RESUMO
BACKGROUND: The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. METHOD: A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. RESULTS: We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (⩾14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. CONCLUSIONS: If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person.
Assuntos
Inteligência Emocional/fisiologia , Expressão Facial , Reconhecimento Facial/fisiologia , Esquizofrenia/fisiopatologia , Percepção Social , Senso de Humor e Humor como Assunto , Adulto , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Abstract: There is only limited epidemiological information on Orthorexia Nervosa; the aim of the present study is, therefore, to assess the prevalence of ON in a population of young adults and to identify possible specific features and eventual psychopatological dimensions. 1317 participants (732 females and 585 males; mean age 22.36 yrs) completed a battery containing the orthorexia measure (ORTHO-15), statements about demographic characteristics as well as physiological parameters. The mean ORTO-15 score was 31.89; considering the cut-off of 40 in the reference test, our results showed a 11.9% prevalence of ON. Analyzing the characteristics of the orthorexic group, the prevalence in females compared to males appears to be statistically very significant (115 vs 43; 72.8% vs 27.2%); moreover shows higher and statistically significant scores in each of the 15 items of the reference test compared to the non-orthorexic group. Our data confirming that ON might be a relevant and potentially underestimate phenomenon in the community. Further studies are warranted in order to explore the diagnostic boundaries of this syndrome, its course and outcome, and the possible therapeutic strategies.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Comportamentos Relacionados com a Saúde , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Ortorexia Nervosa , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Prevalência , Comportamento Alimentar , Inquéritos e Questionários , Itália/epidemiologiaRESUMO
Despite a wide range of available antidepressants, the effect of the treatment is often suboptimal and there is a need for more effective and better tolerated drugs. Unlike other antidepressants, agomelatine represents a new approach to depression with an innovative mechanism of action. It is an agonist of melatoninergic receptors MT1 and MT2 and a selective antagonist of 5-HT2c receptors. In this open-label 8-week study we aimed to investigate the efficacy of agomelatine on depressive symptoms in patients with major depression. Secondary endpoints were the effect of agomelatine on anhedonia. Thirty major depressive patients received a flexible dose (25-50 mg; per os, daily) of agomelatine. Depressive (Hamilton Depression Scale) and anxious (Hamilton Anxiety Scale) symptoms, anhedonia (Snaith Hamilton Rating Scale), and sleep quality (Leeds Sleep Evaluation Questionnaire) were assessed. Twenty-four patients (80%) completed 8 weeks of treatment. Significant improvements were seen at all visits on the HAM-D (p<.05), HAM-A(p<.01), SHAPS (p<.05), LSEQ (p<.05). Nine subjects (30%) were responders and 5 (17%) remitters at week 1; 18 (60%) were remitters by the end of the trial. There was no serious adverse event. No aminotrasferase elevations were noted. In line with previous studies, in which agomelatine was associated with early clinical improvement, this study also provides evidence of an early response and the findings of improvements in depression scores. Moreover, this is the first study where agomelatine was effective in the treatment of anhedonia. Additional trials are needed to delineate the place of agomelatine in the contemporary pharmacotherapy for depressive disorders.
Assuntos
Acetamidas/administração & dosagem , Antidepressivos/administração & dosagem , Transtorno Depressivo Maior/tratamento farmacológico , Hipnóticos e Sedativos/administração & dosagem , Antagonistas do Receptor 5-HT2 de Serotonina/administração & dosagem , Acetamidas/efeitos adversos , Adolescente , Adulto , Antidepressivos/efeitos adversos , Transtorno Depressivo Maior/metabolismo , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Receptor MT1 de Melatonina/agonistas , Receptor MT1 de Melatonina/metabolismo , Receptor MT2 de Melatonina/agonistas , Receptor MT2 de Melatonina/metabolismo , Receptor 5-HT2C de Serotonina/metabolismo , Antagonistas do Receptor 5-HT2 de Serotonina/efeitos adversosRESUMO
Daily rhythms regulate everiday life and sleep/wake alternation is the best expression of this. Disruptions in biological rhythms is strongly associated with mood disorders, often being the major feature of this, major depressive disorder first of all. Although stabilization of rhythms produced by treatments have important outcome on therapeutic efficacy, insomnia often remains an unresolved symptom when major depression has otherwise been successfully treated with antidepressant. We review scientific literature in order to better clarify how to better approach insomnia as a clinical aspect to investigate and to early treat while treating other psychiatric conditions, major depression in particular. Insomnia is associated with impaired quality of life. It can be resolved with adequate diagnosis and treatment: it should be considered a comorbid condition and should be early identificated and treated in a multidisciplinary way, so that the ideal of treatment for patients with treatment resistant insomnia in major depression is an integration of non-pharmacologic measures, along with judicious use of medication, often used as an adjunctive therapy.
Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Hipnóticos e Sedativos/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Tronco Encefálico/efeitos dos fármacos , Tronco Encefálico/fisiopatologia , Ritmo Circadiano/efeitos dos fármacos , Ritmo Circadiano/fisiologia , Terapias Complementares , Transtorno Depressivo Maior/complicações , Resistência a Medicamentos , Tolerância a Medicamentos , Humanos , Hipnóticos e Sedativos/classificação , Hipnóticos e Sedativos/farmacologia , Melatonina/agonistas , Melatonina/uso terapêutico , Neurotransmissores/fisiologia , Psicotrópicos/farmacologia , Psicotrópicos/uso terapêutico , Receptores de Melatonina/agonistas , Receptores de Melatonina/fisiologia , Receptores de Neurotransmissores/efeitos dos fármacos , Receptores de Neurotransmissores/fisiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Fases do Sono/efeitos dos fármacos , Fases do Sono/fisiologiaRESUMO
Psychiatric disorders are frequently associated with disturbances of sleep and circadian rhythms. This review focus on the relationship between sleep disturbances and eating disorders. In the first part are discussed the presence of sleep disorders among patients suffering from anorexia nervosa and bulimia nervosa, the macrostructure and microstructure of theirs sleep, the differences between the various subtypes in ED patients, the dreams of eating disordered patients and their recurrent contents. In the second part, there are treated sleep disturbances in binge eating disorder and other eating disorders not otherwise specified, such as nocturnal (night) eating syndrome and sleep-related eating disorder. In the third part, there are presented data concerning the neurobiological and neuroendocrinological correlates between feeding, metabolism, weight restoration and the processes regulating sleep. In conclusion, possible future investigations are proposed.