Photosensitivity and panic-agoraphobic spectrum: a pilot study.

BACKGROUND: The aims of this study were to assess photosensitivity (photophobia and photophilia) in panic disorder (PD) patients compared to healthy controls, and to evaluate the correlation between photosensitivity and panic-agoraphobic spectrum self-report (PAS-SR) scores. METHODS: The PAS-SR and Photosensitivity Assessment Questionnaires were administered to 24 PD subjects and 33 healthy controls. RESULTS: Compared to controls, PD patients showed significantly higher levels of photophobia and lower levels of photophilia items. The PAS-SR total score was positively correlated with the photophobia score. CONCLUSIONS: This study shows a strong correlation between PD and photophobia. However, whether photophobia develops before or after the onset of PD remains unclear. Further research is warranted to assess the potential role of light stimuli exposure in the onset, course and outcome of PD.

Evidence of diffuse damage in frontal and occipital cortex in the brain of patients with post-traumatic stress disorder.

A number of MRI studies have shown focal or diffuse cortical gray matter (GM) abnormalities in patients with post-traumatic stress disorder (PTSD). However, the results of these studies are unclear regarding the cortical regions involved in this condition, perhaps due to the heterogeneity of the PTSD population included or to the differences in the methodology used for the quantification of the brain structures. In this study, we assessed differences in cortical GM volumes between a selected group of 25 drug-naive PTSD patients with history of adulthood trauma and 25 matched non-traumatized controls. Analyses were performed by using two different automated methods: the structural image evaluation using normalization of atrophy (SIENAX) and the voxel-based morphometry (VBM), as we trusted that if these complementary techniques provided similar results, it would increase the confidence in the validity of the assessment. Results of SIENAX and VBM analyses similarly showed that cortical GM volume decreases in PTSD patients when compared to healthy controls, particularly in the frontal and occipital lobes. These decreases seem to correlate with clinical measures. Our findings suggest that in drug-naïve PTSD patients with a history of adulthood trauma, brain structural damage is diffuse, with a particular prevalence for the frontal and occipital lobes, and is clinically relevant.

Antidepressants in healthy subjects: what are the psychotropic/psychological effects?

A wide debate is ongoing regarding whether antidepressant effects should be considered a general property of these agents or whether they exclusively belong to the context of target symptoms. The aim of the present review is to summarize findings on antidepressant influences on healthy volunteers, focusing on changes in psychological and cognitive functions. Differences have been detected between acute and chronic treatments. Acute treatment has been found to lead to positive bias in emotion processing and facilitation in negative emotion recognition. Chronic treatments have been found to stabilise some changes induced by acute treatment, such as increased social behaviours. Regarding antidepressant modulation of affective symptomatology contrasting results have been reported suggesting that the link between action on cognitive processes and mood may be not direct. In fact, meta-analyzing data on mood and anxiety symptoms no difference was detected between subjects receiving placebo and SSRIs. However, meta-analyzing data on negative affects, a significant decrease was detected in subjects receiving SSRIs in comparison with subjects receiving placebo. In summary, antidepressants seem to exert a detectable influence also in healthy subjects.

Photosensitivity in panic disorder.

BACKGROUND: The objective of this study is to evaluate abnormal light-related behavior in patients with panic disorder (PD). METHODS: We administered the Photosensitivity Assessment Questionnaire to 30 subjects with PD and to 40 healthy subjects. The Photosensitivity Assessment Questionnaire is a self-report questionnaire that evaluates two dimensions of photosensitivity: photophilia and photophobia. RESULTS: Compared to healthy controls, PD subjects reported significantly higher scores on the photophobia (P<.003) and significantly lower scores on the photophilia (P<.001) questions. CONCLUSIONS: Subjects with PD indicated that they tolerate and seek light to a significantly lower degree than normal controls.

Quality of life, anxiety and depression in sarcoidosis.

OBJECTIVES: This study sought to evaluate the quality of life and the presence of psychiatric disorders in patients with sarcoidosis. METHODS: Data were collected from 80 consecutive outpatients with sarcoidosis presenting to the Sarcoidosis Center of the Respiratory Diseases Division at the University of Siena, Italy. RESULTS: Forty-four percent of the subjects endorsed at least one psychiatric DSM-IV axis I diagnosis. Specifically, 25% of subjects met the criteria for Major Depressive Disorder, 6.3% for Panic Disorder, 6.3% for Bipolar Disorder, 5% for Generalized Anxiety Disorder and 1.3% for Obsessive Compulsive Disorder. Statistically significant correlations were found between Forced Expiratory Volume in the first second (FEV(1)), Forced Vital Capacity (FVC) and several domains of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) questionnaire. Subjects with multi-systemic involvement, with asthenia and with a more severe radiographic stage and subjects receiving steroids, reported a poorer quality of life. CONCLUSIONS: Sarcoidosis is associated with a high rate of psychiatric comorbidity and may contribute to a poorer quality of life. A referral for a psychiatric or psychological evaluation and counseling should be considered for many of the sarcoidosis patients.

Infertility and psychiatric morbidity.

OBJECTIVE: To assess the relationship between psychiatric disorders and infertility. DESIGN: Case-control study. SETTING: Fertile and infertile volunteer couples in an academic research setting. PATIENT(S): Eighty-one infertile couples recruited from an infertility center before fertility treatment and 70 fertile controls recruited from an obstetrics and gynecology clinic. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The presence of Axis 1 psychiatric disorders. RESULT(S): The occurrence of current psychiatric disorders was significantly higher among infertile subjects than among fertile controls, especially for adjustment disorder with mixed anxiety and depressed mood (16% vs. 2%) and for binge eating disorder (8% vs. 0). CONCLUSION(S): Our data highlight that a percentage of infertile patients have already developed a psychiatric disorder at the time of their first contact with a specialized fertility service. Possible applications are discussed, including the recommendation that gynecologists screen for clinical or subclinical psychiatric disorders in infertility patients and offer treatment accordingly.

Magnetic resonance imaging volumes of the hippocampus in drug-naïve patients with post-traumatic stress disorder without comorbidity conditions.

Most brain imaging studies have showed smaller hippocampal volume in adults with chronic PTSD; however, some other studies have not replicated this finding. Most of these investigations included subjects with other psychiatric comorbidities, such as major depression or alcohol abuse. The prevalence of psychiatric comorbidities in PTSD is generally high and this makes it difficult, if not impossible, to disentangle the contribution of other disorders to hippocampal volume. Therefore, the main goal of the current study is to compare hippocampal volumes of healthy subjects and drug-naïve patients with PTSD caused by different types of mixed civilian traumas (i.e. car accident, physical abuse, sudden death of a family member, assault or robbery, natural disaster and traumatic abortion) and without comorbidity conditions. Magnetic resonance imaging (MRI) was used to measure the hippocampi, total cerebrum, gray matter, white matter and cerebrospinal fluid volumes in 34 patients with single diagnosis of PTSD, and 34 case-matched non-PTSD comparison subjects. The patients with single diagnosis of PTSD had an 11.8% smaller left hippocampus (p<0.001) and an 8.7% smaller right hippocampus (p=0.003) than the healthy controls. The results were controlled for the total brain volume and for gray matter volumes. Subjects with PTSD also displayed lower overall gray matter volume (p=0.006). There were no significant correlations between hippocampal volumes and illness duration or severity of PTSD. The findings indicate the presence of smaller hippocampal volumes in drug-naïve patients with single diagnosis of PTSD, compared with healthy subjects.

Repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of panic disorder (PD) with comorbid major depression.

BACKGROUND: Studies suggest that the dorsolateral prefrontal cortex (DLPFC) participates in neural circuitry that is dysregulated in Panic Disorder (PD) and Major Depressive Disorder (MDD). We tested whether low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) could normalize the overactivity of right frontal regions and thereby improve symptoms. METHODS: Six patients with PD and comorbid MDD were treated with daily active 1-Hz rTMS to the right DLPFC for 2 weeks in this open-label trial. RESULTS: Clinical improvements were apparent as early as the first week of treatment. After the second week, 5/6 of patients showed improvements in panic and anxiety, and 4/6 showed a decrease in depression, with sustained improvement at 6 months of follow-up. Right hemisphere resting motor threshold increased significantly after rTMS. LIMITATIONS: Limitations of this study are the open design and the small sample size. CONCLUSIONS: Slow rTMS to the right DLPFC resulted in significant clinical improvement and reduction of ipsilateral motor cortex excitability. Replications in larger sample will help to clarify the relevance of this preliminary data and to define the potential role of right DLPFC rTMS in panic with major depression.

Quality of life and subthreshold obsessive-compulsive disorder.

OBJECTIVE: This study investigates the relationship between subthreshold obsessive-compulsive disorder (OCD) and quality of life (QoL) in a sample from the Italian general population. METHODS: A sample of 202 psychiatrically healthy (defined as absence of current axis I and axis II disorders) subjects was recruited by word of mouth from the residential population in the Siena, Salerno and Milano municipalities (Italy). All study subjects completed the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Questionnaire for Obsessive-Compulsive Spectrum (OBS-SR), which explore a wide array of threshold and subthreshold OCD symptoms, behaviours and traits. A diagnostic assessment was conducted to exclude the presence of DSM-IV axis I and axis II disorders using the Mini International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-III-R personality disorders, respectively. RESULTS: A statistically significant correlation was found between the OBS-SR total score and the Q-LES-Q domains of physical health, subjective feelings, work, school, social relationships and general activities. There was also a statistically significant correlation between several Q-LES-Q and OBS-SR domains. CONCLUSIONS: The presence of subthreshold OCD is correlated with poorer QoL. More research is needed to evaluate if specific therapeutic interventions targeting subthreshold obsessive-compulsive symptoms can lead to a significant improvement in the QoL of the affected individuals.

Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS).

There is evidence that motor and premotor cortex are hyperexcitable in obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). We tested whether low-frequency repetitive transcranial magnetic stimulation (rTMS) could normalize overactive motor cortical regions and thereby improve symptoms. Subjects with OCD or TS were treated with active rTMS to the supplementary motor area (SMA) for 10 daily sessions at 1 Hz, 100% of motor threshold, 1200 stimuli/day. Suggestions of clinical improvement were apparent as early as the first week of rTMS. At the second week of treatment, statistically significant reductions were seen in the YBOCS, YGTSS, CGI, HARS, HDRS, SAD, BDI, SCL-90, and SASS. Symptoms improvement was correlated with a significant increase of the right resting motor threshold and was stable at 3 months follow-up. Slow rTMS to SMA resulted in a significant clinical improvement and a normalization of the right hemisphere hyperexcitability, thereby restoring hemispheric symmetry in motor threshold.

Quality of life and subthreshold affective symptoms.

Although Quality of Life in patients with Mood Disorders has been widely investigated, there are very few studies that examine the relationship between quality of life and subthreshold affective symptoms. The aim of this study was to analyze the relationship between mood spectrum and subjective quality of life in the general population. A sample of 200 healthy subjects was recruited from the general population. None of the subjects were treated with psychotropic medications or were receiving psychotherapy at the time of the assessments. Subjects were 22-55 years old. The mean age was 33.56 years. Subjects rated themselves on the 'Quality of Life Enjoyment and Satisfaction Questionnaire' (Q-LES-Q) and the 'Self-Report Questionnaire for Mood Spectrum' (MOODS-SR). We found a statistically significant correlation between Q-LES-Q total score and MOODS-SR total score (r = -0.43; p < 0.001) and between Q-LES-Q total score and depressive symptoms-related subtotal score of MOODS-SR (r = -0.35; p < 0.001), but not between Q-LES-Q total score and manic symptoms-related subtotal score of MOODS-SR. Our data suggests that subjects who report subthreshold affective symptomatology also report a low degree of enjoyment and satisfaction from life. The depressive aspects of the mood spectrum seem to have the greatest negative influence.

Activity of citalopram on adenosine and serotonin circulating levels in depressed patients.

Citalopram is a selective serotonin reuptake inhibitor used in the treatment of depression. Recent investigations have shown that it reduces in rat brain the release of excitatory amino neurotransmitters acid glutamate and aspartate by the involvement of the inhibitory neuromodulator adenosine. In this study, we described citalopram and serotonin levels in plasma and platelets, as well as plasma adenosine levels, in depressive patients during acute and chronic administration of citalopram. Twelve patients affected by Major Depression (DSM-IV) received a single oral dose of citalopram in the morning, 5 mg in the first 5 days, 10 mg from the 6th to the 10th day, and 20 mg from the 11th to the 40th day. Blood samples for citalopram, serotonin, and adenosine were collected at Time 0 and 4, 12 and 24 hours after drug administration on the first day of citalopram 5 mg, and on the first and the last day of citalopram 20 mg. Citalopram, serotonin, and adenosine concentrations in plasma increased after citalopram administration, and the highest levels were observed on the last day of treatment. Citalopram was detectable in platelets with concentrations showing a time variation similar to plasma values. Serotonin levels in platelets decreased after drug administration, reaching the lowest values on the last day of treatment.

Panic-agoraphobic spectrum and light sensitivity in a general population sample in Italy.

OBJECTIVE: This study aimed to verify a possible correlation between panic symptoms and photosensitivity, not only in panic disorder (PD) but also in the panic-agoraphobic spectrum. METHOD: One hundred and sixty-nine healthy and drug-free subjects completed the Structured Clinical Interview for Panic-Agoraphobic Spectrum-Lifetime version (SCI-PAS-Lifetime) and the Photosensitivity Assessment Questionnaire (PAQ). RESULTS: The SCI-PAS-Lifetime total score was positively correlated with the total score of the PAQ photophobia subdimension (r = 0.44; P < 0.001); the SCI-PAS-Lifetime total score was not significantly correlated with the photophilia subdimension. As photophobia increased, we observed significant score increases in all SCI-PAS-Lifetime domains. Bivariate correlation showed higher coefficient correlation between the panic-like symptoms domain and photophobia (r = 0.44; P < 0.001). CONCLUSIONS: A high total score in the SCI-PAS-Lifetime, which denotes more typical features of the spectrum, is associated with a higher level of light sensitivity and intolerance toward bright stimuli. This finding reflects clinical evidence that widely documents photophobic behaviours in subjects with PD and the importance of light stimuli exposure during the onset and course of such a disorder. Bright stimulation seems to be relevant both in PD diagnosed according to current DSM criteria and in the entire panic-agoraphobic spectrum, from nuclear elements of the disorder through subclinical states to the normal condition.

Plasma catecholamine levels after fluoxetine treatment in depressive patients.

It is known that selective serotonin reuptake inhibitors, widely used as antidepressive drugs, act by inhibiting the cell reuptake of serotonin, but their effect on the catecholaminergic system is not yet completely understood. In this study, we investigated plasma concentrations of norepinephrine, epinephrine and dopamine after acute and chronic administration of fluoxetine in depressive patients. Twelve patients affected by major depression received a single oral dose of fluoxetine in the morning, 5 mg in the first 5 days, 10 mg from the 6th to the 10th day and 20 mg from the 11th to the 40th day. Twelve healthy subjects received a placebo under identical testing procedures. Blood samples were collected at baseline and 7, 10 and 24 h after drug administration on the 1st day of fluoxetine administration at a dose of 5 mg, and on the 1st and the 30th day of fluoxetine administration at a dose of 20 mg (days 11 and 40 of treatment, respectively). We found that plasma norepinephrine, epinephrine and dopamine levels significantly increased after acute and chronic treatment (p < 0.001), reaching the highest concentrations on the last day. No significant changes of these parameters were observed in control patients.

Hypofunctioning of sensory gating mechanisms in patients with obsessive-compulsive disorder.

BACKGROUND: In obsessive-compulsive disorder (OCD) patients, functional abnormalities in basal ganglia/precentral circuitries cause cortical hyperexcitability and lack of inhibitory control. These loops can be partly explored by median-nerve somatosensory evoked potentials (SEPs), which functionally reflect the brain responsiveness to somatosensory stimuli. In healthy humans, SEPs' amplitude during voluntary finger movements is lower than during muscular relaxation (i.e., sensory gating). Cortical hyperexcitability in OCD could be eventually responsible for a reduction of sensory gating. This might have pathophysiologic implications for motor compulsions. METHODS: Median-nerve SEPs were recorded in 11 OCD patients and 9 healthy volunteers during muscle relaxation ("Relax") or finger movements of the stimulated hand ("Move"). Latencies and amplitudes of pre- and postcentral SEP components were compared between groups during "Relax" and "Move" conditions. RESULTS: In OCD patients, the responsiveness to sensory stimuli was enhanced for precentral SEPs. Sensory gating ("Relax" vs. "Move") in control subjects involved both pre- and postcentral SEPs, the former being reduced in amplitude by approximately 60%. In OCD patients, sensory gating was spatially restricted to precentral SEP components and was significantly reduced compared with control subjects (approximately 30%). CONCLUSIONS: Enhanced precentral SEPs and hypofunctioning of centrifugal sensory gating in OCD might reflect the inability to modulate sensory information due to a "tonic" high level of cortical excitability of motor and related areas, likely resulting from basal ganglia dysfunction. This might offer new insights into the pathophysiology of OCD.