Vladimir Carli

The Association between Pathological Internet Use and Comorbid Psychopathology: A Systematic Review

Background: Pathological Internet use (PIU) has been conceptualized as an impulse-control disorder that shares characteristics with behavioral addiction. Research has indicated a potential link between PIU and psychopathology; however, the significance of the correlation remains ambiguous. The primary objective of this systematic review was to identify and evaluate studies performed on the correlation between PIU and comorbid psychopathology; the secondary aims were to map the geographical distribution of studies, present a current synthesis of the evidence, and assess the quality of available research. Sampling and Methods: An electronic literature search was conducted using the following databases: MEDLINE, PsycARTICLES, PsychINFO, Global Health, and Web of Science. PIU and known synonyms were included in the search. Data were extracted based on PIU and psychopathology, including depression, anxiety, symptoms of attention deficit and hyperactivity disorder (ADHD), obsessive-compulsive symptoms, social phobia and hostility/aggression. Effect sizes for the correlations observed were identified from either the respective publication or calculated using Cohen’s d or R2. The potential effect of publication bias was assessed using a funnel plot model and evaluated by Egger’s test based on a linear regression. Results: The majority of research was conducted in Asia and comprised cross-sectional designs. Only one prospective study was identified. Twenty articles met the preset inclusion and exclusion criteria; 75% reported significant correlations of PIU with depression, 57% with anxiety, 100% with symptoms of ADHD, 60% with obsessive-compulsive symptoms, and 66% with hostility/aggression. No study reported associations between PIU and social phobia. The majority of studies reported a higher rate of PIU among males than females. The relative risks ranged from an OR of 1.02 to an OR of 11.66. The strongest correlations were observed between PIU and depression; the weakest was hostility/aggression. Conclusions: Depression and symptoms of ADHD appeared to have the most significant and consistent correlation with PIU. Associations were reported to be higher among males in all age groups. Limitations included heterogeneity in the definition and diagnosis of PIU. More studies with prospective designs in Western countries are critically needed.

Mono- and polysubstance dependent subjects differ on social factors, childhood trauma, personality, suicidal behaviour, and comorbid Axis I diagnoses

BACKGROUND The study aimed to examine the clinical correlates of polysubstance dependence. SUBJECTS AND METHODS Seven hundred and fifty two substance-dependent subjects were interviewed with the Mini-International Neuropsychiatric Interview, the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA), and the Hamilton Depression Rating Scale (HDRS). Subjects completed the Childhood Trauma Questionnaire (CTQ), Eysenck Personality Questionnaire (EPQ), and Barratt Impulsivity Scale (BIS). Subjects found to have polysubstance dependence were compared with subjects with monosubstance dependence. RESULTS Polysubstance dependence was found in 48.3% of the subjects. Subjects with polysubstance dependence were significantly younger, more were separated/divorced and unemployed, and they had significantly higher CTQ scores for childhood emotional and physical neglect, higher EPQ psychoticism scores, higher BGLHA aggression scores, and higher BIS impulsivity scores. Significantly more of the polysubstance dependent subjects had attempted suicide, self-mutilated, and exhibited aggressive behavior. Significantly more monosubstance dependent subjects had an Axis I psychiatric disorder and they had higher HDRS depression scores. CONCLUSIONS Polysubstance dependence is common among the groups studied and may be associated with certain socio-demographic, developmental, and personality factors.

Association of polymorphism (Val66Met) of brain-derived neurotrophic factor with suicide attempts in depressed patients

Introduction: Recent post-mortem studies of suicide victims have implicated brain-derived neurotrophic factor (BDNF) in suicide. Therefore, it was decided to examine the possible role of a gene in the regulation of BDNF activity in relation to suicidal behaviour among depressed patients. Method: A series of 170 depressed patients were evaluated for their history of suicide attempts and genotyped for the BDNF Val66Met polymorphism (SNP ID: rs6265). Depressed patients who had (n = 97) or had not (n = 73) attempted suicide were compared. Results: Depressed patients who carried the BDNF Val66Met polymorphism variant (GA + AA) appeared to show a significantly increased risk of suicidal behaviour. The risk of a suicide attempt was also significantly higher among those reporting higher levels of childhood emotional, physical and sexual abuse. Secondary analyses suggested that depression severity was a significant risk factor only in the wild-type BDNF genotype, and that the risk of suicide attempts was more predictable within the wild-type group. Conclusion: These preliminary data suggest that BDNF may play a role in the suicidal behaviour of depressed patients.

Childhood trauma as a correlative factor of suicidal behavior via aggression traits. Similar results in an Italian and in a French sample

BACKGROUND AND OBJECTIVE Childhood trauma and aggressive traits are considered risk factors for suicidal behavior. The hypothesis we aimed to test in this study was the existence of an association between childhood trauma and aggression in two distinct samples of Italian and French suicide attempters. METHOD Study participants comprise 587 subjects with different psychiatric diagnoses according to DSM-IV-TR criteria. Three different samples were analyzed and compared: a group of French suicide attempters (N=396; mean age 40.47 SD=13.52; M/F: 110/286); a group of Italian suicide attempters (N=103; mean age 38.60 SD=12.04; M/F 27/76) and an Italian psychiatric comparison group (N=88; mean age: 41.49 SD=12.05; M/F; 37/51). Patients were interviewed with the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and the Childhood Trauma Questionnaire (CTQ) 34-items for Italian data and 28-items for French data. RESULTS When compared with the comparison group, Italian suicide attempters had significantly higher scores on the BGLHA scale and reported higher scores on the CTQ scores for physical abuse, sexual abuse and emotional abuse. Significant correlations between childhood trauma and aggression were found in both groups, Italian and French, of suicide attempters. CONCLUSION The hypothesis tested was supported as psychiatric patients who had attempted suicide reported significantly more childhood trauma and aggression. Significant correlations were found between aggressive behavior, and childhood trauma in suicidal patients. This finding was replicated in two independently recruited samples in two countries with different prevalence of suicidal behavior.

Low resilience in suicide attempters

Resilience is an important personality feature that is thought to be protective against the development of psychiatric disorder. However, it appears not to have been previously examined directly in relation to suicidal behavior. Therefore, with the recent development of a resilience scale, the purpose of this preliminary study was to examine resilience in relation to attempting suicide. In order to do this 100 abstinent substance dependent patients were interviewed about whether or not they had ever attempted suicide and completed the Connor–Davidson Resilience Scale. The results showed that patients who had attempted suicide (N = 41) had significantly lower resilience scale scores than patients who had never attempted suicide (N = 59). This suggests the possibility that low resilience may be a risk factor for suicidal behavior. Longitudinal studies among suicide attempters, including measures of depression, may further evaluate the possible relevance of resilience to suicidal behavior.

Association between childhood trauma and aggression in male prisoners

Childhood trauma and aggression were examined in 540 male prisoners. The Thus 540 male prisoners had a psychiatric interview, completed the Childhood Trauma Questionnaire (CTQ), and were assessed with the Brown-Goodwin Lifetime History of Aggression (BGHA) interview. There were significant correlations between CTQ scores and BGHA scores. Also prisoners with CTQ scores above the median had significantly higher BGHA scores than prisoners with CTQ scores below the median. Significantly more of the prisoners with CTQ scores above the median had more than one conviction, and significantly more had convictions as minors, and had exhibited violent behavior in prison. However, in logistic regression analyses that included possible confounding variables, CTQ scores related only to violence in prison while BGHA scores related to violent crime, having more than one conviction, conviction as a minor, and violence in prison. The relationship between CTQ and BGHA scores suggests the possibility that childhood trauma may be one determinant of aggression in prisoners.

The role of impulsivity in self-mutilators, suicide ideators and suicide attempters — A study of 1265 male incarcerated individuals

OBJECTIVE We explored differences between high and low-impulsive incarcerated individuals in the context of lifetime self-mutilation, suicide ideation and suicide attempt. METHODS A total of 1265 males detained in Italian penitentiary institutions were studied between January 2006 and December 2008. The study raters were specifically trained to discriminate between suicide attempters, ideators and self-mutilators. Participants completed the Barratt Impulsivity Scale, Childhood Trauma Questionnaire (CTQ), Eysenck Personality Questionnaire (EPQ), Connor-Davidson Resilience Scale (CD-RISC), Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and Buss and Durkee Hostility Inventory (BDHI). Based on BIS 7 total score distribution, two extreme quarters - high-impulsive group (n=306) and low-impulsive group (n=285) - were compared. RESULTS Over 42% of participants had lifetime suicide ideation, 13% attempted suicide and 17% were self-mutilators. High-impulsive subjects were younger, more often single and with more prominent psychoticism, extraversion, aggression, hostility and resilience capacity. They were more frequently diagnosed with substance use disorders and engaged in self-mutilating behaviour. There was no difference in the rate of suicide attempts between the two groups. CONCLUSION Although high-impulsive subjects were more prone to suicidal behaviour, it was not predicted by higher impulsivity when other psychological variables were accounted for.

Risk Factors for Attempting Suicide in Prisoners

We wished to examine determinants of suicidal behavior in prisoners. 903 male prisoners had a psychiatric interview which included various psychometric tests. Suicide attempters were compared with prisoners who had never attempted suicide. Significantly more of the attempters had a history of psychiatric disorder, substance abuse, a family history of suicidal behavior, convictions for violent crime, had exhibited aggressive behavior in jail, and had higher BGLHA aggression scores. A similar pattern of risk factors was found for prisoners with suicidal ideation. A lifetime history of attempting suicide, or of having suicidal ideation, is frequent in prisoners. Risk factors include family, developmental, aggression, personality, psychiatric, and substance abuse factors.

Brain derived neurotrophic factor (BDNF) genetic polymorphism (Val66Met) in suicide: a study of 512 cases.

Brain Derived Neurotrophic Factor (BDNF) Genetic Polymorphism (Val66Met) in Suicide: A Study of 512 Cases F. Zarrilli, A. Angiolillo, G. Castaldo, L. Chiariotti, S. Keller, S. Sacchetti, A. Marusic, T. Zagar, V. Carli, A. Roy, and M. Sarchiapone* Facolt a di Scienze MFN, Universit a del Molise, Isernia, Italy Dipartimento di Biochimica e Biotecnologie Mediche and Facolt a di Scienze Biotecnologiche, Universit a ‘‘Federico II’’, CEINGE-Biotecnologie Avanzate, Naples, Italy Dipartimento di Biologia e Patologia Cellulare e Molecolare, Universit a ‘‘Federico II’’, CEINGE-Biotecnologie Avanzate, Naples, Italy University of Primorska, Primorska, Slovenia Department of Health Sciences, University of Molise, Campobasso, Italy Psychiatry Service, Department of Veteran Affairs, Newark, New Jersey

Rare Genotype Combination of the Serotonin Transporter Gene Associated With Treatment Response in Severe Personality Disorder

The insertion deletion (ins/del) polymorphism of the serotonin transporter gene (5‐HTTLPR) has been associated with several psychiatric phenotypes and antidepressants response. We investigated, in a large cohort of 5,608 controls and subjects suffering from various psychiatric disorders, the frequency of haplotypes and corresponding genotypes combining the 5‐HTTLPR and the other serotonin transporter promoter functional variant (rs25531). We showed that rs25531 lies 18 bp 5′ to the site where the 43 bp (and not 44 bp as previously described) ins/del defines the 14‐ and 16‐repeat alleles. These polymorphisms should therefore be considered as four alleles instead of a triallelic unique locus. The very rare G‐14/G‐16 genotype was carried on by only three subjects. These are women with a history of suicide attempt with a psychiatric history strongly suggesting a borderline personality disorder. Two of them have shown a non‐response to serotoninergic antidepressant. Interestingly, in one of them was observed a spectacular response after the introduction of bupropion. The genotyping droved our therapeutic approach, by preferring a dopaminergic over a serotoninergic agent. This study highlights the usefulness of studying very rare clinical cases as well as rare variants, in order to deal with the biological heterogeneity of spectral disorders.