Emotional reactivity in bipolar depressed patients.

OBJECTIVE: Emotional reactivity in bipolar affective disorders has received increased attention as a relevant issue with regard to the ability to respond to emotional external stimuli for individual real world adaptation. We investigated emotional reactivity using the International Affective Picture System (IAPS) paradigm in bipolar patients during the depressive phase compared to healthy controls. METHOD: Twenty-three bipolar patients with a major depressive episode without manic symptoms and 27 healthy control subjects were recruited. They were asked to judge their emotional reactivity while viewing 90 pictures selected from the IAPS. Their ratings were categorized according to the emotional valence and arousal in response to pleasant, neutral, and unpleasant stimuli. RESULTS: The patients showed lower valence ratings for neutral pictures compared to healthy subjects. No significant between-group differences were found for the pleasant and unpleasant pictures. Higher activation for patients to all emotional stimuli was seen. CONCLUSION: Patients during the depressive phase gave more negative valence to neutral images. This can suggest that they are more pessimistic in the way they perceive the environment as more reactive to emotional cues.

Characteristic differences in barrier and hygroscopic properties between normal and cosmetic dry skin. I. Enhanced barrier analysis with sequential tape-stripping.

OBJECTIVE: Cosmetic dry skin often has a lower hydration level but a similar apparent barrier function, as measured by transepidermal water loss (TEWL), than that of the normal skin. To investigate the intrinsic difference in barrier property and moisture-holding ability between the cosmetic dry and normal skin, we developed a new clinical and data analysis procedure based on sequential tape-stripping with TEWL measurement, coupled with chemical analysis for protein and natural moisturizing factors (NMF) in the stratum corneum. METHODS: A clinical study consisting of 64 healthy Caucasian female subjects with normal and cosmetic dry skin was conducted according to our clinical and data collection protocols. After the baseline visual dryness assessment, 20 tape-strips were placed and removed on each test site using D-Squame tapes. TEWL was measured at baseline and after the 5th, 10th, 15th and 20th tape-strips. All tapes were analysed for protein mass via chemical extraction and the Pierce BCA protein assay, as well as using an infrared densitometry device SquameScan 850A. The stratum corneum thickness and barrier quality (water transport resistance per thickness of the stratum corneum) were decoupled from the apparent barrier function using the TEWL and protein data. RESULTS: A linear relationship between 1/TEWL and cumulative protein removal was observed for both normal and cosmetic dry skin. However, the slope of the linear relation was significantly steeper for normal skin, and significantly more protein was removed from cosmetic dry skin. The results showed that on average, the barrier quality of the stratum corneum of the normal skin is about 40% higher than that of the dry skin, whereas the stratum corneum of the dry skin is about 30% thicker than that of the normal skin. In addition, the amount of SC removal in sequential tape-stripping is generally non-uniform. CONCLUSION: Our results demonstrated that there are characteristic differences in the barrier property between normal and cosmetic dry skin. In comparison to the normal skin, the stratum corneum of the cosmetic dry skin is considerably thicker, however, with a lower barrier quality. The results also showed that the amount of the SC removal in sequential tape-stripping is generally non-uniform. Therefore, the number of tape strips is not a good indicator for the tape-stripping depth.

Neuropsychological functioning in young subjects with generalized anxiety disorder with and without pharmacotherapy.

The purpose of this study was to investigate the neuropsychological functioning and the effect of antidepressant drug intake on cognitive performance in a group of relatively young generalized anxiety disorder (GAD) patients. Forty patients with a DSM-IV diagnosis of GAD and 31 healthy subjects participated in the study (Control group, CON). None of the selected subjects had comorbid depression. GAD subjects were divided into two different subgroups: 18 were taking antidepressants [GAD-pharmacotherapy (GAD-p group)] and 22 were treatment-naïve (GAD group). Each group was administered with a comprehensive neuropsychological battery to assess attention, memory and executive functions. Performance on executive and non-verbal memory tasks of both GAD groups was largely worse than the CON group. However, these deficits seem to be more marked in patients taking antidepressants, especially in the domains of attention, non-verbal memory and executive functions. The present study indicates that GAD is associated with cognitive impairments among young adults. However, the observed association of neuropsychological deficits and the use of pharmacotherapy suggest a possible effect of antidepressant treatment on attention, executive functioning and non-verbal memory.

Hepatic iron overload is common in chronic hepatitis B and is more severe in patients coinfected with hepatitis D virus.

Hepatic iron overload has been described in chronic hepatitis C as a cofactor affecting fibrosis progression. Data in patients with chronic hepatitis B infection are scarce. We investigated hepatic iron deposits and serum iron indices in 205 consecutive patients with hepatitis B and compensated liver disease. Mean age of the patients was 42.4 ± 12.4 years and 72.5% were males. Coinfection with hepatitis delta virus (HDV) was present in 8.8%. At least one of the serum iron indices was elevated in 41.5% of cases. Hepatic iron deposits were detected in 35.1% of patients, most of them being minimal (grade I) (59.7%) or mild (grade II) (27.8%). Variables significantly associated with hepatic iron deposits were male gender (P = 0.001), serum ferritin (P = 0.008), γGT (P = 0.05) and alkaline phosphatase (P = 0.05) levels. By multivariate analysis hepatic iron deposits correlated with serum ferritin [odds ratio (OR) 1.2, 95% confidence interval (CI) 1.05-1.4, P = 0.002]. Presence of mild-moderate (grades II and III) hepatic iron deposits could be excluded with high negative predictive value (90%) when serum ferritin was within normal values. A significant correlation between coinfection with HDV and hepatic iron deposits was also found (OR 4.23, 95% CI 1.52-11.82, P = 0.003). When compared to monoinfected cases, HDV positive patients had more elevated γGT (P = 0.03), more advanced fibrosis and more severe iron deposits (P < 0.0001). In conclusion, in well-compensated chronic hepatitis B infection, hepatic iron deposits and elevation of serum iron indices are common, especially in male gender and in patients coinfected with HDV. As HBV/HDV liver disease is generally more rapidly progressive than that caused by HBV monoinfection, we speculate that iron overload may be one of the factors contributing to the severity of liver disease.

The impact of one night of sleep deprivation on moral judgments.

Recent studies have shown the existence of a relationship between sleep and moral judgment. In this study, we investigated whether one night of sleep deprivation affects the ability to judge the appropriateness of moral dilemmas. Forty-eight students had to judge 30 moral dilemmas at test, after a night of home sleep, and another 30 dilemmas at retest, following one night of continuous wakefulness. The 60 dilemmas (20 moral impersonal, 20 moral personal, and 20 non-moral) were selected from Greene's dilemmas. Both groups judged the appropriateness of personal and impersonal dilemmas in the same way. A close to significant effect of sleep deprivation was observed on the reaction times for impersonal moral dilemmas, to which the deprived subjects responded faster (p = .05) than the control subjects. However, this was not the case for personal ones, for which no difference was significant. This result shows a greater ease/speed in responding to the (impersonal) dilemmas, which induce low emotional engagement after sleep deprivation, although the willingness to accept moral violations is not affected. This suggests that one night of sleep loss selectively influences the response speed only for moral impersonal dilemmas, probably due to disinhibition processes. The quality of moral judgment dilemmas does not seem to be easily influenced by a single night of sleep deprivation, but only by a longer lack of sleep.

A specific deficit in spatial memory acquisition in post-traumatic stress disorder and the role of sleep in its consolidation.

Posttraumatic stress disorder (PTSD) is characterized by the presence of anatomo-functional hippocampal alterations. To date, the ability to orient within the environment, which relies on hippocampal integrity, has never been investigated in PTSD. We hypothesized that the ability to form a cognitive map of the environment would be impaired in PTSD. Moreover, spatial memory consolidation benefits from postlearning sleep. Because PTSD individuals often complain about sleep disturbances, we hypothesized that any sleep effect on memory performance would be hampered in these subjects. Twenty-two subjects, all survivors of the L'Aquila 2009 earthquake, were divided into a PTSD and a control group, based on clinical evaluation. After an acquisition phase, they were tested twice ("test" and "retest") on a virtual navigation task. In addition, participants were administered the Digit Span and Task Switching. Subjective sleep quality and sleep disturbances were also assessed. The two testing sessions were on consecutive mornings, interspersed with a night of sleep. During the acquisition phase, the PTSD group took more than twice as long to form a cognitive map of the environment compared to the control group. However, once this phase was successfully completed, the two groups did not differ at test, but they tendentially differed at postsleep retest. Additional analyses comparing performances between groups on test-retest difference scores confirm that sleep-dependent consolidation may be differentially affected in the two groups. Our findings are strictly confined to the navigation performance, excluding a generalized cognitive deficit. PTSD also reported more subjective sleep disturbances and shorter sleep time than controls, which were correlated to worse performance at retest. The specific deficit in the formation of a cognitive map reported in PTSD may be related to hippocampal dysfunctions as well as to the sleep disturbances experienced by these patients. The possible deficiency of sleep-dependent spatial performance improvement should however be confirmed by further studies comprising a wake control group.

Does premorbid IQ have a pathoplastic effect on symptom presentation in schizophrenic and bipolar disorders?

INTRODUCTION: The poor premorbid IQ has been considered as a predisposing factor for the development of schizophrenia and other psychoses as well as predictive of poor long-term outcome. We hypothesise that premorbid IQ could influence symptom expression during an index episode (i.e. a short-term outcome). AIM OF THE STUDY: We studied 48 patients with schizophrenic disorder and 56 with bipolar disorder during an 'index episode' using the test di intelligenza breve (TIB) for the premorbid IQ evaluation, and the positive and negative syndrome scale (PANSS). RESULTS: Using the premorbid IQ as a criterion variable (i.e. low versus high IQ groups) the one-way ANOVA analysis showed that low IQ schizophrenic patients had more PANSS positive symptoms and "thought disturbances" than both high and low IQ bipolars. The low IQ schizophrenic patients showed more cognitive symptoms than bipolar patients with high IQ. Furthermore, no PANSS differences were seen between high IQ schizophrenics and low IQ bipolars. In the total and bipolar groups the correlation coefficients between TIB scores and PANSS scales reached statistical significance for the cognitive cluster only. No correlations were seen in the schizophrenic group. CONCLUSION: This categorisation (i.e. low versus high IQ) adds clinically relevant knowledge to patients who, in spite of having similar symptom profile (i.e. high IQ schizophrenic patients and low IQ bipolar patients), fall into different diagnostic categories.