart rate. In this review we present the methodologies adopted to study the effect of antidepressant drugs on QT length and heart rate variability and we summarize data on electrophysiological changes related to antidepressant treatment. Clinical implications for the choice of different antidepressants in different clinical populations are discussed.

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.

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.

Psychological correlates of decision-making during prenatal diagnosis: A prospective study

Abstract Objective: Decision-making during prenatal diagnosis has not been extensively studied. We aimed to determine psychological correlates and level of decisional conflict following prenatal diagnosis. Method: A total of 159 pregnant women were consecutively enrolled. All participants completed three questionnaires (the Hospital Anxiety and Depression scale, the Berlin Social Support scales and the Decisional Conflict scale) at three time points (T1 – waiting period between prenatal testing and disclosure of the results; T2 – decision phase within 3 days from test result disclosure; T3 – digestion period within 3 weeks from disclosure). Results: Women with fetal anomaly who terminate pregnancy were significantly more anxious and depressed than controls at each time point. Additionally, women with a normal fetus who terminate pregnancy presented higher level of anxiety and depression compared with controls at T2. Women who terminated pregnancy showed increased uncertainty scores at T2 and T3. Anxious and depressed individuals at T2 (decision period) were more uncertain about their choice at T3 compared to women with normal levels of anxiety and depression. Conclusion: The decision to terminate pregnancy, irrespective of test results, may determine emotional distress and psychiatric morbidity. Women who were anxious and depressed at decision appeared to be more uncertain about their choices as time passed by. A careful assessment of women during prenatal diagnosis should be useful to identify women who may benefit from psychological support.

Repetitive TMS on left cerebellum affects impulsivity in borderline personality disorder: A pilot study

The borderline personality disorder (BPD) is characterized by a severe pattern of instability in emotional regulation, interpersonal relationships, identity and impulse control. These functions are related to the prefrontal cortex (PFC), and since PFC shows a rich anatomical connectivity with the cerebellum, the functionality of the cerebellar-PFC axis may impact on BPD. In this study, we investigated the potential involvement of cerebello-thalamo-cortical connections in impulsive reactions through a pre/post stimulation design. BPD patients (n = 8) and healthy controls (HC; n = 9) performed an Affective Go/No-Go task (AGN) assessing information processing biases for positive and negative stimuli before and after repetitive transcranial magnetic stimulation (rTMS; 1 Hz/10 min, 80% resting motor threshold (RMT) over the left lateral cerebellum. The AGN task consisted of four blocks requiring associative capacities of increasing complexity. BPD patients performed significantly worse than the HC, especially when cognitive demands were high (third and fourth block), but their performance approached that of HC after rTMS (rTMS was almost ineffective in HC). The more evident effect of rTMS in complex associative tasks might have occurred since the cerebellum is deeply involved in integration and coordination of different stimuli. We hypothesize that in BPD patients, cerebello-thalamo-cortical communication is altered, resulting in emotional dysregulation and disturbed impulse control. The rTMS over the left cerebellum might have interfered with existing functional connections exerting a facilitating effect on PFC control.

Utilità e limiti della Reflective Function Rating Scale nella valutazione della funzione riflessiva dei pazienti con Disturbo Borderline della Personalità

La funzione riflessiva e la capacita dell’individuo di pensare ai comportamenti propri ed altrui come il risultato di una vasta gamma di cosiddetti stati mentali, ossia di sentimenti, pensieri, emozioni e cosi via. Tale abilita non e innata, bensi viene acquisita con lo sviluppo a partire dai primi anni di vita e la sua carenza sembra essere connessa alla fisiopatologia di alcuni disturbi psichiatrici, tra cui il Disturbo Borderline della Personalita. Per valutare questa abilita nei diversi individui e stata sviluppata la Reflective Function Rating Scale, ossia uno strumento basato sull’Adult Attachment Interview capace di fornire una stima della capacita di mentalizzare del soggetto intervistato. Seppur molto utile, la scala ideata presenta alcuni difetti, in quanto non consente una valutazione quantitativa della funzione riflessiva, richiede molti giorni prima di fornire dei risultati in parte passibili di variazioni operatore-dipendente e, infine, stabilisce singole categorie, non tenendo conto della multidimensionalita del concetto di mentalizzazione.

La mentalizzazione nella psicopatogenesi e nel trattamento del Disturbo di Personalità Borderline

Il Disturbo Borderline di Personalita (BPD) e un disturbo mentale grave e complesso, molto frequente nella popolazione generale, caratterizzato da relazioni interpersonali instabili ed intense, agiti autolesivi, suicidarieta, labilita affettiva e sentimenti cronici di vuoto. Bateman e Fonagy hanno avanzato l’ipotesi che il BPD possa essere compreso nei termini di un’assenza o una compromissione della mentalizzazione, una forma di attivita mentale immaginativa, rappresentazionale e preconscia definita come la capacita di concepire se stessi e gli altri come esseri dotati di pensieri, credenze, desideri e sentimenti, nonche di comprendere e spiegare il comportamento in termini di stati mentali intenzionali. Riconoscere un fallimento della mentalizzazione e incrementare i processi riflessivi nel paziente divengono quindi nuclei centrali del trattamento terapeutico, al fine di stimolare un progressivo recupero di tale capacita.

Effetto dell’introduzione di quetiapina durante una recidiva maniacale nei pazienti con disturbo bipolare I

Obiettivo di questo studio e la verifica dell’efficacia del trattamento con quetiapina associata nei primi tre giorni ad aloperidolo nel ridurre i sintomi della fase maniacale acuta in pazienti con diagnosi di disturbo bipolare I. In questo studio in aperto sono stati reclutati sette pazienti che soddisfano i criteri diagnostici per disturbo bipolare I. La gravita della sintomatologia maniacale e stata misurata attraverso la Young Mania Rating Scale, somministrata all’ingresso, dopo una settimana e dopo due settimane dal ricovero e la CGI (Clinical Global Impressions), eseguita all’ingresso e dopo due settimane dal ricovero. Il trattamento e consistito nell’impiego di quetiapina fino a un dosaggio di 1000 mg in 5 giorni. Nei primi 3 giorni della titolazione sono state somministrate anche benzodiazepine (lorazepam 6 mg/die) e aloperidolo (5 mg in prima giornata e poi a scalare fino alla sospensione in quarta giornata). L’efficacia del trattamento con quetiapina e stata provata dalla riduzione dei punteggi alla YMRS nelle valutazioni a una e a due settimane dall’inizio del trattamento rispetto ai valori di ingresso (p=0.004 ANOVA per misure ripetute) e dal miglioramento dei punteggi alla CGI (p=0.007 ANOVA per misure ripetute). I dati raccolti dimostrano che i pazienti con disturbo bipolare I che nonostante trattamento farmacologico standard vanno incontro a recidiva maniacale rispondono in maniera efficace all’introduzione di quetiapina. Si osserva infatti una rapida regressione sintomatologica, considerabile come l’endpoint principale.

L’azione del trauma e dello stress nella patogenesi del Disturbo di Personalità Borderline: analisi della letteratura

Many studies have revealed the presence of an association between traumatic experiences, exposure to stress and Borderline Personality Disorder (BPD). In particular, seems to assume greater importance in the etiopathogenesis of BPD abuse during childhood. In 40-70% of cases is, in fact, reported a history of sexual abuse, while physical abuse in 25-73% of the patients. These negative experiences are not neither necessary nor sufficient conditions for the development of BPD, but are undoubtedly important risk factors.