Calcite as a Precursor of Hydroxyapatite in the Early Biomineralization of Differentiating Human Bone-Marrow Mesenchymal Stem Cells.

Biomineralization is the process by which living organisms generate organized mineral crystals. In human cells, this phenomenon culminates with the formation of hydroxyapatite, which is a naturally occurring mineral form of calcium apatite. The mechanism that explains the genesis within the cell and the propagation of the mineral in the extracellular matrix still remains largely unexplained, and its characterization is highly controversial, especially in humans. In fact, up to now, biomineralization core knowledge has been provided by investigations on the advanced phases of this process. In this study, we characterize the contents of calcium depositions in human bone mesenchymal stem cells exposed to an osteogenic cocktail for 4 and 10 days using synchrotron-based cryo-soft-X-ray tomography and cryo-XANES microscopy. The reported results suggest crystalline calcite as a precursor of hydroxyapatite depositions within the cells in the biomineralization process. In particular, both calcite and hydroxyapatite were detected within the cell during the early phase of osteogenic differentiation. This striking finding may redefine most of the biomineralization models published so far, taking into account that they have been formulated using murine samples while studies in human cell lines are still scarce.

Hyperprolactinemia Induced by Antipsychotics: From Diagnosis to Treatment Approach.

Schizophrenia is one of the most severe psychiatric diseases with a significant impact on the psychosocial functioning of the patients. People with schizophrenia are at risk to die prematurely because of their illness with their poor lifestyle contributing to the excess morbidity and higher mortality rate. In particular, lifestyle (e.g. poor diet, low rates of physical activity and increased likelihood to smoke cigarettes) predisposes them to poor physical health and comorbid medical diseases. In addition, the treatment of schizophrenia usually involves the long-term administration of antipsychotic drugs and some of these medications are implicated in the increased risk of metabolic and cardiovascular effects. The antipsychotic-induced hyperprolactinemia was ascertained for the first time by Kleinberg in 1971 and was considered for this treatment. Antipsychotics are the most common pharmacological agents which cause hyperprolactinemia The aim of this review is to describe PRL physiology, PRL biological effects and pathway to the diagnosis, causes, consequences of HPRL focusing on the antipsychotic effects on the PRL. We conducted a review of studies published between 1974 and December 2014. The search was performed using the following PubMed search terms: "Hyperprolactinemia" and "antipsychotic" and 827 papers were detected. The articles were examined and the overlapping or insufficiently clear works were excluded. Finally we chose 104 titles. We added to the selected articles additional articles, including 28 articles regarding the latest international guidelines, the pathophysiology of hyperprolactinemia and the various therapeutic choices.

Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder.

INTRODUCTION: Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. METHODS: A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry "A. Fiorini" Hospital, Terracina (Latina, Italy), was performed. RESULTS: The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium-high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. CONCLUSION: Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications.

[A case of shared psychotic disorder (folie à deux) with original aspects associated with cross-cultural elements]. / Un caso di disturbo psicotico condiviso (folie à deux) con aspetti di originalità connessi a elementi di natura transculturale.

Shared psychotic disorder (folie à deux) is a rare condition characterized by the transmission of delusional aspects from a patient (the "dominant partner") to another (the "submissive partner") linked to the first by a close relationship. We report the case of two Moroccan sisters who have experienced a combined delusional episode diagnosed as shared psychotic disorder. In these circumstances, assessment of symptoms from a cross-cultural perspective is a key factor for proper diagnostic evaluation.

[Socio-demographic, clinical and criminological features of a population discharged from forensic hospital and admitted to neuropsychiatric clinic, in scheme of restriction of freedom]. / Caratteristiche socio-demografiche, cliniche e criminologiche di una popolazione di pazienti dimessi dall'ospedale psichiatrico giudiziario, in regime di restrizione della libertà, ricoverati presso una clinica neuropsichiatrica.

INTRODUCTION: Over the past twenty years, in Italy there has been an intense debate that has focused on the function, and overcoming the limits of the institution Judicial Psychiatric Hospital (ospedale psichiatrico giudiziario - OPG). Although the contribution of legislative proposals, conferences and workshops on the OPG subject has received significant, the interest focused on the development and elaboration of criminological and epidemiological research on a national scale has been proportionately less impetum. In this study a survey aimed to explore the socio-demographic, clinical and criminological features of patients discharged from the OPG and admitted to neuropsychiatric clinic, under the restriction of freedom, has been performed. METHODS: The information was gathered at the time of entry in the clinical management, by means of the first clinical interview and during subsequent interviews. During hospitalization, patients were administered the Mini-Mental State Examination (MMSE) and K Axis (Axis V of Kennedy) questionaires. RESULTS: 23 patients from forensic hospitals of Aversa, Secondigliano and Castiglione delle Stiviere were included in the study. The main characteristics investigated delineate a profile of an individual with an average age of about 49 years, unmarried, from a low socio-economic context, unemployed at the time of internment. About the diagnosis, schizophrenic spectrum disorders prevail, there is history of substance abuse in 35% of cases, history of previous admission to psychiatric facilities in 87% of these subjects. The type of committed crimes regards crimes against the person. About 40% of individuals have exhausted the danger to society correlate at the time of admission. CONCLUSIONS: Despite the small sample size, the data from this study are consistent with those reported in few studies in the literature. The specificity of clinical care needs of mentally ill offenders requires greater definition that could be achieved through the development of this research area.

Changes in dream experience in relation with antidepressant escitalopram treatment in depressed female patients: a preliminary study.

INTRODUCTION: Sleep disturbances have long been considered as a cardinal symptom of endogenous depression and dreams in depressed patients usually differ from those of healthy people. The aim of the present study was to investigate dream subjective experiences and their modifications in relation to clinical response in a group of escitalopram-treated depressed patients. METHODS: Twenty-seven female patients meeting DSM-IV-TR criteria for Major Depressive Disorder (MDD) and starting SSRI therapy were included in the study. Data about psychopathological status and dreaming subjective experiences were collected at baseline (T0), 4 weeks after the beginning of the treatment (T1) and after further 4 weeks of therapy (T2). RESULTS: At T0 dream experience was impaired and negatively toned. Concomitantly with the decrease of symptoms severity, the 8-week escitalopram treatment yielded to significant improvements in the recall of both quantity and quality of dreams; those patients whit lower clinical benefits kept on reporting impaired dream experiences. DISCUSSION: The results of the present study evidence how the changes in some specific dreaming characteristics, such as the subjective recall of dream activity, the dream recall quality, the dream emotional content and the dream complexity represent reliable markers of the effectiveness of antidepressant therapy.

L-Acetylcarnitine in dysthymic disorder in elderly patients: a double-blind, multicenter, controlled randomized study vs. fluoxetine.

INTRODUCTION: L-Acetylcarnitine (LAC), the acetyl ester of carnitine naturally present in the central nervous system and involved in several neural pathways, has been demonstrated to be active in various animal experimental models resembling some features of human depression. The aim of the study is to verify whether LAC can have an antidepressant action in a population of elderly patients with dysthymic disorder in comparison with a traditional antidepressant such as fluoxetine. METHODS: Multicentric, double-blind, double-dummy, controlled, randomized study based on a observation period of 7 weeks. 80 patients with DSM-IV diagnosis of dysthymic disorder were enrolled in the study and subdivided into 2 groups. Group A patients received LAC plus placebo; group B patients received fluoxetine 20 mg/die plus placebo. Clinical assessment was performed through several psychometric scales at 6 different moments. RESULTS: Group A patients showed a statistically significant improvement in the following scales: HAM-D, HAM-A, BDI and Touluse Pieron Test. Comparison between the two groups, A and B, generally showed very similar clinical progression. DISCUSSION: The results obtained with LAC and fluoxetine were equivalent. As the subjects in this study were of senile age, it is possible to hypothesize that the LAC positive effect on mood could be associated with improvement in subjective cognitive symptomatology. The difference in the latency time of clinical response (1 week of LAC treatment, compared with the 2 weeks' latency time with fluoxetine) suggests the existence of different mechanisms of action possibly in relation to the activation of rapid support processes of neuronal activity.

Comparison of facial expression in patients with obsessive-compulsive disorder and schizophrenia using the Facial Action Coding System: a preliminary study.

BACKGROUND: Research shows that impairment in the expression and recognition of emotion exists in multiple psychiatric disorders. The objective of the current study was to evaluate the way that patients with schizophrenia and those with obsessive-compulsive disorder experience and display emotions in relation to specific emotional stimuli using the Facial Action Coding System (FACS). METHODS: Thirty individuals participated in the study, comprising 10 patients with schizophrenia, 10 with obsessive-compulsive disorder, and 10 healthy controls. All participants underwent clinical sessions to evaluate their symptoms and watched emotion-eliciting video clips while facial activity was videotaped. Congruent/incongruent feeling of emotions and facial expression in reaction to emotions were evaluated. RESULTS: Patients with schizophrenia and obsessive-compulsive disorder presented similarly incongruent emotive feelings and facial expressions (significantly worse than healthy participants). Correlations between the severity of psychopathological condition (in particular the severity of affective flattening) and impairment in recognition and expression of emotions were found. DISCUSSION: Patients with obsessive-compulsive disorder and schizophrenia seem to present a similarly relevant impairment in both experiencing and displaying of emotions; this impairment may be seen as a chronic consequence of the same neurodevelopmental origin of the two diseases. Mimic expression could be seen as a behavioral indicator of affective flattening. The FACS could be used as an objective way to evaluate clinical evolution in patients.

Premorbid circadian profile of patients with major depression and panic disorder.

AIMS: This study aims to compare some behavioural characteristics related to circadian functions in healthy subjects, in patients with major depressive disorder (MDD) and panic disorder (PD) during adulthood (disease period) and during the premorbid age (between 12 and 20 years old). METHODS: 132 adult patients with MDD, 144 with PD and 151 adult healthy controls were enrolled in the study. All subjects completed a retrospective questionnaire. RESULTS: Several behaviours (such as falling asleep, awakening, having, appetite, perceiving energy and cognitive functioning) showed a phase delay or a phase advance in MDD and PD patients compared to healthy controls. Behavioural differences where found in patients even before the clinical onset of the disease. CONCLUSIONS: Circadian profiles of MDD and PD patients diverge from those of healthy controls not only during the disorder but also in the ages preceding its clinical onset. The analysis of these circadian patterns may aid physicians to early identify subjects with specific psychiatric vulnerabilities.

[Facial Action Coding System (FACS): an instrument for the objective evaluation of facial expression and its potential applications to the study of schizophrenia]. / Facial Action Coding System (FACS): uno strumento di valutazione obiettiva dell'espressività mimica facciale e le sue potenziali applicazioni allo studio della schizofrenia.

INTRODUCTION: Affective flattening and the consequent anomalous expression of emotions are considered as key elements of the negative symptoms of schizophrenia. The purpose of this work is to assess how a survey instrument based on objective evaluation of emotional facial expressiveness (FACS) and a method of elicitation of emotions (film clips) can provide psychopathological manifestations about schizophrenia. METHODS: Relevant literature was identified through a search of Medline, PsychInfo and PubMed. Search terms included: "elicitation of emotions", "facial action coding system" and "schizophrenia". The research was limited to English-language publications and studies conducted exclusively in humans. RESULTS: The overall evaluation of the studies analyzed in this work show that the FACS is a useful tool to highlight specific clinical characteristics of schizophrenic patients with significant deficits in the expression and recognition of emotions, such as the status of hospitalization, the age of onset, the treatment with antipsychotic drugs, the SANS, SAPS and BPRS scores. CONCLUSIONS: Even if we have preliminary and incomplete data, the FACS and the elicitation of emotions through film clips can give an original contribution to the development of knowledge on pathophysiological events and interpretive models of schizophrenia.