Giuseppe Bersani

5‐HT2 receptor antagonism in dysthymic disorder: a double‐blind placebo‐controlled study with ritanserin

Thirty patients suffering from dysthymic disorder participated in a 6‐week double‐blind trial comparing ritanserin 10 mg and placebo. After a single blind placebo wash‐out period of one week, the test medication was administered during 5 weeks on a double‐blind basis. Twenty‐three patients completed the study. At the end of the trial, ritanserin was significantly superior to placebo in its effect as manifested on the 19‐item Hamilton Rating Scale for Depression, the Hamilton Rating Scale for Anxiety and the State Trait Anxiety Inventory X‐1 and X‐2. At the end of the study, the therapeutic effect was rated marked or moderate in 75% of the ritanserin‐treated patients, but only in 18% of the controls. These data are consistent with the hypothesis of serotonin abnormalities in dysthymic disorder and suggest a therapeutic role of 5‐HT2 antagonists. Ritanserin treatment was very well tolerated; no serious adverse experiences were reported.

Melatonin add-on in manic patients with treatment resistant insomnia

1. A profound alteration of circadian rhythm of sleep is often a central feature in manic syndrome. Melatonin (MLT) is a main synchronizer of the sleep/wake cycle, playing a role of transduction to brain functioning of informations about periodical environmental changes, i.e. the duration of daylength. 2. In several sleep phase disorders, MLT exerts a therapeutic effect, by normalizing the sleep/wake cycle. 3. Eleven patients, 8 males and 3 females, aged 22-43, meeting DSM IV diagnostic criteria for Bipolar Disorder, Manic Type, were selected for the presence of insomnia not responding to usual hypnotic therapies (benzodiazepine). 4. All the patients were on antimanic treatment. MLT 3 mg per os was administrated at 22.30 h for 1 month, without changing the previous antimanic and hypnotic treatments. All patients showed a significantly longer duration of sleep following MLT add-on. The severity of mania showed a parallel significant decrease. 5. The results of this pilot clinical study suggest that MLT add-on can be useful in antimanic therapy to treat resistant circadian sleep alterations as well as consequently exert a global therapeutic action on the manic state.

Reduced natural killer cell activity in major depression: neuroendocrine implications

Natural killer cell activity (NKCA) was significantly reduced in a group of depressed patients, melancholic subtype, compared to sex- and age-matched controls. Corticotropin and cortisol values were significantly higher in the depressed subjects than in the controls, but no correlation between high hormone levels and low immunological activity was found in the patients.

25C-NBOMe: Preliminary Data on Pharmacology, Psychoactive Effects, and Toxicity of a New Potent and Dangerous Hallucinogenic Drug

Introduction. The use of novel psychoactive substances (NPSs) has rapidly increased as well as their online availability. The aim of this paper is to provide a comprehensive review of the nature and the risks associated with 25C-NBOMe, which has recently appeared in the drug market. Methods. A systematic analysis of the scientific literature and a qualitative assessment of online and media resources (e.g., e-newsgroups, chat-rooms, and e-newsletters) in 10 languages were carried out. Results. 25C-NBOMe is sold online as legal LSD or as research chemical with different designations such as “Boom,” “Pandora,” “Holland film,” or “N-bomb.” It is a partial agonist of 5-HT2A receptors. It is usually ingested orally/sublingually and, less commonly, nasally, through injection, vaginally, rectally, and smoked. Its effects include sublingual numbing, stimulation, “body high,” hallucinations, dissociation, and anxiety. 25C-NBOMe presents high risk of overdoses; acute toxicity and fatalities have been reported. Conclusions. 25C-NBOMe consumption represents an emerging phenomenon with potential harmful effects. Its use is increased by its online availability at low costs. Health and other professionals should be informed about this new trend of substance use.

Studies in animal models and humans suggesting a role of nerve growth factor in schizophrenia-like disorders.

Neurotrophic factors, such as nerve growth factor (NGF) and brain‐derived neurotrophic factor (BDNF), are known to play a crucial role in growth, differentiation and function in a variety of brain neurons during development and in adult life. We have recently shown that environmental changes, aggressive behavior and anxiety‐like responses alter both circulating and brain basal NGF levels. In the present review, we present data obtained using animal models which suggest that neurotrophic factors, particularly NGF and BDNF, might be implicated in mechanism(s) leading to a condition associated with schizophrenic‐like behaviors. The hypothesis that neurotrophins of the NGF family can be implicated in some maldevelopmental aspects of schizophrenia is supported by findings indicating that the constitutive levels of NGF and BDNF are affected in schizophrenic patients.

Haloperidol Administration in Humans Lowers Plasma Nerve Growth Factor Level: Evidence that Sedation Induces Opposite Effects to Arousal

Studies reported in recent years have indicated that the level of nerve growth factor (NGF), in both the brain and in the bloodstream, increases following stressful events and anxiety-associated behaviour. These observations prompted us to investigate whether an anti-arousal drug would induce an opposite effect. We have reported that the administration of haloperidol (HA), a neuroleptic drug clinically used for psychiatric disorders, decreases NGF levels in the hypothalamus of adult male mice. In the present study, we showed that HA reduced the basal NGF plasma levels in 8 neuroleptic-free schizophrenic patients. These observations strengthen the hypothesis that NGF may play a functional role in stress-coping responses.

Ethological predictors of amitriptyline response in depressed outpatients

Non-verbal behaviour of 22 unipolar, non-delusional depressed outpatients was video-recorded during psychiatric interview to determine whether response to tricyclic treatment (50-100 mg/day of amitriptyline for 5 consecutive weeks) could be predicted on the basis of the ethological profile at baseline. At the end of the study, patients were divided into two treatment outcome groups on the basis of their final Hamilton Depression Rating Scale (HDRS) scores. At baseline, responders (n = 14, HDRS score less than or equal to 10) and non-responders (n = 8, HDRS score greater than 10) did not differ with respect to sex, age, education, DSM-III diagnosis, and HDRS score. In contrast, ethological profiles of the two treatment outcome groups at baseline were different, with non-responders showing significantly more assertive and affiliative behaviours. The results are discussed in the light of previous studies which have identified subgroups of depressive patients with different responsiveness to tricyclic treatment.

Cannabis and neurological soft signs in schizophrenia: absence of relationship and influence on psychopathology.

Background: Cannabis is a possible risk factor for the onset of schizophrenia and can induce neurocognitive, behavioural and motor co-ordination alterations. The aim of this study was to evaluate the role of cannabis in the occurrence of neurological soft signs (NSS) and, considering that this drug has been related to positive symptoms, whereas NSS have been linked to negative symptoms, we also examined the role of clinical features. Methods: The study investigated NSS in 25 male cannabis-consuming and 25 male non-consuming schizophrenic patients, using the Neurological Evaluation Scale. Clinical features were studied using SANS and SAPS. Results: Significant differences emerged after comparison analysis, with more NSS in non-consuming patients. The SANS subscales Alogia and Anhedonia-asociality were also statistically significant in this group of patients. Discussion: If non-consuming patients show a higher incidence of both NSS and negative symptoms, which, according to the literature, seem to be associated, then these findings suggest that NSS are relatively independent from cannabis, but not from clinical features.

“Spice,” “Kryptonite,” “Black Mamba”: An Overview of Brand Names and Marketing Strategies of Novel Psychoactive Substances on the Web

Abstract Introduction: Novel Psychoactive Substances (NPSs) are often sold online as “legal” and “safer” alternatives to International Controlled Drugs (ICDs) with captivating marketing strategies. Our aim was to review and summarize such strategies in terms of the appearance of the products, the brand names, and the latest trends in the illicit online marketplaces. Methods: Scientific data were searched in PsychInfo and Pubmed databases; results were integrated with an extensive monitoring of Internet (websites, online shops, chat rooms, fora, social networks) and media sources in nine languages (English, French, Farsi, Portuguese, Arabic, Russian, Spanish, and Chinese simplified/traditional) available from secure databases of the Global Public Health Intelligence Network. Results: Evolving strategies for the online diffusion and the retail of NPSs have been identified, including discounts and periodic offers on chosen products. Advertisements and new brand names have been designed to attract customers, especially young people. An increased number of retailers have been recorded as well as new Web platforms and privacy systems. Discussion: NPSs represent an unprecedented challenge in the field of public health with social, cultural, legal, and political implications. Web monitoring activities are essential for mapping the diffusion of NPSs and for supporting innovative Web-based prevention programmes.

Deficit of Executive Functions in Schizophrenia: Relationship to Neurological Soft Signs and Psychopathology

Cognitive deficits and neurological soft signs (NSS) have frequently been reported in schizophrenic patients and they both appear related to prominent negative symptoms. The aim of the present study was to examine the relationship between deficit of executive functioning, assessed by the Wisconsin Card Sorting Test (WCST), NSS and psychopathological dimensions of schizophrenia in order to address the issue of whether a typology of schizophrenic patients may be identifiable by clinical, neurological and neuropsychological features. A sample of 26 male schizophrenic patients was divided, on the basis of the performance on the WCST, into two subgroups (‘good performers’ and ‘poor performers’) that were compared for the prevalence and severity of NSS, assessed by the Neurological Evaluation Scale (NES), and for the psychopathological features, assessed using the Positive and Negative Syndrome Scale (PANSS). To test for between-group differences, ANOVA was conducted. The ‘poor performers’ group showed greater severity of NSS: significant differences emerged for the NES total score and for the ‘sequencing of complex motor acts’ score. However, no significant differences between the groups emerged for any PANSS score. These findings seem to indicate that a common neurobiological abnormality could underlie cognitive deficits, especially concerning executive functioning, and subtle neurological abnormalities often present in schizophrenia, but they appear to deny that such dysfunctional correlates of schizophrenia are related to a prominent negative symptomatology.