Is Food Addiction a Specific Feature of Individuals Seeking Dietary Treatment from Nutritionists?

Objective: Food addiction (FA) is a condition characterized by excessive and dysregulated consumption of high-energy food, and impulsivity. The diagnostic and nosological framework of FA is still controversial. Therefore, this study aimed at exploring the prevalence of FA in patients seeking help from nutritionists for weight loss, along with its relationship with eating habits, in a pool of 842 participants of both sexes. Method: Eating habits and FA were assessed by, respectively, a self-administered questionnaire and the Yale Food Addiction Scale (YFAS). Statistical analysis included Chi-square for categorical variables, independent t tests to investigate continuous variables and an univariate logistic regression analysis to determine potential risk factors for FA. The relationship between FA diagnosis and potential risk factors was assessed through a stepwise logistic regression model, controlling for age, sex, and body mass index (BMI) classes. Results: Our results indicate that a prevalence of FA in our sample was 15.3%, with no difference between women and men. A higher prevalence was recorded in overweight subjects or obese. According to the YFAS criteria, women were more likely to report a persistent desire and withdrawal than men. Patients with FA compared with those without it, reported a greater number of attempts to lose weight, to self-dieting, a different mealtime repertoire, and to nibble continuously throughout the day. Moreover, the amount of carbohydrates ingested in the same meal seems to represent an eating habit significantly associated with FA. Conclusions: Taken together, our findings show how patients seeking help from nutritionists may display some peculiar features of FA. In spite of its diagnostic controversies, it is evident that FA may play a role in obesity and may also be a feature of some psychopathological conditions. Therefore, it should be more deeply investigated and possibly specifically targeted with tailored therapeutic interventions.

GABA System in Depression: Impact on Pathophysiology and Psychopharmacology.

BACKGROUND: The pathophysiology of major depressive disorder (MDD), one of the major causes of worldwide disability, is still largely unclear, despite the increasing data reporting evidence of multiple alterations of different systems. Recently, there was a renewed interest in the signalling of gamma aminobutyric acid (GABA) - the main inhibitory neurotransmitter. OBJECTIVE: The aim of this study was to review and comment on the available literature about the involvement of GABA in MDD, as well as on novel GABAergic compounds possibly useful as antidepressants. METHODS: We carried out a narrative review through Pubmed, Google Scholar and Scopus, by using specific keywords. RESULTS: The results, derived from various research tools, strongly support the presence of a deficiency of the GABA system in MDD, which appears to be restored by common antidepressant treatments. More recent publications would indicate the complex interactions between GABA and all the other processes involved in MDD, such as monoamine neurotransmission, hypothalamus-pituitary adrenal axis functioning, neurotrophism, and immune response. Taken together, all these findings seem to further support the complexity of the pathophysiology of MDD, possibly reflecting the heterogeneity of the clinical pictures. CONCLUSION: Although further data are necessary to support the specificity of GABA deficiency in MDD, the available findings would suggest that novel GABAergic compounds might constitute innovative therapeutic strategies in MDD.

Food addiction and psychiatric comorbidities: a review of current evidence.

BACKGROUND: Food addiction (FA) is characterised by the consumption of appetible foods and by addictive psychological and behavioural symptoms such as cravings, tolerance, limited control of substance intake and withdrawal symptoms. Despite previous research on FA has been hindered by the lack of a formal definition for this condition, recent global trends have stirred the interest of the scientific community towards a proper classification and construct of FA. More specifically, recent studies have pointed towards shared defective neurobiological mechanisms as well as frequent comorbidities between FA, eating disorders, mood disorders, anxiety disorders and substance-related and addictive disorders. OBJECTIVE: In this review, we will provide an overview of the complex symptomatology of food addiction evaluating its relationship with mood disorders, anxiety disorders, eating disorders and substance-related and addictive disorders. METHODS: We wrote a systematic review and followed a PRISMA methods. RESULTS: Patients with FA and substance use disorders show similar risk factors, neurobiological and hormonal correlates, personality traits and symptom profiles. The presence of FA appears to be directly proportional to the burden of symptoms of affective disorder. The comorbidity between FA and other eating disorders is associated with worse clinical conditions and symptoms. CONCLUSION: FA should be considered a sort of transnosological construct existing in different psychopathological domains that have similarities with substance-related, affective, and eating disorders. Furthermore, FA seems to be likely an important factor related to several psychopathological dimensions, but further studies are needed to clarify this view. LEVEL OF EVIDENCE: Level V, review article.

Characteristics of Internet Use amongst Italian University Students.

BACKGROUND: Problematic Internet use (PIU), that may be defined as the inability to control one's use of Internet with negative consequences in daily life, is an emerging problem involving primarily, but not only young generations. Different studies have shown that students are particularly vulnerable to PIU. Given the paucity of information on PIU in our country, the aim of this paper was at investigating the characteristics of PIU amongst Italian University students. SUBJECTS AND METHODS: A self-assessment questionnaire, referred by the acronym QUNT ("Questionario sull'Utilizzo delle Nuove Tecnologie"), composed by 101 items grouped together to identify a series of factors, was developed and sent through e-mail invitation to several students from three Italian Universities. RESULTS: The returned questionnaires were 3324, out of a total of 51,304 sent, with no difference between the two sexes. On the contrary, the distribution of the QUNT factors was different in the two sexes, in people living alone and in overweight subjects. Men resulted to be more involved in online recreational activities, whereas women seemed more attracted to instant messaging and generally to social networks. PIU was significantly more present in men than women. The comparisons of QUNT factor scores in the four BMI categories showed that the greater the BMI the greater the score of some factors. CONCLUSIONS: The findings of the present study indicate that the use of Internet through new technologies may exceed its real utility amongst Italian university student, with some sex-related differences. Men seem more prone to use Internet for passing time and women for social relationships. Men are also at risk of developing PIU. Again, Internet use might be a basic vulnerability factor of increasing weight gain and obesity amongst young people.

Effectiveness of clozapine, oxcarbazepine and rivastigmine combination in a bipolar disorder patient with initial cerebral atrophy.

This paper reports the case of a 46-year-old woman suffering from bipolar disorder of type I with mixed features with initial fronto-temporal atrophy. Although considered treatment-resistant to conventional strategies, she successfully responded to a combination of rivastigmine, clozapine, and oxcarbazepine.

Sex-Related Differences in Plasma Oxytocin Levels in Humans.

BACKGROUND: Increasing evidence supports a key role of Oxytocin (OT) as a modulator of social relationships in mammals. OBJECTIVE: The aim of the present study was to investigate possible sex-related differences in plasma OT levels in human beings. METHODS: Forty-five healthy men and 45 women (mean age: 34.9 ± 6.2 years), were included in the study. Plasma preparation, peptide extraction and OT radioimmunoassay were carried out according to standardized methods. RESULTS: The results showed that OT plasma levels (pg / ml, mean ± SD) were significantly higher in women than in men (4.53 ± 1.18 vs 1.53 ± 1.19, p ˂ 0.001). CONCLUSIONS: The present finding demonstrates sex-related differences in plasma OT levels in humans. It is tempting to hypothesize that such differences might be related to behaviours, attitudes, as well as susceptibility to stress response, resilience and social emotions specific of women and men.

Pharmacotherapeutic strategies for treating binge eating disorder. Evidence from clinical trials and implications for clinical practice.

INTRODUCTION: Binge eating disorder (BED) is the most common eating disorder and was newly recognized in 2013 in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). BED is frequently associated with obesity and the metabolic syndrome, as well as with other psychiatric diseases, such as mood (49%), anxiety (41%), and substance use (22%) disorders. BED is highly prevalent and carries a high burden of mental and physical illness and disability. However, BED is frequently under-recognized and under-treated. AREAS COVERED: This paper reviews the main pharmacological treatments for BED and provides an expert opinion based on the available evidence and on the authors' clinical experience with patients affected by BED. EXPERT OPINION: Several medications have proven to be effective for the treatment of BED, including Lisdexamfetamine (LDX), topiramate as well as anti-anxiety and antidepressant medications. To date, LDX is the only FDA approved medication for BED. Consequently, as a general rule, the use of an FDA approved medication should always be preferred. However, when in the presence of concomitant psychiatric conditions such as anxiety or depression, other medications that have proven efficacy in those comorbid conditions can be used and may contextually provide a benefit for BED.

Food addiction: is it a nosological category or a psychopathological dimension? Preliminary results of an Italian study.

Background Food addiction (FA) is a controversial concept, denoting the craving for certain foods. Given the little information available, the aim of this study was to evaluate the possible relationships between FA and full-blown and subthreshold psychopathology or eating behaviors in subjects consulting nutritional biologists. Materials and methods Three-hundred and fifty subjects completed the following self-questionnaires: Yale Food Addiction Scale (YFAS), Structured Clinical Interview for Mood Spectrum, Self-Report, Lifetime Version (MOOD-SR-LT), Symptom Checklist-90-Revised (SCL-90-R), Structured Clinical Interview for Anorexic-Bulimic Spectrum, Self-Report, Lifetime Version (ABS-SR-LT). Results Most of the subjects were women (n = 278) and the remaining were 72 men. A large proportion of the subjects (77.1%) had a YFAS score <3 and 22.9% ≥3, with no difference between men and women. The YFAS scores ≥3 were significantly and positively related to the all ABS-SR-LT domains, as well as to three dimensions (Depression, Hypomania, Rhythmicity) of the MOOD-SR-LT, and some SCL-90-R domains (Sensitivity, Psychoticism, General Symptom Index and Positive Symptom). Conclusion Our data, while indicating that FA is related to different subthreshold psychopathological domains, in particular, with both depressive and manic symptoms, as well as with rhythmicity of mood spectrum, or with eating subthreshold symptoms, would suggest that it might be a dimension underlying different conditions or symptom clusters.

Human Appeasing Pheromone (HAP) influence on behavior and psychopathological residual symptoms of patients with complex psychiatric disorders.

This article is a case-report series showing the effectiveness of a three-month exposure to a synthetic analogue of Human Appeasing Pheromone as add-on strategy to psychopharmacological treatment on behavioral and residual symptoms of three patients suffering from severe psychiatric disorders with complex clinical pictures.

The Glutamate and the Immune Systems: New Targets for the Pharmacological Treatment of OCD.

BACKGROUND: In the last decades the pharmacological treatment of obsessivecompulsive disorder (OCD) has been significantly promoted by the effectiveness of selective serotonin (5-HT) reuptake inhibitors (SSRIs) and the subsequent development of the 5-HT hypothesis of OCD. However, since a large majority of patients (between 40% and 60 %) do not respond to SSRIs or strategies based on the modulation of the 5-HT system, it is now essential to search for other possible therapeutic targets. AIMS: The aim of this paper was to review current literature through a PubMed and Google Scholar search of novel hypotheses and related compounds for the treatment of OCD, with a special focus on the glutammate and the immune systems. DISCUSSION: The literature indicates that glutamate, the main excitatory neurotransmitter, might play an important role in the pathophysiology of OCD. In addition, a series of clinical studies also supports the potential efficacy of drugs modulating the glutamate system. The role of the immune system alterations in OCD in both children and adults needs to be more deeply elucidated. In children, a subtype of OCD has been widely described resulting from infections driven by group A streptococcus ß-hemolitic and belonging to the so-called "pediatric autoimmune neuropsychiatric disorders associated with streptococcus" (PANDAS). In adults, available findings are meager and controversial, although interesting. CONCLUSION: The glutamate and the immune systems represent two intriguing topics of research that hold promise for the development of open novel treatment strategies in OCD.

Psychopathology of terrorists.

Terrorist behavior represents a subtype of human aggression probably determined by a combination of biological, psychological, and social factors, as well as by peculiar environmental influences and group dynamics. As regards terrorists' psychological characteristics, the available studies (mostly carried out with no sound scientific design) have failed to identify the common or typical pathological personality traits of modern terrorists. The popular opinion that terrorists must be insane or psychopathic is still widespread; however, no evidence exists that terrorist behavior may be caused either by prior or current psychiatric disorders or psychopathy. Not surprisingly, some theories have proposed social factors and non-pathological psychological traits as predisposing elements for terrorist acts, but they generally lack of empirical validation. Moreover, most of these theories do not explain why, even if so many people are exposed to the same social factors or show the same psychological traits, only a tiny minority of them join a terrorist group. Therefore, it is mandatory that systematic and scientific investigations be carried out in order to understand the possible bases for terrorist aggression, including the early detection of possibly associated psychopathology, and to design an appropriate counterterrorism prevention policy.

The mind of suicide terrorists.

After reviewing the available literature about the main hypotheses on suicide terrorism and the psychological characteristics of terrorists that have been proposed throughout the years, the present authors have put forward some personal considerations on what the distinctive traits of today's suicide bombers might be. In spite of the heterogeneity and paucity of "real" data, it is evident that there is no peculiar familial, educational, or socioeconomic factors that may account for religious radicalization leading to suicide terrorism. On the contrary, some common psychological features can be highlighted: such as isolation, feelings of emptiness, cold rationality, a lack of empathy, and a lust for martyrdom and death. To die to kill: this is the core feature, a sort of organizer that can twist higher cognitive and emotional processes, resulting in the supreme and highly rewarding suicidal and killing behaviors.

Italian prescribing patterns in obsessive-compulsive disorder.

The aim of the present study was to investigate psychopharmacological prescribing patterns in a large sample (n = 1815) of patients suffering from obsessive-compulsive disorder (OCD) recruited in 4 Italian centers specialized in OCD, in comparison to available national and international guidelines. The centers were asked to complete a specific data sheet questionnaire on patients' therapeutic status. Statistical analyses were carried out by SPSS. The results showed that almost all patients referred to the centers of Milan, Pisa and Rome received psychotropic medications, whereas only 59.9% (313) did so in Turin. Selective serotonin reuptake inhibitors were the most used drugs ranging between 49.0% and 71.5%. Clomipramine was prescribed more often in Rome and Pisa than in Milan and Turin. The same was true for other tricyclic antidepressants. Second-generation antipsychotics were more often prescribed in Pisa and in Milan. Mood stabilizers were almost exclusively used in Pisa. Taken together, the overall findings would suggest that, although the main Italian centers specialized in OCD follow available guidelines, a certain degree of variability does exist. This may depend on the different educational background, availability of other specific therapeutic strategies, as well as varying levels of severity and comorbidity of the patients.

Decreased lymphocyte dopamine transporter in romantic lovers.

OBJECTIVE: The role of dopamine (DA) in romantic love is suggested by different evidence and is supported by the findings of some brain imaging studies. The DA transporter (DAT) is a key structure in regulating the concentration of the neurotransmitter in the synaptic cleft. Given the presence of DAT in blood cells, the present study aimed to explore it in resting lymphocytes of 30 healthy subjects of both sexes in the early stage of romantic love (no longer than 6 months), as compared with 30 subjects involved in a long-lasting relationship. METHODS: All subjects had no physical or psychiatric illness. The DAT was measured by means of the [3H]-WIN 35,428 binding and the [3H]-DA reuptake to resting lymphocytes membranes. Romantic love was assessed by a specific questionnaire developed by us. RESULTS: The results showed that the subjects in the early phase of romantic love had a global alteration of the lymphocyte DAT involving both a decreased number of proteins (Bmax) and a reduced functionality (Vmax). CONCLUSIONS: Taken together, these findings would indicate the presence of increased levels of DA in romantic love that, if paralleled by similar concentrations in the brain, would explain some peculiar features of this human feeling.

Clinical correlates of plasma brain-derived neurotrophic factor in post-traumatic stress disorder spectrum after a natural disaster.

Clinical correlates of plasma Brain-Derived Neurotrophic Factor (BDNF) have been investigated in a clinical population with Post Traumatic Stress Disorder (PTSD) symptoms and healthy control subjects who survived to the L'Aquila 2009 earthquake. Twenty-six outpatients and 14 control subjects were recruited. Assessments included: Structured Clinical Interview for DSM-IV Axis-I disorders Patient Version, Trauma and Loss Spectrum-Self Report (TALS-SR) for post-traumatic spectrum symptoms. Thirteen patients were diagnosed as Full PTSD and 13 as Partial PTSD. The subjects with full-blown PTSD showed lower BDNF level than subjects with partial PTSD and controls. Different relationship patterns of BDNF with post-traumatic stress spectrum symptoms have been reported in the three samples. Our findings add more insight on the mechanisms regulating BDNF levels in response to stress and further proofs of the utility of the distinction of PTSD into full and partial categories.

Current Trends on Antipsychotics: Focus on Asenapine.

Over the years, both first- (FGAs) and second-generation antipsychotics (SGAs), continue to gain increasing evidence of being effective in the treatment of psychotic symptoms. Currently, they represent the first-line treatment of schizophrenia and bipolar disorder, although they are widely used in psychotic depression and other clinical conditions, such as agitation and/or behavioural disturbances. Despite representing an indispensable tool for the treatment of severe psychotic disorders, they are widely known to have a number of unwanted side effects that the clinician must be aware of, and handle carefully to provide the patient the best available treatment in the short and long-term. However, even with respect to the long-term use of some of the most effective SGAs, it is imperative for clinicians not to overlook the risk linked to the onset of potentially severe metabolic side effects such as weight gain, dyslipidaemia, insulinresistance and type II diabetes. Asenapine is one of the newest SGAs licenced in Europe for the treatment of manic episodes and in the US for schizophrenia. It belongs to the same class of clozapine, olanzapine and quetiapine, sharing with them a rather complex pharmacological binding profile. In fact, asenapine shows a high affinity for the serotonin (5HT) receptor of the type 2A (5HT2A) and to a lesser extent for the dopamine receptor of the type 2 (D2), similar to other SGAs. Asenapine behaves also as an antagonist at the level of 5HT2C, H1 and α2-receptors. Asenapine has been reported to be effective either in monotherapy or in combination with mood stabilers (lithium and valproate) in the treatment of manic or mixed episodes, with a lower propensity to induce, or being followed by, depressive symptoms, when compared to other SGAs. These unique properties may explain the increasing interest towards the use of this drug in mixed states, besides schizophrenia and acute mania. The aim of this paper was at reviewing current data on pharmacological properties and clinical use of asenapine, as well as on possible future indication of this SGA.

Asenapine augmentation in bipolar disorders: a case series.

Asenapine, a novel second-generation antipsychotic is effective in acute treatment of bipolar I disorder patients in combination with mood stabilizers even in resistant cases. Although there is no evidence for asenapine's efficacy to be superior to currently available agents, asenapine's favorable weight and metabolic profile are of clinical interest.

Plasma Oxytocin Levels in Untreated Adult Obsessive-Compulsive Disorder Patients.

BACKGROUND AND AIM: Given the paucity of information on the possible role of oxytocin (OT) in the pathophysiology of obsessive-compulsive disorder (OCD), our study aimed at evaluating plasma OT levels in a group of 44 OCD outpatients, as compared with a similar group of healthy control subjects. At the same time, the relationships between OT and clinical features and romantic attachment characteristics were examined as well. METHODS: Diagnosis was assessed according to DSM-IV-TR criteria, while the OCD severity was measured by means of the Y-BOCS rating scale. All patients were drug free and not depressed. The romantic attachment was assessed by means of the Italian version of the 'Experiences in Close Relationships' questionnaire. Plasma OT levels were evaluated by means of a standard RIA kit. RESULTS: The main findings of our study showed that OT levels were increased in OCD patients, as compared with healthy subjects, and negatively related to symptom severity. Positive relationships were detected between OT levels and the fearful-avoidant and dismissing styles of romantic attachments, but only in male OCD patients. CONCLUSION: Taken together, these findings suggest that OT may play a role in OCD pathophysiology and also in the romantic attachment of patients with gender specificity.

Nalmefene: A Novel Drug for an Old Disorder.

Alcoholism is an increasing problem all over the world, and nowadays especially amongst teenagers. Although several drug treatments have been proposed for this condition, only a few have demonstrated a significant efficacy. Nalmefene, a novel compound that combines opioids mu-receptors antagonism and kappa-receptors partial agonism, was recently approved by the European Medicine Agency for the treatment of alcoholism. This drug can be very helpful in reducing the alcohol intake, and, as such, it can be considered one of the first and fundamental steps towards alcohol abstinence. The aim of this review is to discuss and comment on the available literature on nalmefene, as well as on novel treatment strategies of this condition (and perhaps of other addictions) opened by this latest pharmacological approach.