Association of the COMT synonymous polymorphism Leu136Leu and missense variant Val158Met with mood disorders

BACKGROUND

Major depressive disorder (MDD) and bipolar disorder (BD) are the two most common mood disorders. Given the recognized involvement of catecholamines in depression, genetic research focused on the evaluation of polymorphisms in genes coding for proteins that regulate neurotransmitter release, transport and degradation. Here we aimed at evaluating the distribution of two genetic variants of catechol-O-methyltransferase (COMT), namely the well characterized missense polymorphism G1947A (Val158Met) and the recently reported synonymous polymorphism C1886G (Leu136Leu), in MDD and BD patients compared with healthy subjects.

METHODS

Genotyping for COMT polymorphisms was carried out by DNA direct sequencing in 112 patients (54 MDD and 58 BD) and 58 healthy subjects.

RESULTS

We did not find significant differences in the Val158Met variant distribution between patients and controls. Instead, we found that the C1886 major allele and the CC1886 wild-type genotype frequencies were significantly higher in controls than in both groups of patients. On the contrary, the G1886 minor allele and the heterozygous CG1886 genotype were significantly more present in both MDD and BD patients than in healthy subjects. When looking at combined polymorphisms, we found a significantly higher frequency of the double heterozygous diplotype CG/GAVal/Met158 in both MDD and BD patients than in controls. Instead, the diplotype CC/GAVal/Met158 showed a significantly higher frequency in controls than in BD patients.

LIMITATIONS

The small size of our study cohort may limit the generalizability of the present findings.

CONCLUSIONS

This work first showed the association of combined Leu136Leu and Val158Met variants of COMT gene with MDD and BD.

Topiramate augmentation of clozapine in schizophrenia: a double-blind, placebo-controlled study

The persistence of psychotic, affective, cognitive, and psychosocial symptoms despite medications is commonly observed in schizophrenic patients. The present study was a 24-week double-blind, randomized, placebo-controlled trial aimed to explore the efficacy of topiramate add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of treatment-resistant schizophrenic patients receiving clozapine. After clinical and cognitive assessments were randomly allocated to receive either up to 200 mg/day of topiramate or a placebo. A final sample of 43 patients completed the study. The results obtained indicate that topiramate appeared to be scarcely effective for reducing clinical symptomatology in schizophrenic patients who have had an incomplete clinical response to clozapine. Regarding cognitive functioning, in our sample a trend to experience cognitive impairment in the examined domains was observed, as the patients included in the topiramate groups expressed cognitive complaints partially confirmed by a mild worsening of performances on certain cognitive tasks. Schizophrenia is a heterogeneous disorder with regard to pathophysiology; therefore, data reflecting the mean response of a sample of patients may fail to reveal therapeutic effects. More research is needed to better identify subgroups of patients with peculiar features which may account for responsivity to experimental medications and augmentation strategies.

Temperament and Character Dimensions in Opiate Addicts: Comparing Subjects Who Completed Inpatient Treatment in Therapeutic Communities vs. Incompleters

The aim of this study was to compare temperamental profiles of patients who completed inpatient treatment of drug dependence with those who failed to complete the program. One hundred forty four opiate addicts, all resident in therapeutic communities and screened to exclude Axis I disorders, were assessed using the Temperament and Character Inventory (TCI). After one year, the TCI scores were compared between those who were still resident and those who had dropped out. Significant differences between groups were found in Reward Dependence, Persistence, Cooperativeness, Self-Transcendence. Temperament and character features may have an influence on motivation and on the adherence to treatment and community rules, as they modulate the maintenance of ongoing behaviors and the sensitivity to social rewards. The findings suggest that personality assessment with TCI in opiate addicts may be helpful in screening procedures to increase the efficiency of treatment and rehabilitative strategies.

Mental disorders and request for psychiatric intervention in an Italian local jail

The issue of the prevalence of psychiatric illnesses in Italian prison samples has not received the same attention paid at an international level. The aims of the present study were to evaluate the prevalence of psychiatric disorders diagnosed according to DSM-III-R criteria among an Italian prisoner population, and to examine prisoners' requests for psychiatric intervention in relationship to the presence or absence of different psychiatric disorders. One hundred forty-two Italian male subjects from the Casa Circondariale of Messina, Italy, were evaluated using the Structured Clinical Interview for DSM-III-R Non-Patient Version - SCID I and SCID II. A very high rate of disorders was found among inmates: 85.2% (n=121) of the sample were affected by a psychiatric disorder. Of the total sample, 51.4% (n=73) had requested psychiatric treatment during detention. The detection, diagnosis and treatment of the mentally ill prisoners is a primary goal for a better organization of services and prison settings; screening procedures for evaluating the presence of psychiatric disorders, with the aim to promote differential strategies for the care and rehabilitation of inmates, are needed.

The effect of lamotrigine augmentation of clozapine in a sample of treatment-resistant schizophrenic patients: a double-blind, placebo-controlled study

Based on the evidence that lamotrigine added to clozapine in refractory schizophrenic patients has reported promising results, the present 24-week double-blind, randomized, placebo-controlled trial had the aim to explore the efficacy of lamotrigine add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of treatment-resistant schizophrenic patients receiving clozapine. After clinical and neurocognitive assessments patients were randomly allocated to receive, in a double-blind design, either up to 200 mg/day of lamotrigine or a placebo. A final sample of fifty-one patients completed the study. The results obtained indicate that lamotrigine added to stable clozapine treatment showed a beneficial effect on the negative, positive and general psychopathological symptomatology in a sample of treatment-resistant schizophrenic patients. Regarding cognitive functions, improvement was observed in some explored areas, such as attentional resistance to interference, verbal fluency and executive functioning. The findings provide evidence that lamotrigine augmentation of clozapine treatment is well tolerated and may be proposed as an effective therapeutic strategy to improve outcome in treatment-resistant schizophrenia.

Association between burnout and anger in oncology versus ophthalmology health care professionals

The prevalence of burnout in oncology staff was compared with that of the ophthalmology staff, who normally present a low prevalence of burnout as described in this literature. The correlation of burnout with the emotion of anger was also investigated. Thirty-six subjects working in an oncology department and 32 working in an ophthalmology department were examined using the Maslach Burnout Inventory and the State-Trait Anger Expression Inventory. The oncology group showed higher mean scores on the MBI Emotive Exhaustion and Depersonalization scales with respect to ophthalmology staff. Correlation analysis showed that increasing burnout was associated with higher anger expressed towards the environment and loss of anger control. Anger, as a response to frustration, appears to be a feature constantly associated with the clinical expression of burnout and it should not be underestimated in theoretical and preventive contexts.

[Comparation of levels of anxiety and depression in patients with autoimmune and chronic-degenerative rheumatic: preliminary data]

Scientific research on rheumatic diseases was often focused on the link between psychological features and disease. Depression and anxiety are frequently observed with an higher incidence among rheumatic patients in comparison to general population. In autoimmune diseases, such as rheumatoid arthritis, an important role for psychiatric symptoms could be played by the alteration of cytokines levels. In the chronic-degenerative diseases, psychological factors such as stress and depression, can be involved in perception of pain.

OBJECTIVE

We aimed at evaluating in a sample of 50 patients (25 with rheumatoid arthritis and 25 with osteoarthritis) levels of pain, anxiety and depression.

METHODS

We evaluated two group of patients with rheumatic disease, group A (25 with Rheumatoid Arthritis, mean age = 45.1; DS =15.24) and group B (25 with osteoarthritis, mean age = 54.3; DS =14.74) by clinic examination and with the following tests, SF-MPQ, HAQ, HAM-A, HAM-D.

RESULTS

We found in group A higher levels of depression and anxiety but lower levels of pain, which was more expressed in group B.

CONCLUSION

Depression and anxiety were observed with an higher prevalence in patients with autoimmune disease, whereas pain was stronger in patients with osteoarthritis, a degenerative disease. We could explain this phenomenon considering the aetiopathology of the two conditions. As regard to autoimmune disorders, these symptoms may reflect the direct effect of cytokines on the central nervous system. As far as it concerns chronic-degenerative diseases, anxiety and depression are usually considered "reactive" to pain, not "constitutive".

Anger and ego-defence mechanisms in non-psychiatric patients with irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome is commonly accepted as a disorder closely influenced by affective factors, which can either trigger the symptoms or contribute to their persistence, independently from their aetiology. It has been previously documented that irritable bowel syndrome patients respond to a variety of emotional states (anger, fear and anxiety) with an increase in colonic motility.

AIMS

The aim of this study was to evaluate the experience and the expression of anger and the prevalent ego-defence mechanisms in a group of non-psychiatric patients with irritable bowel syndrome.

SUBJECTS

Fifty-two patients with irritable bowel syndrome (18 males, 34 females) and 100 healthy volunteers from the community (44 males, 56 females) matched for age, level of education and social-status were enrolled.

METHODS

Assessment was conducted using the State-Trait Anger Expression Inventory and the Defence Mechanism Inventory.

RESULTS

No important differences between the two examined groups were found using the State-Trait Anger Expression Inventory and Defence Mechanism Inventory.

CONCLUSIONS

It can be hypothesised that stable personality features and habits, such as anger disposition and defence mechanisms, play only a marginal role in irritable bowel syndrome, while psychological and psychosocial influences may act as predisposing or precipitating factors which contribute to the pathogenesis or expression of irritable bowel symptoms.

Defense mechanisms in hemodialysis-dependent patients

Defense mechanisms are automatic psychological processes that protect the individual against anxiety and from the awareness of internal or external dangers or stressors. The influence of defense mechanisms in patients on chronic hemodialysis treatment was studied. There were 53 uremic subjects (37 males and 16 females), aged between 22 and 88 years (mean age 60.11, SD 15.03), on chronic dialysis and 50 healthy subjects as controls have been enrolled in the study. According to the duration of dialysis, uremic patients were divided in two subgroups: 21 patients with less than 5 years and 19 patients with more than 10 years of dialytic treatment. Assessment was conducted using the Defense Mechanisms Inventory DMI. The inventory identifies five defensive styles: turning against the object (TAO), projection (PRO), principalization (PRN), turning against the self (TAS) and reversal (REV). Results showed DMI scores within the normal range both for uremics and controls with significant differences in TAO (t = -3.053, p = 0.003) and REV (t = 5.067, p < 0.0001) between groups. No significant differences in the use of defensive styles related to the duration of dialytic treatment were observed. Besides other psychological features, the assessment of defense mechanisms in patients with chronic and invalidating diseases may contribute to ameliorate the knowledge of the adjustment processes and of the psychological well-being of the patients.

Panic-agoraphobic spectrum in obese binge eaters

OBJECTIVE

This study investigated the frequency of the panic-agoraphobic spectrum symptoms in a sample of obese subjects affected by Binge Eating Disorder (BED) vs controls.

METHOD

Fifty obese with BED were matched by age, sex and marital status to twenty-five normal weight controls. The Structured Clinical Interview For Panic-Agoraphobic Spectrum--SCI-PAS was administered to all participants.

RESULTS

Obese subjects with BED presented significantly higher frequencies of typical and atypical panic symptoms (82% vs 8%, p<0.0001), agoraphobia (58% vs 12%, p=0.002) and reassurance orientation (56% vs 8%, p=0.001) than controls.

DISCUSSION

BED frequently co-occurs with other major psychiatric disorders, traditionally assessed using categorical methods of classification of mental disorders. The spectrum of the subthreshold, atypical and partial symptoms of full-blown mental disorders, often neglected by categorical approach, may also affect subjective well-being and functioning as full-blown disorders. The identification of the subthreshold symptomatology may have relevant implications for the response to treatment and the outcome of the eating disorder.

Longitudinal survey of mental retardation during adolescence among Italian pupils

In this paper are analysed the increases in mental age during a 3- to 31/2-yr. interval of 54 adolescents classified as mildly or moderately mentally retarded who had participated in rehabilitation therapy (therapy) or had no therapy (control). Analysis showed that the rehabilitation therapy significantly increased mental age only for subjects with mild retardation but not those with moderate mental retardation.