Functional studies in Autism Spectrum Disorder (ASD) have shown localised focal hypoperfusion and abnormalities in the anatomo-functional connectivity of limbic-striatal “social” brain. However, no common regional abnormalities have been found across studies.

The aim of this study was to investigate the cerebral blood flow (CBF) at rest in subjects with ASD as compared to a group of healthy controls.

In this preliminary investigation six normal intelligence patients with ASD and 5 age and sex matched healthy controls (HC) were examined using PET/CT camera and, as CBF tracer, 11C-butanol, a radiopharmaceutical produced on-site. The combination of these two methodologies reduced the whole examination time to less than 10 minutes. Statistical Parametric Mapping was implemented to analyse the data.

As compared to HC, ASD showed a highly significant CBF increase (height threshold p=0.001, p< 0.0001 at voxel-level), bilaterally, in large portions of the cerebellum, of the visual associative cortex and of the posterior parietal lobe.

This preliminary study was performed by the state-of-the-art neuroimaging methodologies that reduced considerably the examination time and resulted in less stress and more reliable investigations. The occipital and parietal associative cortex as well as the cerebellum showed an increased CBF in ASD, underscoring their involvement in the disease and raising methodological and diagnostic issues to be considered when exploring the neuroanatomy of ASD.

To examine potential similarities in neural activation during the STROOP colour word test (SCWT) in patients with Bipolar Disorder (BD) and their unaffected first degree relatives of BD patients as an expression of genetic predisposition.

39 remitted BD patients were compared to 46 of their healthy relatives and to 42 controls. fMRI data were collected on a 1.5 T GE Signa MR system using a blocked periodic design and analysed in SPM5.

There was no statistically significant group difference in the behavioural performance. At the corrected cluster level threshold of p< 0.001 controls showed more activation than:

1. a. BD patients in the caudate, the inferior (BA 47), middle and superior frontal gyri (BA 8, 6, 46), the parietal cortices (BA 7, 40), the precuneus and occipital cortices (BA 7, 19).

2. b. Relatives in the caudate and cingulate cortex (BA 24, 31!). No other contrasts were significant.

These findings suggest that changes in neural activation during response inhibition may reflect genetic predisposition to BD.

To examine the effect of a polymorphism in the Dopamine Transporter (DAT) gene on brain activation during executive function and, for the first time:

1. 1. determine the extent to which this is altered in schizophrenia and

2. 2. use a verbal fluency paradigm.

1. 1. DAT plays a key role in the regulation of dopamine, which modulates cortical activation during cognitive tasks and

2. 2. a disruption of dopamine function is a fundamental pathophysiological feature of schizophrenia.

Functional magnetic resonance imaging was used to measure whole-brain responses during overt verbal fluency in 85 subjects: 44 healthy volunteers and 41 DSM-IV schizophrenia patients. Main effects of genotype and diagnostic group on activation and their interaction were estimated using an ANOVA in SPM5.

The 10-repeat allele of the 3'UTR VNTR was associated with greater activation than the 9-repeat allele in the left (Z=4.8; FWEp=0.005) and right (Z=4.2; FWEp=0.057) anterior insula and with decreased activation in the rostral anterior cingulate (Z=4.3 FWEp=0.04) during word generation (versus baseline). These effects were irrespective of diagnostic group but generally more marked in patients. There were also strong trends for groupxgenotype interactions in the left middle frontal gyrus and the left nucleus accumbens. Analysis was controlled for task performance, IQ, antipsychotic medication, psychopathology and demographics.

Cortical function during executive tasks is normally modulated by variation in the DAT gene, effect which is dependent on the brain region. DAT's effect may be altered in schizophrenia patients, which may reflect altered central dopamine function.

Affective deficits (flat affect, a diminished expression of emotion, anhedonia, and lowered ability to experience pleasure) are very common in schizophrenia. In emotion feeling, the crucial role of the insula, rather than of the primary somatosensory cortices, strongly suggests that the neural substrate for emotions is not merely sensorial. It is more likely that the activation of the insula representation of the viscero-motor activity is responsible for feeling of disgust. A recent MRI study demonstrated specific left anterior insular volume reduction in chronic schizophrenia patients: sustainable is the suggestion that emotion of disgust or of taste may be related to the experience of pleasure, which probably is compromise in schizophrenics.We investigated fMRI brain activations in first episode schizophrenic subjects with negative symptoms and in healthy subjects elicited by pleasant and unpleasant visual stimuli.

Ten first-episode schizophrenic subjects with normal IQ were recruited from the psychiatric service “SMILE” of San Salvatore Hospital and 10 healthy volunteers matched for age and education were scanned during observation of pleasant and unpleasant visual stimuli. Functional images were acquired with a 1.5T MRI scanner. Blood oxygenation level dependent (BOLD) contrast was obtained using EPI T2* weighted images.

The most important result of the study was the demonstration that anterior insula was activated by the exposure to disgusting stimula in normal subjects but not in schizophrenic subjects.

This failure of the neural systems used to support emotional attribution is consistent with pervasive problems in experiencing emotions by schizophrenics.

Disturbances in affect recognition may be one of the most pervasive and serious aspects of the schizophrenic patient's interpersonal problems. Many of the studies used chronic patients, and therefore present difficulties in interpretation of results, due to the confounding influence of institutionalization, length of disease, cognitive deficits, and positive symptoms. If emotion recognition deficits are a core feature of schizophrenia, they should be apparent in a first-episode sample.

Aim of the study was to examine affect recognition deficits in first psychotic episode and in young suffering of anxiety disorders (using a case-control design) during event-related potentials (ERPs).

Pictures from Ekman and Friesen series has been used in an ERPs study to investigate the neurophysiological correlates of the emotional processing of fear and happiness in patients with first episode (N°12) and in patients (N°12) with anxiety disorders versus healthy subjects. The three groups were compared using a visual oddball design.

Significant differences between groups in ERP components, the P100, N170, and N250 latency and amplitude differences for target stimuli faces were found. Significant differences were also observed in amplitude between positive and negative expression. First episode schizophrenic patients showed reduced amplitude in front of positive vs. negative stimuli. Anxious subjects did not show amplitude difference between the two kinds of emotional stimuli.

We can hypothesized that subjects with first-episode show specific altered patterns of cognitive effort in the perception of different emotional stimuli compared to normal controls and subjects affected by anxiety disorders.

The more recent advances in the field of Neurosciences include the study of abnormal pathophysiological findings in patients suffering from Psychiatric disorders. Several new brain imaging technologies are conveying numerous data concerning structural and functional abnormalities in such patients.

To provide an overview of the role of quantitative Electroencephalography (qEEG) in Psychiatry.

Review of the literature.

Among the various imaging studies, the application of three-dimensional qEEG may be the most practical and economic alternative. The qEEG consists in the statistical analysis of the EEG parameters, with computer-treated data. It is a portable, radiation-free, non-invasive method that measures excitatory and inhibitory cortical neuronal activity directly.

The latest literature regarding the potential role of the qEEG in Psychiatry debates its applicability in clinical settings. Several authors have been trying to evaluate its usefulness in clinical diagnosis and prediction of response to medication. We review the possible recommendations for the use of this test and the controversies surrounding them.

Velocardiofacial syndrome (VCFS) is a common genetic disorder due to a micro deletion on chromosome 22q11. This region includes several risk-associated genetic variants, including COMT, and VCFS is associated with a substantially increased risk for schizophrenia. As such, VCFS may serve as a valuable model for clarifying the neuroanatomical changes associated with genetic risk for psychosis.

A systematic literature search was conducted. Studies were included if they presented original data and were published by March 2008, compared subjects with VCFS and healthy controls and reported measures of brain regions according to SI units as mean and standard deviation. Data extracted from the studies included diagnosis, demographic variables and IQ. Statistical analysis was conducted using STATA 8.0 supplemented by ‘Metan’ software.

Twenty studies were retrieved. All measures were expressed in volumes apart from the corpus callosum (area). Subjects with VCFS showed reduced total brain volume (N=156 versus N=138), ([ES]=1.04, 95% CI:1.40, -0.67), with no significant heterogeneity or publication bias. This reduction was reflected in total hemisphere grey and white matter. Prefrontal, parieto-occipital and temporal cortices appeared to be particularly affected. A number of sub-cortical areas also showed decreased volumes including the hippocampus and putamen. In contrast, callosal areas were increased in VCFS.

In relation to controls, subjects with VCFS present with an overall reduction in brain volumes and specific abnormalities in multiple cortical and subcortical brain regions. These abnormalities may explain partly why VCFS is associated with a greatly increased risk of psychosis and other psychiatric disorders.

The aim was to determine the relation between characteristics of [123I]-ADAM binding to serotonin transporters (SERT) in several brain regions to different symptoms in patients diagnosed with major depressive disorder (MDD) and to analyze data for males and females separately. Differences of [123I]-ADAM binding in patients before and after treatment with Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant Citalopram were assessed.

12 non medicated patients (5 females and 7 males) diagnosed with MDD were examined by SPECT with specific Serotonin transporter radioligand [123I]-ADAM before and after treatment with SSRI Citalopram. We administered the dose of 10 mg Citalopram per day intravenously at first day, followed by a 6 days period of oral application. After 7 days of treatment patients were examined for second time with SPECT. The relationships between [123I]-ADAM binding and different aspects of major depression represented by HAMD items, assessed twice by Hamilton Depression-Scale (HAMD) once at baseline and second after treatment period, were evaluated.

We found significant correlations with significant gender differences between singular sub items of HAMD and indices of [123I]-ADAM binding in midbrain before and after treatment. These findings points to the need of data analysis separately in males and females. No correlations between HAMD total scores at baseline and indices were found.

SERT availability for 123-ADAM binding in the midbrain in drug naives as well as in treated patients with major depression disorder seems to be related to intensity of sub items in the HAMD and the outcome of treatment.

Exploration of the essential features of Mindfulness-based therapies, considered the third wave of cognitive therapy.

Databases were searched for literature on the principles through which mindfulness-based therapies may operate, the possible mechanisms of action underlying these interventions, their clinical applications and evidence of their therapeutic and adverse effects. Mindfulness-based cognitive therapy (MBCT), which has been developed for depression relapse prevention, is highlighted.

These techniques have been used for various applications such as chronic pain control, stress reduction and prevention of depression relapse. Some of their important features are cultivation of conscious awareness and attention on a moment-to-moment basis, with openness, curiosity and a non-judgemental attitude and their aim is to change cognitive processes, rather than cognitive content. There have been some well-designed empirical evaluation studies published addressing the effectiveness of these interventions but current evidence of their mechanisms is limited.

There is evidence that mindfulness-based approaches add an important dimension to available psychotherapies in the management of the psychological aspects of a range of mental and physical health problems.

1. 1. Study on the association between health and risk behaviours and psychosocial variables: The better the self-concept, the better the behaviours; The higher the satisfaction with social support, the better the behaviours; The higher the assertiveness, the better the behaviours; The association between control locus and healthy and risk behaviours is not significant.

2. 2. Study on the association between health and risk behaviours and cognitive variables: The more favourable the attitudes towards health, the better the behaviours; The more adequate the health beliefs, the better the behaviours.

3. 3. Study on the psychosocial variables interaction effects with cognitive variables in health and risk behaviour prediction: The interaction variable was revealed as the best health and risk behaviour predictor is the variable resulting from Factor 1 - behavioural aspect (Self-Concept) and Factor 4 - preventive attitude (Attitudes Towards Health) interaction, with a determination coefficient (R2) of .409. The patterned coefficient analysis Beta (beta=.427) indicates that the higher this interaction effect (F1 - behavioural aspect * F4 - preventive attitude) the better the behaviours.

Tobacco dependence is common in patients with mental disorders. At the same time the self-esteem of these patients is very low. Failures, which inmates may suffer during smoke cessation, may lower their self-esteem more and more. The aim of the study was to indicate the influence of CBT on self-esteem and smoking cessation among inmates.

The study comprised 44 mentally ill heavy smokers (38 with schizophrenia and 6 with depression). CBT was adopted for the experimental group (n=19). The CBT-group participated in twelve weekly two-hour therapeutic sessions concentrated on enhancing a self-esteem, and twelve weekly educational sessions. The control group (n=25) participated in educational training only. The study was of a linear character. The following methods were used: Self-Esteem Scale, Fagerstrom Test for Nicotine Dependence, characteristic of tobacco use questionnaire and monitoring the amount of cigarettes.

An improvement in self-esteem was observed in the period following the therapy among CBT-group in comparison with the control group. After therapy inmates from CBT-group smoked less cigarettes than control group and faster decided on a smoking cessation. After interventions self-esteem was negatively correlated with amount of cigarettes. Twelve patients from CBT-group stopped smoking completely in comparison with eight from control group.

CBT improves the self-esteem in mentally ill patients and it may by used as a very helpful method for smoking cessation among this group of smokers.

Research using fMRI indicates that sustained limbic activity is linked to processing negative words and self-reported rumination in currently depressed individuals. It is unknown whether this is also present in remitted depressed individuals. We tested the hypothesis that a tendency to ruminate constitutes a trait for depression by using a standard covert fMRI emotional task face in previously and never depressed volunteers and postulated that high rumination scores would correlate with activity in brain areas previously associated with depression.

37 controls (25 female) and 30 remitted depressed (RD, 22 female) were enrolled. Volunteers completed the Ruminative Responses Scale (RRS) and underwent fMRI scanning using a standard covert fMRI emotional task faces. Significance level was set at p < 0.05 (FWE).

With RRS score controlled for RD showed reduced subcortical and limbic activity to sad and fearful faces compared to controls. Correlations between RRS scores and neural activity in all participants and control participants alone were very limited. However, in RD, RRS score was negatively correlated with neural response to happy faces and positively correlated with neural response to sad and fearful faces, in cortical and limbic regions associated with depression (hippocampus, thalamus, caudate, insula and cingulate gyrus).

The results suggest that reduced limbic activity is associated with remission, possibly as a maintenance mechanism. However, within the remitted group the more ruminative participants show greater response in these areas to negative stimuli, and less to positive stimuli. This could be a neurobiological marker for risk of relapse.

Cytokine-induced sickness behaviour is an adaptative response to infection. Activation of the immune system, particularly the increased activity of several cytokines, has been implicated in the provocation or exacerbation of mood disorders.

To discuss the relevance of psychoneuroimmunologic research in the understanding of the patophysiology and therapeutic targets of certain mental health disorders.

Review of the literature. MEDLINE and PubMed databases searches for peer-reviewed studies, published between 2000 and 2008, using combinations of the Medline Subject Heading terms cytokines, sickness behaviour, immune system and depression, depressive illness.

Several lines of evidence support the relationship between cytokines and mood disorders. Cytokine elevations are more marked in severe depression and their activity may also relate with illness chronicity, neurovegetative features and high stress perception. It is argued that the activation of the inflammatory system, eliciting cytokine release and synthesis, provoke neuroendocrine and neurotransmitter changes, contributing to the development of depression. Some studies support that the brain cytokine system can become sensitized in response to non-immune stressors or to immune stressors occurring early in life.

The cytokines actions in the brain can help to clarify the patophysiology of certain psychiatric disorders, including depression. The research findings show an association between the activation of the brain cytokine system and depression, although the precise relationship between sickness behaviour and depression is still not clear. Further research in such a promising area of study is needed and can contribute to new therapeutical targets and a broader understanding of psychiatric disorders.

Patients with ABI present with a relatively higher risk of developing psychotic illness. A co-morbid psychotic illness may pose multiple challenges in rehabilitation of these patients. The medical literature provides limited information on the nature, presentation, diagnosis, course, and prognosis of psychotic disorders after ABI.

Clinically generated data was used to study the prevalence and nature of co-morbid psychotic illness and cause of ABI amongst inpatients requiring multidisciplinary neurobehavioral rehabilitation. The data were collected in an anonymized fashion and analyzed using SPSS version 16.

We examined data from 64 patients (51 Male, 13 Female). The age range was 21-61 years (Mean 39, S.D. 10.6). 40% patients had a history of mental illness or self harm prior to ABI. 16% had sustained their ABI as a result of suicide attempts. 12% had history of schizophrenia or bipolar mood disorder prior to ABI.

A third (33%) had a Post-ABI diagnosis of a psychotic illness. The most common diagnosis was organic psychosis (21%) followed by schizophrenia (9%) and bipolar mood disorder (3%). The factors that influenced diagnostic differentiation in organic or non-organic psychotic illness included consideration of past psychiatric history, family history, psychopathology, and course of the disorder. The overall patient group showed a significant difference in post admission and latest HONOS-Secure (P< 0.01) and HONOS ABI (P< 0.01) ratings, showing improvement in outcomes during rehabilitation programme. This difference persisted when sub-groups of psychotic and non-psychotic patients were analysed separately.