L. Dell’Osso

Associations between Brain-Derived Neurotrophic Factor Plasma Levels and Severity of the Illness, Recurrence and Symptoms in Depressed Patients

Background: There is increasing evidence that the brain-derived neurotrophic factor (BDNF) is involved in the pathophysiology of mood disorders and that its peripheral levels represent a reliable mirror of its concentration in the brain. The aim of the present study was to measure BDNF plasma levels in patients affected by major depression and to explore the possible relationship between the biological parameter and characteristics of the illness. Method: BDNF plasma levels were evaluated in 30 inpatients suffering from major depression, according to DSM-IV criteria, by means of a commonly employed ELISA method. The clinical characteristics were assessed by the Hamilton Rating Scale for Depression (HRSD) and the Clinical Global Impression Scale. Results: BDNF plasma levels were significantly lower in the patients with the severest illness compared with the others, and the same was true for patients with dissociative symptoms, severe sleep disturbance and recurrent depression. A significant and negative correlation was observed between the biological parameter and the retardation factor score of the HRSD. Conclusion: These findings suggest that low BDNF levels are related to both recurrence and severity of depression, as well as to symptoms typical of dysfunctions of the hypothalamic-pituitary-adrenal axis.

Silent pericardial effusion in a sample of anorexic patients

Mortality in anorexic patients is mainly due to suicide or cardiac failure. The aim of this study was to investigate structural and functional cardiovascular alterations further by means of echocardiography in a sample of 15 medication-free patients with DSM-IV anorexia nervosa (AN) (BMI<17.5 kg/m2) and without any known cardiovascular disease and/or a family history of deafness or sudden death, and correlate the findings with clinical variables. The controls consisted of a sample of 10 constitutionally thin women (BMI<19 kg/m2), of comparable age, height and degree of physical activity. All of the subjects underwent Doppler echocardiography (ECHO), and the patients were also administered the Diagnostic Schedule for Eating Disorders (DSED) in order to assess the features and course of the eating disorder. ECHO revealed silent pericardial effusion in 71.4% of the patients vs. 10% of the controls (p<0.05); among the patients, the separation of pericardial leaflets was more frequent in those with a shorter duration of illness (p<0.05). Mitral valve motion abnormalities were more frequent among the patients than the controls (69.2% vs. 10%, p<0.005), and the left ventricular mass/body surface area was lower (54.8% vs. 59%, p<0.001). Isovolumetric relaxation time was longer in the patients (98.4 vs. 65 msec, p<0.01), but there were no significant differences in left ventricular ejection fraction (53.8% vs. 59%) or early diastolic deceleration time (146 vs. 155 msec). The results of this study support the association between AN and demonstrable anatomic and functional cardiac abnormalities, such as a reduced ventricular mass and mitral valve abnormalities. The ECHO findings provide evidence for clinically silent pericardial effusion in AN, which may be an early sign of cardiovascular involvement.

Patterns of caffeine consumption in psychiatric patients. An Italian study

PURPOSE The aim of the present study was to explore and compare the caffeine intake, intoxication, withdrawal and dependence prevalence in Italian psychiatric patients and healthy subjects. MATERIALS AND METHODS Three hundred and sixty-nine out- and inpatients, suffering from different psychiatric disorders, and 104 healthy subjects were included in the study. They were assessed by the SCID and by a structured interview for caffeine intoxication and withdrawal and for substance dependence applied to caffeine use. RESULTS Patients and healthy subjects did not differ in terms of current caffeine intake (mg/day, mean+/-SD: 281+/-325 vs. 288+/-148, respectively), while the maximum lifetime intake of caffeine was significantly higher in the first group (mg/day, mean SD: 630+/-549 vs. 504+/-344, respectively; F=4.897, p=.03) where it was significantly related to the CGI severity item scores (rho=.107; p=.04). In both patients and healthy subjects, a lower age was related to a higher current caffeine intake, while both current and maximum lifetime caffeine intake in the healthy subjects were significantly higher in men than in women. The patients suffering from eating disorders reported higher current caffeine intake than those with anxiety or mood disorders. The prevalence of dependence and intoxication was significantly higher in the patients than in the healthy subjects, without inter-group differences. Healthy subjects showed a trend towards a higher prevalence of withdrawal. CONCLUSIONS Our study highlights the need that a more accurate attention should be paid to the caffeine use which seems to be strongly, although generically, related to different psychiatric disorders.

Normalisation of immune cell imbalance after pharmacological treatments of patients suffering from obsessive-compulsive disorder

Abstract Recent data have shown the presence of immunological alterations in adult patients suffering from obsessive-compulsive disorder (OCD). The objective of this study was to examine the possible effects of 12 months of treatment with different serotonergic drugs, such as clomipramine and selective serotonin reuptake inhibitors (SSRIs) on peripheral immunological cells of 18 OCD patients. Both the absolute number and percent of CD4+, CD8+, CD3+, CD19+ and CD56+ cells were measured in peripheral blood before and after treatment by means of a Facstar Flow Sorter apparatus. At baseline, all patients showed a significant increase of CD8+ and decrease of CD4+ lymphocytes when compared with a similar group of healthy control subjects; after the treatment, CD8+ and CD4+ cells, respectively, decreased and increased significantly, and the CD4+/CD8+ ratio increased, when compared with baseline values, in parallel with the clinical improvement. These data suggest that the alterations of immune cells reported in patients with OCD at baseline may be reverted by treatment with SRIs and should be considered a state-dependent marker, perhaps related to a condition of stress.

Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy

AimsOrthorexia nervosa (ON) has been recently defined as a pathological approach to feeding related to healthiness concerns and purity of food and/or feeding habits. This condition recently showed an increasing prevalence particularly among young adults. In order to investigate the prevalence of ON and its relationship with gender and nutritional style among young adults, we explored a sample of students from the University of Pisa, Italy.MethodsAssessments included the ORTO-15 questionnaire and a socio-demographic and eating habits form. Subjects were dichotomized for eating habits (i.e. standard vs vegetarian/vegan diet), gender, parents’ educational level, type of high school attended, BMI (low vs high vs normal BMI). Chi square tests were performed to compare rates of subjects with overthreshold ORTO-15 scores, and Student’s unpaired t test to compare mean scores between groups. Two Classification tree analyses with CHAID growing method were employed to identify the variables best predicting ON and ORTO-15 total score.Resultsmore than one-third of the sample showed ON symptoms (ORTO-15 ≥ 35), with higher rates among females. Tree analyses showed diet type to predict ON and ORTO-15 total score more than gender.ConclusionsOur results seem to corroborate recent data highlighting similarities between ON and anorexia nervosa (AN). We propose an interpretation of ON as a phenotype of AN in the broader context of Feeding and eating disorders (FEDs) spectrum.

Affective temperament in the eating disorders.

Background: In this study, we investigate the affective temperamental characteristics in a sample of ED (eating disorder) patients. Methods: 49 ED patients diagnosed by the SCID (Structured Clinical Interview for DSM-IV), were divided into two groups on the basis of the presence or absence of Binge Eating (restricting-anorexia nervosa [R-AN]= 16; Binge Eaters= 33). All patients were administered the TEMPS-I (Temperament Evaluation Memphis Pisa Semistructured — Interview), to assess affective temperament. A third group of controls (N= 1010), derived from a study with the TEMPS-I on normal subjects, was included for comparison. Results: A full affective temperament was not found in patients of the restricting group. By contrast 24% of the binge eating group had a full affective temperament of one of three types. Comparing the three temperaments for the three groups, only cyclothymic temperament proved to be significant, with higher levels in the binge eating group (p<0.01). Conclusions: In this study, people with R-AN do not show a full affective temperament. However, people with binge eating, had depressive and hyperthymic temperament, and displayed higher level of cyclothymic temperament than the normal population. The findings of this study add to a growing literature on temperament in people with ED; particularly, they add to the view that may be various paths leading to R-AN, and these may differ from those of binge eating.

Impact of Mood Spectrum Spirituality and Mysticism Symptoms on Suicidality in Earthquake Survivors with PTSD

The aim of the present study was to explore the correlations between Spirituality/Mysticism/Psychoticism symptoms and suicidality in young adult survivors of the L’Aquila earthquake. The sample included 475 subjects recruited among high school seniors who had experienced the April 6, 2009, earthquake. Assessments included: Trauma and Loss Spectrum–Self Report and Mood Spectrum–Self Report (MOODS-SR). Mysticism/Spirituality dimension and suicidality were evaluated by means of some specific items of the MOOD-SR. The Spirituality/Mysticism/Psychoticism MOODS-SR factor score was significantly higher among subjects with PTSD diagnosis with respect to those without. Similarly, subjects with suicidal ideation, as well as those who committed a suicide attempt, reported significantly higher scores than those without.

Differential dynamic responses of luteinizing hormone to gonadotropin releasing hormone in patients affected by bulimia nervosa-purging versus non-purging type

Objective: Aim of the study was to investigate the presence of underlying abnor malities affecting the hypothalamus-pituitary-gonadal axis in 13 normal weight eumenhorreic bulimics as expressed by a different gonadotropin response to gonadotropin releasing hormone (GnRH), comparing patients with (n= 6) and without (n= 7) purging behaviours to controls (n= 5) Method: Subjects were administered an intravenous GnRH infusion for four hours, with an additional bolus at first and third hour. Results: Non-purging bulimics showed a significantly reduced luteinizing hormone (LH) response to GnRH compared to controls; purging bulimics following the second bolus, demonstrated a statistically reduced peak, in comparison to both controls and non-purging bulimics. Discussion: even in the absence of overt menstrual distur bances, an altered LH secretion elicited by pulsatile stimulation of endogenous GnRH was found, with a more severe impairment in purging than in non-purging bulimics, possibly related to their greater psychopathological and physical burden.

P01-143 - Gender differences in the correlations between cortisol levels or DHEA-S/cortisol ratio and panic-agoraphobic dimensions in healthy subjects

Introduction A link between anxiety and disfunctions of the Hypotalamic-pituitary-adrenal (HPA) axis has been widely reported in both normal and pathological anxiety, but research findings are controversial. Objectives To explore gender differences in the relationships between cortisol and neurosteroids and subthreshold anxiety dimensions. Aims To investigate the possible correlations between serum cortisol and dehydroepiandrosterone sulphate (DHEA-S) levels, or DHEA-S/cortisol ratio, and the subthreshold panic dimensions in a sample of healthy subjects. Methods Forty-two Italian civilians, without current or lifetime psychiatry disorders, were recruited and assessed by means of the Structured Clinical Interview for DSM-IV (SCID-I/P) and a specific questionnaire, the so-called Panic Agoraphobic Spectrum-Self Report lifetime version (PAS-SR), for assessing subthreshold panic-agoraphobic dimensions. Results The results showed the presence of significant negative correlations between the cortisol levels and the total scores of the PAS-SR and of the following domains: separation sensitivity, panic like symptoms and medication/substance sensitivity. The PAS-SR total and the panic-like symptoms domain scores were related positively to the DHEAS/cortisol ratio. When the sample was distinguished in women and men, it turned out that this correlations were present only in women. Conclusions This findings would indicate that cortisol levels are related to subthreshold panic-agoraphobic symptoms, with a gender specificity. Therefore, further studies are needed to investigate those subthreshold conditions in order to indentify possible gender differences that may account for phenotypes at higher risk for psychiatric disorders.

Post-traumatic stress and subthreshold autism spectrum among divers of the Italian Navy employed in search and rescue activities

Introduction Rescue emergency personnel is at high risk to develop PTSD due to possible extreme and repetitive exposition to “cruel details of traumatic events”. Objective This study aimed to explore posttraumatic stress and subthreshold autism symptomatology and their impact on social and working functioning level among sub mariner of Italian Navy, who were employed in the Costa Concordia and Genova tower rescue operation. Methods Eighty-five subjects were enrolled and investigated by the following instruments: Trauma and Loss Spectrum Self-Report (TALS-SR), Adult Autism Subthreshold Spectrum (AdAS Spectrum) and Work and Social Adjustment Scale (WSAS). Results The response rate was about 50%. Ninety-five percent of the subjects were employed in recovering corpses and 80% reported at least one rescue operation in the last three years. Full and partial DSM-5 PTSD rates were 8% and 27.5%, respectively. A strong correlation emerged between several TALS-SR and ADAS domain. Furthermore, TALS-SR domain scores were related to WSAS domain. Conclusion This data showed rescue personnel to be at risk for post-traumatic stress spectrum and related work and social impairment. Further studies are needed to better investigate possible risk and resilience factors associated to PTSD.