Valentina Roselli

Cortical and brainstem plasticity in Tourette syndrome and obsessive-compulsive disorder.

Gilles de la Tourette syndrome is characterized by motor/vocal tics commonly associated with psychiatric disorders, including obsessive‐compulsive disorder. We investigated primary motor cortex and brainstem plasticity in Tourette patients, exposed and unexposed to chronic drug treatment, with and without psychiatric disturbances. We also investigated primary motor cortex and brainstem plasticity in obsessive‐compulsive disorder. We studied 20 Tourette patients with and without psychiatric disturbances, 15 with obsessive‐compulsive disorder, and 20 healthy subjects. All groups included drug‐naïve patients. We conditioned the left primary motor cortex with intermittent/continuous theta‐burst stimulation and recorded motor evoked potentials. We conditioned the supraorbital nerve with facilitatory/inhibitory high‐frequency stimulation and recorded the blink reflex late response area. In healthy subjects, intermittent theta‐burst increased and continuous theta‐burst stimulation decreased motor evoked potentials. Differently, intermittent theta‐burst failed to increase and continuous theta‐burst stimulation failed to decrease motor evoked potentials in Tourette patients, with and without psychiatric disturbances. In obsessive‐compulsive disorder, intermittent/continuous theta‐burst stimulation elicited normal responses. In healthy subjects and in subjects with obsessive‐compulsive disorder, the blink reflex late response area increased after facilitatory high‐frequency and decreased after inhibitory high‐frequency stimulation. Conversely, in Tourette patients, with and without psychiatric disturbances, facilitatory/inhibitory high‐frequency stimulation left the blink reflex late response area unchanged. Theta‐burst and high‐frequency stimulation elicited similar responses in drug‐naïve and chronically treated patients. Tourette patients have reduced plasticity regardless of psychiatric disturbances. These findings suggest that abnormal plasticity contributes to the pathophysiology of Gilles de la Tourette syndrome. However, obsessive‐compulsive disorder patients have normal cortical and brainstem plasticity.

Psychiatric disturbances in patients with progressive supranuclear palsy: A case-control study

OBJECTIVES To investigate the frequency and the different types of psychiatric disturbances in PSP patients using validated psychiatric instruments. METHODS We conducted a case-control study using the Structured Clinical Interview (SCID-I) for DSM-IV to investigate psychiatric disorders in 28 PSP patients and 28 age and gender matched healthy controls. PSP severity was scored using the PSP rating scale; cognitive functions were assessed using the Montreal Cognitive Assessment scale and the Frontal Assessment Battery scale. RESULTS SCID-I disclosed that psychiatric disturbances were more frequent in PSP patients (53%) than in healthy controls (17.8%) (p = 0.005). Psychiatric disorders in PSP patients were characterized by mood disorders. Depression due to PSP was the most frequent diagnosis and was found in 8 of the 15 patients with depressive disorders. None of the PSP patients had a diagnosis of other SCID-I disorders. No clinical or demographic differences were found when comparing PSP patients with and without psychiatric disturbances. CONCLUSIONS Psychiatric disturbances, namely depressive disorders, were more frequent in PSP patients than in controls. A thorough evaluation of psychiatric disorders is important to insure appropriate treatment of PSP patients..

Development and validation of the Italian version of the 15-item Dispositional Resilience Scale

Studies have shown that psychological hardiness is an important stress resilience resource for individuals. The 15-items Dispositional Resilience Scale (DRS-15) is a short, reliable and valid self-report instrument to measure hardiness that is not available in Italian. The present study was undertaken to create an Italian version of the DRS-15, and evaluate its psychometric properties and validity in the Italian context. An Italian version was produced using multiple independent bilingual translators. This version was administered to a non-clinical sample of adults (N=150), along with measure o psychological well-being (PWB-18) and health. A sub-sample (N = 66) completed the DRS-15 again one month later. Results showed good reliability in terms of internal consistency and test-retest stability. With regard to the subscale, stability was high for all three subscales, whereas two subscales (Commitment and Control) showed marginal internal consistency. DRS-15 total and subscales scores showed a theoretically meaningful pattern of correlations with PWB-18 subscales, supporting the validity of the Italian DRS. Also, multiple regression analysis revealed a correlation between DRS-15 scores and self-rated general health, even after controlling for age and sex. The new Italian DRS-15 provides a valid, reliable and easy to use tool fr assessing stress resilience in clinical and research settings.

Treatment with β-Blockers and Incidence of Post-Traumatic Stress Disorder After Cardiac Surgery: A Prospective Observational Study

OBJECTIVE The aim was to investigate perioperative factors associated with the development of post-traumatic stress disorder (PTSD) in patients who underwent cardiac surgery. DESIGN Prospective observational study. SETTING Single academic center. PARTICIPANTS One hundred twenty-eight consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Patients were interviewed within the surgical unit 1 to 3 days before cardiac surgery. MEASUREMENTS AND MAIN RESULTS Six months after surgery, participants were mailed the modified version of the Posttraumatic Stress Symptom Inventory 10. Of the 71 patients who completed the questionnaire and mailed it back at follow-up, 14 (19.7%) received a diagnosis of PTSD. Seven of 13 female patients who were not treated with β-blockers received a diagnosis of PTSD compared with 0 of 12 who were treated with β-blockers (p = 0.005, Fisher exact test). In a general linear model, including sex and β-blocker treatment as predictors, the Posttraumatic Stress Symptom Inventory 10 score was significantly predicted by β-blockade (F = 4.74, p = 0.033), with a significant interaction between sex and β-blockade (F = 9.72, p = 0.003). CONCLUSIONS These findings suggest that the use of β-blockers might be protective against the development of PTSD in women after cardiac surgery.

The Association of Anger with Symptom Subtypes in Severe Obsessive-Compulsive Disorder Outpatients

Background: Despite the theoretical and clinical relevance of psychopathological dimensions in obsessive-compulsive disorder (OCD), no studies to date have investigated their possible association with obsession subtypes. Thus, we aimed to examine whether, in OCD patients, anger and other psychopathological dimensions are associated with specific obsession subtypes. Methods: We consecutively recruited 57 first-visit OCD patients (66.7% female, mean age 34 years) at our Psychiatric Outpatient Clinic. We used the point biserial coefficient (rpbi) to measure the correlation between psychopathological dimensions and obsession subtypes. Results: We found significant correlations (p < 0.05) between the following: (1) anger/aggressiveness dimension and aggressive, contamination, and sexual obsessions; (2) apprehension/fear dimension and contamination, religious, and somatic obsessions; (3) sadness/demoralization dimension and contamination and somatic obsessions; (4) impulsivity dimension and aggressive and sexual obsessions, and (5) somatic concern/somatization dimension and contamination and somatic obsessions. We also found that OCD patients with comorbid obsessive-compulsive personality disorder - but not schizotypal or histrionic disorders - showed higher levels (p < 0.05) of obsessiveness/iterativity and anger/aggressiveness than OCD patients without the personality disorder. Conclusions: Anger and other psychopathological dimensions seem to be linked with specific obsession subtypes in OCD patients, suggesting an association between these dimensions and OCD.

Cognitive Behavioral Therapy in Movement Disorders: A Review

In addition to motor symptoms, patients with movement disorders often complain of psychiatric disturbances, including mood, anxiety, and impulse‐control disorders and psychosis. These abnormalities are often misdiagnosed and left untreated, thus resulting in a worse prognosis and lower quality of life. Besides the use of standard pharmacological treatments, psychiatric abnormalities can be treated by means of nonpharmacological approaches. These approaches include various types of psychological therapies, the most widely used being cognitive behavioral therapy (CBT). We reviewed all articles, conducted until 2014, that contained primary data derived from clinical trials and case reports on the effect of CBT in the most common movement disorders. One randomized, controlled study and several uncontrolled studies on the efficacy of CBT in Parkinsons disease (PD) have shown a short‐term benefit of depression and anxiety. In Tourettes syndrome (TS), CBT has been assessed in a number of large controlled clinical trials that have demonstrated an improvement in psychiatric disturbances and tics. There are no controlled studies on the efficacy of CBT in other types of movement disorders, such as dystonia, Huntingtons disease, and essential tremor. Only a limited number of studies have evaluated the efficacy of CBT in the management of psychiatric disorders in movement disorders. The evidence available suggests that CBT is useful in TS and probably useful in PD. We recommend the planning of randomized, controlled clinical trials to investigate the effects of CBT and group CBT in the treatment of psychiatric disturbances in movement disorders.

2273 – Attachment style and posttraumatic stress disorder after cardiac surgery

Introduction Cardiac surgery with cardiopulmonary bypass represents a severe source of stress and has been reported to be associated to the development of Posttraumatic Stress Disorder (PTSD). This disorder leads to a significant disability that might greatly decrease the benefits of surgery. Research rarely focused on the role of attachment styles in the development of PTSD, and no studies addressed this issue in patients undergoing cardiac surgery. Objectives To assess the influence of attachment styles on the development of PTSD. Aims The identification of specific personological traits predictive of the development of PTSD. Methods Participants were recruited among patients scheduled for elective cardiac surgery with cardiopulmonary bypass and evaluated through a) Experiences in Close Relationships (ECR) b) Post-traumatic 10 Stress Symptom Inventory - Modified (PTSS-10) c) Perceived Stress Scale (PSS). Six months after surgery, participants were mailed the PTSS-10 and the PSS. Multiple logistic regression analysis was performed with PTSD as dependent variable, and attachment-related avoidance and anxiety, sex, age and perceived stress as independent variables. Results One hundred twenty-one patients (94% of candidates for elective cardiac surgery who met study inclusion criteria) underwent surgery; 61(59%) were assessed after 6 months. Fourteen subjects (19.7%) scored ≥35 on the PTSS-10 at followup and were considered as having a probable diagnosis of PTSD. Attachment related avoidance at baseline predicted the development of PTSD at follow-up (p Conclusions Subjects endorsing the avoidant attachment style are more likely to develop PTSD after cardiac surgery.

Psychic euosmia and obsessive compulsive personality disorder

Patients with obsessive compulsive personality disorder (OCPD) often refer to a prompt mood improvement upon encountering good scents in general, or fresh laundry borax on their clothes, pillows or home settings. The Authors propose the new term psychic euosmia in the mean of an overstated psychological predisposition for a real pleasant smell that elicits an immediate sense of pleasure, order and calm. The prompt reactions to a pleasant odor might be explained by the involvement of rhinencephalon and its proximity to mood-related limbic circuits, which bypass the cognitive awareness. Cleanliness may not preclude a subject to enjoy a good smell, even if we are representing smells that resemble freshness, in other words order. A potentially even more important argument is given by the continuum of personality disorders and their variability. Not all personality characteristics led to disturbed behaviors. In evolutionary perspectives having the ability to differentiate between unpleasant and pleasant odors should have made the difference in surviving. On the other hand, psychic euosmia could be considered a normal reaction, but in our clinical experience it is over-represented among OCPD subjects with marked orderliness and disgust. Therefore, detecting psychic euosmia might vicariously confirm the relevance of disgust as a cognitive driver of OCPD. Hereby we support research to characterize psychic euosmia as a feature of orderliness and cleanliness for OCPD.

EPA-1328 - Psychiatric comorbidities in the joint hypermobility syndrome/ehlers danlos syndrome hypermobility type

Introduction Joint Hypermobility Syndrome/Ehlers Danlos Syndrome Hypermobility Type (JHS/EDS-HT) is a hereditary connective tissue disorder, mainly characterized by joint hypermobility and instability, widespread chronic pain, and other secondary features. To date, psychiatric disorders have been scarcely investigated in the context of JHS/EDS-HT. Previous studies reported a high rate of panic and other anxiety disorders. No data regarding personality disorders are currently available. Aims To determine the prevalence of psychiatric comorbidities among patients with JHS/EDS-HT Methods We conducted a single-centre case-control study, enrolling consecutive JHS/EDS-HT patients and healthy controls. The psychiatric evaluation was based on the Structured Clinical Interview for DSM-IV Axis I and II disorders. Symptom severity was assessed using the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Brief Psychiatric Rating Scale. The Global Assessment of Functioning Scale was used to assess the overall severity of psychological, social, and occupational functioning. Results Forty-seven JHS/EDS-HT patients and 45 healthy controls were recruited. Cases had significantly higher mean scores for all the adopted measures, and a 4.3 higher risk of being affected by any psychiatric disorder when compared to controls. In particular, they had a 5.8 higher risk of having a personality disorders, and, specifically, a higher rate of OCPD (10.6%). Conversely, we did not observe a high prevalence of panic disorders, as previously reported. Conclusions Patients with JHS/EDS-HT show higher rates of mood and personality disorders (OCPD particularly), while we found low rate of anxiety disorders. The psychiatric evaluation of these patients is strongly recommended.

Is amisulpride safe when prescribed to breast and prostate cancer patients

In the last decades, the potential association between antidepressants and cancer risk has been increasingly investigated. Fundamental researches, performed on animal models and cell tumoral lines, have highlighted several biological mechanisms possibly supporting this association. Nevertheless, the epidemiological studies investigating the risk of cancer in patients receiving selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) have provided conflicting and inconclusive results. Therefore, the prescription of several antidepressants in oncologic patients still remains a matter of discussion. The aim of this review is to present and discuss available evidence concerning the association between the risk of breast and prostate cancer and the use of antidepressant medications. Thus, consistencies, differences, and contradictions of available data are reported. A special focus is addressed to amisulpiride, a widely prescribed drug still poorly investigated with regard to the risk of cancer occurrence and recurrence. Overall, there is no definitive evidence of increased risk of breast and prostate cancer among patients exposed to SSRIs and TCAs. The association between amisulpiride and cancer risk has been to date scarcely explored and considered in clinical settings. Nevertheless, the hyperprolactinemia frequently resulting from its adoption has been repeatedly associated, to increased cancer risk and poorer prognosis in cancer patients. Thus, the use of amisulpiride among cancer patients should be carefully considered.