MELDNa score is associated with psychopathology and reduced quality of life in cirrhotic patients with a liver transplant perspective.

Psychopathological symptoms and reduced health related quality of life (HRQoL) are frequent in cirrhotics, but no data on their association with cirrhosis prognosis assessed by the MELDNa score are available. Prospective data on the long-term effect of deceased donor liver transplantation (LT) on psychopathological symptoms are needed. Before entering the LT waiting list, 44 consecutive LT cirrhotic candidates without a major psychiatric disorder underwent a psychopathological assessment, including Symptom Checklist-90-revised (SCL-90-R) and Defense Style Questionnaire (DSQ). HRQoL was measured by Short Form 36 Health Survey (SF-36). Abnormal performance at each questionnaire was defined by using 44 age, gender, BMI and education-matched healthy subjects. Separate binary logistic regression models were used to test the association of the Child-Pugh, MELD and MELDNa scores with abnormal performance at each questionnaire. Fourteen patients repeated the battery tests 3 years after LT. Before LT, increasing MELDNa was the only prognostic score independently associated with an abnormal SCL-90-R global psychopathological score index (OR: 1.207; 95% CI: 1.026-1.420; P = 0.02) and the best independent predictor of reduced HRQoL. After LT, compared to status prior to LT, performance at SF-36 general health perception scale ameliorated (P = 0.02), performance at SCL-90-R somatization scale (P = 0.001) and global psychopathological score index (P < 0.001) worsened and the negative correlation between the psychopathological global score index and HRQoL disappeared. The severity of cirrhosis in LT candidates should be monitored by the MELDNa score to better establish the right psychological counselling. Psychopathology, and in particular somatization, worsens after LT and should be carefully investigated.

Olanzapine as the ideal "trip terminator"? Analysis of online reports relating to antipsychotics' use and misuse following occurrence of novel psychoactive substance-related psychotic symptoms.

OBJECTIVE: The pharmacological self-management of novel psychoactive substance (NPS)-induced psychopathological consequences represents a fast growing phenomenon. This is facilitated by the frequent sharing of NPS intake experiences online and by the ease of access to a range of psychotropic medications from both the online and street market. Olanzapine is anecdotally reported by Web users to be the most frequent self-prescribed medication to cope with NPS-induced psychoses. Hence, we aimed here at better assessing olanzapine use/misuse for this purpose. METHODS: Exploratory qualitative searches of 163 discussion fora/specialized websites have been carried out in four languages (English, German, Spanish, and Italian) in the time frame November 2012-2013. RESULTS: Most NPS-users allegedly self administer with olanzapine to manage related psychotic crises/"bad trips". This may be typically taken only for a few days, at a dosage range of 5-50 mg/day. CONCLUSIONS: Only a few research studies have formally assessed the effectiveness of olanzapine and indeed of other second-generation antipsychotics to treat NPS-induced psychosis. Olanzapine was suggested here from a range of pro drug websites as being the "ideal" molecule to terminate "bad trips". Health professionals should be informed about the risks related to olanzapine misuse.

Generalized and specific emotion impairments as potential markers of severity in Obsessive-Compulsive Disorder: a preliminary study using Facial Action Coding System (FACS).

BACKGROUND: The role of emotional deficits in the poor outcomes of patients with Obsessive-Compulsive Disorder (OCD) has been emphasized. Generalized and specific emotional abnormalities have been reported, often related to OCD severity and functional disabilities. The objective of the present study was to assess the abilities of experiencing and displaying emotions in OCD patients in response to specific stimuli in relation with the severity of their clinical condition. SUBJECTS AND METHODS: Thirty-six individuals participated in the study: 10 OCD patients with severe symptoms, 11 with mild-moderate symptoms, and 15 healthy controls. All participants watched emotion-eliciting video clips while their facial activity was videotaped. The congruent/incongruent feeling of emotions and the facial expression in reaction to emotions were evaluated. RESULTS: The two subgroups of OCD patients presented similarly incongruent emotive feelings and facial expressions (significantly worse than healthy participants). Moreover, OCD patients with severe symptoms expressed the emotion of happiness and disgust significantly less appropriately than OCD patients with mild-moderate symptoms. CONCLUSIONS: The present data support the hypothesis that impaired emotional processing may: (i) represent a potential contributor to poor outcome in OCD; (ii) constitute a warning sign for clinicians to establish a more comprehensive protocol for more severe cases; (iii) influence therapeutic strategies used to treat this disorder.

Changes in dream experience in relation with antidepressant escitalopram treatment in depressed female patients: a preliminary study.

INTRODUCTION: Sleep disturbances have long been considered as a cardinal symptom of endogenous depression and dreams in depressed patients usually differ from those of healthy people. The aim of the present study was to investigate dream subjective experiences and their modifications in relation to clinical response in a group of escitalopram-treated depressed patients. METHODS: Twenty-seven female patients meeting DSM-IV-TR criteria for Major Depressive Disorder (MDD) and starting SSRI therapy were included in the study. Data about psychopathological status and dreaming subjective experiences were collected at baseline (T0), 4 weeks after the beginning of the treatment (T1) and after further 4 weeks of therapy (T2). RESULTS: At T0 dream experience was impaired and negatively toned. Concomitantly with the decrease of symptoms severity, the 8-week escitalopram treatment yielded to significant improvements in the recall of both quantity and quality of dreams; those patients whit lower clinical benefits kept on reporting impaired dream experiences. DISCUSSION: The results of the present study evidence how the changes in some specific dreaming characteristics, such as the subjective recall of dream activity, the dream recall quality, the dream emotional content and the dream complexity represent reliable markers of the effectiveness of antidepressant therapy.

Tinnitus: clinical experience of the psychosomatic connection.

BACKGROUND: The connection between psychopathology and tinnitus is complex and not adequately studied. The aim of this study is to investigate the relationship between tinnitus and psychiatric comorbidities from different points of view: categorical, dimensional, temperamental, and perceived stress level. METHODS: Two hundred and thirty-nine patients affected by tinnitus were recruited between January and October 2012. Patients underwent a preliminary battery of tests including the Tinnitus Handicap Inventory (THI), Symptom Check List (SCL90-R), Temperament and Character Inventory (TCI), and Stress-Related Vulnerability Scale (VRS), and eventually a full psychiatric evaluation. RESULTS: One hundred and fourteen patients (48% of the total sample) presented psychiatric comorbidity. Among these, a higher prevalence of depression, somatization, obsession, and anxiety was found. More than 41% of patients affected by decompensated tinnitus reported a family history of psychiatric disorders. Significant positive correlations between the psychopathological screening tools (SCL90-R and VRS) and THI were found. Patients affected by comorbid psychiatric disorder showed specific temperamental and characterial predispositions. CONCLUSION: Psychiatric comorbidity in subjects affected by tinnitus is frequent. Stress can be considered as a factor leading to damage and dysfunction of the auditory apparatus. The vulnerability to neurotic disorders and the lack of coping capabilities can play a critical role in the clinical history of patients affected by severe tinnitus.

Facial expression in patients with bipolar disorder and schizophrenia in response to emotional stimuli: a partially shared cognitive and social deficit of the two disorders.

INTRODUCTION: It has recently been highlighted that patients affected by schizophrenia (SCZ) and those affected by bipolar disorder (BD) undergo gradual chronic worsening of cognitive and social functioning. The objective of the current study was to evaluate and compare (using the Facial Action Coding System [FACS]) the way by which patients with the two disorders experience and display emotions in relation to specific emotional stimuli. MATERIALS AND METHODS: Forty-five individuals participated in the study: 15 SCZ patients, 15 BD patients, and 15 healthy controls. All participants watched emotion-eliciting video clips while their facial activity was videotaped. The congruent/incongruent feeling of emotions and the facial expression in reaction to emotions were evaluated. RESULTS: SCZ and BD patients presented similar incongruent emotive feelings and facial expressions (significantly worse than healthy participants); SCZ patients expressed the emotion of disgust significantly less appropriately than BD patients. DISCUSSION: BD and SCZ patients seem to present a similar relevant impairment in both experiencing and displaying emotions; this impairment may be seen as a behavioral indicator of the deficit of social cognition present in both the disorders. As the disgust emotion is mainly elaborated in the insular cortex, the incongruent expression of disgust of SCZ patients can be interpreted as a further evidence of a functional deficit of the insular cortex in this disease. Specific remediation training could be used to improve emotion and social cognition in SCZ and BD patients.

Manic-like psychosis associated with elevated trough tacrolimus blood concentrations 17 years after kidney transplant.

Several neurological side effects induced by tacrolimus are described in the scientific literature, ranging from mild neurological symptoms to delirium and psychosis. We report the case of a 46-year-old man with no prior psychiatric history who suddenly manifested manic-like psychosis associated with elevated trough tacrolimus blood concentrations 17 years after kidney transplant. The use of antipsychotics may improve the severity of symptoms; but in order to obtain a complete remission, the reduction in the dose of tacrolimus, or its replacement with alternative immunosuppressant therapies, is recommended.

The Tinnitus Handicap Inventory as a screening test for psychiatric comorbidity in patients with tinnitus.

BACKGROUND: Psychiatric comorbidity is common in patients who seek help for tinnitus. The perceived severity of tinnitus correlates closer to psychological and general health factors than to audiometrical parameters. Audiologists need valid screening tools in order to identify patients with psychiatric disorders and to tailor treatment in a multidisciplinary setting. The tinnitus handicap inventory (THI) has gained widespread acceptance as a self-report measure of tinnitus handicap. In several studies, THI test score correlates with the level of psychopathologic distress. The aim of our study was to investigate the predictive power of the test THI in relation to psychiatric disorders. METHODS: We recruited 156 patients with chronic tinnitus who have requested help at our tinnitus center. All patients underwent psychiatric evaluation, the diagnosis was made in agreement with the DSMIV-TR criteria; all patients filled out the following questionnaires: THI, Symptomatic Check List-90-Revised (SCL-90-R) and Stress-related Vulnerability Scale (VRS). Sensibility and specificity of tests as screening tool for psychiatric disorders was evaluated using Receiver Operating Characteristic (ROC) curve. RESULTS: Sixty-eight patients (prevalence: 43.59%) were found to be affected by a psychiatric disorder. AUC = 0.792 (p > 0.001) shows that THI is a moderately accurate test to individuate psychiatric affected people among our sample. We identified a score of 36 at THI (sensibility = 86.76%; specificity = 59.09%) as an appropriate cut-off point. CONCLUSIONS: If a patient reports a THI score greater than 36, the audiologist should supplement diagnostic studies with a psychiatric evaluation.