Orsola Gambini

Deep-brain stimulation of the nucleus accumbens in obsessive compulsive disorder: clinical, surgical and electrophysiological considerations in two consecutive patients

Obsessive compulsive disorder is a highly disabling pathological condition which in the most severe and drug-resistant form can severely impair social, cognitive and interpersonal functioning. Deep-brain stimulation has been demonstrated to be an effective and safe interventional procedure in such refractory forms in selected cases. We here report the first Italian experience in the treatment of this pathology by means of nucleus accumbens stimulation, pointing out to some technical data which could be of help in localization of the target.

Burnout Among Psychiatrists in Milan: A Multicenter Survey

OBJECTIVES This study evaluated the prevalence of job burnout and estimated psychiatric morbidity and job satisfaction among psychiatrists in Milan. Also investigated were the contributions of personal and environmental factors to burnout. METHODS Data were gathered via a cross-sectional, descriptive, multicenter survey. All psychiatrists working in departments of psychiatry within the Italian Public Health System in Milan were invited to participate, and an overall response rate of 70% (N=81) was achieved. The Maslach Burnout Inventory, the 12-item General Health Questionnaire, a job satisfaction measure, and a study-specific questionnaire were used in the assessments. RESULTS Psychiatrists showed high levels of emotional exhaustion and depersonalization. Main sources of stress were related to work environment. According to regression models, the variable that most predicted burnout was a low level of job satisfaction. CONCLUSIONS Data suggested that psychiatrists had higher levels of burnout than other physicians employed in general medical settings and confirmed that job satisfaction could have a protective role.

Theory of mind in schizophrenia: First person vs third person perspective

Patients suffering from schizophrenia have an impaired meta-representation also known as Theory of Mind (ToM). Moreover, the presence of delusions or other positive symptoms of schizophrenia has been correlated to poor ToM performances. Lack of insight is a common symptom of schizophrenia and can be considered a critical manifestation of impaired ToM abilities. In particular, the present study addresses the role of perspective ToM ability in schizophrenic patients. Thirty severely delusional schizophrenic patients completely lack insight when interviewed about their delusions. Seven subsequently gain insight about their mental state when perspective is shifted from the first person to third person. These data suggest that in some delusional schizophrenic patients, it may be possible to gain access to and modify their mental states.

The Wisconsin Card Sorting Test discriminates schizophrenic patients and their siblings

The following report is an evaluation of the performances of 35 schizophrenic patients and 35 of their siblings on the Wisconsin Card Sorting Test (WCST), a neuropsychological test considered sensitive to frontal lobe functioning. Thirty five normal subjects matched for age and education were the comparison group. The purpose of this study was to examine the relationship of the neurofunctional basis for schizophrenia to its familiar occurrence. Non-schizophrenic siblings of schizophrenic patients did not perform significantly different from normal subjects on the WCST; however, schizophrenic patients performed significantly worse than both their siblings and normal subjects. These results indicate that WCST dysfunction seems to be a characteristic related to the presence of the disease and that non-genetic factors could contribute to the WCST pathological profile.

Smooth pursuit and saccadic eye movements and Wisconsin card sorting test performance in obsessive- compulsive disorder

Smooth pursuit eye movements (SPEMs), voluntary saccadic eye movements (VSEMs), and neuropsychological test (Touluse-Pieron Test and Wisconsin Card Sorting Test) performance were studied in 23 patients with obsessive-compulsive disorder and 27 age-matched normal control subjects. The patients performed more poorly than the control subjects on the SPEM and, to a lesser degree, VSEM measures. They also showed impairment on some aspects of the neuropsychological tests. No relationship was found between eye movement performance and neuropsychological impairment.

Patients with epilepsy and patients with psychogenic non-epileptic seizures: Video-EEG, clinical and neuropsychological evaluation

PURPOSE The incidence of psychogenic non-epileptic seizures (PNES) is 4.9/100,000/year and it is estimated that about 20-30% of patients referred to tertiary care epilepsy centers for refractory seizures have both epilepsy and PNES. The purpose of our study is to evaluate psychiatric disorders and neuropsychological functions among patients with PNES, patients with epilepsy associated with PNES and patients with epilepsy. METHODS We evaluated 66 consecutive in-patients with video-EEG recordings: 21 patients with epilepsy, 22 patients with PNES and 10 patients with epilepsy associated with PNES; 13 patients were excluded (8 because of mental retardation and 5 because they did not present seizures or PNES during the recording period). RESULTS All patients with PNES had a psychiatric diagnosis (100%) vs. 52% of patients with epilepsy. Cluster B personality disorders were more common in patients with PNES. We observed fewer mood and anxiety disorders in patients with PNES compared with those with epilepsy. We did not find statistically significant differences in neuropsychological profiles among the 3 patient groups. CONCLUSION This study can help to contribute to a better understanding of the impact of PNES manifestations, in addition to the occurrence of seizures, in order to provide patients with more appropriate clinical, psychological and social care.

Combined measure of smooth pursuit eye movements and ventricle-brain ratio in schizophrenic disorders

Smooth pursuit eye movements (SPEM) were examined in 67 schizophrenic patients and 101 control subjects. Our study confirms that eye tracking in schizophrenic patients is impaired compared to that in controls. The similar pattern of distribution of SPEM abnormalities in Italian patients as in ethnically different populations strengthens the hypothesis that these abnormalities may be a biological marker for schizophrenia. We also examined the relationship between SPEM abnormalities and the ventricle-brain ratio (VBR), which is also considered useful for differentiating schizophrenic subgroups. Our preliminary results indicate that there is an inverse correlation between abnormal SPEM performance and ventricular enlargement, suggesting that these abnormalities mark distinct subgroups of patients.

The Wisconsin Card Sorting Test (WCST) Performance in Normal Subjects: A Twin Study

The aim of this study was to evaluate the WCST, a task linked to the frontal (prefrontal) cortex, in normal twins to detect an inherited component of frontal lobe function. The WCST scores of 15 monozygotic (MZ) twin pairs, 9 dizygotic (DZ) twin pairs, and 15 unrelated control pairs were used to compute genetic estimates. No significant differences were detected between MZ, DZ and control groups intrapair correlation coefficients. No significant heritability estimates different by zero were computed. The frontal lobe function measured by WCST performance in normal twins does not seem to have a high degree of genetic component, and larger samples of twins are required to detect low genetic effects. The possible implications of such results about the genetic predisposition of frontal deficit in schizophrenia have been discussed.

Asymmetrical distribution of beta-endorphin in cerebral hemispheres of suicides: Preliminary data

The assessment of beta-endorphin levels in several symmetrical brain regions of seven suicides and seven sudden death controls reveals a decreased concentration in the left temporal cortex, the left frontal cortex, and the left caudate nucleus of suicides compared to controls. Moreover, the comparisons of beta-endorphin concentrations in the symmetrical brain regions reveals an asymmetrical concentration in suicides (left less than right) in frontal cortex and caudate nucleus. These data confirm previous reports of abnormalities of neurochemical pathways in the brains of suicides and suggest that suicidal behavior might be related to the lateralized mechanisms of mood control.

Depressive symptoms and major depressive disorder in patients affected by subclinical hypothyroidism: a cross-sectional study.

Abstract The relationship between subclinical hypothyroidism and depression is still controversial. Our objective was to compare the prevalence of depressive symptoms and major depressive disorder in a population of patients affected by subclinical hypothyroidism and a control group without thyroid disease. The authors enrolled 123 consecutive outpatients affected by subclinical hypothyroidism undergoing follow-up at the endocrinology department of San Paolo Hospital in Milan and 123 controls without thyroid disease under the charge of general physicians. All patients and controls underwent an evaluation by means of a psychiatric interview; Hamilton Rating Scale for Depression (HAM-D); Montgomery-Asberg Depression Rating Scale (MADRS); and serum thyroid stimulating hormone, free T4, and free T3 levels. Patients were also screened for thyroid peroxidase antibodies and thyroglobulin antibodies. Patients affected by subclinical hypothyroidism had a prevalence of depressive symptoms of 63.4% at HAM-D and 64.2% at MADRS; 22 patients (17.9%) had a diagnosis of depressive episode (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria). The control group had a prevalence of depressive symptoms of 27.6% at HAM-D and 29.3% at MADRS, and only seven controls had a diagnosis of depressive episode. The prevalence of depressive symptoms between these two groups was statistically different. This study underlines a strong association between subclinical hypothyroidism and depressive symptoms, which could have some important diagnostic and therapeutic implications in the clinical practice.