Patrizia Moretti

An uncovered XIII century icon: Particular use of organic pigments and gilding techniques highlighted by analytical methods

The restoration of a panel painting depicting a Madonna and Child listed as an unknown Tuscan artist of the nineteenth century, permitted the hidden original version, a XIII century Medieval icon to be uncovered. It is discovery provided the opportunity for an extensive in situ campaign of non-invasive analytical investigations by portable imaging and spectroscopic techniques (infrared, X-ray fluorescence and diffraction, UV-Vis absorption and emission), followed by aimed micro-destructive investigations (Raman and SEM-EDS). This approach permitted characterization of the original ground and paint layers by complementary techniques. Furthermore, this protocol allowed supplementary particularities of great interest to be highlighted. Namely, numerous original gilding techniques have been accentuated in diverse areas and include the use of surrogate gold (disulphur tin), orpiment as a further false gold and an area with an original silver rich layer. Moreover, pigments including azurite mixed with indigo have been non-invasively identified. Micro-invasive analyses also allowed the diagnosis of organic colorants, namely, an animal anthraquinone lake, kermes and an unusual vegetal chalcone pigment, possibly safflower. The identification of the latter is extremely rare as a painting pigment and has been identified using an innovative adaption to surface enhanced Raman techniques on a cross-section. The resulting data contributes new hypotheses to the historic and artistic knowledge of materials and techniques utilized in XIII century icon paintings and ultimately provides scientific technical support of the recent restoration.

Schizophrenia and obsessive-compulsive disorder: from comorbidity to schizo-obsessive disorder

Current genetic, neurobiological, clinical-descriptive and pharmacological data about obsessive-compulsive symptoms (OCS) and/or obsessive-compulsive disorder (OCD) in schizophrenia hypothesize that schizophrenia combined with OCD is more than a mere comorbidity. To prove this hypothesis, “dimensional diagnosis”, based on the identification of a dysfunctional area common to different clinical cases, should replace “categorical diagnosis”, that focuses on discrete parameters that define specific disorders. It is our hope that the DSM-V will make reference to principles based on psychopathological “spectra” because these reflect the integration of pharmacotherapeutic, descriptive and etiopathogenetic aspects (genotypes common to various disorders, temperamental predispositions, neurobiological and chemical alteration). These three aspects explain how obsessive phenomena can develop into delusional phenomena.

MOLAB® meets Persia: Non-invasive study of a sixteenth-century illuminated manuscript

Abstract Using the MOLAB® non-invasive analytical mobile laboratory, we studied a finely illuminated sixteenth-century Persian manuscript at the Fitzwilliam Museum, Cambridge, UK, in collaboration with its Department of Manuscripts and Printed Books. Three miniatures belonging to the manuscript, but ascribable to different periods, were analyzed in order to identify similarities and differences in the painting materials and techniques used by Safavid artists over a period of 150 years. The use of multiple analytical techniques indicated a common palette characterizing the three decorative schemes, along with some differences mainly regarding the pigment mixture used to obtain brown hues in the first scheme, as well as the presence of different mixtures in green and dark purple areas in the third scheme.

The State of the Art of the DSM-5 “with Mixed Features” Specifier

The new DSM-5 “with mixed features” specifier (MFS) has renewed the interest of the scientific community in mixed states, leading not only to new clinical studies but also to new criticisms of the current nosology. Consequently, in our paper we have reviewed the latest literature, trying to understand the reactions of psychiatrists to the new nosology and its epidemiological, prognostic, and clinical consequences. It seems that the most widespread major criticism is the exclusion from the DSM-5 MFS of overlapping symptoms (such as psychomotor agitation, irritability, and distractibility), with a consequent reduction in diagnostic power. On the other hand, undoubtedly the new DSM-5 classification has helped to identify more patients suffering from a mixed state by broadening the narrow DSM-IV-TR criteria. As for the clinical presentation, the epidemiological data, and the therapeutic outcomes, the latest literature does not point out a univocal point of view and further research is needed to fully assess the implications of the new DSM-5 MFS. It is our view that a diagnostic category should be preferred to a specifier and mixed states should be better considered as a spectrum of states, according to what was stated many years ago by Kraepelin.

Pharmacological treatment of borderline personality disorder: a retrospective observational study at inpatient unit in Italy.

Abstract Objective: Borderline personality disorder (BPD) is a high prevalence personality disorder. Pharmacotherapy is commonly used, however, a minority of studies investigated patterns of prescription for BPD, particularly in inpatients unit. We aimed to describe the clinical features and the prescribing practice for BPD patients, and to investigate the possible advantages of a single class of medications or of combined drug treatments in terms of length of stay in hospital. Methods: This is a retrospective observational study evaluating 109 BPD inpatients from June 2011 to June 2013. Results: There was evidence of an extensive use of drugs: benzodiazepines/hypnotics (85.2%), antipsychotics (78.7%), mood stabilizers (70.4%) and antidepressants (31.5%). Polypharmacy was common (83.5%). A longer length of stay in hospital was associated with the prescription of antipsychotic and/or antidepressant medication, while a shorter hospitalization was associated with the use of a mood stabilizer. Conclusions: The rates of prescription of different classes of drugs reported in our sample and in similar ‘naturalistic’ studies highlight a heterogeneous pattern of prescriptions for BPD. Mood stabilizers showed a more favourable profile in terms in length of stay in hospital than antipsychotic and/or antidepressant. Our results reiterate the discrepancy between international recommendations and everyday clinical practice.

Delusions in first-episode psychosis: Principal component analysis of twelve types of delusions and demographic and clinical correlates of resulting domains

Although delusions represent one of the core symptoms of psychotic disorders, it is remarkable that few studies have investigated distinct delusional themes. We analyzed data from a large sample of first-episode psychosis patients (n=245) to understand relations between delusion types and demographic and clinical correlates. First, we conducted a principal component analysis (PCA) of the 12 delusion items within the Scale for the Assessment of Positive Symptoms (SAPS). Then, using the domains derived via PCA, we tested a priori hypotheses and answered exploratory research questions related to delusional content. PCA revealed five distinct components: Delusions of Influence, Grandiose/Religious Delusions, Paranoid Delusions, Negative Affect Delusions (jealousy, and sin or guilt), and Somatic Delusions. The most prevalent type of delusion was Paranoid Delusions, and such delusions were more common at older ages at onset of psychosis. The level of Delusions of Influence was correlated with the severity of hallucinations and negative symptoms. We ascertained a general relationship between different childhood adversities and delusional themes, and a specific relationship between Somatic Delusions and childhood neglect. Moreover, we found higher scores on Delusions of Influence and Negative Affect Delusions among cannabis and stimulant users. Our results support considering delusions as varied experiences with varying prevalences and correlates.

Adult-Onset Case of Undiagnosed Neurodegeneration with Brain Iron Accumulation with Psychotic Symptoms

Neurodegeneration with brain iron accumulation (NBIA) is a collective term to indicate a group of neurodegenerative diseases presenting accumulation of iron in the basal ganglia. These disorders can result in progressive dystonia, spasticity, parkinsonism, neuropsychiatric abnormalities, and optic atrophy or retinal degeneration. Onset age ranges from infancy to late adulthood and the rate of progression is very variable. So far, the genetic bases of nine types of NBIA have been identified, pantothenate-kinase-associated neurodegeneration (PKAN) being the most frequent type. The brain MRI “eye-of-the-tiger” sign, T2-weighted hypointense signal in the globus pallidus with a central region of hyperintensity, has been considered virtually pathognomonic for PKAN but recently several reports have denied this. A significant percentage of individuals with clinical and radiographic evidence of NBIA do not have an alternate diagnosis or mutation of one of the nine known NBIA-associated genes (idiopathic NBIA). Here we present an adult-onset case of “undiagnosed” NBIA with the brain MRI “eye-of-the-tiger” sign, and with psychotic symptoms which were successfully treated with antipsychotic and mood stabilizer medications. Here, the term “undiagnosed” is used because the patient has not been screened for all known NBIA genes, but only for two of them.

Comorbilità di ansia e depressione nei pazienti con tumori carcinoidi Comorbility between anxiety and depression in patients with carcinoid tumors

BACKGROUND People who have malignant cancer are plagued with a variety of symptoms that often severely limit their lives. In the case of carcinoid tumors, symptoms of anxiety and depression are two manifestations often associated with disturbances produced by the tumor itself and the chemicals that the tumor secretes. The aim of this study was to compare the incidence of these symptoms for gastro-entero-pancreatic (GEP) tumors and non-gastro-entero-pancreatic (non-GEP). METHODS Patients with GEP and patients with non-GEP completed the Hospital Anxiety and Depression Scale (HADS). HADS and all of its subscales were analyzed. RESULTS Patients with GEP tended to have higher average total scores on the HADS-D than those with non-GEP (p<0.08), and items in which the difference between GEP and non-GEP were statistically significant were anhedonia (p<0.05), a reduced ability to laugh and have fun (p<0.05), and the feeling of hopelessness (p<0.05). No significant differences emerged, however, in HADS-T and HADS-A scores. CONCLUSIONS On the basis of these findings, patients with GEP are affected more than patients with non-GEP with increased levels of depressive and anxiety symptoms. What is difficult to determine, however, is whether these symptoms are related to hormone overproduction, or whether they are related to tumor-related emotional distress.

S99. CANNABIS USE, PSYCHOTIC-LIKE EXPERIENCES AND ABERRANT SALIENCE IN A SAMPLE OF BELGIAN STUDENTS

Abstract Background Cannabis is the most popular illicit drug in the western world and its use seems to be strongly associated with an increased risk of developing schizophrenia and other psychotic disorders. Its use can induce transient psychotic symptoms in healthy individuals and increase rate of subclinical psychotic symptoms in the general population. Subclinical psychotic experiences (also called Psychotic Like Experiences: PLEs), such as magical thinking, paranoid ideation or hallucinations, could be considered as a phenotype qualitatively similar to the symptomatology of psychotic disorders but quantitatively less severe in terms of intensity, frequency and impairment. They are fairly common in the general population and usually transitory and self-limiting but they could become abnormally persistent and evolve to a full-blown psychotic disorder, especially if combined with certain environmental risk factors, such as trauma, urbanicity, cannabis use. PLEs may be considered as an early marker of a latent psychosis vulnerability and the frequently good outcome of subclinical psychosis can be turned in negative outcomes by the association with environmental risk factors, such as cannabis use. We focus our attention on aberrant salience, a peculiar psychotic experience, frequently reported during the prodromal phase that precede the onset of full-blown psychotic illness. Aberrant salience is the unusual or incorrect assignment of salience or significance to innocuous stimuli; it has been hypothesized to be an important mechanism in the development of psychosis. Methods Undergraduate students of ULB (Universitè Libre de Bruxelles) and INSAS (Institut national supérieur des arts du spectacle) of Brussels (Belgium) were invited to participate to the study. A self-report questionnaire, investigating socio-demographic characteristics, and cannabis use was administered, evaluating lifetime and current cannabis use. Aberrant Salience Inventory (ASI) is a 29 item Yes–No questionnaire developed to evaluate aberrant salience. French version of Community Assessment of Psychic Experiences (CAPE), was used to evaluate dimensions of psychosis and PLEs. CAPE is a 42-item, self-report questionnaire, developed to measure the lifetime prevalence of PLEs in the general population. The questionnaire assesses three symptom dimensions (positive, depressive and negative symptoms). All statistical analysis was carried out with Statistical Package for Social Sciences, Version 20.0. We evaluated individual correlations between years of cannabis use and days of cannabis use in the last month with the tools scores. We also explored correlation of ASI score with different CAPE scores and different types of PLEs. Correlations were carried out by using the nonparametric Spearman correlation test. Results The final sample was of 257 participants. 46,3% of subjects reported a lifetime cannabis use and 35.0% reported a current cannabis use (last 30 days). Compared with non-users, cannabis users showed significant higher ASI scores and also higher positive and negative dimensions CAPE scores. No significant association was found between cannabis consumption and the depressive dimension of CAPE. Years of cannabis use and frequency of use in the last 30 days showed a small positive correlation with ASI score; also, weaker positive correlations with CAPE positive and negative dimensions scores were observed. Discussion To some extent, our results support the evidences that cannabis use is associated with an increased rate of psychotic experiences in individuals without clinical form of psychosis. Future prospective longitudinal studies are required to better investigate the meaning of the association between cannabis use and PLEs.

Depressive mood and circadian rhythms disturbances as outcomes of seasonal affective disorder treatment: A systematic review

BACKGROUND The present systematic review was aimed at critically summarizing the evidence about interventions focused on circadian rhythms and mood symptoms in seasonal affective disorder (SAD). METHODS A systematic search of the electronic databases PUBMED, PsycINFO and Web of Science was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Original papers reporting data about the effects of treatments on both mood and circadian rhythms disturbances in SAD patients were considered for inclusion. The quality of the evidence provided by the eligible studies was assessed using the Revised Cochrane Risk of Bias Tool (RoB 2.0) and the Cochrane Risk of Bias in Non-Randomized Studies of Interventions Tool (ROBINS-I). RESULTS Forty papers were deemed eligible for the systematic review. The evidence of treatment outcomes referring to circadian disturbances was not robust. Despite this, bright light therapy (BLT) demonstrates to phase-advance delayed rhythms and to improve sleep-wake disorders. As for mood symptoms, both BLT and selective serotonin reuptake inhibitors (SSRIs) show evidence of efficacy. The possible connection between improvements of mood symptoms and changes in circadian outcomes seems controversial. LIMITATIONS The included studies presented considerable methodological heterogeneity, small sample sizes and non-optimal sample selection. CONCLUSIONS The effectiveness of BLT in depressive symptoms and circadian disturbances of SAD was outlined by the present systematic review. The evidence about other biological and pharmacological treatments, although promising, should be replicated. A multifactorial etiopathogenesis could explain the heterogeneous clinical presentations of SAD and the complex link between mood and circadian symptoms.