Background Studies in the literature mainly focus on understanding the risk factors for suicide, giving little relevance to protective variables. This study aimed at exploring the specific contribution of protective variables (resilience, coping and psychological well-being) in hospitalized suicide attempt (SA) makers. Methods We recruited 50 inpatients who made a SA before admission and 50 inpatients with no history of SA matched for DSM-5 diagnosis, gender and age. Protective variables were evaluated with: Brief COPE questionnaire, Dispositional Resilience Scale (DRS-15), Psychological Well-Being Scale (PWB-18). Psychopathological features and symptom severity were assessed with: Global Assessment of Functioning Scale (GAF), Rapid Dimensional Assessment Scale (SVARAD), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions (CGI), Hamilton Depression Rating Scale (HDRS17). Results The DRS-15 total score was significantly lower in SA makers. SA makers displayed significantly lower scores on the Engagement and Cognitive Restructuring subscales of the Brief COPE. On the PWB-18, the Self-Acceptance subscale score was lower in SA makers. Limitations The small sample size suggests the need for caution in interpreting the results. Matching was carried out by excluding diagnoses of personality disorders. Conclusions Patients hospitalized following a SA are more often diagnosed with personality disorders, have deficit areas concerning resilience and coping, and lower psychological well-being compared to patients without a SA. When approaching a patient who has committed a SA, it may be useful to evaluate protective variables as well as risk factors, and encourage the development of adaptive coping mechanisms and positive self-evaluation through more dynamic therapeutic paths.

INTRODUCTION:Patients with bipolar disorder show a high relapse rate generally related to their poor adherence to the prescribed medications and to their high stress vulnerability, linked to genetic, neuroendocrine and cognitive factors.AIMS:The first aim of this study was to verify if for a group of pharmacologically stabilized bipolar patients, the attendance to a Group Psychoeducation program according to the Barcelona model would result in an improvement of their stress resilience, as measurable by evaluating their morning cortisol secretory profile. The second aim of the study has been to verify if these effects would maintain stable over time, organizing follow-up evaluations, after one year and after two years form the end of the group psychoeducation program.MATERIALS AND METHODS:96 patients who had been euthymic for at least 6 months and were under stabilized pharmacologic maintenance treatment, were randomized in two groups: pharmacological treatment as usual (TAU) or pharmacological treatment plus group Psychoeducation (PE). Patients in both groups underwent a psychological assessment (HAMD, YMRS e ARMS), and to a functional assessment of the HPA axis activity, obtained evaluating cortisol levels from salivary samples collected in 5 different moments of the day: at baseline, at the end of the group psychoeducation program, and after 1 year and 2 years from the end of the last PE session.RESULTS:At the end of the study, both groups (PE and TAU) did not show any significant intergroup difference with regard to all the clinical variables and the patients' adherence to the prescribed medications. On the contrary, significative intergroup differences were observed with regard to morning cortisol secretory profile, that was found normalized at the endpoint only among patients of the PE group, but not among those of the TAU group. This normalization of the morning cortisol secretory profile observed among patients of the PE group, proved to maintain stably overtime, since it was observed also in the two follow-up assessments, organized after 1 year and after 2 year from the end the treatment.DISCUSSION:Data collected in this study may indicate that the efficacy of the psychoeducation programs for bipolar patients may activate an improvement of the functional activation of the HPA axis, and so obtaining a reduction of their stress vulnerability.

Introduzione. I pazienti affetti da disturbo bipolare vanno incontro a frequenti ricadute, correlate a una scarsa aderenza alle terapie farmacologiche e a una elevata vulnerabilità allo stress, legata a fattori genetici, neuroendocrini e cognitivi. Obiettivi. Il primo obiettivo dello studio è stato di verificare se sottoponendo un campione di pazienti bipolari stabilizzati farmacologicamente a un programma psicoeducativo di gruppo secondo il modello di Barcellona fosse o meno possibile incrementare la loro resilienza allo stress, valutandola attraverso lo studio del loro profilo di secrezione del cortisolo mattutino. Il secondo obiettivo è stato invece quello di verificare il grado di stabilità temporale di queste variazioni (2 follow-up, a 1 anno e a 2 anni dal termine). Materiali e metodi. 96 pazienti eutimici da almeno 6 mesi e in terapia farmacologica di mantenimento, sono stati suddivisi in modo randomizzato in 2 gruppi: solo trattamento farmacologico (treatment as usual - TAU), o trattamento farmacologico più psicoeducazione di gruppo (PE). I pazienti di entrambi i gruppi sono stati sottoposti a valutazioni psicometriche (mediante HAMD, YMRS e ARMS) e a valutazioni biologiche dell’asse HPA mediante 5 prelievi di cortisolo salivare effettuati nell’arco di una intera giornata, al momento dell’arruolamento, alla conclusione del programma psicoeducativo, dopo 1 anno e dopo 2 anni dal termine di quest’ultimo. Risultati. La valutazione psicometrica non ha evidenziato differenze statisticamente significative tra i 2 gruppi, né relativamente alle variabili psicopatologiche, né relativamente all’aderenza al trattamento. L’analisi dei valori del cortisolo salivare ha invece evidenziato una normalizzazione del profilo secretivo del cortisolo salivare mattutino solo nei pazienti del gruppo PE, persistente fino a 2 anni dal termine del ciclo di psicoeducazione, ma non in quelli del gruppo TAU. Discussione. Questi dati appaiono indicativi dell’esistenza di un potenziale ulteriore meccanismo d’azione del trattamento di psicoeducazione di gruppo, consistente nella possibilità di ottenere con questo trattamento un miglioramento dell’efficienza funzionale dell’asse ipotalamo-ipofisi-corticosurrene, con conseguente riduzione della vulnerabilità allo stress dei pazienti trattati.

SUMMARY. We report a case of a forty-nine-year-old patient suffering from his first psychiatric episode, who required hospitalization in a psychiatric unit. The presence of mood alterations with Schneiderian first-rank symptoms could have suggested an initial diagnosis of bipolar disorder (BD) with psychotic symptoms, directing the patient towards a definite therapeutic process. However, we hypothesized that the presence of a clear dissociative state similar to the hypnotic trance preceded by an uncontrolled self-hypnosis process, the presence of ‘inner voices’ and a high vulnerability to dissociation, were all elements that may reasonably lead to a diagnosis of Dissociative Identity Disorder (DID). Several authors have reported the presence of psychotic-like symptoms in patients with DID. However, in clinical practice there is a tendency not to acknowledge the possibility of dissociative disorders diagnoses, in favor of others more frequent psychiatric disorders. This paper aims to highlight some etiopathogenetic and psychopathological features that might help clinicians in identifying a DID.

We report a case of a forty-nine-year-old patient suffering from his first psychiatric episode, who required hospitalization in a psychiatric unit. The presence of mood alterations with Schneiderian first-rank symptoms could have suggested an initial diagnosis of bipolar disorder (BD) with psychotic symptoms, directing the patient towards a definite therapeutic process. However, we hypothesized that the presence of a clear dissociative state similar to the hypnotic trance preceded by an uncontrolled self-hypnosis process, the presence of ‘inner voices’ and a high vulnerability to dissociation, were all elements that may reasonably lead to a diagnosis of Dissociative Identity Disorder (DID). Several authors have reported the presence of psychotic-like symptoms in patients with DID. However, in clinical practice there is a tendency not to acknowledge the possibility of dissociative disorders diagnoses, in favor of others more frequent psychiatric disorders. This paper aims to highlight some etiopathogenetic and psychopathological features that might help clinicians in identifying a DID.

Nonmotor functions of the cerebellum are well known. Within this frame, the aim of this study was to compare psychiatric morbidity rates among patients affected by cerebellar diseases or Parkinson's disease (PD). Forty-seven patients (27 cerebellar and 20 PD) underwent a comprehensive psychiatric evaluation (psychopathological rating scales and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders). Psychiatric disorders were slightly more frequent among cerebellar than among PD patients (89% vs. 75%; p = 0.21). Mood disorders were more frequent in the cerebellar than in the PD group (90% vs. 55%; p < 0.01). Among those subjects with no psychiatric history prior to the onset of neurological disease, bipolar spectrum disorders were more frequent within the cerebellar group (p < 0.01). These results confirm high rates of psychiatric disorders among cerebellar patients. The higher frequency of bipolar spectrum presentations found in the cerebellar group may suggest a specific involvement of cortico-cerebellar circuits in the pathophysiology of mood dysregulation.

UNLABELLED:Suicide attempts (SA) have been recognized among the most important predictors of suicide.AIM:The aim of this study was to assess suicidal ideation, socio-demographic and clinical characteristics in patients admitted to the emergency room for a SA and to identify factors associated with clinical outcome. Admission to a Psychiatric Intensive Care Unit and further SA within one year were considered.MATERIALS AND METHODS:Patients that agreed to participate in the study were evaluated in the emergency room with a clinical interview and they were administered the Intent Score Scale. Patients were then contacted and interviewed by telephone 1, 6, and 12 months after the SA. Clinical outcomes and the occurrence of new SA were investigated.RESULTS:Seventy-four patients were enrolled and 49, 24, and 20 patients were reassessed at the 1, 6, and 12 month follow-up respectively. Eight patients reported at least one new SA within one year. Six SA occurred within the first month. Unemployment and underemployment were significantly associated with further SA. The time interval before a new SA was longer for patients admitted at the Psychiatric Intensive Care Unit and shorter for those with high suicidal intent at the first SA.CONCLUSIONS:Although with limitations, our study might suggest that future research should focus on the role of hospitalization in the management of SA.

I tentativi di suicidio (TS) sono annoverati tra i fattori di rischio più importanti per suicidio. Scopo. L’obiettivo dello studio è stato quello di valutare l’ideazione suicidaria, le caratteristiche sociodemografiche e cliniche di un campione di pazienti condotti in Pronto Soccorso per un TS e di individuare i fattori associati all’esito clinico in termini di dimissione e in ricovero in reparti per la gestione delle acuzie psichiatriche e a eventuali ulteriori TS entro un anno da quello osservato. Materiali e metodi. I soggetti che hanno accettato di partecipare allo studio sono stati valutati in Pronto Soccorso con un’intervista clinica e con la Intent Score Scale. I pazienti sono stati ricontattati telefonicamente a uno, sei e dodici mesi dall’evento. Durante l’intervista telefonica sono state indagate le condizioni cliniche del paziente e l’eventuale occorrenza di nuovi TS. Risultati. Sono stati valutati in Pronto Soccorso 74 pazienti e ne sono stati rivalutati 49 a un mese, 24 a sei mesi e 20 a dodici mesi. Otto pazienti hanno effettuato almeno un nuovo TS durante il follow-up. Sei TS sono avvenuti entro il primo mese. L’unica variabile risultata significativamente associata a ulteriori TS è stata la disoccupazione o la sottoccupazione. Il tempo intercorso prima di un nuovo TS è risultato più lungo per i soggetti ricoverati presso il Servizio Psichiatrico di Diagnosi e Cura, mentre è stato più breve per i soggetti che avevano presentato un’elevata intenzionalità suicidaria durante il primo TS. Conclusioni. Sebbene lo studio presenti alcuni limiti, questi risultati potrebbero suggerire ricerche future sul ruolo del ricovero nella gestione dei TS.

Seizure threshold (ST) is a parameter that differs in each person and can be modified both spontaneously and because of drug intake and/or other exogenous factors. A rise in ST during a course of electroconvulsive therapy (ECT) has been demonstrated in patients with depression and mania, but little information has been available as to whether the same result occurs in schizophrenia (SCZ). 11 male patients underwent estimation of the seizure threshold over a bilateral ECT course. Mean ST changed not significantly. No correlations were found between baseline ST and Positive and Negative Syndrome Scale (PANSS) scores. A significant positive correlation emerged between baseline ST and the variation of Hamilton Depression Rating Scale (HDRS) total and cognitive scores. The results suggest that ST in SCZ patients is not related to baseline psychopathological features, it is not related to clinical improvements of negative or positive SCZ symptoms and it does not change during the ECT course but it appears predictive of the improvement of affective and cognitive symptmos.

In 1998 the Japanese psychiatrist Tamaki Sait¯o invented the term hikikomori, referring to a condition characterised by a state of social withdrawal and avoidance (education, work, friendships) combined with a persistent isolation and confinement in the own home for at least 6 months, due to various factors. Initially it undoubtedly regarded a disorder related to a specific socio-cultural context, however in the last couple of years some cases of hikikomori behaviour have also been observed in other countries far from Japan, both geographically and culturally. By way of hypothesis this diffusion can probably be attributed to the cultural revolution represented by mass communication in the internet era; in particular, it seems to be closely related to the immediateness and diffusion of web 2.0, i.e. of social networks. Therefore, we report a case of hikikomori behaviour, who was referred to our ward. M. is a 28-year-old man, who has lived the last 10 years in a state of almost complete isolation. He has maintained contacts with the outside world almost exclusively via internet. He started several therapies with psychiatrists and psychologists, without achieving significant results. The case of M. represents, to our knowledge, the first case of hikikomori described in Italy.

Nel 1998, dallo psichiatra giapponese Tamaki Sait¯o, è stato coniato il termine hikikomori, a indicare una condizione caratterizzata da uno stato di evitamento del contatto sociale (educazione, lavoro, amicizie), con un persistente ritiro nella propria residenza per almeno 6 mesi, in conseguenza di diversi fattori. Inizialmente questo disturbo è parso legato al particolare contesto socio-culturale, ma negli ultimi anni si è assistito al verificarsi di alcuni casi di comportamento hikikomori anche in altri paesi, geograficamente e culturalmente lontani dal Giappone. È ipotizzabile che tale diffusione sia riconducibile alla rivoluzione culturale rappresentata dalla comunicazione di massa dell’era di internet; in particolare sembrerebbe strettamente legata all’immediatezza e alla diffusione del web 2.0, quello dei social network. Presentiamo, dunque, un caso di comportamento hikikomori giunto alla nostra osservazione: M. è un uomo di 28 anni, che, da quasi 10 anni vive in uno stato di pressoché totale isolamento. Mantiene contatti con il mondo esterno quasi esclusivamente attraverso Internet. I contatti con psichiatri e psicologi avuti nel corso della sua vita (iniziati all’età di 7 anni) non hanno mai dato risultati soddisfacenti. Il caso di M. rappresenta, a nostra conoscenza, il primo caso di hikikomori descritto in Italia.

Phenomena of autoimmunity are frequent among psychiatric patients, but we don’t know yet if they should be considered primary and linked to the pathophisiology of the disorder, or aspecific and associated to a general immune system activation. Paraneoplastic Cerebellar Degeneration (PCD) represents a well known model of specific autoimmunity. In order to better understand the abovementioned issues, we used this condition to compare a set of immune dysfunctions found in a group of psychiatric patients. For this reason we tested sera from 48 psychiatric patients (24 schizophrenics, 17 bipolars and 7 obsessive-compulsive), 22 PCD patients and 52 healthy controls for the presence of anti-Purkinje autoantibodies and of some natural autoantibodies (ANAs, AMAs, APCAs, ASMAs). Psychopatological status of the psychiatric patients was assessed with BPRS, SANS, SAPS, HAM-D, CGI-S. In the psychiatric group anti-Purkinje autoantibodies were identified in 11/48 (22,9%) patients, while they were present in 22/22 (100%) PCD patients and in 0/52 (0%) healthy controls. Among all anti-Purkinje autoantibody positive patients (in the PCD and psychiatric samples), only those belonging to the psychiatric sample, but not those with PCD, were frequently found positive also for natural autoantibodies, that are considered good markers of aspecific immune activation. In these patients, both anti-Purkinje and natural autoantibodies were found associated with acute/positive psychopathological symptoms. These results seem to point out that some phenomena of auto-immunity described in psychiatric patients could be aspecific, unrelated to the pathophysiology of the concomitant mental disorders and could be more frequent during phases of acute/positive symptoms.

Aims. A robust psychopathological and psychotherapeutic tradition underscores the importance of the clinician's feelings in the assessment and therapeutic process. Our aim is to develop an instrument to evaluate psychiatrist' experience induced by each patient. This paper describes the development and preliminary validation of this instrument. Methods. Based on the relevant literature and our clinical experience, we developed a self-completed questionnaire consisting of 65 items covering various aspects of the clinician' emotional resonance. Ten psychiatrists completed our questionnaire immediately after first clinical interviews involving a total of 125 patients with various psychiatric diagnoses. Also, they completed the Profile of Mood State (POMS) immediately before and after these interviews. The factor structure and convergent validity of the questionnaire was examined. Results. We identified a six-factor structure. The factors showed acceptable internal consistency and were interpretable as different aspects of the clinician-patient interaction as experienced by the clinician. There was a consistent pattern of correlations between factor scores and changes in POMS scale scores during the clinical interviews. Discussion. The study results, though preliminary, suggest that clinicians' subjective reactions during their interactions with patients can be validly and reliably measured. Quantitative measurement of clinician's subjectivity is potentially useful in both clinical and research settings.

BACKGROUND:Antipsychotic augmentation is an effective treatment intervention for Obsessive Compulsive Disorder (OCD) patients resistant to Selective Serotonin Reuptake Inhibitors (SSRI) agents. This pilot study was conducted to evaluate the effectiveness and tolerability of Aripiprazole for the augmentation of standard treatments in patients with resistant OCD.METHODS:Twenty patients diagnosed with OCD according to DSM-IV TR criteria and having a history of resistance to standard pharmacological treatment were included in the study. Aripiprazole was added to ongoing SSRI or clomipramine treatment with a starting dose of 5 mg/day and titrated up to a maximum of 20 mg/day (mean dose 12.62 mg ± 4.25). Efficacy was assessed with the Yale-Brown obsessive compulsive scale (Y-BOCS) and the Clinical Global Improvement-severity scale (CGI-S) at baseline and at week 12 of Aripiprazole augmentation. Side effects were monitored by the Udvalg for Kliniske Undersogelser (UKU) side effect rating scale.RESULTS:All 20 subjects enrolled in our study completed the full 12-week course of treatment. A significant improvement over the 12-week study period was observed (paired t-test for mean Y-BOCS total score at week 12 as compared with baseline - all patients: t = 13.146, d.f. = 19, p= 0.0001). Aripiprazole was generally well tolerated and no changes were observed in vital signs. The most commonly observed side effects after the introduction of the augmenting agent included: akathysia, nausea/vomiting, hyperkinesia, tension/inner unrest, tremors, asthenia/lassitude/increased fatiguability.CONCLUSIONS:Although results of this pilot study are preliminary and require confirmation in randomized controlled trials, our experience suggested that Aripiprazole is effective and well-tolerated as an augmenting agent in patients with treatment resistant OCD.

Obiettivi. Una solida tradizione psicopatologica e psicoterapeutica sottolinea l’importanza dei sentimenti del clinico nel processo diagnostico e terapeutico. Il nostro obiettivo è la costruzione di uno strumento per la valutazione dell’esperienza indotta nello psichiatra da ciascun paziente. Sono qui descritte la costruzione e la validazione preliminare di tale strumento. Metodi. È stato costruito, sulla base dello studio della letteratura pertinente e dell’esperienza clinica del gruppo di lavoro, un questionario di autovalutazione comprendente 65 item relativi a vari aspetti della risonanza emotiva del clinico. Un gruppo di dieci psichiatri ha compilato il questionario al termine di 125 primi colloqui clinici con pazienti con varie diagnosi psichiatriche. All’inizio e alla fine di tali colloqui è stato inoltre compilato il Profile of Mood State (POMS). Sono state esaminate la struttura fattoriale e la validità convergente del questionario. Risultati. È stato possibile riconoscere una struttura costituita da sei fattori con discreta coerenza interna, interpretabili come differenti aspetti dell’interazione clinico-paziente così come esperita dal clinico. I punteggi fattoriali hanno mostrato un profilo coerente di correlazioni con la variazione dei punteggi alle scale del POMS nel corso del colloquio. Discussione. I risultati dello studio, benché preliminari, suggeriscono che sia possibile misurare in modo valido e affidabile le reazioni soggettive del clinico alla sua interazione con il paziente. Tale operazione di quantificazione della soggettività dello psichiatra è potenzialmente utile in ambito sia clinico sia di ricerca.

The Night Eating Syndrome (NES) is a disorder characterized by the clinical features of morning anorexia, evening hyperphagia, and insomnia with awakenings followed by nocturnal food ingestion. The core clinical feature appears to be a delay in the circadian timing of food intake. The diagnosis and early treatment of NES may represent an important means of prevention for obesity. Aims. The aim of the present study was to determine the vulnerability to develop NES between a clinical sample of patients with psychiatric disorders and a non clinical sample. We investigated a possible relation between stress and a dysfunctional eating behaviors as NES. Methods. The Night Eating Questionnaire (NEQ) has been administered to 147 psychiatric outpatients and to 531 subjects attending the University of L'Aquila. The NEQ is a questionnaire used to evaluate the prevalence of NES. The sample has been also evaluated through the Stress-related Vulnerability Scale (SVS) to measure both perceived stress and social support. Results. The 8.2% of patients scored above the diagnostic cut-off of the NEQ, compared to the 2.1% in the sample of healthy subjects. The majority of patients who had shown NEQ>25 had a diagnosis of major depressive disorder (MDD). The total scores on the NEQ were strongly associated with the SVS total score and especially with the lack of social support subscale. Conclusions. This study shows the increased vulnerability of NES in the sample of psychiatric patients compared to the sample of healthy subjects. The study further confirms the strong association between perceived stress, social support, altered eating behaviors and obesity.

Background: Clinicians generally agree on the association between depression and hypertension. Less clear is if the nature of the link is direct or indirect and if this should be considered confined only to syndromal forms or if it concerns also subsyndromal affective presentations. This study investigated the nature of the association between hypertension and subsyndromal depression in hospitalized hypertensive patients.Methods: 196 hypertensive and 96 non hypertensive inpatients underwent a SCID interview, to exclude patients positive for any Axis I or Axis II diagnosis. Symptomatic Subsyndromal Depression (SSD) was identified according to criteria proposed by Judd.. Psychopathological assessment was performed with Anxiety Sensitivity Index (ASI) and Hopkins Symptom Checklist-90 (SCL-90). Clinical assessments included blood pressure measurement, evaluation of general health conditions and screening cardiovascular risk factors (smoke, alcohol, body weight, sedentary life style).Results: Hypertensives met more frequently criteria for SSD. They also scored higher on AS! and SCL-90. However, those with more severe physical conditions, if compared with more healthy patients, did not show increased psychopathological severity. Similarly, psychopathological symptom severity did not differ among hypertensives positive for other cardiovascular risk factors, commonly more frequent among depressed subjects.Limitations: Further analyses are needed to explore the potential advantage obtained on blood pressure control by treating SSD.Conclusions: Hospitalized hypertensives, more frequently satisfied criteria for Symptomatic Subsyndromal Depression. These milder affective forms are probably directly linked to the presence of hypertension, rather than being indirectly associated to physical impairment or to higher prevalence of other cardiovascular risk factors. (C) 2011 Published by Elsevier B.V.

La Night Eating Syndrome (NES) è un disturbo dell’alimentazione caratterizzato da scarso appetito durante il giorno, iperfagia serale e insonnia centrale con abbuffate notturne. La sindrome appare collegata a un’alterazione dei ritmi circadiani nell’assunzione di cibo. La diagnosi e il trattamento precoce della NES potrebbero costituire un importante mezzo di prevenzione per l’obesità. Scopo. Lo scopo di questo studio è stato quello di determinare la vulnerabilità allo sviluppo della NES tra un campione di pazienti affetti da disturbi psichiatrici e un campione di soggetti sani. Abbiamo indagato il possibile ruolo dello stress nella patogenesi di comportamenti alimentari disfunzionali come la NES. Metodi. Il Night Eating Questionnaire (NEQ) è stato somministrato a 147 pazienti psichiatrici ambulatoriali e a 531 soggetti sani afferenti all’Università di L’Aquila. Il questionario NEQ è utilizzato per valutare la prevalenza della NES. Il campione è stato inoltre valutato attraverso la Stress-related Vulnerability Scale (SVS) allo scopo di valutare sia lo stress percepito sia il supporto sociale. Risultati. L’8,2% dei pazienti ha superato il cut-off diagnostico del NEQ rispetto al 2,1% del campione di soggetti sani. La maggior parte dei pazienti con NEQ>25 presentava una diagnosi di disturbo depressivo maggiore (DDM). Il punteggio totale ottenuto al NEQ è significativamente associato con i livelli di stress percepito valutato dalla SVS, in particolare nella sottoscala “ridotto supporto sociale”. Conclusioni. Questo studio mostra una maggiore vulnerabilità alla NES nel campione dei pazienti psichiatrici rispetto al campione della popolazione sana. Lo studio inoltre conferma la forte associazione tra stress percepito, comportamenti alimentari disregolati e obesità.

Objectives: The objective of this study was to investigate the immediate response of the dopamine-regulated growth hormone (GH) to electroconvulsive therapy (ECT) in schizophrenic patients and the changes in the serum GH levels throughout the consecutive sessions of the therapeutic ECT course.Methods: Serum GH levels were measured in a sample of 11 men with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, who were administered a course of 8 bilateral ECT treatments. Measurements were performed 5 minutes before ECT, during ECT, 15 minutes after an ECT session, and 30 minutes after an ECT session during the first, fourth, and eighth ECT sessions.Results: At both the fourth and the eighth ECT sessions, a significant decrease in GH levels 15 and 30 minutes after ECT was observed compared with the baseline values. No change in baseline serum GH levels was observed either during or at the end of the treatment. Clinical improvement was indicated by a significant reduction in the total score, negative subscale score, and positive subscale score of the Positive and Negative Syndrome Scale.Conclusions: The results are consistent with the potential role of immediate serum GH changes as an index of potential dopamine-mediated response to ECT. It can be assumed that GH reduction may be partially related to an antidopaminergic action of ECT, but further research is still needed to better evaluate the correlation of the dopamine system instability during the course of the illness with the previously mentioned immediate treatment response. Also, the role of other neurotransmitters in the regulation of GH production and ECT response must be taken into account for the purpose of an overall evaluation of the results and of their potential clinical implications.