Mario Fulcheri

Nutrition and cancer prevention

Cancer cells invade surrounding tissues and metastasize to distant sites. Diet high in fat is a strong link to, and perhaps causes, a high incidence of tumours. Trans-fatty acid might impair the function and it could be involved in the development of cancer. Cholesterol is also strongly suspected to be involved in the development of tumours, therefore it is important for everyone to eat well, especially for people with cancer to prevent the body tissues from breaking down and helping to rebuild the normal tissue that may have been affected by the treatments. Factors secreted by adipocytes and macrophages such as TNF-alpha and other inflammatory proteins are involved in inflammation in cancer. In addition, MCSF which up-regulates adipocyte tissue is also important for the stimulation of fat cell proliferation and is expressed by human adipocytes. Many cytokines, such as IL-1, IL-6, IL-8, IL-32, IL-33 and MCP-1, are biomarkers for cancer and chronic diseases along with transcription factors NFkB and AP-1; these last two factors are important bioactive substances on the molecular mechanism of the control of genes which in turn affect cellular metabolism. In this paper we revisit the interrelationship between cancer and metabolism.

Mental Pain and Suicide: A Systematic Review of the Literature

Background Mental pain, defined as a subjective experience characterized by perception of strong negative feelings and changes in the self and its function, is no less real than other types of grief. Mental pain has been considered to be a distinct entity from depression. We have performed a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies. Methods We have conducted, in accordance with PRISMA guidelines, a systematic search for the literature in PubMed, Web Of Science, and Scopus. Search terms were “mental pain” “OR” “psychological pain” OR “psychache” combined with the Boolean “AND” operator with “suicid*.” In addition, a manual search of the literature, only including the term “psychache,” was performed on Google Scholar for further studies not yet identified. Results Initial search identified 1450 citations. A total of 42 research reports met the predefined inclusion criteria and were analyzed. Mental pain was found to be a significant predictive factor of suicide risk, even in the absence of a diagnosed mental disorder. Specifically, mental pain is a stronger factor of vulnerability of suicidal ideation than depression. Conclusion Mental pain is a core clinical factor for understanding suicide, both in the context of mood disorders and independently from depression. Health care professionals need to be aware of the higher suicidal risk in patients reporting mental pain. In this regard, psychological assessment should include a clinimetric evaluation of mental pain in order to further detect its contribution to suicidal tendency.

Epilepsy and its main psychiatric comorbidities in adults and children.

Psychiatric disorders seem to be more frequent in patients with epilepsy (PWE) than the general population. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. According to this, psychiatric diseases are often underdiagnosed and undertreated in PWE with further decrease of the quality of life of patients. The aim of the review was to examine the most frequent psychiatric comorbidities in adults with epilepsy (AWE) and the main psychiatric comorbidities in children with epilepsy (CWE) in order to better understand the relationship between epilepsy and the development of psychiatric disorders.

Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study.

Background Psychological factors are known predictors of cardiovascular disease in many clinical settings, but data are lacking for HIV infection. We carried out a prospective cohort study to evaluate potential psychological predictors of preclinical and clinical vascular disease in HIV patients. Methodology/Principal Findings HIV patients were consecutively enrolled. Demographics, viral and immune parameters and traditional cardiovascular predictors were considered; Intima-Media Thickness (c-IMT, continuous measure) and Carotid Plaques (CPs, focal thickening ≥1.5 mm) were investigated by B-mode ultrasonography; depressive symptoms by the Beck Depression Inventory (BDI-II), Type D personality (Distressed Personality or Type D) by the DS14, alexithymia by the Toronto Alexithymia Scale (TAS-20). Vascular outcomes included transient ischemic attacks or stroke, acute coronary syndrome, myocardial or other organ infarction. We enrolled 232 HIV subjects, 73.9% males, aged 44.5±9.9 y, 38.2% with AIDS diagnosis, 18.3% untreated. Mean Nadir CD4 T-cell counts were 237.5±186.2/mmc. Of them, 224 (96.5%) attended IMT measurements; 201 (86.6%) attended both IMT assessment and psychological profiling. Mean follow-up was 782±308 days. Fifty-nine patients (29.4%) had CPs at baseline. Nineteen patients (9.5%) had ≥1 vascular event; 12 (6.0%) died due to such events (n = 4) or any cause. At baseline cross-sectional multivariate analysis, increasing age, total cholesterol, current smoking and Alexithymia score≥50 were significantly associated with both increased cIMT (linear regression) and CPs (logistic regression). At follow-up analysis, log-rank tests and Cox’s regression revealed that only older age (p = 0.001), current smoking (p = 0.019) and alexithymia score≥50 (p = 0.013) were independently associated with vascular events. Conclusions/Significance In HIV-infected subjects, the Alexithymic trait emerges as a strong predictor of increased IMT, presence of CPs and vascular events. Such results are preliminary and require confirmation from studies with larger sample size and longer follow-up.

Psychological stress and cancer.

All the concepts reported in this editorial are based on recent literature data obtained through a PubMed search, using both Medline and manual searches, with particular reference to articles, which could be relevant to clinical practice. This paper contributes to the existing literature on depression and stress and provides important information for the development of effective strategies to manage these conditions among patients with cancer.

The Clinical Link between Type D Personality and Diabetes

Introduction Type D personality consists of a mixture of high levels of negative affectivity and social inhibition, resulting in a stable tendency to experience negative emotions, by inhibiting the expression of these emotions. We have reanalyzed the clinically relevant studies examining the role of this personality profile in diabetes, by providing a qualitative synthesis of the data. In this regard, the aim of this study is to provide a systematic review by evaluating the clinical link between Type D personality and diabetes. Method When focusing on PRISMA guidelines, we have performed a comprehensive research of the literature on PubMed, Scopus, ScienceDirect, ISI Web of Science, PsycINFO, and Google Scholar by using search terms as “distressed personality” OR (i.e., Boolean operator) “Type D personality” combined with the Boolean “AND” operator with “diabetes.” Results A total of seven research studies were identified and included in the review. Type D was found to be more prevalent in diabetes patients than controls. As regards the specific association with diabetes variables, Type D personality is a significant predictor of both poor medication adherence and unhealthy behaviors, by predicting negative mental health consequences also (i.e., depressed mood, anhedonia, and anxiety). Conclusion Our review emphasized for the first time that Type D personality affects clinical factors in patients with diabetes by provoking adverse outcomes. The core implication of the study comprises the clinical relevance to detect, from a clinimetric point of view, Type D personality in diabetes in order to prevent potentially negative clinical outcomes.

Anxiety in adolescent epilepsy. A clinimetric analysis

Abstract Background Anxiety and depression have been considered to be neglected disorders in epilepsy. Because panic disorder is one of the most important anxiety disorders, it has been problematic to use very comprehensive anxiety questionnaires in epilepsy patients, as panic attacks and epileptic seizures, although two distinct clinical entities from a diagnostic point of view, show a significant overlap of symptoms. Aims We have focused on single items for anxiety and depression as screening candidates in adolescent epilepsy. Methods The individual panic attack item in the Screen for Children Anxiety Related Emotional Disorders Scale (SCARED) and the single depression item in the Kellner Symptom Questionnaire were tested. Our samples consisted of adolescent patients with epilepsy and a matched control group with healthy participants, as well as two numerical groups acting as controls. Results The single panic attack item identified panic anxiety in 24.1% in the group of patients with epilepsy and 0.0% in the matched control group (p = 0.01). The single depression item identified 52.2% with depression in the epilepsy group and 6.2% in the matched control group (p = 0.001). Conclusion As screening instruments, single items of panic attack and depression are sufficient to screen for these affective states in adolescent epilepsy. The clinical implications are that it is important to be quite specific when screening for depression and panic attacks in adolescent patients with epilepsy.

Psychometric evaluation of the Italian translation of the Gamblers’ Beliefs Questionnaire

Abstract Italy has experienced a rapid growth in gambling accessibility, expenditures and problems. Gambling-related cognitive distortions are established risk factors for disordered gambling, although little is known about the role of gambling-related cognitive distortions among Italians. To establish a valid tool for assessing these distortions, an Italian version of the Gamblers’ Beliefs Questionnaire (GBQ-I) was translated and psychometrically evaluated in a sample of 749. Eighty-five percent had gambled recently and 110 were identified as probable disordered gamblers. Good reliability, internal consistency and test-retest reliability were demonstrated. Concurrent, convergent and predictive validities also suggested that the GBQ-I is a valid and reliable measure for assessing gambling-related cognitive distortions among clinical and non-clinical Italian samples. Factor analysis explored the two-factor structure from the measures’ initial validation but was unable to replicate it. The validation of this translation of the GBQ allows for future cross-cultural research on the role of cognitive distortions in the study and treatment of gambling problems.

Somatization in Parkinson's Disease: A systematic review

ABSTRACT The current systematic review study is aimed at critically analyzing from a clinimetric viewpoint the clinical consequence of somatization in Parkinsons Disease (PD). By focusing on the International Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, we conducted a comprehensive electronic literature research strategy on ISI Web‐of‐Science, PsychINFO, PubMed, EBSCO, ScienceDirect, MEDLINE, Scopus, and Google Scholar databases. Out of 2.926 initial records, only a total of 9 studies were identified as clearly relevant and analyzed in this systematic review. The prevalence of somatization in PD has been found to range between 7.0% and 66.7%, with somatoform disorders acting as clinical factor significantly contributing to predict a progressive cognitive impairment. We highlighted that somatization is a highly prevalent comorbidity affecting PD. However, the clinical consequence of such psychiatric symptom should be further evaluated by replacing the clinically inadequate diagnostic label of psychogenic parkinsonism with the psychosomatic concept of persistent somatization as conceived by the Diagnostic Criteria for Psychosomatic Research (DCPR). HIGHLIGHTSSomatization is a highly prevalent comorbidity in Parkinsons Disease.Somatization significantly influences Parkinsons Disease prognosis.A clinimetric reappraisal of the somatization concept is proposed.Clinimetrics provides a clinically based method for evaluating somatization.

Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review

Background and Objective. Diagnosis of Gestational Diabetes Mellitus (GDM) could significantly increase the likelihood of health problems concerning both potential risks for the mother, fetus, and childs development and negative effects on maternal mental health above all in terms of a diminished Quality of Life (QoL). The current systematic review study is aimed at further contributing to an advancement of knowledge about the clinical link between GDM and QoL. Methods. According to PRISMA guidelines, PubMed, Web of Science, Scopus, and Cochrane databases were searched for studies aimed at evaluating and/or improving levels of QoL in women diagnosed with GDM. Results. Fifteen research studies were identified and qualitatively analyzed by summarizing results according to the following two topics: GDM and QoL and interventions on QoL in patients with GDM. Studies showed that, in women with GDM, QoL is significantly worse in both the short term and long term. However, improvements on QoL can be achieved through different intervention programs by enhancing positive diabetes-related self-management behaviors. Conclusion. Future studies are strongly recommended to further examine the impact of integrative programs, including telemedicine and educational interventions, on QoL of GDM patients by promoting their illness acceptance and healthy lifestyle behaviors.