[First episode psychoses: psychosocial, interpersonal and cognitive bases for a therapeutic approach]. / Le psicosi all'esordio: le basi psicosociali, interpersonali e cognitive per un razionale approccio terapeutico.

The occurrence of psychotic symptoms in first episode psychoses is the ultimate stage of a series of behavioural, cognitive and psychosocial signs. Among these, only a small set are pathognomonics, but more importantly, they continue to operate and to modify the clinical picture. The instability of diagnosis and outcome require a large series of multimodal and atheoretical treatment approaches. Interventions should be flexible, acceptable, intrinsically effective and evidence based. Clinical and therapeutic decisional algorithms will be presented to be adopted in mental health services for people at first episode psychoses.

Sensorimotor gating and habituation evoked by electro-cutaneous stimulation in schizophrenia.

The present study has been performed in order to evaluate two relevant phenomena related to startle reflex (SR) evoked by electro-cutaneous stimulation in schizophrenic patients: 1) the effect of different interstimulus intervals on R1, R2 magnitude and on R2 latency in schizophrenia in order to verify if the gating effect influences all blink reflex (BR) parameters and 2) to replicate and extend our previous data on SR habituation. Our data have confirmed the existence of an impairment of habituation and an abnormal facilitatory effect of R1 component of BR in schizophrenics compared to healthy controls. The present study provides further evidence of specific defective mechanisms of information processing in schizophrenia. The methodology used for SR paradigm appears to be founded on a sound research basis and represents an advantageous paradigm for assessing attentional variables of information processing in mental disorders.

Reduced temporal lobe areas in schizophrenia: preliminary evidences from a controlled multiplanar magnetic resonance imaging study.

Seventeen young patients with relapsing schizophrenia and 13 normal controls matched for age, gender, and educational level underwent magnetic resonance imaging (MRI) scans. Three sagittal, eight axial, and seven coronal images were obtained for all subjects. Schizophrenic patients showed a reduction of brain tissue in the temporal lobes. Among the several brain structures identified, left temporal lobe area, but not ventricular brain ratio (VBR), discriminated between the two groups. As VBR has been reported to be increased in the more severe forms of schizophrenia, temporal lobe abnormalities may characterize the less severe cases of schizophrenia.

Startle reflex habituation in functional psychoses: a controlled study.

The habituation of the startle reflex in a paradigm using electrical stimulation was studied in 17 psychotic patients and 18 healthy controls. The magnitude of the R2 component of the blink reflex differed between the groups (ANOVA, F = 5.81; P = 0.022) and during the course of trials (F = 25.72; P < 0.0001). Furthermore a statistically significant interaction of diagnosis x trials (F = 3.34; P = 0.022) emerged suggesting that an impairment in habituation of startle is present in patients but not in healthy controls despite a comparable reactivity.

No evidence of linkage between schizophrenia and D2 dopamine receptor gene locus in Italian pedigrees.

Our purpose was to test the dopamine D2 receptor gene (DRD2), the tyrosine hydroxylase (TH) gene and the monoamino oxydase A (MAO-A) gene for linkage to schizophrenia and bipolar disorders. We have analyzed seven Italian families with schizophrenia and four families with bipolar disorders for a total of 68 individuals; 32 individuals were affected. Diagnoses were made using the structured clinical interview Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L). The results of our study provide no evidence of linkage between alleles at D2 dopamine receptor loci and schizophrenia or bipolar disorders. The markers TH gene and MAO-A gene give slightly positive or negative results suggesting the utility of further analysis on more informative families.

Etizolam in the treatment of generalized anxiety disorder: a double-blind study versus placebo.

A double-blind, placebo-controlled study was carried out in 36 patients diagnosed as suffering from Generalized Anxiety Disorder with associated depressive symptoms to assess the efficacy and tolerability of two unitary doses of etizolam. After a 1-week wash-out period on placebo, patients were assigned at random to receive 1 tablet twice daily of either 0.50 mg or 0.25 mg etizolam or placebo for 5 weeks. Assessments were made at entry, on Day 21 and Day 35 of the patients' condition and symptoms using a battery of four psychometric tests (the Hamilton rating scales for anxiety and for depression, the Covi scale for anxiety and the Raskin scale for depression). Ten patients were withdrawn before the end of the study, 8 because of inadequate response (4 on placebo, 3 on 0.25 mg etizolam and 1 on 0.50 mg etizolam) in spite of dosage increase to 1 tablet 3-times daily, and 2 because of side-effects (both on 0.50 mg etizolam). Analysis of the results from the remaining 26 patients showed that, at the 0.50 mg dosage level, etizolam produced significant improvement in anxiety and depressive symptoms, particularly somatic manifestations, and was significantly more effective than placebo or the 0.25 dosage regimen. Etizolam was generally well tolerated and the few side-effects reported, mainly daytime drowsiness, were of mild to moderate severity.

Double-blind study of the efficacy and safety of sertraline versus fluoxetine in major depression.

An eight-week double-blind, multicentre study was performed to evaluate the efficacy and safety of sertraline vs. fluoxetine in the treatment of major depression (DSM-III-R). There were 108 out-patients, from nine Italian centres, entered into the study, of whom 88 were evaluable (48 sertraline, 40 fluoxetine). The final mean daily dose of sertraline was 72 mg and for fluoxetine it was 28 mg. Both treatment groups showed a statistically significant improvement from baseline at one week, and this was maintained until the end of treatment for all of the following measures: Hamilton Rating Scales for Depression and Anxiety, the Montgomery Asberg Depression Rating Scale, Clinical Global Impressions Scale, Zung Self-Rating Scale for Anxiety and the Leeds Sleep Evaluation Questionnaire. Although there was a numerical advantage for sertraline on several efficacy measures, there was no statistically significant difference found between the treatment groups. The incidence of adverse events was similar for both treatments; 40.4% for sertraline and 39.3% for fluoxetine. However, adverse events were generally rated by patients as of lower severity in the sertraline group. In addition, for the fluoxetine group, there was a higher incidence of agitation, anxiety and insomnia than for sertraline. Sertraline was considered to be better tolerated than fluoxetine overall, since only 9.6% of sertraline-treated patients discontinued treatment due to therapy failure whereas in the fluoxetine-treated group this figure was 19.6%. By contrast, 13.5% of sertraline-treated patients discontinued prematurely because of clinical improvement, compared with 10.7% of fluoxetine-treated patients.

Neurological soft signs as predictors of central nervous system involvement in HIV-1 infection.

There is increasing evidence in the literature to suggest that HIV-1 infection involves the central nervous system (CNS) as a result of its direct neurotropic properties. In order to find predictors of neurological dysfunction in HIV-1 infection 20 seropositive patients were studied. Data support the notion that neurological soft signs correlate with the stage of infection that may be considered an informative predictor of CNS involvement during the course of HIV-1 infection.

Chronic tension-type headache, mood depression and serotonin: therapeutic effects of fluvoxamine and mianserine.

Forty out-patients affected by chronic tension-type headache were selected according to the diagnostic criteria of International Headache Society (IHS) Headache Classification Committee. In a controlled trial patients received placebo for a four-week baseline period, then they were randomized in double-blind fashion to therapy with mianserine (30-60 mg/day) of fluvoxamine (50-100 mg/day) for another eight-week period. Frequency of headache, pain severity and analgesic consumption were evaluated using a self-monitoring system. Mood depression was evaluated at 0, 4 and 8 weeks by using Zung's Self-Rating Depression Scale and Hamilton Rating Scale for Depression. Both drugs were beneficial in the treatment of chronic tension-type headache. Non-depressed subjects with more severe headache responded best to fluvoxamine, whereas mianserine was more effective in the treatment of depressed patients with moderate headache. These results suggest that central serotoninergic neurotransmission can play a role in the pathophysiology of chronic tension-type headache also in non-depressed patients.

[Symptoms and social functioning features in chronic schizophrenia are aggregate in a tripartite structure]. / Le caratteristiche sintomatologiche e di funzionamento sociale nella schizofrenia cronica si aggregano in una struttura tripartitica.

OBJECTIVE: To verify the association between schizophrenic symptoms and multidimensional variables of social functioning and to look for a possible classification based on an empirical classification outcome oriented. DESIGN: Forty chronic schizophrenic patients, with a diagnosis ascertained through clinical interview and diagnostic criteria were enrolled in the study. SETTING: All patients were followed in a State Mental Health center and were assessed in a stabilized phase of illness. PRINCIPAL OUTCOME MEASURES: Psychopathological assessment was made with PANSS and CGI. Psychosocial assessment was made with Life Skills Profile and Global Functioning Scale. RESULTS: A pervasive correlation among symptoms and psychosocial variables emerged suggesting a unitary concept of behavior related to diagnosis. Factor analysis revealed 2 main components able to explain the 79% of variance. Cluster analysis separated the patients in 3 different groups showing that clinical symptoms are aggregated with specific variables of social functioning. CONCLUSION: Schizophrenic symptoms and social functioning are organized in a tripartite structure. It suggests the existence of three different syndromes that are outcome oriented, and compatible with an unitary concept of schizophrenia.

Acoustic and electrically elicited startle reaction: similar patterns of habituation and reflex modifications in humans.

The present study was performed in order to verify two relevant phenomena related to Startle Reaction in normal subjects: 1) the response habituation, that consists of an exponential decrement of the R2 component of Blink Reflex after repeated identical stimuli, and 2) the modification of R1 magnitude, R2 magnitude and latency when the startle eliciting stimulus is preceded by a warning stimulus. Our data confirm: 1) that habituation is independent of paradigm and type of stimulation (acoustic vs electrocutaneous), and 2) an electrical prestimulus has a facilitatory effect on the R2 latency of the electrically elicited Blink Reflex onset with an inhibition of R2 magnitude. The present study support the view of a systemic supramodal central mechanism of information processing and sensorial gating with super-imposable effects on the different sensorial pathways.

Neuropsychological and clinical correlates of temporal lobe anatomy in schizophrenia.

Twenty-five DSM-III schizophrenic patients were assessed neuromorphologically and neuropsychologically. Reduced temporal lobes were found through magnetic resonance imaging (MRI) evaluation. In addition, in order to look for the neuropsychological correlates of temporal anatomy in schizophrenia, patients were divided into cognitive normal and abnormal schizophrenics, according to their Luria Nebraska Neuropsychological Battery profile. The latter group had statistically significant temporal lobe abnormalities as assessed by MRI, irrespective of medication, clinical picture or any other relevant variables. The implication of such findings in the light of the diaschisis model is discussed.

Social disability and clinical symptomatology in schizophrenia: their impact on compulsory admission.

In order to evaluate the peculiar features of a population of compulsorily admitted (CA) versus voluntarily admitted (VA) schizophrenics, the psychopathological status, disability measure and sociodemographic characteristics were recorded for the two studied groups. Among other assessed variables only the total score of the Current Behavioral Schedule (CBS), used as a global index of impairment, differentiated the two groups, CA patients being the more severely impaired. The severity of the CBS measure correlated with the length of current hospitalization in the CA but not in the VA group.

A computerized tomographic study in patients with depressive disorder: a comparison with schizophrenic patients and controls.

Using computed tomography, Ventricular Brain Ratio (VBR) was assessed in a sample of 42 depressive patients, 36 schizophrenic patients and 37 controls. The values of affective patients laid between, but did not differ significantly from those of schizophrenic patients on the one hand and controls on the other. The schizophrenic patients showed VBR increase when compared to controls. Possible implications of VBR measurement, in patients with affective illness are discussed.