Silvio Scarone

Increased right caudate nucleus size in obsessive-compulsive disorder: detection with magnetic resonance imaging.

Magnetic resonance images were used to measure the volume of the head of the caudate nucleus in 20 patients with obsessive-compulsive disorder and 16 normal control subjects. The obsessive-compulsive patients showed a significant increase in the volume of the right side of the head of the caudate nucleus compared with that of control subjects. This finding was not correlated with demographic, psychopathological, or clinical characteristics.

The selective breakdown of frontal functions in patients with obsessive–compulsive disorder and in patients with schizophrenia: A double dissociation experimental finding

In an our recent preliminary study, we reported the neuropsychological finding of a double dissociation in the frontal lobe functioning between 25 OCD patients and 25 schizophrenics. The first group performed normally in the Wisconsin Card Sorting Test (WCST), which is considered sensitive to Dorso-Lateral Prefrontal Cortex (DLPFC) dysfunctions and abnormally to the Object Alternation Test (OAT), which has been proposed as a tool sensitive to Orbito-Frontal Cortex (OFC); on the other hand, schizophrenics performed abnormally to the WCST and normally to the OAT. The present study, conducted on a new sample of 60 schizophrenic in-patients, 60 OCD in-patients and 30 normal subjects, matched according to age, educational level, handedness and duration of illness, confirms our preliminary data and it suggests a more selective impairment of OFC system in OCD and of DLPFC in schizophrenia. Moreover, schizophrenic patients with paranoid subtype showed worse WCST performance compared to non-paranoid subtype. Our results could open some interesting perspectives about the neuroanatomical systems involved in these two major psychiatric illnesses and so, about their pharmacological treatment, on the basis of the prominent catecholaminergic characterization of the DLPFC and, respectively, the cholinergic innervation of the OFC.

Wisconsin Card Sorting Test performance in obsessive-compulsive disorder: no evidence for involvement of dorsolateral prefrontal cortex

Wisconsin Card Sorting Test (WCST) performances were studied in 33 patients with obsessive-compulsive disorder (OCD) and 33 age-, sex-, and education-matched normal comparison subjects; the OCD patients were divided into four subgroups on the basis of their symptomatology. Neither the two groups of subjects nor the four OCD subgroups differed on any of the WCST neuropsychological indices. No relationship was demonstrated between test performance and clinical-epidemiological characteristics of the OCD patients. All of the OCD patients were being treated with fluvoxamine maleate, which improves OCD symptoms and could also improve WCST performances. Nevertheless, no remarkable differences in the WCST indices were observed in patients treated with fluvoxamine when compared with patients who had not received a specific therapy for at least 3 weeks. Since the WCST is widely considered sensitive to dysfunction of the dorsolateral prefrontal cortex, our results do not support the involvement of that brain region in OCD.

CYTOKINES PRODUCTION IN CHRONIC SCHIZOPHRENIA PATIENTS WITH OR WITHOUT PARANOID BEHAVIOUR

1. Several immunological abnormalities have been found in schizophrenia but their significance still remains largely unknown. In this study the authors analyzed mitogen-stimulated interleukin (IL)-2, Interferon gamma (IFN)-gamma and IL-10 (type 2 cytokine) production in a sample of 37 chronic schizophrenic patients as compared with a sample of 40 age and sex-matched controls with the aim to evaluate whether patients belonging to different diagnostic subtypes (i.e. paranoid patients vs non paranoid patients) could be immunologically different from each other. 2. The findings indicate that paranoid patients produce less IL-10 than the others and thus, from an immunological viewpoint, they are more similar to healthy controls. 3. Furthermore, neuroleptic medications were observed to differently affect IL-2 production; this preliminary finding might stimulate further studies aiming to get a link between different drug profile of action both in terms of clinical and receptorial profile and different immunological effects.

Frontal lobe dysfunction in obsessive-compulsive disorder and major depression : a clinical-neuropsychological study

Neuropsychological findings support a hypothesized relationship between obsessive-compulsive disorder (OCD) and the frontal lobe. The aim of the present study was to compare findings of neuropsychological tests of frontal lobe function in 28 OCD patients and 29 patients with major depressive disorder (MDD), all diagnosed according to DSM III-R criteria. The patient groups were homogeneous for educational level, handedness, duration of illness, and sex distribution. All 57 subjects received a battery of tests sensitive to frontal lobe dysfunction as well as the Wechsler Memory Scale (WMS). Clinical symptomatology in the MDD and OCD groups was assessed with the Hamilton Rating Scale for Depression and the Yale-Brown Obsessive-Compulsive Scale, respectively. The only significant difference between the two diagnostic groups for any of the neuropsychological indices, with age as a covariate, was in the Object Alternation Test, in which OCD patients had a significantly higher number of perseverative responses. Test performances were not correlated with clinical symptomatology or severity of illness. Our preliminary results confirm the hypothesis that there is a selective impairment of orbito-frontal cortex in OCD and seem to exclude the existence of specific frontal lobe dysfunction in MDD, even though the two disorders show clinical similarities.

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.

β-endorphin and β-lipotropin plasma levels in chronic schizophrenia, primary affective disorders and secondary affective disorders

Abstract Plasma levels of β-endorphin (β-EP), β-lipotropin (β-LPH) and ACTH were assayed in 15 chronic schizophrenics, nine patients with primary affective disorders (PAD) and seven patients with secondary affective disorders (SAD). Patients received no therapy for 10 days prior to study. All subjects were studied once; eight schizophrenics were studied again after 10 days of Haloperidol therapy, at a dose of 0.1 mg/kg body weight. β-LPH levels were significantly higher in the schizophrenics without hallucinations and in the PAD and SAD patients in comparison to the controls; β-EP levels were higher in the schizophrenics and SAD patients compared to the controls; and ACTH concentrations were significantly lower in the SAD than in the PAD patients. Haloperidol therapy failed to induce significant changes in β-LPH, β-EP or ACTH plasma levels. Statistical evaluation by multiple linear regression confirmed the significant positive correlations among β-LPH, β-EP and ACTH in the controls, schizophrenics with hallucinations, and PAD and SAD patients, while inverse correlations between β-LPH and the other two peptides were found in the schizophrenics without hallucinations. The same analysis revealed that, while in the PAD patients equimolar amounts of the three peptides occurred, the SAD patients were characterized by ACTH/β-LPH and ACTH/β-EP molar ratios of 0.5. Although these results are preliminary, they seem to indicate that β-LPH, β-EP and ACTH secretion patterns in chronic schizophrenia, PAD and SAD may help in revealing specific groups of patients with different biochemical substrates.

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.

Memory functions and temporal-limbic morphology in schizophrenia

Several psychopathological and morphological studies support the hypothesis of temporal-limbic involvement in the pathophysiology of schizophrenia. In the present study, magnetic resonance imaging was used to evaluate the areas of the temporal lobes and related structures in 18 schizophrenic patients and 18 normal control subjects who were homogeneous for sex and age. The Wechsler Memory Scale was used to assess the memory functions of all subjects. Although the MRI data did not reveal any significant differences between the two groups, the Wechsler Memory Scale indices of memory functions showed significant differences between the schizophrenic patients and the control subjects.