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Mental disorders account for one of the most prevalent categories of the burden of disease worldwide, with depression expected to be the largest contributor by 2030, closely followed by anxiety. The COVID-19 pandemic possibly exacerbated these challenges, especially amongst adolescents, who experienced isolation, disrupted routines, and limited healthcare access. Notably, the pandemic has been associated with long-term neurological effects known as "long-COVID", characterized by both cognitive and psychopathological symptoms. In general, psychiatric disorders, including those related to long-COVID, are supposed to be due to widespread inflammation leading to neuroinflammation. Recently, the endocannabinoid system (ECS) emerged as a potential target for addressing depression and anxiety pathophysiology. Specifically, natural or synthetic cannabinoids, able to selectively interact with cannabinoid type-2 receptor (CB2R), recently revealed new therapeutic potential in neuropsychiatric disorders with limited or absent psychotropic activity. Among the most promising natural CB2R ligands, the bicyclic sesquiterpene ß-caryophyllene (BCP) has emerged as an excellent anti-inflammatory and antioxidant therapeutic agent. This review underscores BCP's immunomodulatory and anti-inflammatory properties, highlighting its therapeutic potential for the management of depression and anxiety.
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Agonistas de Receptores de Cannabinoides , Disfunción Cognitiva , Sesquiterpenos Policíclicos , Humanos , Adolescente , Agonistas de Receptores de Cannabinoides/farmacología , Agonistas de Receptores de Cannabinoides/uso terapéutico , Pandemias , Síndrome Post Agudo de COVID-19 , Receptores de Cannabinoides , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico , Receptor Cannabinoide CB2RESUMEN
INTRODUCTION: Several studies carried out mainly in North America revealed high rates of mood, anxiety and sleep disorders in patients with fibromyalgia (FM), while the information in other countries is scant. Therefore, we aimed at investigating the prevalence and the impact of such conditions on the health-related quality of life (HRQoL) and the severity of pain in a sample of Italian FM patients. METHODS: One-hundred and sixty-seven women suffering from primary FM were consecutively enrolled. Psychiatric diagnoses were made by means of DSM-IV criteria. The HRQoL and the severity of pain were measured through the Medical Outcomes Study 36-item Short-Form Health Survey (MOS-SF-36) and the FM Impact Questionnaire (FIQ). RESULTS: Fibromyalgia patients showed a high rate (80.8%) of lifetime and/or current comorbidity with mood and anxiety disorders. Patients with psychiatric comorbidity resulted significantly more impaired on the Mental Component Summary score of the MOS-SF-36 and showed a higher FIQ total score than those suffering from FM only. The severity of pain was associated with current psychiatric comorbidity. Patients with current mood disorders showed significantly lower Mental and Physical Component Summary scores of the MOS-SF-36 and higher FIQ total scores than those with current anxiety disorders or those without psychiatric comorbidity. Finally, patients with sleep disorders reported a lower HRQoL than those with a normal sleep, and specifically those with difficulty in falling in sleep had higher severity of pain. CONCLUSION: Psychiatric comorbidity, in particular with mood disorders, provokes a significant impairment of the HRQoL and, when current, a higher severity of pain in FM patients.
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Trastornos de Ansiedad/psicología , Fibromialgia/psicología , Trastornos del Humor/psicología , Calidad de Vida/psicología , Trastornos del Sueño-Vigilia/psicología , Adulto , Anciano , Trastornos de Ansiedad/complicaciones , Femenino , Fibromialgia/complicaciones , Estado de Salud , Humanos , Persona de Mediana Edad , Trastornos del Humor/complicaciones , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/complicaciones , Encuestas y CuestionariosRESUMEN
The aim of our study was to investigate and compare the dopamine (DA) transporter (DAT) in resting lymphocytes of 20 psychotic patients and 20 healthy control subjects, by means of both the binding parameters (Bmax and Kd) of 3H-WIN 35,428, and the reuptake parameters (Vmax and Km) of 3H-DA. The results showed that both the Bmax of 3H-WIN 35,428 binding and the Vmax of 3H-DA reuptake of the patients were significantly lower than those of healthy subjects, while the Kd or Km did not show any change. These findings, while indicating a reduced density of the lymphocyte DAT proteins, provide further support of the role of DA in psychoses and suggest that DA alterations may not be limited to brain structures.
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Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/metabolismo , Linfocitos/metabolismo , Trastornos Psicóticos/clasificación , Trastornos Psicóticos/patología , Adolescente , Adulto , Antipsicóticos/farmacología , Membrana Celular/efectos de los fármacos , Membrana Celular/metabolismo , Cocaína/análogos & derivados , Cocaína/farmacocinética , Dopamina/metabolismo , Femenino , Humanos , Linfocitos/citología , Linfocitos/efectos de los fármacos , Masculino , Unión Proteica/efectos de los fármacos , Estadística como Asunto , Tritio/farmacocinética , Adulto JovenRESUMEN
INTRODUCTION: Despite the general agreement that normal jealousy is heterogenous, little is known about this specific topic. METHODS: In the present study, we explored the possibility of distinguishing between four subtypes of "normal" jealousy (depressive, anxious, obsessive, and paranoid) amongst a cohort of 500 healthy university students by means of a specifically designed questionnaire, "Ouestionario della gelosia" (QUEGE). QUEGE is a self-report instrument of 30 items which explores the presence, frequency, and duration of feelings and behaviors related to jealousy. It was devised to investigate four hypothetical psychopathological profiles: depressive, paranoid, obsessive, and anxious. RESULTS: The factor analysis identified five rather than four clear-cut factors: self-esteem, paranoia, interpersonal Sensitivity, fear of being abandoned, and obsessionality. Women showed statistically significant lower levels of self-esteem and higher levels of obsessionality than men. Younger age (<25 years) was associated with lower self-esteem and higher levels of paranoia and obsessionality, while being single was associated with lower self-esteem and higher levels of obsessionality. CONCLUSION: The present study provides evidence of the reliability and validity of the QUEGE instrument, which seems to identify the presence of five psychopathological dimensions within the jealousy phenomenon in the general population.
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Ansiedad/epidemiología , Trastorno Depresivo/epidemiología , Celos , Conducta Obsesiva/epidemiología , Trastornos Paranoides/epidemiología , Adolescente , Adulto , Estudios de Cohortes , Análisis Factorial , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Inventario de Personalidad , Grupos de Población , Autoimagen , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The present study explored the possible relationship between romantic attachment and jealousy in 100 healthy subjects. The romantic attachment and jealousy were evaluated by means of, respectively, the "Experiences in Close Relationships" questionnaire (ECR), and the "Questionario della Gelosia" (QUEGE). The ECR anxiety scale was related to all QUEGE dimensions, while the ECR avoidance scale to three. Individuals with the preoccupied attachment style showed higher scores than secure subjects on the obsessionality, interpersonal sensitivity and fear of loss dimensions. Fearful-avoidant individuals had higher score than secure subjects on the fear of loss dimension only, while dismissing individuals had lower scores on the self-esteem dimension.These findings suggest that romantic attachment and jealousy are intertwined.
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BACKGROUND: Brain-derived neurotrophic factor (BDNF) has been hypothesized to be involved in the neurobiology of major depression. The aim of this study was to assess the possible relationships between depressive symptoms and serum and/or plasma BDNF levels during 1 year of antidepressant treatment. METHODS: Plasma and serum BDNF levels were assayed in 15 drug-free depressed patients and in 15 healthy control subjects at baseline and the 1st, 3rd, 6th and 12th month of antidepressant treatment. RESULTS: At baseline, patients' serum and plasma BDNF levels were significantly lower (p<.001 and p=.004, respectively) than those found in healthy control subjects. However, while from the 1st month of treatment patients' plasma BDNF levels did not differ significantly from those observed in healthy control subjects, serum BDNF levels in patients remained significantly lower at all times. LIMITATIONS: The main limitations of the current study are represented by the small sample size and the high discontinuation rate. CONCLUSIONS: Untreated depressed patients showed reduced baseline serum and plasma BDNF levels, as compared with control subjects. The clinical improvement paralleled the normalization of plasma BDNF after 1 month of treatment, while, at every assessment time, patients' serum BDNF levels were lower than those of control subjects. This would suggest that serum BDNF might represent a non-specific trait marker of depression.
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Antidepresivos/uso terapéutico , Factor Neurotrófico Derivado del Encéfalo/sangre , Trastorno Depresivo Mayor/sangre , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
BACKGROUND/AIMS: The aim of this study was to investigate the serotonin transporter (SERT), by means of the 3H-paroxetine ([3H]-Par) binding to platelet membranes, in patients affected by pathological gambling (PG), as compared with a similar group of healthy control subjects. METHODS: Seventeen PG patients were selected amongst those who were drug-free and at the first psychiatric interview in a Department of Addiction. The diagnosis was assessed according to DSM-IV criteria and PG severity was measured by means of the South Oaks Gambling Screen. The platelet [3H]-Par binding was carried out according to a standardized method. The binding parameters, the maximum binding capacity (B(max)) and the dissociation constant (K(d)), were obtained by means of the Scatchard analysis. RESULTS: The B(max) values of PG patients were significantly lower than that of healthy subjects, while the K(d) values were not different in the two groups. No significant effect of age, sex or psychiatric comorbidity on B(max) or K(d) was observed; there were also no correlations between clinical and biological variables. CONCLUSIONS: PG patients showed a dysfunction at the level of the platelet SERT that would suggest the involvement of the 5-HT system in this condition.
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Plaquetas/patología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/sangre , Juego de Azar/psicología , Proteínas de Transporte de Serotonina en la Membrana Plasmática/sangre , Adulto , Sitios de Unión , Recuento de Células , Demografía , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastornos Disruptivos, del Control de Impulso y de la Conducta/diagnóstico , Trastornos Disruptivos, del Control de Impulso y de la Conducta/tratamiento farmacológico , Femenino , Humanos , Masculino , Paroxetina/farmacocinética , Paroxetina/uso terapéutico , Glicoproteínas de Membrana Plaquetaria/metabolismo , Inhibidores Selectivos de la Recaptación de Serotonina/farmacocinética , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéuticoRESUMEN
INTRODUCTION: The high percentage (between 40% and 60%) of resistance to first-line drugs, such as clomipramine or selective serotonin reuptake inhibitors, is a major problem in the pharmacologic management of obsessive-compulsive disorder (OCD). In these cases, different strategies have been employed with controversial outcomes. The meager information available on the association of two serotonergic drugs prompted us to explore the possible effectiveness and tolerability of citalopram+clomipramine in resistant OCD patients. METHODS: Twenty outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD, who had failed to respond to at least two trials with a selective serotonin reuptake inhibitor and were currently taking clomipramine at different doses, were administered citalopram at a maximum dose of 60 mg/day. The clinical assessment was carried out at baseline (t0) and at the 4th (t1), 12th (t2), 24th (t3), 36th (t4), and 48th (t5) week by means of the Yale-Brown Obsessive Compulsive Scale, Hamilton Rating Scale for Depression, Clinical Global Impression scale, and the Dosage Record and Treatment Emergent Symptom Scale. The response was defined as a 35% decrease of the Yale-Brown Obsessive-Compulsive Scale total score. RESULTS: The results showed that approximately 50% of the patients improved significantly after 1 month of this regimen and after 1 year of treatment. CONCLUSION: This study, although carried out in a small sample and in an open fashion, represents one of the few experiences with the association of two serotonergic compounds in resistant OCD and confirms its potential usefulness and good tolerability profile. Controlled research on this association in OCD is recommended.
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Citalopram/farmacología , Citalopram/uso terapéutico , Clomipramina/metabolismo , Clomipramina/uso terapéutico , Resistencia a Medicamentos , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Adulto , Demografía , Sinergismo Farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno Obsesivo Compulsivo/diagnóstico , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Pathological gambling (PG) is an impulse control disorder characterized by persistent and maladaptive gambling behaviors with disruptive consequences for familial, occupational and social functions. The pathophysiology of PG is still unclear, but it is hypothesized that it might include environmental factors coupled with a genetic vulnerability and dysfunctions of different neurotransmitters and selected brain areas. Our study aimed to evaluate a group of patients suffering from PG by means of some neuropsychological tests in order to explore the brain areas related to the disorder. METHODS: Twenty outpatients (15 men, 5 women), with a diagnosis of PG according to DSM-IV criteria, were included in the study and evaluated with a battery of neuropsychological tests: the Wisconsin Card Sorting Test (WCST), the Wechsler Memory Scale revised (WMS-R) and the Verbal Associative Fluency Test (FAS). The results obtained in the patients were compared with normative values of matched healthy control subjects. RESULTS: The PG patients showed alterations at the WCST only, in particular they had a great difficulty in finding alternative methods of problem-solving and showed a decrease, rather than an increase, in efficiency, as they progressed through the consecutive phases of the test. The mean scores of the other tests were within the normal range. CONCLUSION: Our findings showed that patients affected by PG, in spite of normal intellectual, linguistic and visual-spatial abilities, had abnormalities emerging from the WCST, in particular they could not learn from their mistakes and look for alternative solutions. Our results would seem to confirm an altered functioning of the prefrontal areas which might provoke a sort of cognitive "rigidity" that might predispose to the development of impulsive and/or compulsive behaviors, such as those typical of PG.
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Although the beneficial effects of balneotherapy have been recognized since a long time, a few information is available on the biological mechanisms underlying them and the subjective feelings of increased well-being and mood. The links between the serotonin (5-HT) system and mood prompted us to investigate the 5-HT platelet transporter (SERT), which is considered a reliable, peripheral marker of the same structure present in presynaptic neurons, in 20 healthy volunteers before (t0) and 30 min after (t1) thermal balneotherapy with ozonized water of Montecatini spa, as compared with a similar group who underwent a bath in non-mineral water. The SERT was evaluated by means of the specific binding of (3)H-paroxetine ((3)H-Par) to platelet membranes. Equilibrium-saturation binding data, the maximal binding capacity (Bmax) and the dissociation constant (Kd), were obtained by means of the Scatchard analysis. The results showed that, while Bmax values did not change in both groups, the Kd values decreased significantly at t1 only in those subjects who bathed in ozonized water. The results of this study, while showing a decrease of the dissociation constant (Kd) which is the inverse of affinity constant, of (3)H-Par binding to SERT in all subjects after balneotherapy and not in those bathing in normal water, suggest that SERT modifications may be related to a specific effect of ozonized water and, perhaps, also to the increased sense of well-being.
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Balneología , Plaquetas/metabolismo , Proteínas de Transporte de Serotonina en la Membrana Plasmática/sangre , Adulto , Envejecimiento/metabolismo , Femenino , Calor , Humanos , Masculino , Persona de Mediana Edad , Aguas Minerales , Paroxetina , Valores de Referencia , Inhibidores Selectivos de la Recaptación de Serotonina , Caracteres SexualesRESUMEN
INTRODUCTION: Comorbid anxiety disorders are frequently encountered in psychoses and mainly assessed during the hospitalization. METHODS: Comorbidity was investigated in 98 patients with schizophrenia, schizoaffective, or bipolar disorder, previously hospitalized for psychotic symptoms. Assessments, including Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Brief Psychiatric Rating Scale, and Clinical Global Impressions Scale, were performed during hospitalization (t0) and subsequently in a phase of remission (t1). Comorbidity was assessed at t1 only. RESULTS: One or more comorbid anxiety diagnoses were made in 46 (46.9%) patients. Of these, 15 (32.6%) received multiple anxiety diagnoses, while 31 (67.4%) single anxiety diagnoses. Schizophrenic patients had a rate of social anxiety disorder (SAD) higher (P<.05) than the others. Patients assessed with panic disorder or with obsessive-compulsive disorder at t1 showed significantly greater severity of illness at t0; patients with SAD demonstrated greater severity at t1. No significant differences in the rates of individual anxiety disorders were found in patients treated with typical or atypical antipsychotics or with both. CONCLUSION: Anxiety disorders, particularly obsessive-compulsive disorder, panic disorder and SAD, seem to be frequently comorbid in remitted psychotic patients; SAD would be more prevalent in schizophrenia and might negatively impact the course of the illness.
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Trastornos de Ansiedad/epidemiología , Hospitalización/estadística & datos numéricos , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/rehabilitación , Adulto , Anciano , Antipsicóticos/uso terapéutico , Trastorno Bipolar/epidemiología , Trastorno Bipolar/rehabilitación , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno Obsesivo Compulsivo/epidemiología , Trastorno Obsesivo Compulsivo/terapia , Trastorno de Pánico/epidemiología , Trastorno de Pánico/rehabilitación , Esquizofrenia/epidemiología , Esquizofrenia/rehabilitación , Factores de TiempoRESUMEN
INTRODUCTION: Romantic attachment is the establishment of a relationship with a partner and is strongly influenced by the individual's attachment style. While several studies have shown that attachment style may contribute to the development of psychopathology, less information is available for romantic attachment. The aim of the present study was to compare romantic attachment styles among patients with different mood and anxiety disorders and control subjects. METHOD: The study sample included a total of 126 outpatients, 62 of whom were affected by bipolar disorders, 22 by major depressive disorder (MDD), 27 by panic disorder, 15 by obsessive-compulsive disorder, and 126 healthy control subjects. Romantic attachment was assessed by means of the Italian version of the "Experiences in Close Relationships" (ECR) questionnaire. RESULTS: The results showed that the secure attachment style was more frequent in the control group, while the preoccupied style prevailed among the patients, with no difference among the diagnostic categories. The scores of the ECR anxiety and avoidance scales were significantly higher in the patients than in the control subjects. A trend toward higher ECR anxiety scale scores in women with panic disorder was detected, with the opposite being true for MDD. CONCLUSION: Our findings indicate that patients with different psychiatric disorders would be characterized by higher scores on both the ECR anxiety and the avoidance scales, as well as by the preoccupied style of attachment. In addition, women with panic disorder and MDD seem to be characterized by, respectively, higher and lower scores of the ECR anxiety scale than men.
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Trastornos de Ansiedad/psicología , Amor , Trastornos del Humor/psicología , Apego a Objetos , Adulto , Trastornos de Ansiedad/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Trastornos del Humor/diagnósticoRESUMEN
Our objectives were to investigate thyroid abnormalities and autoimmunity in 120 patients affected by fibromyalgia (FM) and to study their relationships with clinical data and symptoms. Thyroid assessment by means of antithyroglobulin antibodies, antithyroid peroxidase antibodies, free triiodo-thyronine, free thyroxine, and thyroid stimulating hormone analyses was carried out. The clinical parameters "Fibromyalgia Impact Questionnaire", pain, tender points, fatigue, and other symptoms, and the presence of depression or anxiety disorders were evaluated. The basal thyroid hormone levels of FM patients were in the normal range, while 41% of the patients had at least one thyroid antibody. Patients with thyroid autoimmunity showed a higher percentage of dry eyes, burning, or pain with urination, allodynia, blurred vision, and sore throat. Correlations found between thyroid autoimmunity and age or with the presence of depression or anxiety disorders were not significant. However, in the cohort of post-menopausal patients, the frequency of thyroid autoimmunity was higher with respect to pre-menopausal patients. In conclusion, autoimmune thyroiditis is present in an elevated percentage of FM patients, and it has been associated with the presence of typical symptoms of the disease.
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Autoinmunidad/inmunología , Fibromialgia/complicaciones , Enfermedades de la Tiroides/inmunología , Adolescente , Adulto , Anciano , Autoanticuerpos/inmunología , Biomarcadores/sangre , Femenino , Fibromialgia/sangre , Fibromialgia/inmunología , Humanos , Yoduro Peroxidasa/inmunología , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Factores de Riesgo , Tiroglobulina/inmunología , Enfermedades de la Tiroides/epidemiología , Enfermedades de la Tiroides/etiología , Tirotropina/sangre , Tiroxina/sangre , Triyodotironina/inmunologíaRESUMEN
OBJECTIVE: To assess the psychometric properties of the Italian adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) treatment-seeking outpatients. METHODS: A back-to-back Italian adaption of the "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" English module of the HCL-32-R2 was administered between March 2013 and October 2014 across twelve collaborating sites in Italy. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS: In our sample (n=441, of whom, BD-I=68; BD-II=117; MDD=256), using a cut-off of 14 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=89% and specificity=79%. Area under the curve was .888; positive and negative predictive values were 75.34% and 90.99% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factor analyses, whereas items n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the scale slightly loaded onto F2 and F1 respectively. Cronbach׳s α=.88 for F1 and .71 for F2. LIMITATIONS: No cross-validation with any additional validated screening tool; treatment-seeking outpatient sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, neither record of severity of current MDE. CONCLUSIONS: Our results seem to indicate fair accuracy of HCL-32 as a screening instrument for BD, though replication studies are warranted.
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Trastorno Bipolar/epidemiología , Trastorno Depresivo Mayor/epidemiología , Valor Predictivo de las Pruebas , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
AIM: Although the precise nature of pathological gambling (PG) is still elusive, currently it is considered an impulse-control disorder that shares several features with substance dependence, such as deficit in self-regulation and impaired impulsivity. The aim of this study was to evaluate the impulsivity of PG patients by means of the Barratt Impulsivity Scale, version 11 (BIS-11), as compared with healthy control subjects, and to explore the possible correlations with gambling severity. METHODS: Thirty-five outpatients (all men) with a diagnosis of PG were recruited at their first psychiatric interview in a psychiatric outpatient ward, and compared with a similar group of healthy control subjects. The severity of PG was assessed by means of the South Oaks Gambling Screen (SOGS). RESULTS: The results showed that the BIS-11 total score, as well as the scores of different factors (motor impulsity and cognitive complexity) and subscales (motor and non-planning impulsivity) were significantly higher in PG patients than in control subjects. In addition, positive correlations were detected between the SOGS and the BIS-11 total scores, and the attention and cognitive instability factor scores, or the attentional and motor impulsivity (rs=0.459, p=.021) subscale scores. CONCLUSIONS: These findings support the notion that impulsivity represents a core element of PG linked to the severity of the clinical picture.
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Juego de Azar/psicología , Conducta Impulsiva , Humanos , Italia , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
IMPORTANCE OF THE FIELD: In the last decades, the treatment of obsessive-compulsive disorder (OCD) has improved significantly with the introduction into the clinical practice of the selective serotonin reuptake inhibitors (SSRIs): this has led to a renewed interest in this condition and development of appropriate therapeutic strategies, including non-pharmacological techniques. AREAS COVERED IN THIS REVIEW: The aim of this paper is to present a comprehensive and critical review of pharmacological and non-pharmacological treatments usually adopted in the management of OCD. MEDLINE and PubMed (1980 - 2009) databases were searched for English-language articles by using the following keywords: OCD, clomipramine, SSRIs, resistance, predictor of response, cognitive-behavioral therapy, exposure and response prevention, repetitive transcranial magnetic stimulation, deep brain stimulation, neurosurgery, electroconvulsive therapy. WHAT THE READER WILL GAIN: The reader will gain an exhaustive review of the advantages and disadvantages of the treatments usually adopted in OCD, with a special focus on resistance and clinical features that can be used as predictors of response. TAKE HOME MESSAGE: Obsessive-compulsive disorder is a common psychiatric condition that can be adequately managed with the currently available therapeutic options. Although a certain percentage of patients do not achieve complete clinical remission, improvement of some of their core symptoms permits them to live more satisfying lives and to reach a better social adjustment.
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Clomipramina/uso terapéutico , Terapia Cognitivo-Conductual , Terapia Combinada , Terapia por Estimulación Eléctrica , Trastorno Obsesivo Compulsivo/terapia , Ensayos Clínicos como Asunto , Estimulación Encefálica Profunda , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Terapia Electroconvulsiva , Electrochoque , Medicina Basada en la Evidencia , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Estimulación Magnética Transcraneal , Resultado del Tratamiento , Nervio Vago/efectos de la radiaciónRESUMEN
In the past decade, a growing bulk of evidence has accumulated to suggest that patients suffering from major depression (MD) present some cognitive disturbances, such as impairment in attention, working memory, and executive function, including cognitive inhibition, problem- and task-planning. If the results of short-term memory assessment in depressed patients are equivocal, a general consensus exists that memory problems are secondary to attentional dysfunctions, and reflect the inability to concentrate. Moreover, both unipolar and bipolar patients show evidence of impaired verbal learning that has been commonly interpreted as reflecting an inability to transfer information from short-term to long-term storage. According to some authors, there would be a gender-related as well age-related specificity of some disturbances. Depressed patients also show impairments of executive functions and their recent exploration through brain imaging techniques has recently permitted to formulate some general hypotheses on the possible involvement of different brain areas in MD.
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Trastornos del Conocimiento/complicaciones , Trastornos del Conocimiento/fisiopatología , Trastorno Depresivo Mayor/complicaciones , Trastorno Depresivo Mayor/fisiopatología , Función Ejecutiva , Humanos , Inteligencia , Trastornos de la Memoria/complicaciones , Trastornos de la Memoria/fisiopatología , Trastornos Psicomotores/complicaciones , Trastornos Psicomotores/fisiopatologíaRESUMEN
Different data show that circulating lymphocytes possess functional serotonin and dopamine transporters (SERT and DAT, respectively). This papers aims to review most of the available literature on this topic, while highlighting the possible role of SERT and DAT, as well as that of their substrates including antidepressants on the immune system.
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Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/fisiología , Linfocitos/efectos de los fármacos , Linfocitos/fisiología , Proteínas de Transporte de Serotonina en la Membrana Plasmática/fisiología , Animales , Antidepresivos Tricíclicos/efectos adversos , Antidepresivos Tricíclicos/farmacología , Dopamina/fisiología , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/química , Humanos , Inmunomodulación/efectos de los fármacos , Serotonina/fisiología , Proteínas de Transporte de Serotonina en la Membrana Plasmática/química , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Inhibidores Selectivos de la Recaptación de Serotonina/farmacologíaRESUMEN
Trazodone is an antidepressant which behaves as a selective 5-HT(2) antagonist and 5-HT reuptake inhibitor. The lack of information on its effects in vivo prompted us to evaluate alpha(2)-adrenoceptors by means of the specific binding of [(3)H]-rauwolscine, and the 5-HT transporter (SERT) by means of the binding of [(3)H]-paroxetine ([(3)H]-Par), in platelets of depressed patients, before and after one month of treatment with trazodone (75-300 mg/day). Twenty-five outpatients of both sexes with a diagnosis of major depression, as assessed by the Structured Clinical Interview for DSM IV, were included in the study. Depressive symptoms were evaluated by means of the Hamilton Rating Scale for Depression: the total score (mean +/- SD) was 20 +/- 6 at baseline (t(0)) and 7 +/- 4 after one month of treatment (t(1)). Platelet membranes, [(3)H]- rauwolscine and [(3)H]-Par bindings were carried out according to standardized protocols. The results showed that the B(max) values of [(3)H]-Par were statistically lower at t(1) than at t(0) (733 +/- 30 vs 1471 +/- 99, P < 0.001), while the K(d) and the [(3)H]-rauwolscine binding parameters remained unchanged. The findings of this study suggest that in vivo trazodone modifies the number of the SERT proteins and that, perhaps, most of its antidepressant properties are related to this activity.
RESUMEN
The present study explored the possible relationships between impulsivity, gender, and a peripheral serotonergic marker, the platelet serotonin (5-HT) transporter (SERT), in a group of 32 healthy subjects. The impulsivity was measured by means of the Barratt Impulsivity Scale, version 11 (BIS-11), a widely used self-report questionnaire, and the platelet SERT was evaluated by means of the specific binding of (3)H-paroxetine ((3)H-Par) to platelet membranes, according to standardized protocols. The results showed that women had a higher BIS-11 total score than men, and also higher scores of two factors of the same scale: the motor impulsivity and the cognitive complexity. The analysis of the correlations revealed that the density of the SERT proteins, as measured by the maximum binding capacity (B(max)) of (3)H-Par, was significantly and positively related to the cognitive complexity factor, but only in men. Men showed also a significant and negative correlation with the dissociation constant, Kd, of ((3)H-Par) binding, and the motor impulsivity factor. These findings suggest that women are generally more impulsive than men, but that the 5-HT system is more involved in the impulsivity of men than in that of women.