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While both depression and aging have been associated with oxidative stress and impaired immune response, little is known about redox patterns in elderly depressed subjects. This study investigates the relationship between redox/inflammatory patterns and depression in a sample of elderly adults.
The plasma levels of the advanced products of protein oxidation (AOPP), catalase (CAT), ferric reducing antioxidant power (FRAP), glutathione transferase (GST), interleukin 6 (IL-6), superoxide dismutase (SOD), total thiols (TT), and uric acid (UA) were evaluated in 30 patients with mood disorders with a current depressive episode (depressed patients, DP) as well as in 30 healthy controls (HC) aged 65 years and over. Subjects were assessed with the Hamilton Depression Rating Scale (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Geriatric Depression Rating Scale (GDS), the Scale for Suicide Ideation (SSI), the Reason for Living Inventory (RFL), the Activities of Daily Living (ADL), and the Instrumental Activity of Daily Living (IADL).
DP showed higher levels than HC of AOPP and IL-6, while displaying lower levels of FRAP, TT, and CAT. In the DP group, specific correlations were found among biochemical parameters. SOD, FRAP, UA, and TT levels were also significantly related to psychometric scale scores.
Specific alterations of redox systems are detectable among elderly DP.
Patients with schizophrenia display experiential anomalies in their feelings and cognitions arising in the domain of their lived body. These abnormal bodily phenomena (ABP) are not part of diagnostic criteria for schizophrenia. One of the reasons is the difficulty to assess specific ABP for schizophrenia spectrum disorders. The present study aimed to explore the presence in patients with schizophrenia of specific ABP.
We used a semistructured interview—the Abnormal Bodily Phenomena questionnaire (ABPq), an instrument devised to detect and measure ABP specific to patients with schizophrenia. Fifty-one outpatients affected by schizophrenia and 28 euthymic outpatients affected by bipolar disorder type I with psychotic features (BD-pf-e) were recruited. Before assessing the specificity for schizophrenia of the observed ABP, we tested the internal consistency and the convergent validity of the ABPq in patients with schizophrenia. Specificity was assessed by examining potential differences in ABPq among the patients with schizophrenia in remission (SCZ-r) and BD-pf-e.
The ABPq shows strong internal consistency and convergent validity. As to the specificity, ABP measured by ABPq were more frequent and severe in SCZ-r than in BD-pf-e. In particular, all ABPq dimensions, except “Coherence,” had at least mild severity in over 50% of SCZ-r, while dimensions with at least mild severity were observed in 5–10% of the BD-pf-e.
These findings can contribute to establish more precise phenomenal boundaries between schizophrenia and bipolar disorder, to explore the borders between nonpsychotic and psychotic forms of ABP, between ABP and negative and disorganized symptoms, and to enlighten core aspects of schizophrenia.
Obsessive-compulsive disorder (OCD) and tic disorder (TD) represent highly disabling, chronic and often comorbid psychiatric conditions. While recent studies showed a high risk of suicide for patients with OCD, little is known about those patients with comorbid TD (OCTD). Aim of this study was to characterize suicidal behaviors among patients with OCD and OCTD.
Three hundred and thirteen outpatients with OCD (n = 157) and OCTD (n = 156) were recruited from nine different psychiatric Italian departments and assessed using an ad-hoc developed questionnaire investigating, among other domains, suicide attempt (SA) and ideation (SI). The sample was divided into four subgroups: OCD with SA (OCD-SA), OCD without SA (OCD-noSA), OCTD with SA (OCTD-SA), and OCTD without SA (OCTD-noSA).
No differences between groups were found in terms of SI, while SA rates were significantly higher in patients with OCTD compared to patients with OCD. OCTD-SA group showed a significant male prevalence and higher unemployment rates compared to OCD-SA and OCD-noSA sample. Both OCTD-groups showed an earlier age of psychiatric comorbidity onset (other than TD) compared to the OCD-SA sample. Moreover, patients with OCTD-SA showed higher rates of other psychiatric comorbidities and positive psychiatric family history compared to the OCD-SA group and to the OCD-noSA groups. OCTD-SA and OCD-SA samples showed higher rates of antipsychotics therapies and treatment resistance compared to OCD-noSA groups.
Patients with OCTD vs with OCD showed a significantly higher rate of SA with no differences in SI. In particular, OCTD-SA group showed different unfavorable epidemiological and clinical features which need to be confirmed in future prospective studies.
Structural and functional abnormalities of the left hemisphere, often involving the temporal lobe were frequently observed in schizophrenia. However, negative and discrepant findings were also reported. Our study aimed to investigate the presence of lateralized impairment of event-related potentials, recorded during a tonal dichotic listening task, in a group of clinically stabilized patients with schizophrenia.
The ERP component N100, related to sensory processing of stimuli and generated in the temporal lobe cortex, was investigated. A passive dichotic listening task was used in order to exclude the effect of attention impairment on the observed ERP abnormalities.
Patients with schizophrenia showed a pattern of hemispheric lateralization comparable with that observed in healthy controls. In both groups, dichotic listening inhibited the augmenting pattern of N100 amplitude with increasing tone intensity. However, patients failed to demonstrate the augmenting pattern of the N100 also with monaural tones, over the left temporal leads. This abnormality did not correlate with the severity of psychopathology. A role of antipsychotic treatment was excluded as the N100 showed a normal pattern of amplitude increase over right temporal leads.
Our results suggest a state of functional inhibition of the left auditory cortex, akin to that induced by dichotic listening, in subjects with schizophrenia, indipendent of psychopathology or drug therapy.
Symptomatic remission is increasingly perceived as a realistic objective of pharmacological treatment in patients with schizophrenia (2). However the relationships between symptomatic remission, as defined by standardized criteria, and functional outcome remain controversial. In the present study, we designed a one-year follow-up of clinically stable patients with schizophrenia and examined the relationships of clinical remission with several indices of psychosocial functioning.
Thirty-six patients with schizophrenia were included. All the evaluations were carried out both at baseline (T0) and after a one-year follow-up (T12). The categorization in psychosocial remission/non-remission was done by means of the Psychosocial Remission in Schizophrenia (PSRS) scale.
Both at T0 and at T12, R showed, with respect to NR, a better social functioning and a better quality of life. Correlation analysis revealed that the better the psychosocial functioning, the lower the scores on all psychopathological dimensions, except “anxiety/depression” and “hostility” at T0 as well as “anxiety/depression” at T12. At T0, 65% of R resulted also in psychosocial remission; at T12, this percentage reached 90%.
Our findings suggest that symptomatic remission in schizophrenia is associated to functional outcome in the majority of cases, especially when both symptomatic and chronological criteria are met.
Abnormalities of emotional processing have been reported in both anxiety and depressive disorders. Anxiety might be related to a hyperactive preattentive fear response or to a reduced efficiency of late regulatory processes, whereas depression might be related to a reduced response to positive emotions. In the present study event-related potentials (ERPs) were used to investigate involuntary processing of stimuli with different emotional valence in 33 healthy controls [HC] and 55 clinically stable patients (16 with panic disorder [PD], 15 with obsessive-compulsive disorder [OCD], 13 with unipolar depression [UD] and 11 with bipolar depression [BD]).
The ERPs were recorded during a target detection task, in which erotic, threatening, disgusting and neutral stimuli were used as distracters.
Patients showed abnormalities of the sequence, duration and topography of the ERP components related to emotional processing. Patients with anxiety disorders showed abnormalities of the early components in response to threatening stimuli. Patients with BD showed abnormalities of both early and late ERPs components. OCD and UD patients demonstrated similar abnormalities of the late ERP components in response to erotic stimuli.
According to our results, abnormalities of emotional processing are observed in both anxiety and affective disorders and might have both distinct and shared characteristics in these disorders.
Cognitive impairment in patients with eating disorders was reported by the majority of studies addressing this issue. However, heterogeneous patterns of cognitive dysfunctions were observed and, in a minority of studies, no impairment was found. The present study was aimed to define the pattern of neurocognitive impairment in a large sample of bulimia nervosa (BN) patients and to demonstrate that neuroendocrine, personality and clinical characteristics influence neurocognitive performance in BN.
Attention, executive control, conditional and incidental learning were evaluated in 83 untreated female patients with BN and 77 healthy controls. Cortisol and 17β-estradiol plasma levels were assessed. Cloninger's Temperament and Character Inventory-Revised (TCI-R), the Eating Disorder Inventory-2 and the Montgomery-Asberg Depression Rating Scale were administered.
No impairment of cognitive performance was found in subjects with BN vs. healthy controls. The higher the cortisol level and “Self-directedness” scores the better the performance on conditional learning, while 17β-estradiol levels showed an opposite pattern of association; “Reward dependence” scores were associated to a worse performance on incidental learning; depressive symptomatology negatively influenced the performance on the WCST.
No cognitive impairment was found in untreated patients with BN in the explored cognitive domains. An influence of neuroendocrine, personality and clinical variables on neurocognitive functioning was found, which might explain discrepancies in literature findings.
An impairment of several cognitive domains has been largely documented in patients with schizophrenia. The present study aimed to investigate the relationships between cognitive functioning, symptomatic remission and functional outcome in schizophrenia.
The performance on the neuropsychological battery “Brief Assessment of Cognition in Schizophrenia (BACS)” has been investigated in clinically remitted (R) and non-remitted (NR) schizophrenic patients. The associations of neuropsychological performance with psychopathological dimensions derived from PANSS and indices of social functioning (as assessed by the Global Assessment of Functioning scale, the Personal and Social Performance scale, the Quality of Life Scale, the UCSD Performance-Based Skills Assessment-Brief Version and the Psychosocial Remission in Schizophrenia scale) were also explored by means of multiple regression (MR) analyses.
Compared with NR, R patients showed a better performance on tests exploring executive functions, processing speed and verbal fluency. Residual negative symptoms and processing speed were independent predictors of functional outcome, while remission status did not enter the MR function.
Our findings suggest that cognitive abilities, in particular processing speed and executive functions, are preserved in patients who are able to reach clinical remission. Independently from the remission state or residual negative symptomatology, processing speed also predicts functional outcome in schizophrenia. Our findings support the view that cognitive dysfunctions in schizophrenia should be targeted by specific treatment intervention, such as neurocognitive rehabilitation.
The term “deficit syndrome” (DS) refers to a diagnostic subtype of schizophrenia characterized by the presence of primary and enduring negative symptoms. Several authors have supported the hypothesis that DS represents the more severe end of the schizophrenia spectrum; however, the empirical evidence did not clarify this interpretation. The present study is aimed to evaluate neuromorphological abnormalities in Deficit (DS) and Nondeficit Schizophrenia (NDS). We investigated a group of 18 patients with a DSM-IV diagnosis of schizophrenia, categorized as DS (N=10) and NDS (N=8), and 8 matched healthy controls. All subjects underwent a high resolution imaging protocol (MPRAGE) and an extensive psychopathological evaluation. Images were segmented by means of the algorithm implemented within the SPM2 software; quantitative measures of gray matter were manually obtained for hippocampal and dorso-lateral prefrontal (DLPF) regions. Gray matter in DLPF cortex was significantly reduced in the NDS group, with respect to both DS and healthy subjects. ANCOVA analyses revealed that the volumetric abnormalities found in DS vs. NDS patients were not related to dose or type of antipsychotic treatment. Our structural neuroimaging findings in subjects with schizophrenia, revealed significant differences between the DS and NDS subtypes, which were not influenced by antipsychotic medication, and suggested that DS does not simply represent the more severe end of the schizophrenia spectrum.
Cognitive impairment is increasingly regarded as a core aspect of schizophrenia. It is associated with poor functional outcome, may represent a rate limiting factor in rehabilitation programs and is not largely influenced by pharmacological interventions.
Several studies suggest the efficacy of cognitive training programs and advice their inclusion in treatment strategies, while others discourage clinical application.
We recently completed a study involving three Mental Health Departments located in the South of Italy and coordinated by the Department of Psychiatry of the University of Naples SUN. Fifty-eight patients with either a diagnosis of schizophrenia or schizoaffective disorder were recruited and randomly allocated to one of two rehabilitation programs: Social Skill Training (SST) + Computerized Cognitive Training (CCT) (Group A) and usual rehabilitation activities of the Department (Group B). The active treatment phase lasted 6 months. Psychopathological aspects, as well as psychosocial and neurocognitive functioning, were assessed both before and after treatment. Group A subjects participated in two one-hour sessions of CCT and one two-hour session of SST. Group B patients spent an equivalent amount of time in the usual rehabilitation activities.
The two groups did not differ on baseline clinical, neurocognitive and psychosocial variables.
At the end of treatment, a worsening of the negative dimension was observed in group B, but not in group A, in which a significant improvement of two psychosocial indices (participation in family life and availability to work) was found.
The experimental program (SST+CCT) was more effective than usual rehabilitation activities of the departments.
A large body of literature supports the hypothesis that high frequency oscillations within the gamma band are involved in the integration of sensory information across different modalities and cortical areas. A reduction of gamma oscillations around 40 Hz has been reported in schizophrenic patients by several authors. This abnormality indicates a poor integration of the neuronal activity within distributed neural networks in schizophrenia, in line with modern conceptualizations of the disorder and its liability.
In the present study we investigated evoked and induced 40-Hz gamma power as well as fronto-parietal and fronto-temporal event-related coherence in patients with deficit and nondeficit schizophrenia and in matched healthy controls. In patients, correlations between gamma oscillations and psychopathological dimensions were also investigated.
We found that abnormalities of both induced gamma power and event-related coherence were present in patients with nondeficit schizophrenia, but not in those with deficit schizophrenia. These findings suggest that schizophrenia heterogeneity should be taken into account when dealing with indices of cortical functional connectivity.
In line with previous findings, in our study an excess of gamma oscillations has been found to correlate with reality distortion and other psychopathological dimensions, indicating that abnormal thoughts, behaviours and perceptions might be related to abnormal connectivity within distributed neural networks.
It has been hypothesized that cognitive remediation with adjunctive psychiatric rehabilitation would be associated with greater improvements in functional outcome than standalone treatment approaches (1).
Moving from these observations our group designed an individualized rehabilitation program including a computerized cognitive training (CCT) and social skills training (SST), which showed promising results (2).
A critical evaluation of recent studies examining standalone and combined treatment approaches included the understanding of the differential impact of the two approaches among crucial areas for future research (3).
The present study compared the effects of CCT and SST on several indices of outcome in psychotic patients. Fifty-eight patients with schizophrenia or schizoaffective disorder were randomly assigned to one of two treatment groups: CCT or SST. Changes in cognitive, psychopathological and psychosocial indices after 6 and 12 months were compared between the two groups.
After both 6 and 12 months, an improvement of psychosocial indices was observed in both groups, while cognitive functions improved only after CCT; the improvement of psychopathological indices, observed in both groups, was greater in the CCT group.
Our findings suggest that CCT is associated with a greater impact than SST on different indices of outcome in psychotic patients. Future research should focus on possible synergistic effects of cognitive remediation and social skills training on functional outcome.
In subjects with panic disorder (PD), previous studies have reported a high prevalence of alexithymia, a poor inhibition of emotional interferent stimuli on the Emotional Stroop test, and a recognition bias toward fear for facially expressed emotions. Other studies, however, have reported no difference between PD patients and healthy subjects (HS) for emotional stimuli processing.
Twenty-eight drug-free patients with PD and 32 HS were included in the study. The two groups did not differ for age, sex, education level and handedness. The Toronto Alexithymia Scale-20 items (TAS-20) was used to evaluate alexithymia. The Emotional Stroop test was administered to evaluate the ability to suppress interference from different emotional valence stimuli. The Bouhuys' test was used to evaluate the perception of facially expressed emotions.
Compared to HS, patients with PD showed: 1) higher frequency of alexithymia and borderline alexithymia, in particular higher scores on the first (difficulty in identifying feelings) and the second (difficulty in describing feelings) dimension of alexithymia; 2) higher mean reaction time on the Emotional Stroop test for panic-related stimuli; 3) no difference on the Bouhuys' test.
Our data suggest that, in patients with PD, a reduced awareness of emotional experiences, which characterize alexythimic subjects, may underly anxiety symptoms and panic attacks, leading to a failure to identify emotional reactions with a preferential activation of alarm and defence behaviours.
Several studies provided evidence that relationship of cognitive impairment with social functioning is stronger than that of psychopathology. In a group of 88 subjects with schizophrenia or schizoaffective disorders we found that verbal memory, executive function and sustained attention indices explained 19.9% of the global disability variance, while negative symptoms explained 4.4% of the variance.
Based on these data our group designed an individualized rehabilitation program including two one-hour sessions of computerized cognitive training and one two-hour session of social skills training per week (Social Skills And Neurocognitive Individualized Training, SSANIT).
In the present study the efficacy of this rehabilitation program was investigated in 58 subjects with chronic schizophrenia or schizoaffective disorder. Patients were recruited in three Mental Health Departments located in the South of Italy and randomly allocated to one of two rehabilitation programs: SSANIT or Usual Rehabilitation Activities (URA) of each department. The active treatment phase lasted 6 months.
At the end of treatment a significant improvement of psychosocial functioning (global psychosocial index, participation in family life and availability to work) was found in the SSANIT but not in the URA group; furthermore a worsening of the negative dimension was observed in the URA, but not in the SSANIT group.
According to our findings, the SSANIT program is more effective than the rehabilitation activities usually implemented in Mental Health Departments (e.g. carpentry and decoupage).
Few studies were carried out, so far, on neuropsychological aspects of panic disorder (PD). Impairments involving memory, verbal learning, visuospatial abilities, divided attention and executive functioning have been reported; however, some studies found no difference between patients with PD and healthy subjects (HS). Discrepancies might be due to either the use of different tests for neuropsychological assessment or the inclusion of different patient populations (e.g. medicated, unmedicated).
In the present study general cognitive abilities, focused and sustained attention, incidental learning, secondary memory and the ability to suppress interference were evaluated in 28 drug-free patients with PD and 32 HS, matched for sex, age, educational level and handedness. In patients with PD frequency and intensity of panic attacks, anticipatory anxiety, main phobias and avoidance state, along with severity of anxiety and depressive symptoms, were also assessed.
Compared to HS, PD patients showed: 1) lower scores on tests assessing general cognitive abilities, 2) higher accuracy on the test exploring spatial incidental learning, 3) higher degree of interference on a test exploring secondary memory for non verbal materials. No correlation was observed between neuropsychological and psychopathological indices.
Our results suggest an impairment of abstraction and symbolization abilities in patients with PD. Differences in susceptibility to interference on the non verbal memory task may reflect an executive dysfunction involving orbito-frontal and cingulate cortices.
Several studies have documented QEEG changes induced by first generation antipsychotics. Few studies investigated QEEG modifications induced by second generation antipsychotics and reported inconsistent results. The present study is aimed to investigate, by means of high temporal resolution imaging techniques, changes in QEEG cortical current source density induced by haloperidol, risperidone and placebo in young healthy male subjects.
Each subject underwent three sessions, separated by at least a one-week interval. In each session, subjects received a single oral dose of placebo, or haloperidol (3 mg) or risperidone (1 mg). EEGs were recorded during a resting condition, before and 6 hours after drug administration.
With respect to placebo, a significant increase of delta and theta power was observed for both drugs; alpha1 increase was significant only for risperidone; in addition, beta1 power was increased by haloperidol and alpha2 power was decreased by risperidone. LORETA analysis revealed significant differences in cortical generators activity between placebo and haloperidol, involving frontal, cingulate and temporal regions for all EEG bands, except beta3. For risperidone, as compared with placebo, LORETA showed a significant increase of cortical current source density in frontal regions for delta, theta and alpha1.
The widespread increase of current source density for most EEG bands observed after haloperidol may suggest that this drug has a lower regional specificity of action on EEG cortical generators than risperidone.