[Sexual dysfunctions, psychiatric diseases and quality of life: a review]. / Dysfunkcje seksualne, choroby psychiczne a jakosc zycia - praca przegladowa.

Sexual dysfunctions may have a significant effect on the quality of life, but are unreported and under-diagnosed. A review of recent literature highlights the correlation between dysfunction and a decreased quality of life in people with psychiatric comorbidity, and explores several aspects impacting care, from following the patient to pharmacological and non-pharmacological treatments. Sexual dysfunctions (SD) have been shown to be prevalent, but under-diagnosed and un-dertreated because of communication barriers between patients and physicians. Pharmacogenic and morbogenic causes of sexual problems are often difficult to differentiate. Psychiatric diseases may increase the risk of SD, and SD may further exacerbate psychiatric problems, suggesting a bi-directional relationship. Their effective treatment frequently involves combination of elements from psychotherapy, and behavioral along with pharmacotherapeutic intervention, if needed. The persistence of sexual problems has significant negative impact on patient's satisfaction and adherence with the treatment, quality of life and partnership. Routine assessment of sexual functioning needs to be integrated into ongoing care to identify and address problems early. If sexual dysfunction is ignored it may maintain the psychiatric disorder, compromise treatment outcome and lead to non-adherence and compromise treatment outcome.

[Diagnostic mistakes in post-traumatic stress disorder. The problem of symptom overlap with depression]. / Bledy popelniane w diagnostyce zaburzenia stresowego pourazowego--problem nakladania sie objawów tego zaburzenia i depresji.

OBJECTIVES: The overlap between symptoms of PTSD and MDD is substantial. PTSD symptoms arise after a traumatic experience and the trauma is present in all of the diagnostic clusters. In individuals who have experienced a trauma a long time before, it is difficult to establish the exact moment of onset of their symptoms in relation to the trauma suffered. We proposed to raise awareness among operators who may encounter this problem, with the aim of providing them with valuable help in order to achieve a correct differential diagnosis. METHODS: A sample of subjects suffering from PTSD without comorbidity was assessed to confirm the diagnosis and the severity of post-traumatic symptoms. The Kruskal-Wallis test was used to compare any modifications in the parameters analyzed through the Davidson Trauma Scale with the presence and severity of depressive symptoms as evaluated by the Hamilton-D scale. RESULTS: Half of the PSTD patients recruited showed values of HAM-D > 18, although an active Major Depressive Episode was clinically excluded. Symptom of "numbing", despite being different from the apathy experienced in depression, is identified as a depressive symptom by the HAM-D. CONCLUSIONS: Giving prevalence to depressive symptoms may be misleading for diagnosis and may ultimately result in inappropriate treatment.

[Light therapy as a treatment for sexual dysfunctions--beyond a pilot study]. / Rola fototerapii w leczeniu osób z zaburzeniami czynnosci seksualnych--weryfikacja wynik6w badania pilotaiowego.

OBJECTIVES: Seasonal trends were demonstrated in reproduction and sexual activity. Through the secretion ofmelatonin the pineal gland plays an important role in the neuroendocrine control of sexual function and reproductive physiology. We hypothesized that inhibition of the pineal gland activity through a light treatment may favorably affect sexual function. METHODS: We recruited 24 subjects with a diagnosis of hypoactive sexual desire disorder and/or primary sexual arousal disorder. The subjects were randomly assigned to either active light treatment (ALT) or placebo light treatment (L-PBO). Participants were assessed during the first evaluation and after 2 weeks of treatment, using the Structured Clinical Interview for Sexual Disorders DSM-IV (SCID-S) and a self-administered rating scale of the level of sexual satisfaction (1 to 10). Repeated ANOVA measures were performed to compare the two groups of patients. Post-hoc analysis was performed by Holm-Sidak test for repeated comparisons. Results. At baseline the two groups were comparable. After 2 weeks the group treated with Light Therapy showed a significant improvement in sexual satisfaction, about 3 times higher than the group that received placebo, while no significant improvement was observed in the group L-PBO. Conclusions. Our results confirm a potentially beneficial effect of Light Therapy on primary sexual dysfunction. In the future, we propose to correlate clinical findings with testosterone levels pre/post treatment.

Photosensitivity and panic-agoraphobic spectrum: a pilot study.

BACKGROUND: The aims of this study were to assess photosensitivity (photophobia and photophilia) in panic disorder (PD) patients compared to healthy controls, and to evaluate the correlation between photosensitivity and panic-agoraphobic spectrum self-report (PAS-SR) scores. METHODS: The PAS-SR and Photosensitivity Assessment Questionnaires were administered to 24 PD subjects and 33 healthy controls. RESULTS: Compared to controls, PD patients showed significantly higher levels of photophobia and lower levels of photophilia items. The PAS-SR total score was positively correlated with the photophobia score. CONCLUSIONS: This study shows a strong correlation between PD and photophobia. However, whether photophobia develops before or after the onset of PD remains unclear. Further research is warranted to assess the potential role of light stimuli exposure in the onset, course and outcome of PD.

[Evaluation study of clinical and neurobiological efficacy of EMDR in patients suffering from post-traumatic stress disorder]. / Studio di valutazione dell'efficacia clinica e neurobiologica dell'EMDR in pazienti affetti da disturbo da stress post-traumatico.

UNLABELLED: Strong evidences support use of EMDR in patients suffering from post-traumatic stress disorder (PTSD). AIM: To evaluate clinical and neurobiological-structural efficacy of EMDR on drug-naïve PTSD without comorbidity. MATERIALS AND METHODS: We made clinical evaluation and hippocampal volume measurement by MRI on 29 subjects suffering from PTSD and on 30 healthy control-subjects. Then, patients were treated with EMDR and after three months of psychotherapy the clinical evaluation and the MRI exam were replied. RESULTS AND DISCUSSION: Our results demonstrated that the diagnosis of PTSD was no more possible on all the patients who terminated the psychotherapy (n=18). At the same time, all the patients showed an average increase of 6% in hippocampal volumes. CONCLUSIONS: Our reaserach suggests that EMDR treatment correlates not only with a significant improvement of symptoms of PTSD, but also with a significant increase of hippocampal volumes.

Morphovolumetric changes after EMDR treatment in drug-naïve PTSD patients.

INTRODUCTION: Few studies have investigated the effects of efficacious psychotherapy on structural alterations of discrete brain regions associated with posttraumatic stress disorder (PTSD). We therefore proposed to evaluate the neurobiological effects of eye movement desensitization and reprocessing (EMDR) on 19 patients with drug-naïve PTSD without comorbidity, matched with 19 untreated healthy controls. METHODS: We administered the Clinician Administered PTSD Scale (CAPS) and conducted brain MRI measurements (with Optimized Voxel-Based Morphometry). Patients received 12 EMDR sessions over three months. Then patients and controls were reassessed. RESULTS: At baseline, grey matter volume (GMV) differed significantly between patients and controls (F 1,35 =3.674; p=.008; η 2=.298). Analyses of 3-month scans showed no changes for controls, while significant changes were highlighted for patients post-EMDR, with a significant increase in GMV in left parahippocampal gyrus, and a significant decrease in GMV in the left thalamus region. The diagnosis of PTSD was effectively eliminated in 16 of 19 patients, reflected in a significant improvement on the CAPS (t(35)=2.132, p<.004). DISCUSSION AND CONCLUSIONS: Results indicated post-EMDR changes for patients in brain morphology. We discuss whether EMDR's mechanism of action may work at the level of the thalamus, an area implicated in PTSD pathology.

PTSD in victims of terroristic attacks - a comparison with the impact of other traumatic events on patients' lives. / Zespól stresu pourazowego u ofiar zamachów terrorystycznych ­ studium porównawcze wplywu wydarzen traumatycznych na zycie pacjentów.

OBJECTIVES: To identify possible differences, in terms of duration and severity of Post-Traumatic Stress Disorder, between victims of terrorist attacks and subjects who underwent other types of traumatic events. METHODS: A sample of subjects suffering from PTSD was selected. After a clinical interview aimed at the collection of anamnestic data, CAPS to confirm the diagnosis of PTSD and DTS to assess frequency and severity of post-traumatic symptoms were administered. One-way ANOVA was used in order to compare the differences in the parameters analysed through the DTS scales and its clusters between the victims of terrorist attacks and patients undergone other traumatic events. RESULTS: The duration of PTSD was 258 +/ - 144.9 months for people who underwent a terrorist attack and 41.6 +/ - 11.8 months for victims of other traumatic events. As regards the severity of the disorder, the total score of the DTS scale was 65.6 +/ - 26.9 in victims of terrorist attacks and 78.2 +/ - 28.2 in people who undergone other traumatic events. However, the difference was not statistically significant; Avoidance and Hypervigilance clusters showed an important statistical significance. CONCLUSIONS: No significant differences are present in terms of severity, showing that PTSD is a disabling disorder regardless the type of event that triggers it; however, a significant difference in terms of duration of the disorder leads to reflec on the importance of an early diagnostic process aimed toward the victims of terrorism, in order to avoid the risk of chronicity and progression to other psychiatric disorders such as depression.