Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients.

PURPOSE: There is some evidence that eating disorders (ED) and Attention-deficit/hyperactivity disorder (ADHD) share common clinical features and that ADHD might contribute to the severity of eating disorders. A greater understanding of how the presence of comorbid ADHD may affect the psychopathological framework of eating disorder seems of primary importance. The aim of our study was to evaluate rates of ADHD in three ED subgroups of inpatients: anorexia nervosa restricting type (AN-R), anorexia nervosa binge-eating/purging type (AN-BP) and bulimia nervosa (BN). The secondary aim was the evaluation of the associated psychological characteristics. METHOD: The sample consisted of 73 females inpatients (mean age 28.07 ± 7.30), all with longstanding histories of eating disorder (ED). The presence of a diagnosis of ADHD was evaluated in a clinical interview based on DSM-IV-TR criteria. The following psychometric instruments were used: the eating attitude test (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorder Inventory (EDI-2), the Wender Utah Rating Scale (WURS), the Brown Attention Deficit Disorder Scale (BADDS), the Hamilton scales for Anxiety (HAM-A) and Depression (HAM-D), and the Barrat Impulsivity Scale (BIS-10). RESULTS: Among the three ED subgroups, 13 patients reported comorbidity with ADHD; three in the AN-R subtype, nine in the AN-BP and one in the BN. The remaining 60 patients (n = 34 AN-R; n = 19 AN-BP; n = 7 BN) presented only a diagnosis of ED. The EAT (p = 0.04) and HAM-A (p = 0.02) mean scores were significantly higher in patients with comorbid ADHD. CONCLUSIONS: In our study the comorbidity between ADHD and ED appeared to be frequent, particularly among patients with AN-BP. ED inpatients with higher level of anxiety and more abnormal eating attitudes and bulimic symptoms should be assessed for potentially associated ADHD.

[Alcohol and work. Consensus Document of the La.R.A. (Workers representing a risk for others) group]. / Alcol e Lavoro. Documento di consenso del gruppo La.R.A.

AIM: Current Italian legislation obliges employers to prevent workers who are occupationally at risk or who perform jobs that may be hazardous for the safety or health of third parties from consuming alcohol. The LaRA Group undertook to assess whether the law fully safeguards the health and safety of both workers and third parties, without impinging upon the civil rights of workers. METHOD: A written document expressing agreement was produced following discussions between doctors, lawyers, bioethicists and social partners. RESULTS: There are gaps and inconsistencies in current laws; the differences in local and regional provisions prevent authorities from applying a single strategy at national level. There should be a change in existing rules under which the employer's obligation to enforce the ban on consumption alcohol in the workplace is enacted solely by the "competent" physician whose institutional role is to safeguard and promote health. Some occupational categories that are subject to a ban on alcohol consumption do not currently under-go health surveillance. For example, if road transport drivers are not exposed to a specific occupational risk foreseen under another law, they can be placed under health surveillance only in those regions where the local laws contemplate this type of control. In other cases, the practice of assessing the risk to third parties and providing for compulsory health surveillance in the Risk Assessment Document, is considered by some jurists to be a "consuetudo praeter legem" and therefore acceptable in a field not yet covered by a specific law, but to be "contra legem" or unlawful by other jurists. Moreover, the competent physician who uses a breathanalyser or tests for alcohol addiction faces an ethical dilemma, since by communicating the results to an employer or authorities responsible for the issuing of licenses, he may be violating his professional oath of secrecy. Furthermore, the emphasis placed on testing has induced companies and inspectors to overlook educational and rehabilitation aspects. It is essential to involve general practitioners, educators and specialist services in addressing the problems of alcohol abuse so as to inform/train, recover and rehabilitate. The few studies available indicate that the rules are poorly enforced and that non-compliance may go unobserved. CONCLUSIONS: The Group urges all employers to assess the risk for third parties caused by alcohol abuse and to devise a policy on alcohol. Controlling alcohol-related risks in the workplace calls for a better definition of the roles of Vigilance Bod-ies and Company Physicians together with a shift from a reactive to a proactive attitude of all the parties involved.

Psychopathology and eating disorders in patients with psoriasis.

AIM: Psoriasis is a multifactorial chronic inflammatory skin disease that often occurs in patients who are overweight or obese. In literature the connections between obesity and eating disorders are well known, but few studies have investigated the link between eating disorders and psoriasis. We hypothesized that Eating Disorders (ED) can be considered a psychogenic cofactors, which contribute to the development of obesity and metabolic syndrome in psoriatic patients, who are frequently prone to psychiatric comorbidity. METHODS: From January to April 2011 we enrolled 100 consecutive psoriatic outpatients and a control group of 100 selected non-psoriatic outpatients, matched by age, gender, and BMI to the study group. The assessment battery was composed by the Psoriasis Area Severity Index (PASI) score, the Eating Disorder Inventory (EDI) and the Symptom Checklist-90 Revised (SCL-90-R®). RESULTS: Our data showed that most of EDI and SCL-90R subscales was mostly altered in psoriatic population compared to patients without psoriasis. Moreover, we noticed in patients with psoriasis an association between the progressive weight increase and an impairment on most of EDI subscales. CONCLUSION: Psoriasis is associated with psychopathological traits, which are frequently found in EDs. Since obesity makes psoriasis less susceptible to therapy and weight loss improves drug response, dermatologists should be alert to suspect the presence of this condition.

Treatment of prurigo nodularis with pregabalin.

WHAT IS KNOWN AND OBJECTIVE: Prurigo nodularis (PN) is a chronic skin condition that is difficult to treat. Pregabalin is one of the possible treatments for PN but its safety and efficacy are not well defined. We aimed to assess the efficacy of pregabalin in patients with PN. METHODS: Thirty patients (10 men, 20 women; mean age 51.6 ± 9.39 years) were treated with pregabalin (75 mg/day) for 3 months. Efficacy was classified as (i) successful (disappearance of the pruritus and reduction of nodules); (ii) slight improvement/reduction of the nodules, that is, number and/or flattening, no disappearance of itching; or (iii) unsuccessful. RESULTS: Twenty-three patients (76%) responded successfully after 3 months of treatment. There was a statistically significant difference between visual analogue scale scores before and after 1 month treatment period (8·15 ± 2·04 and 1·5 ± 1·12, respectively; P < 0·0001). Pregabalin was generally well tolerated with only six (20%) patients reporting side effects. No patient showed any renal insufficiency. WHAT IS NEW AND CONCLUSION: In our study, pregabalin was effective for the treatment of PN. However, given the open and non-controlled study design used, a properly powered randomized controlled validation study is called for.

Beneficial effects of a program of Mindfulness by remote during COVID-19 lockdown.

OBJECTIVE: In the emergency context of COVID-19 pandemic and lockdown, mindfulness relaxation techniques can provide a safe and effective strategy to obtain in a reasonably short time some degree of relief from suffering and to guarantee a greater confidence with emotional reactions in the general population. SUBJECTS AND METHODS: The Mindfulness-Based Stress Reduction program for coping with COVID-19 emergency was designed as an 8-week program during the early phase of lockdown consisting in practice meditation exercises at least once a day guided and structured by certified instructors entered on a free online platform. At the end of the program all participants completed a survey. RESULTS: A total of 108 surveys were completed (67.6% male; 32.4% female). Despite the difficult moment of lockdown and the fear linked to the pandemic, 61.9% of interviewed subjects declared a state of general well-being from fair to good linked to the practice of mindfulness. Female subjects (p=0.001), married subjects (p=0.05) and people taking pharmacologic therapy demonstrated (p=0.009) significant improvement in daily management of emotions and practical requests during the early phase of the COVID-19 outbreak. CONCLUSIONS: Mindfulness meditation may be effective in helping people to regulate emotions and to support their mental health during this period of worry and uncertainty.

Combined treatment of myo-inositol and d-chiro-inositol (80:1) as a therapeutic approach to restore inositol eumetabolism in patients with bipolar disorder taking lithium and valproic acid.

OBJECTIVE: Patients with bipolar disorder (BD) experience a poor quality of life (QoL) and a weak adherence to the therapy due to the various side effects occurring during the pharmacological therapy. To date clinicians have no tools to intervene on such effects, considering them as an unavoidable part of the therapy. This review paves the way for a step forward in the management of patients with BD bridging the therapeutic gap in clinical practice. MATERIALS AND METHODS: We reviewed the literature, searching through different databases (MEDLINE, Scopus, Google Scholar). We used different keywords, including bipolar disorder, lithium and valproic acid, inositol role in bipolar disorder, side effects, inositol depletion, supplementation of inositols under lithium treatment, inositol role in metabolism, hypothyroidism, renal and cardiac functionality. In particular, we narrowed the search down to English literature, excluding works before 1980s. Regarding clinical studies, we included case reports and both preclinical and clinical studies, especially only those exhibiting a control group. The outcome of the database search was to highlight the threat of side effects and the relationship with inositol lower levels, paving the way for a step forward in the management of patients with BD. RESULTS: Based on the collected evidence, the combined administration of myo-inositol (myo-ins) and d-chiro-inositol (d-chiro-ins) is strongly recommended in order to restore levels and metabolism of inositols. Previous studies pointed out the beneficial effects of inositols in recovering pathological conditions, like polycystic ovary syndrome (PCOS), hypothyroidism, weight gain, cardiac functionality, being all these conditions related to the depletion of inositols. Furthermore, a controlled dosage of inositols, up to 6 grams/daily, may reduce the side effects caused by lithium therapy, without hindering its central therapeutic role on patients' mood. CONCLUSIONS: Considering the iatrogenic depletion of inositols, the tailored ratio 80:1 in favour of myo-ins, may become a safe and effective strategy to counteract side effects, by providing a large amount of myo-ins and an adequate one of d-chiro-ins. The clinical dosage of inositols used as dietary supplementation is 4 grams/daily, and it may allow the recovery of the side effects and improve patients' QoL, without reducing the central therapeutic effect of the pharmacological therapy.

Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: A systematic review.

Considering the importance of evidence on interventions to tackle mental health problems in healthcare workers (HCWs) during pandemics, we conducted a systematic review, aiming to identify and summarize the implemented interventions to deal with mental health issues of HCWs during infectious disease outbreaks and report their effectiveness. Web of Science, PubMed, Cochrane, Scopus, CINAHL and PsycInfo electronic databases were searched until October 2nd, 2020. Primary-data articles, describing any implemented interventions and their effectiveness were considered pertinent. Studies were screened according to the inclusion/exclusion criteria and subsequently data extraction was performed. Twenty-four articles, referring to SARS, Ebola, Influenza AH1N1 and COVID-19 were included. Interventions addressing mental health issues in HCWs during pandemics/epidemics were grouped into four categories: 1) informational support (training, guidelines, prevention programs), 2) instrumental support (personal protective equipment, protection protocols); 3) organizational support (manpower allocation, working hours, re-organization of facilities/structures, provision of rest areas); 4) emotional and psychological support (psychoeducation and training, mental health support team, peer-support and counselling, therapy, digital platforms and tele-support). These results might be helpful for researchers, stakeholders, and policymakers to develop evidence-based sustainable interventions and guidelines, aiming to prevent or reduce the immediate and long-term effect of pandemics on mental health status of HCWs.

The effect of newer serotonin-noradrenalin antidepressants on cytokine production: a review of the current literature.

Cytokines may influence brain activities especially during stressful conditions, and elevated levels of IL-6 and C-reactive protein have been pointed out in subjects with Major Depression. If pro-inflammatory cytokines play a causative role in major depressive disorders, one would expect that antidepressants may down-regulate these cytokines or interfere with their actions, leading to improvement of depressive symptoms. Accumulating evidence has been published that antidepressants modulate cytokine production and this is particularly true for Tricyclics and Selective serotonin reuptake inhibitors (SSRIs), but the influence of newer antidepressants acting on both serotonin (5-HT) and norepinephrine (NE) such as venlafaxine, duloxetine and mirtazapine on cytokine levels has not been extensively studied. However, both pre-clinical and clinical studies examined in this review have demonstrated that newer serotonin-noradrenalin antidepressants can inhibit the production and/or release of pro-inflammatory cytokines and stimulate the production of anti-inflammatory cytokines, suggesting that reductions in inflammation might contribute to treatment response. Moreover, the results of the present review support the notion that the serotonin-noradrenalin antidepressants venlafaxine and mirtazapine may influence cytokine secretion in patients affected by MD, restoring the equilibrium between their physiological and pathological levels and leading to recovery. To date, no studies have evaluated the effect of duloxetine, the newest serotonin-noradrenalin antidepressant, on cytokine levels and therefore this should be evaluated in future studies.

Pregabalin in outpatient detoxification of subjects with mild-to-moderate alcohol withdrawal syndrome.

OBJECTIVE: In this open, prospective study we aimed to investigate the efficacy, medical safety and practicability of pregabalin in outpatient detoxification of alcohol-dependent patients with mild-to-moderate alcohol withdrawal syndrome (AWS). Craving reduction, improvement of psychiatric symptoms and quality of life were the secondary endpoints. METHODS: Forty alcohol dependent patients (DSM-IV) were detoxified receiving 200-450 mg of pregabalin. Withdrawal (Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)) and craving (Visual Analogue Scale (VAS); Obsessive and Compulsive Drinking Scale (OCDS)) rating scales were applied; psychiatric symptoms and quality of life were evaluated using the Symptom Check List-90 Revised (SCL-90-R) and the QL-Index, respectively. Relapsed and abstinent patients in the post-detoxification evaluation have been compared. RESULTS: Alcohol withdrawal symptoms and craving for alcohol resulted significantly reduced (p < 0.001) over time after pregabalin treatment. Pregabalin also resulted in a favourable improvement in psychiatric symptoms and quality of life (p < 0.001). CONCLUSIONS: To our knowledge, this is the first open, prospective study, about the possible use of pregabalin as an outpatient detoxification agent. These preliminary data show its efficacy and safety in the management of patients with mild-to-moderate AWS.

Mental health and counseling intervention for hereditary hemorrhagic telangiectasia (HHT) during the COVID-19 pandemic: perspectives from Italy.

OBJECTIVE: Hereditary hemorrhagic telangiectasia (HHT) is an inherited disorder of fibrovascular tissue, transmitted as an autosomal dominant trait. This rare disease can involve one or more organs and clinical manifestations interest several medical specialties. MATERIALS AND METHODS: A review of recent literature and our clinical experience shows that COVID-19 pandemic greatly influences the autonomy and psychic sphere of patients with HHT, causing them further distress. RESULTS: Often patients affected by HHT experience a sense of loneliness due to the rarity of this pathology and COVID-19 pandemic adds a burden for them and their caregivers who have to face emotional experiences that interfere with personal, social and working functioning. CONCLUSIONS: Multidisciplinary approach and web-mediated counseling intervention could offer a valid and personalized support for patients affected by HHT and their caregivers during quarantine due to COVID-19 pandemic.

Cocaine use disorders and serum magnesium profile.

INTRODUCTION: Magnesium influences the nervous system via its actions on the release and metabolism of neurotransmitters, and abnormal magnesium metabolism has been implicated in several neuropsychiatric disorders with prominent mood symptoms. The aim of this study was to compare the serum levels of magnesium of cocaine addicts to those of heroin addicts and normal controls. We also attempted to clarify the relationship between the pathophysiology of cocaine abuse and magnesium levels by investigating their association with various clinical dimensions. METHODS: Eighty-five consecutive subjects with a history of cocaine or opiate use disorders were recruited, evaluated and compared with 100 controls. The cocaine and heroin abusers were assessed with a 10-cm Visual Analogue Scale, the Symptom Check List-90 Revised, the Brown-Goodwin Scale, and the Barrat Impulsiveness Scale. RESULTS: Magnesium levels were higher in the cocaine group compared to the opiate group and control. Male subjects had lower magnesium levels than the females of all three groups. Scores of impulsiveness, aggressiveness, craving and psychiatric symptomatology were not significantly different between the opiate and cocaine addicts. DISCUSSION: This is the first study evaluating the magnesium level in cocaine addicts. Cocaine addicts showed higher total plasma magnesium levels than opiate addicts and normal controls, even though they remained in the normal range. The roles of the psychiatric comorbidity, of a pharmacokinetic association and of a pharmacodynamic interaction are discussed. Further prospective studies comparing serum levels of cocaine at different times are needed.

Aripiprazole in the treatment of patients with alcohol dependence: a double-blind, comparison trial vs. naltrexone.

Substantial evidence suggests that both partial dopamine agents and mixed 5-HT1A/2A receptor drugs independently show significant efficacy in reducing alcohol use in both animals and humans. Aripiprazole, which acts as a dopamine/5-HT system stabilizer, approaches the optimal characteristics sought in medication to be considered for testing in the treatment of alcohol dependence. In this randomised, double-blind, confrontation trial with naltrexone, we aimed to investigate the efficacy of aripiprazole on alcohol-drinking indices. Craving and psychiatric symptom improvements were the secondary end points. Seventy-five alcohol dependent subjects were detoxified and were subsequently randomised into two groups, receiving 50 mg of naltrexone and 5-15 mg of aripiprazole, respectively. Craving (Visual Analogue Scale; Obsessive and Compulsive Drinking Scale) and withdrawal (Clinical Institute Withdrawal Assessment) rating scales were applied; psychiatric symptoms were evaluated through the Symptom Check List 90-Revised. The number of subjects remained alcohol free for the entire study period (16 weeks) and the number of subjects relapsed were not significantly different in the two groups. The survival function showed that patients treated with aripiprazole remained abstinent from any alcohol amount for a longer time with respect to those treated with naltrexone. As for craving scores, patients treated with naltrexone showed a better outcome. Results from this study globally place aripiprazole at the same range of efficacy of naltrexone, one of the approved drugs used in alcohol relapse prevention. If it could be demonstrated in placebo-controlled trials that aripiprazole is efficacious in decreasing alcohol use, lessening craving, and attenuating psychopathological symptom severity, we will have gained a powerful agent for the treatment of alcohol-dependent subjects.

The role of cholesterol levels in mood disorders and suicide.

The individuation of sensitive and specific biochemical markers, easily assessable on large samples of subjects and usefully employable as predictors of severe psychiatric disorders, such as mood disorders, could help clinicians to improve the diagnostic and therapeutic processes facilitating the long-term follow-up. In particular, serum cholesterol levels may potentially be optimal markers due to their relative easy sampling and low cost. The involvement of cholesterol in affective disorders such as Major Depression (MD), Seasonal Affective Disorder (SAD) and Bipolar Disorders (BD) is a debated issue in current research. However, current literature is controversial and, to date, it is still not possible to reach an agreement on its possible usefulness of cholesterol as a biological marker of affective disorders. Despite the controversial results on the relationships between cholesterol levels and affective disorders, the majority of literature seems to show a more consistent relationship between cholesterol levels and suicidal behaviour, with few studies that have found no relationships. The aim of this review is to elucidate current facts and views about the role of cholesterol levels in mood disorders as well as its involvement in suicidal behaviour.

Quetiapine decreases alcohol consumption, craving, and psychiatric symptoms in dually diagnosed alcoholics.

AIMS: Patients with dual diagnosis are often excluded from clinical trials although more than half of all individuals with Bipolar Disorder have a substance abuse problem at some point in their lifetime, representing a high-risk clinical population. The purpose of this study was to investigate the safety and efficacy of quetiapine in the treatment of alcohol dependence comorbid with disorders characterized by high levels of mood and behavioral instability. METHODS: Twenty-eight subjects, after a detoxification period, were orally treated with flexible doses of quetiapine for 16 weeks. At each assessment patients were evaluated through the Obsessive Compulsive Drinking Scale (OCDS), the Visual Analogue Scale (VAS) for craving, the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS), the Young Mania Rating Scale (YMRS), and the Clinical Global Impression (CGI) scale. RESULTS: Forty-three percent of patients remained totally alcohol free, 32% patients relapsed, with an average of 15.4 drinking days in the period of the study (112 days) and 25% dropped-out. Significant reductions from baseline to exit were observed in the OCDS, VAS, BPRS, HDRS, and number of drinking days per week. Changes in alcohol craving correlated with psychiatric symptoms as to BPRS and HDRS, with the highest level of correlation evidenced for the HDRS items of insomnia. DISCUSSION: In this open-label study, quetiapine decreased alcohol consumption, craving for alcohol, and psychiatric symptoms intensity, maintaining a good level of tolerance. A strength of this study is that the use of quetiapine was not adjunctive with other pharmacological and non-pharmacological treatment. Double-blind placebo-controlled studies are required with a larger study population to confirm these data. In the meantime, for a select group of psychiatric patients, quetiapine may offer some advantages in preventing relapse.

Socio-emotional ability, temperament and coping strategies associated with different use of Internet in Internet addiction.

OBJECTIVE: The aim of the present study was to compare socio-emotional patterns, temperamental traits, and coping strategies, between a group of Internet addiction (IA) patients and a control group. PATIENTS AND METHODS: Twenty-five IA patients and twenty-six healthy matched subjects were tested on IA, temperament, coping strategies, alexithymia and attachment dimensions. Participants reported their prevalent Internet use (online pornography, social networks, online games). RESULTS: The IA patients using Internet for gaming online showed a greater attitude to novelty seeking and a lower tendency to use socio-emotional support and self-distraction compared to patients using Internet for social networking. Moreover, they showed a lower level of acceptance than patients using Internet for pornography. In the control group, the participants using Internet for online gaming showed higher levels of IA, emotional impairments and social alienation compared to social-networks and pornography users. CONCLUSIONS: Findings showed a higher psychological impairment in gaming online users compared to social networking and online pornography users.

[Evalutation of neoplasms prevalence as a consequence of stressful events in the occupational and non-occupational field]. / Valutazione della prevalenza di neoplasie in seguito ad eventi stressanti in ambito lavorativo ed extralavorativo.

Starting from the hypothesis that stressful events, badly elaborated by individuals, can bring a decreasing activity of immunitary system and represent a co-factor in development of breast cancer, analyzing which events are more stressful and as a consequence, which are the ones causing a decreasing of immunitary defence. This study considers the breast cancer in large increasing amongst women. 60 women compiled the Events of Life Questionnaire (Qav) and they have been divided into two groups: 30 elements affected by breast cancer (experimental group) and 30 without evident pathologies (control group). Their age was included between the 25 and 75 years old, they came from the same social class, cultural extraction, instruction level. Throughout every single interview, each one lasting about an a hour with hospitalized patients, we potentially find a depressive personality. The statistic analysis gives extremely interesting results regarding negative events of the affective life: underlining a strong dependence among negative events of affective life relating to the development of the breast cancer This interest start from the evident limit in the medical practice, considering organic problems as the only for disease development, excluding emotional and psychological factors which are part of human being's life. Anyway, today is possible to find especially in onchological medicine, the consciousness that the medical or surgical intervention is not the only duty but is also important to underline, in a more complete view, that the patient's care also depends from the ability of questioning about patient's conditions in every day life; as shown in this study which underlines the necessity of psychotherapeutic intervention for patients affected by breast cancer, specially in pre and post operating phases.

[Chronic exposure to styrene and psychiatric symptomatology: a case-control descriptive study]. / Esposizione cronica a stirene e sintomatologia psichiatrica: studio descrittivo caso-controllo.

BACKGROUND: Although the acute psychiatric consequences exerted by Styrene and other aromatic hydrocarbons are abundantly described, the effects produced by a low-dosages chronic exposure are not known, in spite of the wide employment in the field of industrial production. The aim of this study is to evaluate the psychiatric symptoms in a group of subjects exposed to styrene in comparison with a control group, not exposed to the substance. SUBJECTS AND METHODS: Twenty two qualified workers, divided into 11 subjects in charge of welding and resin tapping exposed to styrene, and 11 not exposed to neurotoxic substances, were evaluated through the Symptom Check List Revised (SCL-90-R), a scale for the global self-evaluation of psychiatric symptomatology. RESULTS: The statistical tests, herein utilized, showed a significant prevalence for the dimensions somatization and psychoticism in the exposed subjects to styrene as compared to the non-exposed subjects. CONCLUSIONS: The results of this study, although limited by the paucity of the sample, emphasize the importance of an early diagnosis and evaluation of the clinical predictors in subjects exposed to styrene. The relatively low concentration levels of styrene in the working area of the subjects exposed underlines the opportunity to arrange preventive evaluation strategies for a prompt intervention in those cases with a clear syndromic presentation.

Pharmacological treatments in alcohol use disorders: state of art and new perspectives.

The main focus of this narrative review is to present and discuss the most relevant clinical data about the pharmacological therapy for alcohol use disorders. By using PubMed we conducted a review of the clinical literature on drugs related to alcohol use disorders. All data are presented following the three phases of treatment: a) from withdrawal to abstinence; b) abstinence and relapse prevention; c) reduction of alcohol consumption. Historical evidence shows that in addition to the drugs already approved for the treatment of alcoholism, there are some off-label medications as effective as the approved ones which deserve therefore further study. The treatment of the alcoholic patient always requires a multidimensional and multidisciplinary approach, directed to the specific needs of each subject in order to achieve a correct care personalization. The study of the cognitive effects of each drug and pharmacogenetics will allow us to increasingly customize therapy for each individual patient.

The complex interplay of Depression, Inflammation and Omega-3: state of the art and progresses in research.

Many epidemiological and preclinical studies have proven the potential benefit and critical role of omega-3 PUFAs in the development and management of depressive disorders. Depression may be the consequence of a complex interplay between cell-mediated-immune activation and inflammation evolving in neuroprogression. Associations between n-3 PUFAs, inflammation, oxidative stress and the risk of depression have been demonstrated and clinical and animal supplementation studies have shown the potential of PUFAs to decrease neurodegeneration and inflammation. Future research should focus on the dynamic interactions between the different cell signaling networks and oxidative and nitrosative stress pathways that cause depression.

Stereospecific effects of acetylcarnitine on the spontaneous activity of brainstem neurones and their responses to acetylcholine and serotonin.

Acetylcarnitine is an endogenous substance, active in the CNS, but its exact role in neurotransmission is still unknown. The present study was made to analyze by means of iontophoretic administration on single neurones of the medullary-pontine reticular formation in the rat the effects of the D- and L-acetylcarnitine on spontaneous and glutamate-evoked firing and on responses to applications of some other putative transmitters, such as acetylcholine, 5-hydroxytryptamine (5-HT), gamma-aminobutyric acid (GABA) and noradrenaline. L-Acetylcarnitine increased both spontaneous and evoked discharges, and potentiated cholinergic and serotonergic responses. The D-isomer was found to be almost ineffective. Neuronal responses to L-acetylcarnitine were reduced by dihydro-beta-erythroidine and enhanced by eserine, while atropine was ineffective. L-Acetylcarnitine increased both excitatory and inhibitory responses to 5-HT and its effect on the increase in firing rate induced by serotonergic drugs was reduced by dihydro-beta-erythroidine, but not by atropine. L- and D-Acetylcarnitine did not affect GABAergic or noradrenergic transmission. These results suggest a stereospecific facilitatory action of acetylcarnitine on neuronal responses to acetylcholine and 5-HT. It is hypothesized that this action could be exerted at a presynaptic level, at least with regard to serotonergic-induced responses, and that nicotinic receptors may be involved in the synaptic mechanism of release or reuptake of both acetylcholine and 5-HT.