Giulio Vidotto

Brain correlates of risky decision-making.

Understanding the neurocognitive basis of risk-taking behavior is an important issue, especially in economic decision-making. Classical behavioral studies have shown that risk-attitude changes across different contexts, but little is so far known about the brain correlates of processing of outcomes across such context shifts. In this study, EEG was recorded while subjects performed a gambling task. Participants could choose between a risky and a safer option, within two different contexts: one in which options yielded gains and losses of the same magnitude (Zero Expected Value context) and another in which gains were larger than losses (Positive Expected Value context). Based on their risk-attitude, two groups were compared: subjects who are risk-seekers in the zero Expected Value context (Zero-Oriented group) and subjects who are risk-seekers in the positive Expected Value condition (Positive-Oriented group). The Feedback Related Negativity (FRN) reflects this distinction, with each group being insensitive to magnitude of outcomes in the condition in which they were risk-prone. P300 amplitude mirrored the behavioral results, with larger amplitudes in the condition in which each group showed a higher risk-tendency. Source analyses highlighted the involvement of posterior cingulate cortex in risky decision-making. Taken together, the findings make a contribution to the clarification of the neurocognitive substrates of risky decision-making.

Prevalence of Eating Disorders in Italy: A Survey on a Sample of 16-Year-Old Female Students

BACKGROUND To date, the number of epidemiological studies on eating disorders (ED) in Italy and in other Mediterranean countries is still limited. This study evaluated the eating attitudes and the prevalence of eating disorders in a sample of 359 16-year-old Italian schoolgirls. METHODS The study followed a two-stage procedure consisting in a first screening stage followed by clinical interviews. A third stage consisting in a case register study and a 1-year followup confirmed the importance of evaluating subjects who chose not to participate in the survey. RESULTS Prevalence rates found in our sample are consistent with those of other prevalence studies conducted on adolescent girls: 0% for anorexia nervosa, 0.5% for bulimia nervosa and 3.7% for ED not otherwise specified. Also some important features associated with the presence of an ED appeared to be present in Italian female students, as in Anglo-Saxon populations: the tendency towards denial that led to an overrepresentation of ED among nonrespondents, and the ascertainment that just a small proportion of people seeks help for ED. The Italian sample reported higher scores on eating attitudes test compared to Anglo-Saxon samples. CONCLUSIONS No evidence of different rates of ED was found in our Italian sample in comparison with non-Mediterranean samples. The importance of using a two-stage design and a third control stage in prevalence studies is emphasized by our findings.

The components of the Maudsley Obsessional-Compulsive Questionnaire

Abstract The Maudsley Obsessional-Compulsive Questionnaire was given to 868 Italian students. Response analysis revealed three factors: checking behavior and worries, problems of contamination and cleaning, and doubts and intrusive thoughts. In males a fourth component was also recognized—the ‘obesssional slowness’ which Hodgson and Rachman (1977) found in obsessive patients, but not in normal and neurotic English patients.

A functional-measurement study of apparent rarefaction

The apparent density of a group of elements (lines, dots, etc.) is affected by the area of the group itself: the smaller the area, the lower the density of the elements (apparent rarefaction). An explanation of apparent rarefaction, in terms of an averaging model, has been offered by Spinelli and Vicario (submitted for publication). If working in isolation, portions of the retina far from the center would contribute an apparent density different in magnitude from that contributed by the center. Thus, the overall apparent density would be a weighted average of the contributions due to the different portions of the retina. The averaging model has been tested here by functional-measurement methods. The results confirm the model.

Behaviour Therapy for DIMS: Comparison of Three Treatment Procedures with Follow-up

Forty patients suffering from persistent psychophysiological Disorders of Initiating and Maintaining Sleep (DIMS) were assigned to one of the following groups: (1) EMG-biofeedback training; (2) cognitive modification treatment, combining paradoxical instructions, cognitive restructuring and thought stopping; (3) stimulus control and progressive relaxation treatment; (4) waiting list (control). Each active treatment consisted of six sessions over a period of 2 weeks. After treatment, the patients in the three treatment groups showed shorter sleep onset latency (37%), shorter wake time after sleep onset (50%), and more positive evaluations of sleep quality and restedness on awakening in the morning. The waiting-list group did not show any changes. Benefits were maintained and further increased during the 1 and 3 year follow-ups. Results did not suggest substantial differences, among the three treatments, in amount and/or stability of benefits. The 3 year follow-up revealed seven failures, as against 23 successes. The initial variables differentiating the failures were shorter sleep time and higher scores on the P scale of the Eysenck Personality Questionnaire.

The EORTC quality of life questionnaire-head and neck 35 in Italian laryngectomized patients

The aim of this study was to test the validity and reliability of the European organization for research and treatment of cancer (EORTC) quality of life questionnaire (QLQ)-head and neck (H&N) 35 in Italian laryngeal cancer patients. The original questionnaire was developed by the EORTC quality of life (QoL) study group and tested in H&N cancer patients from Norway, Sweden, and the Netherlands. The Italian translation of the questionnaire used in this study was made by a team of the CRO, National Cancer Institute, using a double-back translation method between independent translators. The translated EORTC QLQ-H&N35 was given to 99 patients with H&N cancer who had undergone total laryngectomy 1–26 years before and had been then treated with radiotherapy and, in some cases, chemotherapy. The questionnaire was re-administrated to 33 patients after 1 month to test its stability over time. It was structurally made up of seven scales (pain, swallowing, sense, speech, social eating, social contact, and sexuality) and 11 single items that considered the most important clinical aspects characterizing the QoL in H&N cancer patients. The statistical analysis of the indexes of validity and reliability confirmed the results obtained with other linguistic versions of the questionnaire. Our Italian version of the EORTC QLQ-H&N35 proved to be a statistically valid instrument to assess QoL in laryngectomized patients.

Knowledge space theory, formal concept analysis, and computerized psychological assessment

In the present study, the use of knowledge space theory (KST), jointly with formal concept analysis (FCA), is proposed for developing a formal representation of the relations between the items of a questionnaire and a set of psychodiagnostic criteria. This formal representation can be used to develop an efficient adaptive tool for psychological assessment. Rusch and Wille (1996) have shown some interesting connections between KST and FCA; these connections are applied in the construction of knowledge structures, starting from a formal context representing the relations between items and criteria. The proposed general methodology was applied, as an example, to the Maudsley Obsessional-Compulsive Questionnaire. We used a data set provided by a sample of patients with a diagnosis of obsessive-compulsive disorder to validate the obtained structures. The parameters of the basic local independence model (BLIM) were estimated for the obtained knowledge structures. The fit of each model was tested by parametric bootstrap because of the sparseness of the derived data matrix. The results are discussed in light of both psychological and methodological relapses. In particular, we propose a reinterpretation of the BLIM parameters that seems suitable for testing reliability and construct validity; furthermore, it is pointed out how the obtained structures could represent the starting point for the development of a computerized assessment tool.

Maugeri Respiratory Failure questionnaire reduced form: A method for improving the questionnaire using the Rasch model

Purpose. The Maugeri Respiratory Failure questionnaire (MRF-28) is the first instrument specifically developed for use with chronic respiratory failure (CRF) patients. The 28 items were selected using classical test theory. The purpose of the current analysis was to further refine the questionnaire using item response theory, specifically, the Rasch model analysis. Methods. Three hundred and seventeen CRF patients (mean aged 66.7 yrs; Male 219, Female 98) completed the MRF-28 health status measure. Data were collected through the self-report questionnaire and analyzed using 1-parameter logistic models by means of RUMM software. Results. The 28-item questionnaire has good psychometric properties in terms of discriminant power because the Person Separation Index is 0.896. However, the item-trait interaction was not good as shown by the total-item Chi-square (, p<0.001). Removing two items that did not fit the Rasch model well, produced a minor improvement in Person Separation Index to 0.899 and the item-trait interaction improved (, p = NS). In the preliminary analysis we identified 21 patients who were outliers; when they were excluded the distribution of the residuals, according to the Kolmogorov-Smirnov statistics, was normal and factor analysis of the item residuals showed that the components had similar eigenvalues and no strong correlation with items. These results suggest that the MRF-26 is a unidimensional measure of health-related quality of life impairment for chronic respiratory failure patients. Conclusions. A combination of classical psychometric tests and Rasch analysis produced an instrument of moderate size that covers a wide range of effects of CRF and has interval scaling properties.

Psychological and emotional aspects and pain

Abstract. A patients psychological condition can be influenced by symptoms and, at the same time, it can influence the perception of symptoms. In psychological assessment, pain can modify the results of a questionnaire, so a patients state at the moment of the evaluation should be taken into account. Questionnaires used in assessment do not always provide clear-cut answers concerning the individual psychological component. Moreover, difficulties in classifying headache patients does not permit correct comparisons between population samples whenever patients are not classified into well defined homogeneous groups. Overall, in the three groups examined – migraine, tension-type headache and cluster headache – it can be affirmed that with self-report assessment based on questionnaires, the tension-type headache subjects present a more interesting psychological profile for its clinical implications.

Memantine: new prospective in bipolar disorder treatment

UNLABELLED We review preclinical and clinical evidences strongly suggesting that memantine, an old drug currently approved for Alzheimers dementia, is an effective treatment for acute mania and for the prevention of manic/hypomanic and depressive recurrences of manic-depressive illness. Lithium remains the first line for the treatment and prophylaxis of bipolar disorders, but currently available treatment alternatives for lithium resistant patients are of limited and/or questionable efficacy. Thus, research and development of more effective mood stabilizer drugs is a leading challenge for modern psychopharmacology. We have demonstrated that 21 d administration of imipramine causes a behavioural syndrome similar to a cycle of bipolar disorder, i.e., a mania followed by a depression, in rats. Indeed, such treatment causes a behavioural supersensitivity to dopamine D2 receptor agonists associated with an increase sexual activity and aggressivity (mania). The dopamine receptor sensitization is followed, after imipramine discontinuation, by an opposite phenomenon (dopamine receptor desensitization) and an increased immobility time (depression) in the forced swimming test of depression. Memantine blocks the development of the supersensitivity and the ensuing desensitization associated with the depressive like behavior. On the basis of these observations we have suggested the use of memantine in the treatment of mania and in the prophylaxis of bipolar disorders. To test this hypothesis we performed several naturalistic studies that showed an acute antimanic effect and a long-lasting and progressive mood-stabilizing action (at least 3 years), without clinically relevant side effects. To confirm the observations of our naturalistic trials we are now performing a randomized controlled clinical trial. Finally we described the studies reporting the efficacy of memantine in manic-like symptoms occurring in psychiatric disorders other than bipolar. LIMITATIONS A randomized controlled clinical trial is needed to confirm our naturalistic observations. CONCLUSION We believe that this review presents enough pharmacological and clinical information to consider the administration of memantine in the treatment of bipolar disorders that no respond to standard mood stabilizers.