Negative emotion dysregulation is linked to the intensity of suicidal ideation in a mixed inpatient sample.

BACKGROUND: Suicide has been associated with dysfunctional strategies for emotion regulation but, so far, research findings have been inconclusive. METHODS: To investigate how difficulties in emotion regulation impact suicidal ideation (SI) and behavior, 111 psychiatric inpatients were enrolled. Affective instability (AI), emotional impulsivity (EI), and negative and positive emotionality (NE and PE) were measured by the RIPoSt-40 questionnaire; the first three subscales have been summed to form a total negative emotion dysregulation (NED) score. RESULTS: In the sample, 55 subjects reported at least one-lifetime suicide attempt; 50 patients were diagnosed with mood-disorder (MD), 30 with the schizophrenia-spectrum disorder (SSD), and 15 with personality-disorder (PD). Diagnostic groups differed for NED scores (p=.008) but not for PE (p>0.05), with patients suffering from PD having higher scores (p=0.03). Compared to non-attempters, lifetime-suicide attempters were 6.5 times more likely to have a personality disorder (95% CI=1.34/31.83). Partial correlation analyses, controlling for the presence of suicide attempts, showed that lifetime SI-intensity score was significantly and positively associated with NED (r=.39, p<.001), AI (r=.40, p<.001), and NE (r=.42, p<.001). NED scores (p=.001) and the presence of lifetime suicide attempts (p<.001) were independently associated with lifetime SI-intensity scores. LIMITATIONS: The lack of a non-clinical control group and the cross sectional nature of the study limits the generalizability of the results. CONCLUSION: Our findings support the hypothesis that negative emotion dysregulation is independently associated with SI and behavior. Negative emotion dysregulation should be targeted in suicide prevention.

Cannabis use in early psychosis is associated with reduced glutamate levels in the prefrontal cortex.

RATIONALE: Recent studies have shown that cannabis may disrupt glutamate (Glu) signaling depressing Glu tone in frequent users. Current evidence have also consistently reported lower Glu-levels in various brain regions, particularly in the medial prefrontal cortex (mPFC) of chronic schizophrenia patients, while findings in early psychosis (EP) are not conclusive. Since cannabis may alter Glu synaptic plasticity and its use is a known risk factor for psychosis, studies focusing on Glu signaling in EP with or without a concomitant cannabis-usage seem crucial. OBJECTIVE: We investigate the effect of cannabis use on prefrontal Glu-levels in EP users vs. both EP non-users and healthy controls (HC). METHODS: Magnetic resonance spectroscopy was used to measure [GlumPFC] of 35 EP subjects (18 of whom were cannabis users) and 33 HC. For correlative analysis, neuropsychological performances were scored by the MATRICS-consensus cognitive battery. RESULTS: [GlumPFC] was lower in EP users comparing to both HC and EP non-users (p < 0.001 and p = 0.01, respectively), while no differences were observed between EP non-users and HC. A greater [GlumPFC]-decline with age was observed in EP users (r = -.46; p = 0.04), but not in EP non-users or HC. Among neuropsychological outcomes, working memory was the only domain that differentiates patients depending on their cannabis use, with users having poorer performances. CONCLUSIONS: Cannabis use is associated with reduced prefrontal [GlumPFC] and with a stronger Glu-levels decline with age. Glutamatergic abnormalities might influence the cognitive impairment observed in users and have some relevance for the progression of the disease.

White matter microstructure in ultra-high risk and first episode schizophrenia: A prospective study.

There is increasing evidence of white matter (WM) pathology in schizophrenia, but its role at the very early stage of the disorder remains unclear. In an exploration of WM microstructure in ultra-high risk (UHR) subjects and first episode schizophrenia (FES), 34 FES, 27 UHR and 26 healthy control (HC) subjects underwent a magnetic resonance imaging (MRI) tract based spatial statistics (TBSS) investigation. Whole brain fractional anisotropy (FA), mean diffusivity (MD), radial (RD) and axial diffusivity (AD) values were extracted. UHR subjects who later developed psychosis showed lower FA compared with HC in the corpus callosum (CC), the left superior and inferior longitudinal fasciculus, the left inferior fronto-occipital fasciculs (IFO), and the forceps; RD was significantly higher in the CC, the forceps, the anterior thalamic radiation bilaterally, and the cingulum bundle. FES, compared to HC, showed a significant FA reduction of the CC, the superior and inferior longitudinal fasciculi bilaterally, the IFO bilaterally, the corona radiate bilaterally, and the forceps; while RD was found to be significantly increased in the left superior longitudinal fasciculus. UHR who later developed psychosis had WM abnormalities affecting brain pathways that are crucial for intra- and inter-hemispheric connections.

Neurological soft signs discriminate schizophrenia from bipolar disorder.

BACKGROUND: Although neurological soft signs have been consistently described in patients with schizophrenia, their diagnostic specificity is not well clarified. METHODS: To test the hypothesis that neurological soft signs are specifically related to schizophrenia, we examined 305 subjects (patients with schizophrenia-spectrum disorder, n=167; patients with bipolar I disorder, n=88; controls, n=50). Neurological soft signs were assessed using the Neurological Evaluation Scale (NES). Multiple logistic regression analysis was used to compute the diagnostic predictive power of neurological soft signs. RESULTS: Patients in the schizophrenia-spectrum disorder group were found to have significantly greater neurological impairment (NES total score=23.9, standard deviation [SD] 11.2) than those in the bipolar disorder group (NES total score=18.2, SD 7.6; p<0.001). Neurological functioning was closely associated with psychopathology (all p<0.001). The NES total score reliably distinguished patients with schizophrenia spectrum disorders from those with bipolar disorder in 68.7% of the cases (p<0.001). Moreover, a particular set of neurological soft signs showed specificity for the schizophrenia-spectrum disorder diagnostic group. CONCLUSIONS: Our findings suggest that schizophrenia and bipolar disorder can be distinguished in terms of neurological impairment. Furthermore, we recommend the utility of neurological soft signs as a useful, quantifiable, sensitive, and inexpensive tool for the diagnostic work-up of schizophrenia.

Basic symptoms and psychotic symptoms: their relationships in the at risk mental states, first episode and multi-episode schizophrenia.

In the field of the early psychosis two main approaches attempt to develop rating tools, one investigating the basic symptoms domain, and the other the attenuated psychotic symptoms. To explore the relationship between basic symptoms (BSs) and other symptom domains in different phases of the psychotic illness 32 at ultra-high risk (UHR), 49 first episode schizophrenia (FES), 42 multiple episode schizophrenia (MES), and 28 generalized anxiety disorder (GAD) patients were enrolled. Participants were assessed using the SIPS/SOPS and the FCQ scales. Analyses of covariance taking into account socio-demographic and clinical variables significantly different between groups were applied to compare FCQ and SOPS scores. Finally FCQ and SOPS principal component analysis was carried out in the schizophrenia spectrum group. SOPS scores were higher in the UHR, FES and MES groups compared to the GAD control group. Concordantly, FES and MES groups had a higher number of basic symptoms in comparison with the GAD group, whereas UHR did not differ from the control group. The largest number of correlations between BSs and psychotic symptoms was found in the GAD group. According to the principal component analysis (PCA) five factors were extracted, with the BSs loading on a unique factor. Our findings imply that the boundary between psychotic and non-psychotic conditions cannot be outlined on the basis of the presence/absence of basic and psychotic symptoms.

Mental disorders diagnosed in childhood and at-risk mental state in a help-seeking population.

AIM: Disorders usually first diagnosed in infancy, childhood or adolescence (DUFD-ICA) may have preceded the onset of psychosis by several years and share some co-morbidity with psychotic disorders, but only a few studies have investigated this aspect. We looked for past or current DUFD-ICA in a sample of first adult psychiatric service users assessed for the presence of an at-risk mental state with the Structured Interview for Psychosis-risk Syndromes (SIPS). METHODS: We interviewed with the SIPS 159 first-time help seekers (age range 13-30 years) at adult psychiatric services who volunteered to participate in the study. For psychiatric diagnoses, we used the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition-Text Revision. We also assessed retrospectively the presence of DUFD-ICA and administered the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning. The sample has been subdivided diagnostically into first-episode psychosis, multiple episode psychosis, ultra-high risk (UHR) and other diagnoses. RESULTS: The risk for having one of first-episode psychosis, multiple episode psychosis or UHR was over 3.45 higher in the DUFD-ICA-positive history group than in the non-DUFD-ICA. Grouping the UHR with the not full-blown psychosis cases resulted in a further increase of the risk to 4.71. DUFD-ICA-positive participants scored higher than non-DUFD-ICA on the Positive, Negative and Disorganization scales of the SIPS and on several core-psychotic BPRS items. CONCLUSIONS: A positive history of DUFD-ICA increases the risk of a diagnosis of prodromal or current psychosis at help seeking. Impaired neurodevelopment may be shared among the psychoses and DUFD-ICA.

[Neurological soft signs: meaning and relevance along the course of psychiatric illness. An objective and rapid screening for psychosis?]. / Neurological soft signs: significato e rilevanza nel corso della patologia psichiatrica. Uno screening obiettivo veloce per psicosi?

AIMS: Neurological soft signs (NSS) are minor neurological anomalies indicating non-specific cerebral dysfunction, commonly assessed through the Neurological Evaluation Scale (NES). It is generally accepted that NSS are prevalent in schizophrenic patients respect to healthy subjects, but they have been also found in patients with other neurological and psychiatric disorders. We sought to review studies that have specifically investigated NSS in schizophrenia, bipolar disorder and obsessive-compulsive disorder, and we also focused on their relationship with psychopathological features and antipsychotic treatment. METHODS: In this review we selected published studies investigating NSS in psychiatric patients and their relationship with either psychopathological features and antipsychotic treatment. RESULTS: Apart from diagnosis, all patients show more NSS than healthy subjects, but schizophrenic patients perform worse respect to other psychiatric diseases. These signs are already present at the onset of the disease. NSS also show a significant correlation with psychopathological measures and they can be predictive of clinical course and response to medications. On the other hand, NSS can be independent of the pharmacological treatment. CONCLUSIONS: These findings argued the hypothesis that NSS could be a trait characteristic in psychosis. NSS are an objective measure for the assessment of serious psychiatric disorder in the prodromal phase, at onset and along the course of the disease.

Anatomical and functional correlates in major depressive disorder: the contribution of neuroimaging studies.

Several studies suggested the neural networks modulating aspects of emotional behaviour to be implicated in the pathophysiology of mood disorders. These networks involve the medial prefrontal cortex (MPFC) and closely related areas in the medial and caudolateral orbital cortex (medial prefrontal network), amygdala, hippocampus, and ventromedial parts of the basal ganglia, where alterations in grey matter volume and neurophysiological activity are found in cases with recurrent depressive episodes. Such findings hold major implications for models of the neurocircuits that underlie depression. In particular, evidence from lesion analysis studies suggests that MPFC and related limbic and striato-pallido-thalamic structures organize emotional expression. The aim of this paper is to review the contribution of the most relevant studies with single photon emission tomography (SPECT), positron emission tomography (PET) and magnetic resonance imaging (MRI) to the understanding of pathophysiology of major depressive disorder (MDD), with particular focus on the reversibility of functional correlates with treatment.

Improving adherence in mood disorders: the struggle against relapse, recurrence and suicide risk.

Medication nonadherence is a major obstacle to translating treatment efficacy from research settings into effectiveness in clinical practice for patients with affective disorders. Adherence to beneficial drug therapy is associated with lower mortality compared with poor adherence. Reduced adherence is associated with increased suicide risk, especially when lithium is discontinued. The aim of this paper is to review the prevalence, predictors and methods for improving medication adherence in unipolar and bipolar affective disorders. Studies were identified through Medline and PsycInfo searches of English language publications between 1976 and 2009. This was supplemented by a hand search and the inclusion of selected descriptive articles on good clinical practice. Estimates of medication nonadherence for unipolar and bipolar disorders range from 10 to 60% (median: 40%). This prevalence has not changed significantly with the introduction of new medications. There is evidence that attitudes and beliefs are at least as important as side effects in predicting adherence. The limited number of empirical studies on reducing nonadherence indicate that, if recognized, the problem may be overcome. Clinical data highlight the importance of extended courses of medication in improving the long-term prognosis of patients with affective disorders.

Periventricular white matter hyperintensities as predictors of suicide attempts in bipolar disorders and unipolar depression.

The aim of this study was to evaluate whether deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVH) are associated with suicidal behavior in patients with major affective disorders. Subjects were 99 consecutively admitted inpatients (42 men; 57 women; mean age: 46.5 years [SD=15.2; Min./Max.=19/79]) with a diagnosis of major affective disorder (bipolar disorder type I, bipolar disorder type-II and unipolar major depressive disorder). 44.4% of the participants had made at least one previous suicide attempt. T2-weighted brain magnetic resonance images were rated for the presence and extension of WMH using the modified Fazekas scale. Patients were interviewed for clinical data on average 5 days after admission. Bivariate analyses, corrected for multiple-testing, and logistic regression analysis were used to test the association between suicide attempts and clinical variables. Attempters and nonattempters differed only in the presence of PVH--the former were more likely to have PVH. The logistic regression indicated that the presence of PVH was robustly associated with suicidal behaviors after controlling for age (OR: 8.08). In conclusion, neuroimaging measures may be markers of risk for suicidal attempts in patients with major affective disorders.