Physical Activity and Exercise Addiction During the Covid-19 Pandemic in Italy.

Severe restrictive measures were implemented globally to limit the spread of the Covid-19 pandemic leading to significant lifestyle changes and impacting on both the physical and the mental health of citizens. Caught by the fear of getting sick, some individuals have adopted behaviors which favored the development of exercise addiction (EA). Our aim was to evaluate physical activity habits and the risk of EA in the general Italian population during phase 1 of the lockdown. The role of appearance anxiety (AA), self-compassion, and use of performance and image enhancing drugs (PIEDs) as predictors of EA development were investigated. A comparison between physically active subjects with the inactive ones was also included. Between April and May 2020, an online survey was conducted across Italy. Nine hundred thirty-six answers were collected. The rate of EA in the physically active sample (782 subjects) was 4.1%. The physically active group showed higher SCS scores and a greater use of PIEDs. Of the physically active participants, 84.2% reported variations in their fitness routine. Perceived benefit of exercising resulted significantly higher in those with EA. Subjects with EA reported stronger motivation in engaging in physical activity as for "physical wellness," "psychological well-being," and "sexual attractiveness and confidence in relationship." A higher level of AA, a lower level of self-compassion, and a higher perceived benefit of exercising during lockdown were all significant predictors for the presence of EA. Our findings suggest that the fear of getting sick from Covid-19, combined with radical changes in the lifestyles induced by the lockdown and individual personological characteristics, can favor the development of EA and related phenomena in the general population.

Body-environment integration: Temporal processing of tactile and auditory inputs along the schizophrenia continuum.

According to the dimensional approach to psychosis, there is a continuum from low schizotypy to schizophrenia patients. The temporal aspect of sensory processing seems to be compromised across such continuum, as suggested by different studies separately investigating unisensory or multisensory domains. Most of these studies have so far focused primarily on the temporal processing of visual and auditory stimuli, either in schizotypy or schizophrenia, while leaving the tactile domain and the integration of touch with other senses mostly unexplored. Given the relevance of body-related perceptual abnormalities for psychosis proneness, we aimed at filling this gap in the literature across two studies. We asked participants with increasing levels of schizotypy (study 1) and schizophrenia patients (study 2) to perform three simultaneity judgement tasks: a unimodal tactile task, a unimodal auditory task and a bimodal audio-tactile task. Each task allowed estimating a simultaneity range (SR), as a proxy of the individual tolerance to asynchronies in the tactile, auditory and audio-tactile domains, respectively. Results showed larger SRs as the level of schizotypy increases. Specifically, the linear effect of schizotypy levels on the audio-tactile task was stronger than on the auditory task, which in turn was greater than the effect on the tactile task (study 1). Differently, schizophrenia patients showed larger SRs than controls in all the three tasks (study 2). The current study is the first empirical investigation across the continuum from low schizotypy to schizophrenia of the tolerance to asynchronies in the processing of external (auditory) and body-related (tactile) inputs.

Body representations and basic symptoms in schizophrenia.

Patients with schizophrenia report a wide range of anomalous body experiences. According to the basic symptom model of schizophrenia, disturbances of body perception and awareness are among the most powerful predictors of the changes in the subjective experience of the self in schizophrenia. In this study we first investigated the body structural representation (BSR), a specific aspect of body awareness, and its association to basic symptoms in patients with schizophrenia. Using a finger localization task, we found that patients are significantly less accurate than healthy controls when asked to identify pairs of fingers touched by the experimenter, when the hand is hidden from view. Most importantly, patients' performance at the finger localization task was negatively associated to basic symptoms: the worse the individual accuracy, the higher the SPI-A total score. Moreover, the accuracy at the finger localization task was also negatively correlated with the malleability of the sense of body ownership: the less the individual ability to localize fingers, the stronger the rubber hand illusion. These results are in agreement with the idea that self-disorders in schizophrenia reveal a disconnectedness that can be regarded as a problem of disembodiment and traced back to abnormal body experiences.

Disrupted relationship between "resting state" connectivity and task-evoked activity during social perception in schizophrenia.

Schizophrenia has been described as a self-disorder, whereas social deficits are key features of the illness. Changes in "resting state" activity of brain networks involved in self-related processing have been consistently reported in schizophrenia, but their meaning for social perception deficits remains poorly understood. Here, we applied a novel approach investigating the relationship between task-evoked neural activity during social perception and functional organization of self-related brain networks during a "resting state". "Resting state" functional MRI was combined with task-related functional MRI using a social perception experiment. Twenty-one healthy control participants (HC) and 21 out-patients with a diagnosis of schizophrenia (SCH) were included. There were no significant differences concerning age, IQ, education and gender between the groups. Results showed reduced "resting state" functional connectivity between ventromedial prefrontal cortex and dorsal posterior cingulate cortex in SCH, compared to HC. During social perception, neural activity in dorsal posterior cingulate cortex and behavioral data indicated impaired congruence coding of social stimuli in SCH. Task-evoked activity during social perception in dorsal posterior cingulate cortex co-varied with dorsal posterior cingulate cortex-ventromedial prefrontal cortex functional connectivity during a "resting state" in HC, but not in SCH. Task-evoked activity also correlated with negative symptoms in SCH. These preliminary findings, showing disrupted prediction of social perception measures by "resting state" functioning of self-related brain networks in schizophrenia, provide important insight in the hypothesized link between self and social deficits. They also shed light on the meaning of "resting state" changes for tasks such as social perception.

Integrative Processing of Touch and Affect in Social Perception: An fMRI Study.

Social perception commonly employs multiple sources of information. The present study aimed at investigating the integrative processing of affective social signals. Task-related and task-free functional magnetic resonance imaging was performed in 26 healthy adult participants during a social perception task concerning dynamic visual stimuli simultaneously depicting facial expressions of emotion and tactile sensations that could be either congruent or incongruent. Confounding effects due to affective valence, inhibitory top-down influences, cross-modal integration, and conflict processing were minimized. The results showed that the perception of congruent, compared to incongruent stimuli, elicited enhanced neural activity in a set of brain regions including left amygdala, bilateral posterior cingulate cortex (PCC), and left superior parietal cortex. These congruency effects did not differ as a function of emotion or sensation. A complementary task-related functional interaction analysis preliminarily suggested that amygdala activity depended on previous processing stages in fusiform gyrus and PCC. The findings provide support for the integrative processing of social information about others' feelings from manifold bodily sources (sensory-affective information) in amygdala and PCC. Given that the congruent stimuli were also judged as being more self-related and more familiar in terms of personal experience in an independent sample of participants, we speculate that such integrative processing might be mediated by the linking of external stimuli with self-experience. Finally, the prediction of task-related responses in amygdala by intrinsic functional connectivity between amygdala and PCC during a task-free state implies a neuro-functional basis for an individual predisposition for the integrative processing of social stimulus content.

The Interface between Neuroscience and Neuro-Psychoanalysis: Focus on Brain Connectivity.

Over the past 20 years, the advent of advanced techniques has significantly enhanced our knowledge on the brain. Yet, our understanding of the physiological and pathological functioning of the mind is still far from being exhaustive. Both the localizationist and the reductionist neuroscientific approaches to psychiatric disorders have proven to be largely unsatisfactory and are outdated. Accruing evidence suggests that psychoanalysis can engage the neurosciences in a productive and mutually enriching dialogue that may further our understanding of psychiatric disorders. In particular, advances in brain connectivity research have provided evidence supporting the convergence of neuroscientific findings and psychoanalysis and helped characterize the circuitry and mechanisms that underlie higher brain functions. In the present paper we discuss how knowledge on brain connectivity can impact neuropsychoanalysis, with a particular focus on schizophrenia. Brain connectivity studies in schizophrenic patients indicate complex alterations in brain functioning and circuitry, with particular emphasis on the role of cortical midline structures (CMS) and the default mode network (DMN). These networks seem to represent neural correlates of psychodynamic concepts central to the understanding of schizophrenia and of core psychopathological alterations of this disorder (i.e., ego disturbances and impaired primary process thinking).

Binding action and emotion in first-episode schizophrenia.

BACKGROUND/AIMS: Several components of social cognition are compromised in schizophrenia (SCZ) from the early stage of the illness. In this study we first investigated whether mirror neuron-driven embodied simulation (mnES) is altered in first-episode SCZ. Second, we tested whether emotional cues impact on the mnES in SCZ patients. METHODS: Twenty-two SCZ patients and 22 healthy controls (HCs) observed goal-related actions in either a neutral or emotional context during functional magnetic resonance imaging scanning. RESULTS: Observation of neutral action elicited a lower activity in the frontoparietal network in SCZ patients, as compared to HCs. Particularly, activation in the left inferior parietal lobule in response to the same condition negatively correlated with patients' self-experience disturbances. Moreover, observation of an action performed by an angry agent produced poorer neural activity in the right anterior insula in SCZ patients as compared to HCs. This difference was mostly due to the negative ß-values shown by SCZ patients, which positively correlated with their empathy scores. No differences were found contingent upon the observation of an action performed by a happy agent. CONCLUSION: Our results show that emotional cues allow SCZ patients to partially recover mnES. However, their understanding of the emotional components of the actions of others will likely remain deficient.

Altered brain long-range functional interactions underlying the link between aberrant self-experience and self-other relationship in first-episode schizophrenia.

Self-experience anomalies are elementary features of schizophrenic pathology. Such deficits can have a profound impact on self-other relationship, but how they are related through aberrant brain function remains poorly understood. In this functional magnetic resonance imaging (fMRI) study, we provide new evidence for a cortical link between aberrant self-experience and social cognition in first-episode schizophrenia (FES). As identified in previous studies, ventral premotor cortex (vPMC) and posterior insula (pIC) are candidate brain regions underlying disturbances in both self-experience and self-other relationship due to their processing of predominantly externally guided (vPMC; goal-oriented behavior) and internally guided (pIC; interoception) stimuli. Results from functional interaction analysis in a sample of 24 FES patients and 22 healthy controls show aberrant functional interactions (background/intrinsic connectivity) of right vPMC and bilateral pIC with posterior cingulate cortex (PCC), a midline region that has been shown central in mediating self-experience. More specifically, our results show increased functional coupling between vPMC and PCC, which positively correlated with basic symptoms (subjective self-experience disturbances). pIC showed reduced functional coupling with PCC and postcentral gyrus and increased functional interactions with anterior insula. Taken together, our results suggest an imbalance in the processing between internally and externally guided information and its abnormal integration with self-referential processing as mediated by PCC. Due to our correlation findings, we suggest this imbalance to be closely related to basic symptoms in FES and thus anomalous self-experience. The findings further disentangle the cortical basis of how self-experience anomalies may pervade the social domain.

Upcoming tactile events and body ownership in schizophrenia.

Schizophrenic patients may report unusual perception of their own body. Studies using the rubber hand illusion (RHI) proposed that they exhibit a distorted sense of body ownership. However, since the RHI is mostly achieved with the contribution of visuo-tactile integration, the stronger RHI observed in schizophrenic patients could reflect either a general increase of the response to multisensory stimuli or a larger influence of visual cues on the tactile sensory experience. The purpose of the present study is to investigate patients' perception of their own body by means of a behavioral paradigm that measures their proneness to the RHI without relying on multisensory integration occurring during actual experience of touch. In a previous study we demonstrated in healthy participants that expectation of touch experience arising at the sight of a human hand approaching a rubber hand is enough to induce a sense of ownership over the same hand. Here we take advantage of the same paradigm to investigate body ownership in schizophrenia. Patients observed the experimenter's hand while approaching--without touching--either a rubber hand or a piece of wood placed in front of them. The seen object could be either aligned to participant's hand or rotated by 180°. Phenomenology of the illusion revealed that schizophrenic patients exhibited sense of ownership over the rubber hand, but more weakly than healthy controls. The present study sheds new light on the experience of body ownership in schizophrenic patients, corroborating the notion that alterations of bodily self-awareness play an important role in schizophrenia.

Agomelatine treatment of major depressive disorder in Parkinson's disease: a case series.

Major Depressive Disorder (MDD) is among the most frequent comorbidities occurring in the course of Parkinson's disease (PD), and therefore, most PD patients receive antidepressant drugs. Agomelatine is a recently introduced antidepressant drug acting as an MT1/MT2 melatonergic receptor agonist and 5HT2C/5HT2B serotonergic antagonist. The aim of this case series was to evaluate the role of agomelatine in the treatment of MDD associated with PD.

S-Adenosyl-L-Methionine augmentation in patients with stage II treatment-resistant major depressive disorder: an open label, fixed dose, single-blind study.

We investigated the efficacy of S-Adenosyl-L-Methionine (SAMe) augmentation in patients with treatment-resistant depressive disorder (TRD). Thirty-three outpatients with major depressive episode who failed to respond to at least 8 weeks of treatment with two adequate and stable doses of antidepressants were treated openly with fixed dose of SAMe (800 mg) for 8 weeks, added to existing medication. The primary outcome measure was the change from baseline in total score on Hamilton Rating Scale for Depression (HAM-D). The Clinical Global Impression of Improvement (CGI-I) was rated at the endpoint. Patients with a reduction of 50% or more on HAM-D total score and a CGI-I score of 1 or 2 at endpoint were considered responders; remission was defined as a HAM-D score ≤7. Secondary outcome measures included the Snaith-Hamilton Pleasure Scale (SHAPS) and the Sheehan Disability Scale (SDS). At 8 weeks, a significant decrease in HAM-D score was observed with response achieved by 60% of the patients and remission by 36%. Also a statistically significant reduction in SHAPS and SDS was observed. Our findings indicate that SAMe augmentation may be effective and well tolerated in stage II TRD. However, limitations of the present study must be considered and further placebo-controlled trials are needed.

The potential of pregabalin in neurology, psychiatry and addiction: a qualitative overview.

Pregabalin is an anticonvulsant drug that binds to the α2δ (alpha2delta) subunit of the voltage-dependent calcium channel in central nervous system (CNS). Pregabalin decreases the release of neurotransmitters, including glutamate, norepinephrine, substance P and calcitonin gene-related peptide. Purpose of this paper is to offer a qualitative overview of the studies currently available in literature about this drug, examining the effectiveness of pregabalin in its various fields of application. Our analysis, conducted on a final selection of 349 scientific papers, shows that pregabalin may help to reduce pain in diabetic neuropathy, in post-herpetic neuralgia and in some patients affected by fibromyalgia. It is also effective for the treatment of diverse types of seizures and has similar efficacy to benzodiazepines and venlafaxine in anxiety disorder. Moreover, pregabalin may be a therapeutic agent for the treatment of alcohol abuse, in both withdrawal phase and relapse prevention. Possible implications in the treatment of benzodiazepines dependence are emerging, but a potential abuse or misuse of the drug has also been reported. Range of dosage may fluctuate considerably, from 75 mg to 600 mg per day. Further studies are needed to completely understand pregabalin mechanism of action in the different diseases.

Binding action and emotion in social understanding.

In social life actions are tightly linked with emotions. The integration of affective- and action-related information has to be considered as a fundamental component of appropriate social understanding. The present functional magnetic resonance imaging study aimed at investigating whether an emotion (Happiness, Anger or Neutral) dynamically expressed by an observed agent modulates brain activity underlying the perception of his grasping action. As control stimuli, participants observed the same agent either only expressing an emotion or only performing a grasping action. Our results showed that the observation of an action embedded in an emotional context (agent's facial expression), compared with the observation of the same action embedded in a neutral context, elicits higher neural response at the level of motor frontal cortices, temporal and occipital cortices, bilaterally. Particularly, the dynamic facial expression of anger modulates the re-enactment of a motor representation of the observed action. This is supported by the evidence that observing actions embedded in the context of anger, but not happiness, compared with a neutral context, elicits stronger activity in the bilateral pre-central gyrus and inferior frontal gyrus, besides the pre-supplementary motor area, a region playing a central role in motor control. Angry faces not only seem to modulate the simulation of actions, but may also trigger motor reaction. These findings suggest that emotions exert a modulatory role on action observation in different cortical areas involved in action processing.

Out of touch with reality? Social perception in first-episode schizophrenia.

Social dysfunction has been recognized as an elementary feature of schizophrenia, but it remains a crucial issue whether social deficits in schizophrenia concern the inter-subjective domain or primarily have their roots in disturbances of self-experience. Social perception comprises vicarious processes grounding an experiential inter-relationship with others as well as self-regulation processes allowing to maintain a coherent sense of self. The present study investigated whether the functional neural basis underlying these processes is altered in first-episode schizophrenia (FES). Twenty-four FES patients and 22 healthy control participants underwent functional magnetic resonance imaging during a social perception task requiring them to watch videos depicting other individuals' inanimate and animate/social tactile stimulations, and a tactile localizer condition. Activation in ventral premotor cortex for observed bodily tactile stimulations was reduced in the FES group and negatively correlated with self-experience disturbances. Moreover, FES patients showed aberrant differential activation in posterior insula for first-person tactile experiences and observed affective tactile stimulations. These findings suggest that social perception in FES at a pre-reflective level is characterized by disturbances of self-experience, including impaired multisensory representations and self-other distinction. However, the results also show that social perception in FES involves more complex alterations of neural activation at multiple processing levels.

Bodily self and schizophrenia: the loss of implicit self-body knowledge.

Schizophrenia spectrum has been associated with a disruption of the basic sense of self, which pertains, among others, the representation of one's own body. We investigated the impact of either implicit or explicit access to the representation of one's own body-effectors on bodily self-awareness, in first-episode schizophrenia (FES) patients and healthy controls (HCs). We contrasted their performance in an implicit self-recognition task (visual matching) and in an explicit self/other discrimination task. Both tasks employed participant's own and others' body-effectors. Concerning the implicit task, HCs were more accurate with their own than with others' body-effectors, whereas patients did not show such self-advantage. Regarding the explicit task, both groups did not exhibit a self-advantage, and patients showed a higher percentage of self-misattribution errors. Neither self/other nor implicit/explicit effects were found in both groups when processing inanimate-objects. We propose that FES patients suffer of a disturbed implicit sense of bodily self.

Action verb understanding in first-episode schizophrenia: is there evidence for a simulation deficit?

Schizophrenia is often associated with deficits in the domain of language, which are thought to be closely related to deficits in the structure of semantic knowledge. The main aim of the present study was to behaviorally investigate whether semantic impairments in schizophrenia are present also at the very basic level of action verb processing, in particular at the level of motor simulation. We used a go-no go paradigm both for a semantic decision task (with either an early, EGD, or a delayed go-signal delivery, DGD) and for a lexical decision task (control task). Only the first task requires motor simulation to be solved. We found that first-episode schizophrenia (FES) patients, like healthy control (HC) participants, use motor simulation as a basic strategy to semantically judge action verbs. In the EGD condition, both motor simulation and action verb understanding seem to be preserved in FES. However, differently from HC participants, FES patients kept on using the simulation strategy also with the DGD condition, whereas, simultaneously, task performance during this condition appeared to be less efficient and sensitive. Voxel-based morphometry analysis suggested that this altered performance in FES patients could be related to structural brain abnormalities in the right dorsolateral prefrontal cortex. We propose that a prolonged motor simulation in FES may serve as a compensatory strategy for impairments in the selection of action representation and/or for memory deficits disclosed by the DGD condition during the semantic decision task investigated in the present study.

Differential involvement of somatosensory and interoceptive cortices during the observation of affective touch.

Previous studies suggested that the observation of other individuals' somatosensory experiences also activates brain circuits processing one's own somatosensory experiences. However, it is unclear whether cortical regions involved with the elementary stages of touch processing are also involved in the automatic coding of the affective consequences of observed touch and to which extent they show overlapping activation for somatosensory experiences of self and others. In order to investigate these issues, in the present fMRI study, healthy participants either experienced touch or watched videos depicting other individuals' inanimate and animate/social touch experiences. Essentially, a distinction can be made between exteroceptive and interoceptive components of touch processing, involved with physical stimulus characteristics and internal feeling states, respectively. Consistent with this distinction, a specific negative modulation was found in the posterior insula by the mere visual perception of other individuals' social or affective cutaneous experiences, compared to neutral inanimate touch. On the other hand, activation in secondary somatosensory and posterior superior temporal regions, strongest for the most intense stimuli, seemed more dependent on the observed physical stimulus characteristics. In contrast to the detected vicarious activation in somatosensory regions, opposite activation patterns for the experience (positive modulation) and observation (negative modulation) of touch suggest that the posterior insula does not reflect a shared representation of self and others' experiences. Embedded in a distributed network of brain regions underpinning a sense of the bodily self, the posterior insula rather appears to differentiate between self and other conditions when affective experiences are implicated.