Stefano Ferracuti

Suicidal behavior and alcohol abuse

Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.

Functional neuroimaging in obsessive-compulsive disorder.

Background and Aim: Obsessive-compulsive disorder (OCD) is a severe, highly prevalent and chronically disabling psychiatric disorder that usually emerges during childhood or adolescence. This paper aims to review the literature on functional neuroimaging in OCD, analysing the reported dysfunctional connectivity in the corticostriatothalamocortical circuitry. Method: This study included papers published in peer-reviewed journals dealing with functional imaging in OCD. Results: Striatal dysfunction, mainly of the caudate nucleus, leads to inefficient thalamic gating, resulting in hyperactivity within the orbitofrontal cortex (intrusive thoughts) and the anterior cingulate cortex (non-specific anxiety). Compulsions consist of ritualistic behaviours performed to recruit the inefficient striatum and neutralise unwanted thoughts and anxiety. Functional neuroimaging findings are discussed against the background of specific cognitive impairments, mainly regarding visuospatial processing, executive functioning and motor speed. Cognitive deficits are partial and specific, matching imaging data. Conclusions: Several studies have targeted brain regions hypothesised to be involved in the pathogenesis of OCD, showing the existence of dysfunctional connectivity in the corticostriatothalamocortical circuitry. Improvements in spatial resolution of neuroimaging techniques may contribute to a better understanding of the neurocircuitry of OCD and other anxiety disorders.

Temperament and Personality Dimensions in Suicidal and Nonsuicidal Psychiatric Inpatients

Background: Suicide is a serious public health problem. In the international literature there is evidence to support the notion that certain temperaments and personality traits are often associated with suicidal behavior. Sampling and Methods: In this study, 150 psychiatric inpatients were investigated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego autoquestionnaire, the Minnesota Multiphasic Personality Inventory, 2nd edition (MMPI-2) and the Beck Hopelessness Scale and evaluated for suicide risk by means of the critical items of the Mini International Neuropsychiatric Interview. Results: Statistical analysis, including logistic regression analysis and multiple regression analysis, showed that suicide risk contributed to the prediction of hopelessness. Among the temperaments, only the hyperthymic temperament, as a protective factor, and the dysthymic/cyclothymic/anxious temperament contributed significantly to the prediction of hopelessness. Irritable temperament and social introversion were predictive factors for suicidal risk. Hopelessness and depression were associated with higher suicidal behavior and ideation, but, unexpectedly, depression as measured by the MMPI did not contribute significantly to the multiple regressions. Conclusions: The present study indicated that, although suicidal psychiatric patients have MMPI-2 profiles in the pathological range, they exhibit several differences from nonsuicidal patients. Patients at risk of suicide have specific temperaments as well as personality and defense mechanism profiles. They are more socially introverted, depressed and psychasthenic, and use hysterical and schizoid mechanisms more often. Generalizability of the findings was limited by the small sample size and the mix of bipolar disorder I, bipolar disorder II, major depressive disorder and psychotic disorder patients.

A cerebral blood flow study on tonic pain activation in man

&NA; This study examined brain areas involved in tonic pain perception. Cerebral blood flow was assessed by dynamic Xenon‐133 inhalation single‐photon emission tomography (SPET) in 7 healthy right‐handed male volunteers undergoing the cold pressor test (CPT). In single experimental sessions, each subject was scanned twice, once in the resting state and once while immersing the left hand in freezing water (0°C ± 1). Immersion of the hand induced severe pain (visual analogue scale: 6.9 ± 1.9) in all subjects. After correction for pCO2, cerebral blood flow was analyzed by placing a template of square regions of interest (ROIs) over 5 selected tomographic slices. Relative to the resting‐state values, during the CPT, flow determinations revealed a 7–8% regional blood flow increase in the contralateral frontal lobe and bilateral temporal regions and a 15% flow increase in a ROI located over the primary sensorimotor cortex in the tomogram at 80 mm above the orbito‐meatal line (corresponding to the cortical somatotopic representation of the hand) contralateral to the stimulated side. The tonic pain induced by the CPT thus appears to activate the contralateral frontal and bilateral temporal regions and more prominently, the primary sensorimotor cortex. This pattern of activation suggests that tonic painful stimuli activate the cortex partly via complex circuits and partly via direct somatosensory pathways.

Affective temperamental profiles are associated with white matter hyperintensity and suicidal risk in patients with mood disorders

BACKGROUND Patients with white matter hyperintensities (WMH) may be at higher risk for affective disorders and suicide. Affective temperaments may play a significant role in mood disorders. This study aimed to evaluate the eventual association between WMH, affective temperaments and suicidal behaviour in major affective disorder. METHODS A total of 318 patients with major affective disorders were consecutively admitted as psychiatric inpatient. A total of 247 were included and given, brain magnetic resonance imaging (MRI) and assessed with the Mini International Neuropsychiatric Interview (MINI), the Beck Hopelessness Scale (BHS), the Hamilton Depression Rating Scale (HDRS(17)), the Young Mania Rating Scale (YMRS) and the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A). RESULTS A total of 48% of patients had periventricular WMH (PWMH) and 39% of them had deep WMH (DWMH). Patients with higher dysthymia and lower hyperthymia (H-DCIA group) were more likely to have higher BHS scores (BHS≥9=77% vs. 52%; p>0.001), more WMH (46% vs. 29%; χ(2)(n=3)=9.90; p<0.05), higher MINI suicidal risk (54% vs. 42%; p<0.05), and more recent suicide attempts (24% vs. 14%; p<0.05), than patients with higher hyperthymia and lower dysthymia (H-H group). LIMITATIONS The small sample size did not allow the generalization of the present findings. CONCLUSIONS Differences among temperament groups measured by the TEMPS-A are associated with differences in their MRIs, indicating that different temperament profiles are associated with differences in the subcortical structures of the brain. The implications of the results were discussed.

Efficacy of Add-On Deep Transcranial Magnetic Stimulation in Comorbid Alcohol Dependence and Dysthymic Disorder: Three Case Reports

BACKGROUND Craving for alcohol is associated with abnormal activation in the dorsolateral prefrontal cortex. Deep transcranial magnetic stimulation (dTMS) has shown promise in the treatment of depression. There are few treatment options for treatment-resistant dysthymic disorder comorbid with alcohol use disorder. OBJECTIVE To investigate the possible anticraving efficacy of bilateral dorsolateral prefrontal cortex high-frequency dTMS in 3 patients with comorbid long-term DSM-IV-TR dysthymic disorder and alcohol use disorder. METHOD Three patients with alcohol use disorder with dysthymic disorder in their detoxification phase (abstaining for > 1 month) underwent twenty 20-minute sessions of 20 Hz dTMS over the dorsolateral prefrontal cortex over 28 days between 2011 and 2012. Alcohol craving was rated with the Obsessive Compulsive Drinking Scale and depressive symptoms with the Hamilton Depression Rating Scale. RESULTS All 3 patients responded unsatisfactorily to initial intravenous antidepressant and antianxiety combinations but responded after 10 dTMS sessions, improving on both anxiety-depressive symptoms and craving. This improvement enabled us to reduce antidepressant dosages after dTMS cycle completion. DISCUSSION High-frequency bilateral dorsolateral prefrontal cortex dTMS with left prevalence was found to produce significant anticraving effects in alcohol use disorder comorbid with dysthymic disorder. The potential of dTMS for reducing craving in patients with substance use disorder deserves to be further investigated.

Occupational stress and psychopathology in health professionals: An explorative study with the Multiple Indicators Multiple Causes (MIMIC) model approach

Occupational stress is a multivariate process involving sources of pressure, psycho-physiological distress, locus of control, work dissatisfaction, depression, anxiety, mental health disorders, hopelessness, and suicide ideation. Healthcare professionals are known for higher rates of occupational-related distress (burnout and compassion fatigue) and higher rates of suicide. The purpose of this study was to explain the relationships between occupational stress and some psychopathological dimensions in a sample of health professionals. We investigated 156 nurses and physicians, 62 males and 94 females, who were administered self-report questionnaires to assess occupational stress [occupational stress inventory (OSI)], temperament (temperament evaluation of Memphis, Pisa, Paris, and San Diego autoquestionnaire), and hopelessness (Beck hopelessness scale). The best Multiple Indicators Multiple Causes model with five OSI predictors yielded the following results: χ2(9) = 14.47 (p = 0.11); χ2/df = 1.60; comparative fit index = 0.99; root mean square error of approximation = 0.05. This model provided a good fit to the empirical data, showing a strong direct influence of casual variables such as work dissatisfaction, absence of type A behavior, and especially external locus of control, psychological and physiological distress on latent variable psychopathology. Occupational stress is in a complex relationship with temperament and hopelessness and also common among healthcare professionals.

The epidemiology of homicide-suicide in Italy: A newspaper study from 1985 to 2008

Homicide-suicide is an event in which the murderer commits suicide after the homicide. There are at least 14 epidemiological studies on the topic, and all have found that homicide-suicide is more common among family members. The murderers are most often males and the victims females. There is no recent research on this phenomenon in Italy. The purpose of the study was to evaluate the incidence of homicide-suicide in Italy over a period of 24 yrs and to compare Italian data with published international data. We used information gathered by press agencies and from the four major Italian newspapers. Between 1985 and 2008, 662 cases of homicide-suicide were identified, with 1776 deaths. The murderer was male in 84.6% of the cases, typically using a firearm. The most common motivation was romantic jealousy, followed by socio-economic stress. The rate of homicide-suicide was 0.04%. Comparison with international studies is not always possible due to the lack of information for certain categories. The common factors identified may be helpful for prevention.

Cortical sources of resting-state EEG rhythms are abnormal in naïve HIV subjects.

OBJECTIVE The aim of the study was to test the hypothesis that cortical sources of resting-state electroencephalographic (EEG) rhythms show peculiar frequency/spatial features in naïve human subjects with human immunodeficiency virus (HIV) compared to healthy control subjects. METHODS Resting-state eyes-closed EEG data were recorded in 18 naïve HIV subjects (15 males; mean age 39 years±2.0 standard error of mean, SEM) and in 18 age-matched cognitively normal subjects (15 males; 38.7years±2.2 SEM). EEG rhythms of interest were delta (2-4Hz), theta (4-8Hz), alpha1 (8-10Hz), alpha2 (10-12Hz), beta1 (13-20Hz) and beta2 (20-30Hz). Cortical EEG sources were estimated by normalised, low-resolution electromagnetic tomography (LORETA). RESULTS Mini Mental State Evaluation (MMSE) score was lower in HIV (26.5 ± 0.7 SEM) than in healthy (29.2 ± 0.5 SEM) subjects (p<0.05). Central and parietal delta sources showed higher amplitude in the HIV than in control subjects. Furthermore, topographically widespread, cortical sources of resting-state alpha rhythms were lower in amplitude in HIV subjects than in control subjects. CONCLUSIONS The present results suggest that topography and frequency of the cortical sources of resting-state EEG rhythms can distinguish groups of HIV and control subjects. SIGNIFICANCE These results encourage future studies in an enlarged cohort of HIV subjects to test the hypothesis that the present methodological approach provides clinically useful information for an early detection of the effect of HIV infection on brain and cognitive functions.

Add-on deep transcranial magnetic stimulation (dTMS) in patients with dysthymic disorder comorbid with alcohol use disorder: A comparison with standard treatment

Abstract Objectives. Dorsolateral prefrontal cortex (DLPFC) is dysfunctional in mood and substance use disorders. We predicted higher efficacy for add-on bilateral prefrontal high-frequency deep transcranial magnetic stimulation (dTMS), compared with standard drug treatment (SDT) in patients with dysthymic disorder (DD)/alcohol use disorder (AUD) comorbidity. Methods. We carried-out a 6-month open-label study involving 20 abstinent patients with DSM-IV-TR AUD comorbid with previously developed DD. Ten patients received SDT for AUD with add-on bilateral dTMS (dTMS-AO) over the DLPFC, while another 10 received SDT alone. We rated alcohol craving with the Obsessive Compulsive Drinking Scale (OCDS), depression with the Hamilton Depression Rating Scale (HDRS), clinical status with the Clinical Global Impressions scale (CGI), and global functioning with the Global Assessment of Functioning (GAF). Results. At the end of the 20-session dTMS period (or an equivalent period in the SDT group), craving scores and depressive symptoms in the dTMS-AO group dropped significantly more than in the SDT group (P < 0.001 and P < 0.02, respectively). Conclusions. High frequency bilateral DLPFC dTMS with left preference was well tolerated and found to be effective as add-on in AUD. The potential of dTMS for reducing craving in substance use disorder patients deserves to be further investigated.