Isabella Marini

Factors affecting interindividual differences in clozapine response: a review and case report.

Clozapine is the most powerful new‐generation antipsychotic. Although this drug leads to great therapeutic benefits, two types of undesirable conditions frequently occur with its use: side effects and resistance to treatment. Therapeutic drug monitoring of clozapine would be very useful to avoid both these situations. The necessity of monitoring the therapy is the result of a wide interindividual variability in the metabolism of clozapine. In this review, we highlight all the conditions underlying this variability, analyzing them one by one.

Group Psychoeducation Normalizes Cortisol Awakening Response in Stabilized Bipolar Patients under Pharmacological Maintenance Treatment

Patients in the TAU group participated to 21 weekly group meetings in which no special instruction was delivered. Assessments were performed before the beginning of PE (baseline) and at the end of the program (end point). Mental status was evaluated with the Hamilton Depression Rating Scale (HDRS, 21 items) and with the Young Mania Rating Scale (YMRS), while treatment compliance used the Adherence to Refills and Medications Scale (ARMS). Criteria for relapses were HDRS-21 >8 or YMRS >8. Saliva cortisol levels were assessed to evaluate the functional status of the HPA axis (CAR and cortisol circadian fluctuation). Samples were collected with the Salivette sampling device (Sarstedt, Italy) upon waking (08: 00 h ± 15 min), 30 and 60 min thereafter; additional samples were collected at 13: 00 and 20: 00 h. Patients avoided food, coffee or alcohol, teeth brushing, smoking or physical exercise for 60 min after waking and for 30 min prior to the other saliva collection. Saliva samples were recovered from a polyester swab by centrifugation at 3,000 rpm for 15 min and frozen at –20 ° C until analysis [7] . For each sample, duplicate measurements were performed on 25 μl of saliva using an immunoenzymatic Cortisol Saliva kit (Diametra, Italy) for the direct measurement of salivary cortisol (interassay coefficient of variation was <10%, and intra-assay coefficient of variation <7%, with a minimum detectable concentration of 0.5 ng/ml). For intergroup comparisons a Student t test was used, while χ 2

Magnetic Resonance Imaging Studies of Postpartum Depression: An Overview

Postpartum depression is a frequent and disabling condition whose pathophysiology is still unclear. In recent years, the study of the neural correlates of mental disorders has been increasingly approached using magnetic resonance techniques. In this review we synthesize the results from studies on postpartum depression in the context of structural, functional, and spectroscopic magnetic resonance studies of major depression as a whole. Compared to the relative wealth of data available for major depression, magnetic resonance studies of postpartum depression are limited in number and design. A systematic literature search yielded only eleven studies conducted on about one hundred mothers with postpartum depression overall. Brain magnetic resonance findings in postpartum depression appear to replicate those obtained in major depression, with minor deviations that are not sufficient to delineate a distinct neurobiological profile for this condition, due to the small samples used and the lack of direct comparisons with subjects with major depression. However, it seems reasonable to expect that studies conducted in larger populations, and using a larger variety of brain magnetic resonance techniques than has been done so far, might allow for the identification of neuroimaging signatures for postpartum depression.

Acute psychiatric presentation of steroid-responsive encephalopathy: The underrecognized side of autoimmune thyroiditis

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto encephalopathy, represents a rare disorder of presumed autoimmune origins that can be diagnosed when a protean variety of psychiatric symptoms are present in association with elevated titers of anti-thyroid antibodies. Symptoms can have a rapid and complete remission with corticosteroid treatment. A 19-year-old girl, with clinical history of Basedow-Graves disease, has been admitted to our department after presenting acute psychiatric symptomatology. Clinical and serological findings were used to formulate the diagnosis of SREAT, confirmed by subsequent positive response to corticosteroid treatment. SREAT can mimic an acute psychiatric symptomatology, thus it seems extremely relevant for psychiatrists to consider this syndrome in differential diagnosis algorithm, especially in those patients presenting a history of autoimmune thyroid disorder, in order to ensure adequate diagnosis and treatment.

MMPI-2: Cluster Analysis of Personality Profiles in Perinatal Depression—Preliminary Evidence

Background. To assess personality characteristics of women who develop perinatal depression. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, to which was administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Minnesota Multiphasic Personality Inventory 2 (MMPI-2). A clinical group of subjects with perinatal depression (PND, 55 subjects) was selected; clinical and validity scales of MMPI-2 were used as predictors in hierarchical cluster analysis carried out. Results. The analysis identified three clusters of personality profile: two “clinical” clusters (1 and 3) and an “apparently common” one (cluster 2). The first cluster (39.5%) collects structures of personality with prevalent obsessive or dependent functioning tending to develop a “psychasthenic” depression; the third cluster (13.95%) includes women with prevalent borderline functioning tending to develop “dysphoric” depression; the second cluster (46.5%) shows a normal profile with a “defensive” attitude, probably due to the presence of defense mechanisms or to the fear of stigma. Conclusion. Characteristics of personality have a key role in clinical manifestations of perinatal depression; it is important to detect them to identify mothers at risk and to plan targeted therapeutic interventions.

Perinatal Depression and Patterns of Attachment: A Critical Risk Factor?

Background. This study aims to verify if the presence and severity of perinatal depression are related to any particular pattern of attachment. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, who were administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Experience in Close Relationship (ECR). A clinical group of subjects with perinatal depression (PND, 89 subjects) was selected and compared with a control group (C), regarding psychopathological variables and attachment patterns. Results. The ECR showed a prevalence of “Fearful-Avoidant” attachment style in PND group (29.2% versus 1.1%, p < 0.001); additionally, the EPDS average score increases with the increasing of ECR dimensions (Avoidance and Anxiety). Conclusion. The severity of depression increases proportionally to attachment disorganization; therefore, we consider attachment as both an important risk factor as well as a focus for early psychotherapeutic intervention.

Modelli di attaccamento e personalità nella depressione post partum

AIMS This study investigates the prevalence of post partum depression (PPD) in a sample of Roman women, and the role of socio-demographic variables, personality structure and maternal attachment patterns, in order to identify primary and secondary prevention strategies. METHODS Data were collected in two phases. During the third trimester of pregnancy, a sample of 453 women completed a socio-demographic data sheet and the Edinburgh Postnatal Depression Scale (EPDS). Among the patients scoring 12 or more at EPDS, 15 entered the second phase of the study and completed SCID-II and Adult Attachment Interview. PPD diagnosis was confirmed by the SCID-I. The study group was compared with a control group. RESULTS Among the 453 women who were evaluated, 92 (20.3%) scored ≥12 at EPDS, 39 has been enrolled and 15 entered the study. Presence of depressive symptoms was associated with: complications in pregnancy, previous psychiatric disorders, family and marital conflicts. 66.6% of depressed mothers showed more than one diagnosis on Axis II (particularly avoidant/dependent + borderline or histrionic + dependent). The AAI showed a prevalence of insecure (33.3%) and unresolved/disorganized (46.6%) attachment pattern in the clinical group. DISCUSSION AND CONCLUSIONS Our results suggest that psychological factors such as personality structure and attachment patterns are not only involved in post natal affective disorders, but have a key role in the onset and development of PPD.

Early attachement relationships and epigenetic customization

Recently, new findings in epigenetic science switched the focus from the observation of physiological intragenomic dynamics to the idea of an environmental co-construction of phenotypic expression. In psichodynamic field, objectual relations and attachement theoreticians emphasized the interpersonal dimension of individual development, focusing the attention on the relational matrix of self organization. The construction of stable affective-behavioral traits throughout different parenting styles has actually found a coincidence in ethological studies, which have explored the epigenetic processes underlying the relationship between caregiving and HPA stress responsiveness. An adequate parenting style seems to support affective regulation throughout psychobiological hidden moderators, which would tend to rebalance the physiological systems homeostasis; an unconfident attachment style would promote, on the other hand, the allostatic load rise. Sites of longlife epigenetic susceptibility have also been identified in humans; although associated with risk of maladaptive developing in adverse environmental conditions, they seem to confer protection under favorable conditions. This persisting possibility of reorganization of stable traits throughout lifetime, which seems to be activated by a relevant environmental input, grant to significant relationships, and to therapeutical one as well, an implicit reconditioning potential which could result into the configuration of new stable affective-behavioral styles.