Exploring the association between suicidal thoughts, self-injury, and GLP-1 receptor agonists in weight loss treatments: Insights from pharmacovigilance measures and unmasking analysis

INTRODUCTION

The study addresses concerns about potential psychiatric side effects of Glucagon-like peptide-1 receptor agonists (GLP-1 RA).

AIM

The aim of this work was to analyse adverse drug reports (ADRs) from the Food and Drug Administration Adverse Events Reporting System (FAERS) using metformin and orlistat as comparators.

METHODS

Descriptive and pharmacovigilance disproportionality analyses was performed.

RESULTS

A total of 209,354 ADRs were reported, including 59,300 serious cases. Of those, a total of 5378 psychiatric disorder cases, including 383 'serious' cases related to selected ADRs were registered during 2005-2023. After unmasking, 271 cases where individual GLP-1 RA were implicated showing liraglutide (n = 90; Reported Odds Ratio (ROR) = 1.64), exenatide (n = 67; ROR = 0.80), semaglutide (n = 61; ROR = 2.03), dulaglutide (n = 45; ROR = 0.84), tirzepatide (n = 5; ROR = 1.76) and albiglutide (n = 2; ROR = 0.04). A greater association between these ADRs with metformin was observed, but not orlistat. With regards to selected preferred terms (PTs), 42 deaths including 13 completed suicides were recorded. Suicidal ideation was recorded in n = 236 cases for 6/7 GLP-1 RA (excluding lixisenatide).

DISCUSSION

Suicide/self-injury reports pertaining to semaglutide; tirzepatide; and liraglutide were characterised, although lower than metformin. It is postulated that rapid weight loss achieved with GLP-1 RA can trigger significant emotional, biological, and psychological responses, hence possibly impacting on suicidal and self-injurious ideations.

CONCLUSIONS

With the current pharmacovigilance approach, no causality link between suicidal ideation and use of any GLP-1 RA can be inferred. There is a need for further research and vigilance in GLP-1 RA prescribing, particularly in patients with co-existing psychiatric disorders.

Prevalence of Orthorexia Nervosa in a sample of italian young adults

Abstract

There is only limited epidemiological information on Orthorexia Nervosa; the aim of the present study is, therefore, to assess the prevalence of ON in a population of young adults and to identify possible specific features and eventual psychopatological dimensions. 1317 participants (732 females and 585 males; mean age 22.36 yrs) completed a battery containing the orthorexia measure (ORTHO-15), statements about demographic characteristics as well as physiological parameters. The mean ORTO-15 score was 31.89; considering the cut-off of 40 in the reference test, our results showed a 11.9% prevalence of ON. Analyzing the characteristics of the orthorexic group, the prevalence in females compared to males appears to be statistically very significant (115 vs 43; 72.8% vs 27.2%); moreover shows higher and statistically significant scores in each of the 15 items of the reference test compared to the non-orthorexic group. Our data confirming that ON might be a relevant and potentially underestimate phenomenon in the community. Further studies are warranted in order to explore the diagnostic boundaries of this syndrome, its course and outcome, and the possible therapeutic strategies.

To bridge or not to bridge: Moral Judgement in Cocaine Use Disorders, a case-control study on human morality

BACKGROUND

In the "Dual-Process theory", morality is characterized by the interaction between an automatic-emotional process, mediated by the Anterior Cingulate Cortex (ACC) and linked to personal-deontological decisions, and a rational-conscious one, mediated by the Dorso-Lateral Prefrontal Cortex (DLPFC) and linked to impersonal-utilitarian decisions. These areas are altered by chronic use of cocaine, with a possible impact on moral decision-making.

OBJECTIVE

To evaluate the difference between a group of Cocaine Use Disorder (CUD) patients and a control group in moral decision-making.

METHODS

Subjects with CUD were compared to an equal-sized healthy group regarding their moral decision-making. Trolley and Footbridge Moral Dilemmas were administered to each group. The quality of the answer (yes or no) and the time needed to answer were recorded.

RESULTS

The recruited group includes 72 subjects, 36 with CUD and 36 healthy subjects (average age of 39.51 ± 9.89). In the Trolley dilemma, almost all the subjects (97.3%) answered "yes", while in the Footbridge dilemma CUD subjects answered "yes" more often (52.7%) than the healthy group (19.4%).

CONCLUSION

For strong emotional dilemmas (Footbridge), cocaine users answered "yes" with a higher frequency compared to healthy subjects, highlighting a wider utilitarian tendency in decision-making and a poor emotional participation.

Antidepressant discontinuation syndrome: A state-of-the-art clinical review

Antidepressant drugs are prescribed to patients with depressive, anxiety disorders, and other conditions. Evidence about antidepressant discontinuation syndrome (ADS) and related outcomes is sparse, although potentially burdensome in some patients. The present state-of-the-art review aims to appraise the most current evidence about ADS critically. ADS has been documented for most antidepressant drugs, although most literature focuses on selective serotonin reuptake inhibitors prescribed for depression. While down-titration cannot exclude the chance of ADS, it is nonetheless warranted in the clinical setting, especially for short half-life and sedative compounds such as paroxetine. Integrative management with concurrent pharmacotherapy and psychotherapy may minimize the eventual unpleasant effects arising within the discontinuation process. In addition, patient-tailored interventions and education should be part of the discontinuation strategy. Future research must rely on broadly accepted definitions for ADS and related phenomena such as antidepressant withdrawal and shed further light on the underpinning neurobiology. Discriminating between ADS-related phenomena and relapse of depression is likewise warranted, along with a neuroscience-based nomenclature instead of a class one.

Cannabis use disorder and dissociation: A report from a prospective first-episode psychosis study

BACKGROUND

Cannabis is the most used recreational drug worldwide. Its use can increase the risk of developing psychotic disorders and exacerbate their course. However, the relationship between cannabis use and dissociative symptoms has been scarcely investigated.

AIMS

To examine differences in psychotic and dissociative symptoms, and in functioning in first-episode psychotic patients (FEPp) using cannabis compared with those not using cannabis.

METHODS

Between January 2014 and December 2019, seventy FEPp with cannabis use disorder (N = 35) and without it (N = 35) were recruited in psychiatric inpatient facilities in the Italian regions of Lazio and Piemonte. All subjects were assessed at FEP, after 4 and 8 months, using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Dissociative Experiences Scale - II (DES-II). Detailed information on the pattern of cannabis and other substance use were collected.

RESULTS

FEP using cannabis showed higher levels of positive symptomatology, dissociative experiences and worse functioning than their non-user counterpart, despite a comparable antipsychotic treatment. At an eight-month prospective evaluation, FEP using cannabis still showed higher levels of positive symptomatology and dissociation. Moreover, global functioning worsened over time in FEPp using cannabis, whereas it improved those not using it.

DISCUSSION

Our findings suggest that a greater degree of dissociation and positive symptoms at FEPp and their persistence over time may characterise cannabis-associated psychosis. Both these factors might explain the overall functioning worsening over time that we observed in the cannabis-user group compared to the functioning improvement in the non-user group.

Language proficiency and mental disorders among migrants: A systematic review

Background

In this review, we aimed to evaluate the association between language proficiency (LP) and the prevalence and severity of mental disorders in migrants. Secondarily, we aimed to consider whether sociodemographic and migration-related factors may affect the correlation between LP and mental disorders.

Methods

MEDLINE, PsycArticles, EMBASE, and PsycInfo were systematically searched in April 2020 to identify original studies reporting prevalence of psychiatric symptoms or disorders among migrants and taking into account linguistic factors.

Results

The search of electronic databases initially yielded 1,944 citations. Of the 197 full texts assessed for eligibility, 41 studies were selected for inclusion in the systematic review. Thirty-five of the papers included reported a significant negative association between low LP and prevalence and/or severity of psychiatric symptoms or disorders, whereas only two records found the opposite relationship and four papers reported no association between them. Inadequate LP was consistently associated with several mental disorders in migrants, including psychotic, mood, anxiety, and post-traumatic stress disorders. Notably, all the four longitudinal studies that met inclusion criteria for this review reported a positive effect of LP acquisition over time on prevalence or symptom severity of mental disorders.

Conclusions

Even though larger prospective studies are needed to better evaluate the relationship between LP and psychiatric disorders among migrants, we believe that the present findings could be inspiring for authorities to provide support and courses to improve migrants’ language proficiency upon arrival.

BDNF Val66Met polymorphism is associated with aggressive behavior in schizophrenia

Brain-derived neurotrophic factor (BDNF) gene variants may potentially influence behaviour. In order to test this hypothesis, we investigated the relationship between BDNF Val66Met polymorphism and aggressive behaviour in a population of schizophrenic patients. Our results showed that increased number of BDNF Met alleles was associated with increased aggressive behaviour.

Use of Novel Psychoactive Substances and Induced Psychiatric Symptoms: Outcomes From the Eivissa Project

Introduction

Polydrug abuse seems to be especially popular in Ibiza, an important market for new psychoactive substances (NPS). The misuse of psychoactive substances can lead to serious psychiatric symptoms.

Aims

To evaluate symptoms induced by NPSs and other club drugs, correlating with the main classes of drugs.

Methods

Ninety subjects (M/F 59/31) admitted in the Psychiatric Unit of Can Misses Hospital (Ibiza) referring a recent intake of substances were enrolled. The following scales were administered: TLFB (Timeline follow-back); Positive and Negative Symptoms Scale (PANSS); Symptom checklist-90 (SCL-90) ; Young Mania Rating Scale (YMRS) ; Hamilton Depression Scale (HAM-D); Hamilton Anxiety Scale (HAM-A); Modified Overt Aggression Scale (MOAS); Columbia Suicide Severity Rating Scale (C-SSRS).

Results

Polydrug abuse was reported by 67.4% of the sample; the sample was grouped by the main preferred substance in THC-, stimulants-, and depressors-users. The majority of patients reported a previous psychiatric history. Positive symptoms resulted to be higher among THC-users (P < .05). Anxiety evaluated by SCL-90 was prevalent in the group of Depressors-users (P < .05). The scores of MOAS and SCL-90 subscale for hostility/aggression resulted to be significantly (P < .01) greater in the THC-users group.

Conclusions

Some specific psychiatric symptoms are characteristic of some classes of substances and may help to identify them when a urine sample is not available. The possibility to develop psychiatric symptoms after a recent drug use is more common in two situations: (1) patients with a previous psychiatric history; (2) subjects with a history of very strong substance use.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Party Hard: Drug-related Fatalities in Ibiza from 2010 to 2016

Introduction

Illicit drug use is well known as an important contributor to the global burden of diseases, but the physical and psychopathological risks of recreational drugs misuse are often underestimated and drug-related fatalities in specific settings are under-investigated.

Objectives and methods

In the framework of the EU-funded project “EU-Madness”, we collected and analysed all the reports of drug-related fatalities in Ibiza from January 2010 to September 2016, with the aim of characterising the sample, and identifying the involved substances and the nature of deaths associated with their consumption.

Results

Overall, 58 drug-related fatalities were registered from 2010 to September 2016 (87.9% males, 12.1% females, mean age 33.16; females were significantly younger than males). Most of the deceased were Britons (36.2%), followed by Spanish (22.4%), Italians (6.9%) and Germans (5.2%). In half the cases, the substance identified in post-mortem analyses was a stimulant; in 24.1% of the sample it was a depressor a prescription drug or more than two substances in 22.4%. Most of the fatalities were due to cardiovascular accidents (62%); 22.4% were deaths by drowning, 12% by fall from heights and 3.4% were due to mechanical asphyxia.

Conclusions

According to the results from our sample, stimulants (mainly MDMA and cocaine) are the substances of abuse involved in most drug-caused fatalities. The number of fatalities per year has been steadily increasing, but the growing diffusion of novel psychoactive substances (NPS) does not seem to be a direct cause (although better methods of their analysis in post-mortem samples should be designed).

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Augmenting pharmacotherapy with neuromodulation techniques for the treatment of bipolar disorder: a focus on the effects of mood stabilizers on cortical excitability

Introduction: Mood stabilizers and antipsychotics have been demonstrated to be effective in Bipolar Disorder, with lithium as the gold standard. However, the presence of adverse events and treatment-resistance is still a relevant issue. To this respect, the use of brain stimulation techniques may be considered as an augmentation strategy, with both Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) having shown some level of efficacy in bipolar patients although clinical trials are still not sufficient to draw any conclusion. Areas covered: The authors have conducted a systematic review of the literature, in order to evaluate the role of mood stabilizers on neural activity and cortical excitability. Furthermore, the article reviews neuromodulation techniques and highlights the potential of integrating pharmacological first-line therapies with these techniques to treat BD patients. Expert opinion: The combination of neuromodulation techniques and available pharmacotherapies is a valuable opportunity which is not undermined by specific effects on cortical excitability and could improve BD patient outcome. Neurostimulation techniques may be considered safer than antidepressant treatments in BD, with a lower level of manic switches and may represent a new treatment strategy in BD depressive episodes.

Manifesto for a European research network into Problematic Usage of the Internet

The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States (http://www.who.int/classifications/icd/revision/timeline/en/). More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.

Role of Co-occurring Alcohol and Substances Abuse on QTc Interval Prolongation Among Psychiatric Patients: A Cross-sectional National Survey

Introduction

QTc interval prolongation is considered a risk factor for fatal polymorphic ventricular tachycardia, which can result in sudden cardiac death. Most psychotropic drugs have a dose-dependent potential to prolong the QTc interval. However, other factors require appropriate consideration, including: age; gender; other medications; electrolyte abnormalities; severe comorbid conditions, such as co-occurring alcohol or substances abuse/dependence.

Objectives

The objective was to study the potential mediating roles of alcohol/substances abuse on QTc prolongation.

Aims

The Italian research group STAR Network, in collaboration with the Young Italian Psychiatrists Association, aimed to evaluate the frequency of QTc interval prolongation in a sample of patients under treatment with psychotropic drugs through a cross-sectional national survey.

Methods

A sample of 2411 unselected patients were enrolled after performing an ECG during the recruitment period. Sociodemographic and clinical characteristics were collected from medical records. Collected data underwent statistical analysis.

Results

A total of 11.2% of patients reported alcohol abuse, and only 8.9% psychotropic substances. According to the threshold, less than 20% of patients had a borderline value of QTc, and 1% a pathological value. Patients with co-occurring alcohol misuse and drug abuse were more likely to have longer QTc interval.

Conclusions

The present study describes the frequency of QTc prolongation in real-world clinical practice. Before prescribing a psychotropic drug, the physician should carefully assess its risks and benefits to avoid this type of adverse reaction, particularly when additional risk factors are present. The potential role of alcohol and substances on QTc length could be particularly useful in emergency settings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Peripersonal space and schizophrenia: Looking for the self boundaries

Introduction

Peripersonal space has been defined as the area immediately surrounding the body in which interactions with a person or an object can occur. Larger peripersonal space may reflect discomfort in close interpersonal situation or cognitive deficit. Individuals with schizophrenia are more sensitive to social stimulation. The capacity to provide accurate judgments of peripersonal space boundaries depend on the capacity to create an organized and structured mental representation that integrates signals from different sensory modalities and brain regions.

Objectives

We conducted a study on personal space in patients with schizophrenia using a paradigm that was not affected by emotional and social interference.

Aims

We aimed to investigate the characteristics of personal space in patients with schizophrenia.

Methods

We recruited 20 schizophrenic patients according to DSM-V criterion and 20 healthy volunteers, matched by gender and age. Schizophrenic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Participants performed the peripersonal space (PPS) task. Collected data underwent statistical analyses.

Results

Schizophrenic patients demonstrate a stronger/weaker need for personal space, than the comparison group, depending on the score of negative and positive symptom, as assessed by using the PANSS even without emotional and social interference.

Conclusions

Interpersonal interactions between the individual with schizophrenia and people in their immediate environment can lead to increased symptomatology. Social isolation is one of the most primary causes of poor quality of life in mental illnesses. Better understanding of the mechanisms for abnormal interactive behavior could provide significant valid guidelines for innovating intervention programs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Novel psychoactive substances in a psychiatric young adults sample: A multicenter, observational study

Introduction

Comorbidities between psychiatric diseases and consumption of traditional substances of abuse are common. Nevertheless, there is no data regarding the use of novel psychoactive substances (NPS) in the psychiatric population.

Objectives

The purpose of this multicentre survey is to investigate the consumption of a wide variety of psychoactive substances in a young psychiatric sample.

Methods

Between September 2013 and November 2015, a questionnaire has been administered, in ten Italian psychiatric care facilities, to a sample of 671 psychiatric patients (48.5% men; 51.5% women), aged between 18 and 26 years (mean age: 22.24).

Results

8.2% of the sample declared use of NPS at least once in a lifetime and 2.2% have assumed NPS in the last three months. The NPS more used were synthetic cannabinoids (4.5%), followed by methamphetamine (3.6%). The three psychiatric diagnosis with more frequent NPS consumption were bipolar disorder (23.1%), personality disorders (11.8%) and schizophrenia and related disorders (11.6%). Bipolar disorder was associated with NPS consumption (P < .001). Among the illicit drugs investigated, 31.4% of the sample was cannabis smoker and 10.7% cocaine user. Moreover, 70.6% of the sample declared alcohol use and 47.7% had binge drinking conducts. In univariate regression analysis, bipolar disorder was positive associated with binge drinking while obsessive compulsive disorder resulted negative associated.

Conclusions

The use of novel psychoactive substances in a young psychiatric population appears to be a frequent phenomenon, probably still underestimated. Bipolar disorder shows an association with NPS use. Therefore, careful and constant monitoring and accurate evaluations of possible clinical effects related to their use are necessary.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The neural basis of cognitive control in gambling disorder: A systematic review of fMRI studies

Introduction

Decreased cognitive control over the urge to be involved in gambling activities is a core feature of gambling disorder (GD). Cognitive control can be conceptualized as the sum of high-order cognitive faculties interacting in the achievement of goal-oriented behaviors. As such, cognitive control can be differentiated into several cognitive sub-processes, such as response inhibition, conflict monitoring, decision-making and cognitive flexibility, all of which prove to be pivotal in GD clinical phenomenology.

Objectives

Over the past few years, several studies and reviews have indicated a lack of cognitive control in GD through self-report questionnaires and neurocognitive tasks. Conversely, there are only a limited number of neuroimaging studies, which investigate the neural mechanisms underlying diminished cognitive control in GD.

Aims

This research aims to systematically review functional magnetic resonance imaging (fMRI) studies that target cognitive control in GD.

Methods

A literature search was conducted in order to find appropriate published articles on fMRI studies in GD.

Results

Fourteen fMRI studies were included. Depending on which neurocognitive task was employed, the studies were divided into five different sections: conflict monitoring, response inhibition, delay discounting, cognitive flexibility and decision-making.

Conclusions

Impaired activity in prefrontal cortex may account for decreased cognitive control in GD, contributing to the progressive loss of control over gambling behaviors. However, the way in which cognitive control interacts with affective and motivational processes in GD is still matter of investigation. Among prefrontal areas, orbitofrontal cortex has been indicated as a possible nexus for sensory integration, value-based decision-making and emotional processing, thus contributing to both motivational and affective aspects of cognitive control.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Psychopathology, emotional aspects and psychological counselling in infertility: a review

Over the years, infertility has been variably defined. Infertility affects approximately 80 million people from all parts of the world. An important area of discussion has been represented by the possible causal link between psychopathology and infertility. In the past, the prevalence of psychiatric problems among infertile couples was estimated to be 25-60%. The incidence of depression and anxiety in infertile couples is significantly high than in fertile controls and in the general population respectively. Infertility has been linked to obsessive-compulsive symptoms, psychoticism, substance abuse and eating disorders. Psychological impact of infertility is greater in women than in men. Additionally, authors found that infertile patients were more alexithymic than healthy controls. In relation to the different needs, different psychological therapeutic interventions may be indicated. Psychological counseling can provide valuable assistance in dealing with infertility treatments and their eventual failures.

An update of safety of clinically used atypical antipsychotics

INTRODUCTION

The atypical antipsychotic (APs) drugs have become the most widely used agents to treat a variety of psychoses because of their superiority with regard to safety and tolerability profile compared to conventional/'typical' APs.

AREAS COVERED

We aimed at providing a synthesis of most current evidence about the safety and tolerability profile of the most clinically used atypical APs so far marketed. Qualitative synthesis followed an electronic search made inquiring of the following databases: MEDLINE, Embase, PsycINFO and the Cochrane Library from inception until January 2016, combining free terms and MESH headings for the topics of psychiatric disorders and all atypical APs as following: ((safety OR adverse events OR side effects) AND (aripiprazole OR asenapine OR quetiapine OR olanzapine OR risperidone OR paliperidone OR ziprasidone OR lurasidone OR clozapine OR amisulpride OR iloperidone)).

EXPERT OPINION

A critical issue in the treatment with atypical APs is represented by their metabolic side effect profile (e.g. weight gain, lipid and glycaemic imbalance, risk of diabetes mellitus and diabetic ketoacidosis) which may limit their use in particular clinical samples. Electrolyte imbalance, ECG abnormalities and cardiovascular adverse effects may recommend a careful baseline and periodic assessments.

First-generation versus second-generation antipsychotic drugs for depression in schizophrenia

Introduction

A certain degree of depressive symptoms is common in schizophrenic patients. The assessment and treatment of depressive symptoms in schizophrenia is clinically challenging.

Objectives

We conducted a cross-sectional study to investigate the depressive dimension of schizophrenic patients.

Aims

The aim was to evaluate the effect of pharmacotherapy on depressive symptomatology.

Methods

Thirty-four outpatients (18-65 years old) with stable schizophrenia in monotherapy with FGAs or SGAs. We evaluated: depressive symptoms with Calgary Depression Scale for Schizophrenia; positive and negative symptoms (with Positive and Negative Symptom Scale); neurocognition (with Matrics Cognitive Consensus Battery); social cognition (with Facial Emotional Identification Test); social functioning (with Personal and Social Performance Scale and with UCSD Performance-based Skills Assessment). Collected data underwent statistical analyses.

Results

A SGAs therapy was associated with: lower depressive symptoms (mean SGAs group = 4.0; mean FGAs group = 7.86, P < 0.05); lower mean positive symptoms (mean SGAs group = 12.65; mean FGAs group = 17.43, P < 0.05); lower negative symptoms (mean SGAs group = 21.35; mean FGAs group = 29.07, P < 0.05); lower scores on the PANSS-total (mean SGAs group = 71.05; mean FGAs group = 91.86, P < 0.01). After correction for multiple variables, the SGAs group still had significantly lower values towards the FGAs group (P < 0.05).

Conclusions

Our study support the notion that switch from a FGA to a SGA could be a relatively simple first-step for the treatment of this condition. Atypical antipsychotics might exercise antidepressant effects with different potential mechanism including: remission of a FGA-induced depression and action on of 5-hydroxytryptamine, dopamine [other than postsynaptic D2], and α1-noradrenergic receptor sites.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The "Eyeballing" technique: an emerging and alerting trend of alcohol misuse

OBJECTIVE

Alternative methods of alcohol consumption have recently emerged among adolescents and young adults, including the alcohol "eyeballing", which consist in the direct pouring of alcoholic substances on the ocular surface epithelium. In a context of drug and behavioural addictions change, "eyeballing" can be seen as one of the latest and potentially highly risky new trends. We aimed to analyze the existing medical literature as well as online material on this emerging trend of alcohol misuse.

MATERIALS AND METHODS

Literature on alcohol eyeballing was searched in PsychInfo and Pubmed databases. Results were integrated with a multilingual qualitative assessment of the database provided by The Global Public Health Intelligence Network (GPHIN) and of a range of websites, drug fora and other online resources between March 2013 and July 2013.

RESULTS

Alcohol eyeballing is common among adolescents and young adults; substances with high alcohol content, typically vodka, are used for this practice across the EU and internationally. The need for a rapid/intense effect of alcohol, competitiveness, novelty seeking and avoidance of "alcoholic fetor" are the most frequently reported motivations of "eyeballers". Local effects of alcohol eyeballing include pain, burning, blurred vision, conjunctive injection, corneal ulcers or scarring, permanent vision damage and eventually blindness.

CONCLUSIONS

Alcohol eyeballing represents a phenomenon with potential permanent adverse consequences, deserving the attention of families and healthcare providers. Health and other professionals should be informed about this alerting trend of misuse. Larger observational studies are warranted to estimate the prevalence, characterize the effects, and identify adequate forms of interventions for this emerging phenomenon.

Alexithymia and its relationships with acute phase proteins and cytokine release: an updated review

The alexithymia construct is multidimensional and comprises several features: (a) difficulty in identifying and describing feelings, (b) difficulty in distinguishing feelings from the bodily sensations, (c) diminution of fantasy, and (d) concrete and poorly introspective thinking. Altered immune responses have been seen in some psychiatric disorders and several data suggest that analogous changes could also be observable in alexithymia. Hence, the aim of this review is to investigate the relationships between alexithymia and acute phase proteins and cytokines in psychiatric, psychosomatic and medical diseases. Several studies have reported an association between alexithymia and higher circulating levels of acute phase proteins, especially C-Reactive Protein. Moreover, in alexithymic subjects the pro-inflammatory and anti-inflammatory cytokine balance may be tuned toward a pro-inflammatory imbalance with a concomitant altered cell-mediated immunity. These findings may be consistent with the "“stress-alexithymia hypothesis"”. Therefore, the screening of alexithymic traits and the administration of appropriate psychological and psychotherapeutical interventions should be integral parts of disease management programs. Supplying such interventions will probably help with prevention of the development of the disease and/or its exacerbation by improving the quality of life of alexithymic individuals.

Is there a role for agomelatine in the treatment of anxiety disorders?A review of published data

Anxiety disorders (Ads) are the most common type of psychiatric disorders, Pharmacologic options studied for treating ADs may include benzodiazepines, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRIs), noradrenergic and specific serotonergic antidepressants (NaSSA) and serotonin and noradrenaline reuptake inhibitors (SNRIs). Agomelatine, a new melatonergic antidepressant, has been shown effective in various types of mood disorders. Moreover, some evidence points towards a possible efficacy of such a drug in the treatment of ADs. Therefore, the aim of this review was to elucidate current (facts and views) data on the role of agomelatine in the treatment of ADs. The trials evaluating agomelatine in the treatment of generalized anxiety disorder are few but, overall, encouraging in regards to its efficacy. However, further randomized, placebo-controlled studies on larger samples use are needed. Apart from some interesting case reports, no large studies are, to date, present in literature regarding agomelatine in the treatment of other ADs, such as panic disorder, social anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. Therefore, the clinical efficacy and the relative good tolerability of agomelatine in generalized anxiety (GAD) warrants further investigation in ADs.

Treatment of resistant insomnia and major depression

Daily rhythms regulate everiday life and sleep/wake alternation is the best expression of this. Disruptions in biological rhythms is strongly associated with mood disorders, often being the major feature of this, major depressive disorder first of all. Although stabilization of rhythms produced by treatments have important outcome on therapeutic efficacy, insomnia often remains an unresolved symptom when major depression has otherwise been successfully treated with antidepressant. We review scientific literature in order to better clarify how to better approach insomnia as a clinical aspect to investigate and to early treat while treating other psychiatric conditions, major depression in particular. Insomnia is associated with impaired quality of life. It can be resolved with adequate diagnosis and treatment: it should be considered a comorbid condition and should be early identificated and treated in a multidisciplinary way, so that the ideal of treatment for patients with treatment resistant insomnia in major depression is an integration of non-pharmacologic measures, along with judicious use of medication, often used as an adjunctive therapy.

Trouble déficit d’attention avec ou sans hyperactivité chez des adultes souffrant d’un trouble de l’humeur : le rôle des dimensions de la personnalité

Introduction

Dans les cas des troubles bipolaires, les taux de comorbidité avec un TDAH peut varier entre 9,5 % et 27 % [1]. Ces patients présentent un début de trouble plus précoce, avec plus d’épisodes dépressifs et des épisodes mixtes. Il existe peu d’étude sur le lien entre ces deux pathologies et les différentes dimensions de personnalité selon le modèle de Big Five.

Methods

Notre étude comporte 106 patients souffrant de dépression, 102 patients bipolaires et 120 témoins, tous homogènes vis-à-vis de leurs caractéristiques démographiques. Le diagnostic de TDAH se basait sur les critères DSM-IV-TR. Les traits de TDAH étaient autoévalués avec la Wender Utah Rating Scale (WURS), la Adult ADHD Self-rating Scale (ASRS) et la Brown Attention Déficit Disorder Scale (ADD). L’Inventaire de Personnalité-Révisé, le NEO PI-R, servait également à évaluer les dimensions de la personnalité au sein des groupes cliniques.

Résultats

15,7 % des adultes souffrant d’un trouble bipolaire et 7,5 % souffrant d’une dépression sévère manifestaient une comorbidité d’un TDAH en comparaison avec seulement 3,3 % des témoins. Il existe des corrélations significatives entre des traits de personnalité et la présence d’un TDAH. Une analyse de régression logistique de l’ensemble des 208 sujets cliniques a montré que ceux avec des faibles niveaux de névrosisme manifestaient un taux moins important de comorbidité avec un TDAH.

Discussion

Notre étude souligne le lien entre des troubles de l’humeur, notamment les troubles bipolaires, et la présence d’un TDAH chez des adultes. Nos résultats soutiennent la nécessité d’évaluer les sujets souffrant des troubles d’humeur sur une éventuelle comorbidité de TDAH en milieu clinique. Il faudra étudier d’une façon plus approfondie ces traits de personnalité et les liens entre des troubles de l’humeur et un TDAH afin de pouvoir adapter la prise en charge.

Dimensions de personnalité et trouble de déficit d’attention avec ou sans hyperactivité : étude multicentrique des patients d’alcoolodépendants

La présence d’un Trouble Déficit d’Attention avec ou sans Hyperactivité (TDAH) serait corrélée avec l’utilisation de substances (surtout l’alcool), chez des adolescents, avec des taux de 16 % en population générale et 25 à 40 % en population adulte [3,4]. Chez des adultes, un taux de 6 % à 25 % est signalé chez des patients traités pour abus ou dépendances aux substances psychoactives [2]. Par ailleurs, il est nécessaire de connaître ce double diagnostic ainsi que les dimensions de personnalité afin de pouvoir adapter la prise en charge [1]. Nous avons réalisé cette étude multicentrique auprès d’une population de 60 patients alcoolodépendants suivis en consultation dans deux centres hospitalo-universitaires, à Colombes et à Rome. L’objectif de l’étude est d’analyser la sévérité de la pathologie alcoolique et les liens avec la présence d’un éventuel TDAH et des dimensions de personnalité selon le modèle de Costa et Mc Crae (Big Five). Pour le diagnostic de TDAH, nous avons utilisé la Wender Utah Rating Scale (WURS) en rétrospectif et la Brown Attention Déficit Disorder Scale (ADD). Et pour l’évaluation de la personnalité, nous avons utilisé le questionnaire NEO PI-R, et nous avons analysé les facteurs et les facettes. Les résultats des analyses statistiques descriptives seront présentés.

Treatment-resistant insomnia treated with pregabalin

We report a case with refractory insomnia. We diagnosed her case as depression with high levels of anxiety, weakness, with diminished ability to think or concentrate and with a sensory-motor disorder. Although this last symptom was very distressing, it did not satisfy the criteria for RLS (Restless Legs Syndrome). After treatment with paroxetine (20 mg) and zolpidem (10 mg), anxiety and mood deflection were attenuated. Nevertheless, a mild depression, an intermittent awakening (fragmentation of the sleep-wake rhythm) and subsyndromal RLS persisted. Her resistant insomnia was treated with benzodiazepine sleeping drugs (triazolam 0.25 mg, lorazepam 2.5 mg, fluorazepam 30 mg) with only partial insomnia remission, antidepressants (trazodone 150 mg RP, mirtazapine 15-30 mg, agomelatine 50 mg) and antipsychotics (levomepromazine 25 mg, zuclopentixol 25 mg) without results. Her intractable insomnia was markedly responsive to pregabalin without side effects. Our hypothesis is that the therapy with pregabalin may be indicated for resistant insomnia associated with subsyndromal RLS, even when the latter does not satisfy fully all the criteria for diagnosis.

The structure of the corpus callosum in obsessive compulsive disorder

Abnormal brain connectivity has recently been reported in obsessive compulsive disorder (OCD). However, structural differences in the corpus callosum (CC), the primary structure connecting the two hemispheres, have not been extensively studied. In this case-control study, we recruited 30 patients with OCD and 30 healthy control subjects carefully matched for age, sex and handedness. Combining surface-based mesh-modeling and voxel-based morphometry (VBM), we compared callosal thickness and white matter (WM) density in patients and controls. We investigated associations between callosal structure and cortical gray matter (GM) density, and we related CC measures to neuropsychological performance in OCD. OCD patients showed small anterior and posterior callosal regions compared to healthy control subjects. In the OCD group, anterior callosal thickness was positively correlated with GM density of the right mid-dorso-lateral prefrontal (BA 9/46) area, while posterior callosal thickness was positively correlated with GM density in the left supramarginal gyrus (BA 40). Moreover, posterior callosal WM density was positively correlated with verbal memory, visuo-spatial memory, verbal fluency, and visuo-spatial reasoning performances. Callosal attributes were related to GM density in cortical areas innervated by the CC, and were also related to performance in cognitive domains impaired in the disorder. The CC may therefore be integrally involved in OCD.

Aripiprazole, alcohol and substance abuse: a review

Aripiprazole is an atypical antipsychotic used for schizophrenia, manic and mixed episodes associated with bipolar I disorder and as adjunctive therapy for major depressive disorder. It functions as a partial agonist at dopamine D2 and 5-HT1A receptors, and as an antagonist at the 5-HT2A receptor. The most recent results obtained from scientific research showed that dopaminergic mechanisms are involved in motivation, reward, and reinforcement of substance abuse. The use of aripiprazole and partial dopamine agonists could represent a novel strategy for normalizing dopamine neurotransmission. Many studies in the last few years have highlighted aripiprazole as a potential candidate for the treatment of different types of substance dependence. This review aims to describe recent scientific research using aripiprazole in different substance abuse disorders (i.e., alcoholism, cocaine, amphetamine and nicotine use). Furthermore, the efficacy of aripiprazole compared to other pharmacological therapies will be described. Given the low number of studies, the frequent absence of placebo or active comparators, and the low statistical power of the studies, a clear conclusion about the use of aripiprazole in alcohol/substance dependence cannot be drawn. Therefore, we suggest the need for further studies, preferably randomized and placebo-controlled.

Nerve growth factor and brain-derived neurotrophic factor concentrations in schizophrenia: a review

There is growing interest in the role of neurotrophins in the pathophysiology of schizophrenia. Neurotrophins are a large family of dimeric polypeptides that promote the growth and the differentiation of developing neurons in the central and peripheral nervous systems as well as the survival of neuronal cells in response to stress. Nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) concentrations are here reviewed in relation to medication-naive early psychotic patients and in medicated chronic schizophrenic patients. Most data point to decreased plasma and serum NGF and BDNF concentrations in naive drug and in medicated schizophrenic patients compared to healthy controls. Higher BDNF levels were observed in patients with the paranoid subtype of schizophrenia. Low serum BDNF levels were associated with reduction in hippocampal volume (HV) at the onset of schizophrenia. Evidence on the correlation between BDNF levels and positive and negative schizophrenic symptoms were ambiguous. There are contrasting results on a possible correlation between increase in BDNF concentrations and treatment with antipsychotics. Antipsychotic treatment can elevate NGF values, specifically atypical. Growth factors might be good candidates as prognostically and diagnostically useful markers in schizophrenia.

Reboxetine in clinical practice: a review

Reboxetine is a selective noradrenaline reuptake inhibitor (NaRI), the first drug of a new antidepressant class. Reboxetine has been approved for the treatment of Major Depression in many European countries, but the application for approval was rejected in the United States. It has been found useful in Narcolepsy, ADHD, Panic Attack Disorder, treatment of depression in patients with Parkinson' s Disease. Moreover reboxetine has been proposed as an effective and safe therapeutic option for Cocaine Dependence Disorder. Despite a large number of studies have documented that reboxetine was equally effective in treating major depressive illness compared to other antidepressants, recent reports argue reboxetine to be ineffective and potentially harmful for the treatment of acute depression. Aim of the present review is to summarize and discuss the last literature findings, comparing risks and benefits of reboxetine usage in everyday clinical practice.

WITHDRAWN: The structure of the corpus callosum in obsessive compulsive disorder

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Behavioural dependences in adolescents and young adults: results from an observational study

Introduction

Our study aims to assess the prevalence of behavioural addictions in an adolescent populations, evaluating the effects of gender and age, and to assess the correlations and associations between different behavioural addictions.

Methods

A population of 2853 students (1142 F and 1711 M, mean age 16.7± 1.9) was assessed in order to evaluate the prevalence of behavioural dependences such as Pathological Gambling (PG), Compulsive Buying (CB), Exercise Addiction (EA), Internet Addiction (IA), and Work Addiction (WA). The South Oaks Gambling Screen-Revised Adolescent, the Compulsive Buying Scale, the Exercise Addiction Inventory, the Internet Addiction Test, and the Work Addiction Risk Test, were compiled anonymously by the students.

Results

Overall prevalence was 7.0% for PG, 11.3% for CB, 1.2% for IA, 7.6% for WA, 8.5% for EA. PG, and EA were more common among boys, while gender had no effect on the other conditions. CB was more common among younger ( < 18 years old) students. Each of these conditions showed a strong association with others, and the scores of all of these scales were correlated.

Discussion

In line with previous studies our results indicate that behavioural addictions are quite common among adolescents. The strong association between behavioural addictions stresses the concept that treatment for one of these conditions should involve assessment and treatment for the others.

Depression, inflammation and coronary heart disease: prognostical value of c reactive protein and depressive symptoms

Introduction

The aim of this preliminary study is to assess, in a sample of patients with Coronary Heart Disease (CHD), the specific association between depressive symptoms and systemic inflammation.

Methods

Sixty-One inpatients with CHD, 31 Unstable Angina and 28 Myocardial Infarction, participated in the study. The plasma levels of C Reactive Protein were measured using Dade Behring’s High Sensitivity CRP assay (hs-CRP) at T0, T30 and T90.

At the same timings, they were tested by an examiner, unaware of their diagnosis, with a psychometric battery (SCL90-R, HDRS, MADRS, BDI, QlesQ).

Results

The elevation of hs-CRP occurs during the whole observation period, with maximum significance at T90 (p = 0,031).

A multivariate analysis at T0 indicates a statistical correlation between SCL90-R scores and hs-CRP levels (p = 0.02).

The SCL90-R is also associated with the risk of further cardiac events (p = 0.013).

Also the BDI could be useful as a prognostic factor (p = 0.026).

We found a trend towards correlation between CRP values and depressive symptoms, but it never reaches statistical significance for the other scales.

Conclusions

The feelings of loss and the fear of death, related to the environmental and emotional situation of the hospitalization, may prevail in the acute phase of CHDs.

Some patients may overcome this reactive depression, while others may exhibit a biological depression, related to the high level of CRP and thus to an increased risk of re-infarction and other coronary events.

Antidepressant treatment restores brain-derived neurotrophic factor (BDNF) serum levels and ameliorates motor function in parkinson's disease patients

Introduction

Depression is a common psychiatric disorder in Parkinson's disease (PD). It has been proposed that antidepressant drugs may bust brain production of trophic factors, such as brain-derived neurotrophic factor (BDNF) and glial cell derived neurotrophic factor (GDNF), an effect associated with improvement of clinical symptoms. However, BDNF and GDNF play also a role in the maintenance of dopaminergic neurons, which undergo to neuronal death during PD course.

Aims

Based on these findings we explored the hypothesis that PD depressed patients may have altered BDNF or GDNF serum levels and that antidepressant drugs may restore them and potentially have beneficial effects not only for depressive but also parkinsonian symptoms.

Methods

We measured by enzyme linked immunosorbent assay (ELISA) the serum levels of BDNF and GDNF in depressed PD patients, non depressed PD patients and healthy subjects and correlated them with clinical observations.

Results

We found:

(1)

Conclusion

Our data suggest that PD patients are characterized by a reduction of BDNF serum levels and that depression may exacerbate this effect and worse PD symptoms. It is proposed that association between anti-parkinsonian treatment and SSRI could be a good therapeutic chance not only for treating depression in PD but also for improving PD symptoms.