L Conti

Role of serotonin in human aggressive behaviour

This study aimed to evaluate a peripheral serotonergic marker, 3H-imipramine (3H-IMI) binding to platelet membranes, in a group of severely aggressive subjects (A), institutionalized since childhood for mental retardation, as compared with suicide attempters (S) and healthy controls (H). The maximum binding capacity of 3H-IMI to platelet membranes was statistically lower in (A) and (S) than in (H). In addition, a statistically significant difference was observed between the Bmax values of aggressive subjects and those of suicide attempters. No changes in the dissociation constant (Kd) of IMI binding were observed. These data provide further supporting evidence for the hypothesis of an abnormality of the 5HT system in aggressive behaviour and suggest that such an abnormality, as reflected by platelet markers, is more severe in suicide attempters.

When pain is not fully explained by organic lesion: a psychiatric perspective on chronic pain patients

Recent literature demonstrates the relationship between psychopathology and medically unexplained pain, even if the results of several studies show a high degree of variability.

Glycosaminoglycan polysulfate (ateroid) in old-age dementias: effects upon depressive symptomatology in geriatric patients

1. Glycosaminoglycan polysulfate is a mixture of sulfo-muco-polysaccharides with hypolipidemic activity. A number of clinical studies have indicated that it is effective in improving psychopathology in patients with cardiac and/or cerebral disease associated with arteriosclerosis. 2. A multicenter clinical trial was performed to compare the effects of two different dosages of glycosaminoglycan polysulfate upon depressive symptomatology in patients with multi-infarct dementia and primary degenerative dementia. 3. A total of 39 patients were treated in an 18-week clinical trial which followed a single-blind parallel design. 4. Results indicated that patients with both diagnoses improved significantly in depressive symptomatology over the course of treatment, with particular improvement noted in cognitive disturbance. Drug dosage was not a significant determinant of treatment response for either diagnostic group.

Platelet markers in suicide attempters

1. The authors measured 3H-imipramine (3H-IMI) binding and serotonin (5HT) uptake parameters as well as sulphotransferase activity in platelets of suicide attempters. 2. Platelet 3H-IMI binding sites and 5HT uptake are related to similar sites and processes present in the brain, and sulphotransferase (ST) is an enzyme involved in the catabolism of cathecholamines. 3. The results showed the presence of a decreased density of both 3H-IMI binding and of 5HT uptake sites, with no change in ST activity in suicide attempters, as compared with healthy controls. 4. The reduced 3H-IMI binding and 5HT uptake may be related to a hypofunction of presynaptic serotonergic mechanisms which might be altered in suicidal behavior.

Glycosaminoglycan polysulfate in the treatment of old age dementias

1. In a multicenter, placebo-controlled, double-blind clinical trial in 155 elderly patients with cognitive decline, glycosaminoglycan polysulfate was found to be a therapeutically effective agent in the treatment of old age dementias. 2. Treatment with glycosaminoglycan polysulfate in the daily dosage of 600 LRU, administered on the basis of a divided dosage schedule for 12 weeks, was significantly superior to an inactive placebo on several outcome measures including the Wechsler Memory Scale-Russell Revision (Easy Paired Associates Learning and Immediate Visual Reproduction), Mini Mental State Examination, the Sandoz Clinical Assessment Geriatric (Cognitive Dysfunction and Depression), Hachinski Dementia Scale, Brief Psychiatric Rating Scale (Confusion and Depressive Withdrawal) and Global Improvement Scale of the Clinical Global Impression. 3. Adverse effects with glycosaminoglycan polysulfate were few and mild. The drug was equally well tolerated and equally effective in the two major dementias of old age, i.e., primary degenerative and multi-infarct. The number of abnormal laboratory test readings remained essentially unchanged from pre-treatment to post-treatment.

Clinical vs. structured interview on anxiety and affective disorders by primary care physicians. Understanding diagnostic discordance

AIMS To assess in a national sample the ability of GPs to detect psychiatric disorders using a clinical vs. a standardized interview and to characterize the patients that were falsely diagnosed with an anxiety or affective disorder. METHODS This is a national, cross-sectional, epidemiological survey, carried out by GPs on a random sample of their patients. The GPs were randomly divided into two groups. Apart from the routine clinical interview, the experimental group (group A) had to administer the Mini-International Neuropsychiatric Interview (MINI). RESULTS Data was collected by 143 GPs. 17.2% of all patients had a clinical diagnosis of an affective disorder, and 25.4% a clinical diagnosis of an anxiety disorder. In group A, the number of clinical diagnoses was about twice that of MINI diagnoses for affective disorders and one and a half times that for anxiety disorders. The majority of clinical diagnoses were represented by MINI subsyndromal cases (52.3%). Females showed a higher OR of being over-detected by GPs with anxiety disorders or of not being diagnosed with an affective disorder. Being divorced/separated/widowed increased the OR of over-detection of affective and anxiety disorders. The OR of over-detection of an affective or an anxiety disorder was higher for individuals with a moderate to poor quality of life. CONCLUSIONS In the primary care a gap exists between clinical and standardized interviews in the detection of affective and anxiety disorders. Some experiential and social factors can increase this tendency. The use of a psycho.

No Correlation between Aggression and Platelet 3H-Paroxetine Binding in Obsessive-Compulsive Disorder Patients

Different findings suggest that the serotonin (5-HT) system may be involved in both the regulation of aggression and the pathophysiology of obsessive-compulsive disorder (OCD). Our study aimed to evaluate the aggressive features of a group of OCD patients and to explore possible correlations with a serotonergic marker, namely platelet 5-HT transporter. Psychopathological and biological patterns were compared with those of a group of healthy controls and those of patients with major depression. Twenty-one patients affected by OCD, 21 by depression and 21 healthy controls were included in the study. Aggressive features were measured by means of the Buss and Durkee Hostility Inventory (BDHI). The platelet 5-HT transporter was evaluated by means of the 3H-paroxetine binding parameters (maximum binding capacity, Bmax and dissociation constant, Kd). The OCD patients showed a total score on the BDHI not significantly different from that of healthy controls and lower than that of depressed patients. The factor profile was similar in the 3 groups, but higher in the depressed patients. The irritability, resentment, guilt, negativism and suspiciousness factors were significantly more pronounced in depressed patients. Some sex-related difference in single factors were also observed. The Bmax of 3H-paroxetine binding was lower in OCD patients than in depressives or healthy controls. OCD patients were more similar to healthy controls than to depressed patients with regard to aggressive features measured by means of the BDHI. This suggests that aggression in OCD is a complex phenomenon that probably requires specific instruments of evaluation.

Treatment of primary degenerative dementia and multi-infarct dementia with glycosaminoglycan polysulfate: A comparison of two diagnoses and two doses

Abstract Glycosaminoglycan polysulfate is a mixture of sulfomucopolysaccharides with a standardized composition and reproducible biologic activity. In a 12-week, multicenter clinical trial the therapeutic effects of two dosages—250 lipasemic-releasing units (LRU) per day and 500 LRU/day—of parenterally administered glycosaminoglycan polysulfate were compared in two diagnostically distinct populations: (1) patients with primary degenerative dementia of the Alzheimer type, and (2) patients with multi-infarct dementia. It was found that there were significant changes from pretreatment to end of therapy with regard to measures of objective performance, psychopathology, and social behavior. Improvement was consistently greater in the group with primary degenerative dementia than in the group with multi-infarct dementia. On the other hand, no consistent differences in therapeutic effects between the two doses could be seen. The drug was well tolerated; side effects were infrequent and mild. No clinically significant laboratory abnormalities were encountered during the 3-month clinical trial.

[Gestione dei pazienti psichiatrici prima della deistituzionalizzazione: un'indagine della Clinica di Pisa fra 1907 e 1913]

More than other medical branches, psychiatry has been closely related to the concomitant social and cultural context. As a result, historical writing in psychiatry has been defined by Shorter «as broad as the discipline itself»1. Nevertheless, the history of psychiatry has been long identified with the history of asylums. Many classical studies, such as those of Foucault2, Rothman3 and Scull4 have identified psychiatry with the practice of patient isolation from society. If asylum confinement of mental patients was a distinctive characteristic of the 19th and early 20th centuries, it probably does not by itself account for the complexity of this medical discipline as a whole5,6. Regardless of disorder’s core structure, experiences of these patients could vary greatly on the premise of their social class, sex, diagnosis and – lastly – the place they were treated in. This was particularly true in the late 19th-early 20th century Italian psychiatry, given the heterogeneous landscape of the national medical, bureaucratic SUMMARY. Aim.Asylums comprises the main focus of historical research on early 20th century psychiatry. To assess the characteristic of asylum transfers in a clinical population, we analyzed newly found clinical records from University of Pisa Clinic for Mental and Nervous Illness. We focused on the early years of this structure’s activities considering all admissions from 24th April 1907 to 31st January 1913. Method.We collected demographic and clinical data from 1,068 patients performing Chi-Square Tests to study correlation between asylum transfer and diagnosis and gender difference; independent sample Student’s t-tests were also performed to compare mean Age, mean number of Days of Hospitalization and mean number of Subsequent Admissions to the Clinic observed in patients transferred to an asylum versus those who had been discharged. Multiple logistic regression model was employed to identify the best predictors of asylum transfers. Results.Most patient were discharged, and only a third of the hospitalization led to asylum confinement. Our data outlines a peculiar discharge rationale, suggesting that the Clinic acted like a “sieve-institution” to prevent asylum overcrowding from treatable, non-chronic conditions. Discussions. These data suggest that our historical view of psychiatric care is probably not complete, and that a different approach to source materials could provide new research paradigms.Aim Asylums comprises the main focus of historical research on early 20th century psychiatry. To assess the characteristic of asylum transfers in a clinical population, we analyzed newly found clinical records from University of Pisa Clinic for Mental and Nervous Illness. We focused on the early years of this structure’s activities considering all admissions from 24th April 1907 to 31st January 1913. Methods We collected demographic and clinical data from 1,068 patients performing Chi-Square Tests to study correlation between asylum transfer and diagnosis and gender difference; independent sample Student’s t-tests were also performed to compare mean Age, mean number of Days of Hospitalization and mean number of Subsequent Admissions to the Clinic observed in patients transferred to an asylum versus those who had been discharged. Multiple logistic regression model was employed to identify the best predictors of asylum transfers. Results Most patient were discharged, and only a third of the hospitalization led to asylum confinement. Our data outlines a peculiar discharge rationale, suggesting that the Clinic acted like a “sieve-institution” to prevent asylum overcrowding from treatable, non-chronic conditions. Discussion These data suggest that our historical view of psychiatric care is probably not complete, and that a different approach to source materials could provide new research paradigms.

Computer Applications in Psychiatry

The application of computers in psychiatry affords clinicians endless possibilities in terms of information gathering, processing, and sharing. Some systems have been designed and are currently in use, expanding the knowledge of psychiatric pathology and its treatment. This review highlights the uses of computers in psychiatry and the progress being made in this area.