Background: The aims of the study were to assess prevalence and gender differences of addictive behaviors (substance- and non-substance-related) in an adolescent population, and their association with psychopathological features and academic performance. Material and methods: A sample of high school Italian students (n = 996; M = 240, F = 756) was examined using a self-report survey concerning sociodemographic characteristics, cigarette smoking, alcohol and substance use, perceived academic performance, activities, and behaviors (Internet use, gambling, and physical exercising). The Internet Addiction Test, the South Oaks Gambling Screen-revised Adolescent, and the Exercise Addiction Inventory-Short Form were administered to identify problematic behaviors. The Barratt Impulsiveness Scale for Adolescent, the Snaith-Hamilton Pleasure Scale, the Dissociative Experience Scale for Adolescent, and the Toronto Alexithymia Scale were used to investigate psychopathological dimensions. results: Frequent alcohol intake and lifetime substances consumption were more common among males. The occurrence of other addictive behaviors was 22.1% for problematic Internet use (M = F), 9.7% for at-risk/problematic gambling (M > F), and 6.2% for maladaptive physical exercise (M = F). We also found an association between substance-/non-substance-related addictive behaviors and psychopathological dimensions. Addictive behaviors were more frequent among students reporting poor school performance. conclusion: Our study showed a relevant prevalence of addictive behaviors in a sample of Italian high school students, with specific gender differences. We underlined the cooccurrence of substance and non-substance-related addictive behaviors, and their association with worse school performance. Dissociative proneness, anhedonia, alexithymia, and impulsivity were associated with addictive behaviors in adolescents and might represent vulnerability factors for the development of psychiatric disorders in adulthood. A better understanding of psychopathological features associated with addictive behaviors might be useful for the prevention/early intervention.

BACKGROUND:The relationship between coping styles and mental disorders has received considerable attention and instruments have been developed to assess coping strategies. The measurement by means of category systems has been criticized and a functional hierarchy of action types linked to the adaptive processes is preferred. We aimed to determine which factors may exist within the Brief-COPE (Brief Coping Orientation to Problems Experienced--COPE--Inventory) in an Italian sample of patients with anxiety disorders; and if these factors correlate with the severity of psychopathology or with other characteristics.METHODS:A total sample of 148 patients was recruited. The Brief-COPE inventory, the Symptom Check List 90-Revised, the Penn State Worry Questionnaire, the Zung Anxiety Status Inventory and the Zung Self-Rating Anxiety Scale were administered.RESULTS:Factor analysis of the Brief-COPE yielded nine factors accounting for 65.48% of the variance. Patients scored higher on Searching Support, followed by Acceptance, Changing Perspective, and Problem Solving. Associations between measures of psychopathology and factors of coping strategies, mostly Searching support and Avoidance, were found.CONCLUSIONS:Data of the present study support a nine-factor structure of the Brief-COPE that includes five broad dimensions of coping. Psychopathology was mostly related to Searching support and Avoidance factors, showing that these strategies may reflect ineffective ways of coping; Problem solving and Changing perspective could be a valid approach to moderate anxiety/depression symptoms and psychopathology in general.

Purpose: The aims of the study were to evaluate the occurrence of behavioral addictions (BAs) in alcohol use disorder (AUD) subjects and to investigate the role of impulsivity, personality dimensions and craving.Methods: 95 AUD outpatients (DSM-5) and 140 homogeneous controls were assessed with diagnostic criteria and specific tests for gambling disorder, compulsive buying, sexual, internet and physical exercise addictions, as well as with the Barratt Impulsiveness Scale (BIS-11) and Temperamental and Character Inventory-Revised (TCI-R). The Obsessive Compulsive Drinking Scale (OCDS) and Visual Analogue Scale for craving (VASc) were also administered to the AUD sample.Results: 28.4% (n = 27) of AUD subjects had at least one BA, as compared to 15% (n = 21) of controls (x(2) = 6.27; p = .014). In AUD subjects, direct correlations between BIS-11 and Compulsive Buying Scale (CBS), Internet Addiction Disorder test (LAD), Exercise Addiction Inventory-Short Form (EAI-SF) scores (p < .01), between OCDS obsessive and CBS and VASc and CBS, IAD scores (p < .003), were found. BIS11 (t = 2.36; p = .020), OCDS obsessive (Z = 4.13; p < .001), OCDS compulsive (Z = 2.12; p = .034) and VASc (Z= 4.94; p < .001) scores were higher in AUD subjects with co-occurring BAs. The occurrence of BAs was associated with higher impulsivity traits (BIS-11 scores; OR = 1.08; p = .012) and higher craving levels (VASc scores; OR= 2.48; p < .001).Conclusions: Our findings emphasize a significant rate of co-occurrence of BAs in AUD. High levels of impulsivity and craving for alcohol seem to be associated with other addictive behaviors. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Background: The aim of our study was to assess hedonic capacity in euthymic bipolar subjects, identifying possible differences compared to remitted unipolar depressed patients and healthy controls.Methods: 107 subjects with bipolar disorders, 86 with major depressive disorder and 106 healthy controls, homogeneous with respect to demographic characteristics, were enrolled. The following scales were administered: the Snaith-Hamilton pleasure scale (SHAPS), the subscale for 'anhedonia/asociality' of the scale for the assessment of negative symptoms (SANS) and the visual analogue scale (VAS) for hedonic capacity.Results: Scores on SHAPS total, interests and social interactions, SANS 'anhedonia/asociality' and VAS were all significantly higher in affective disorder patients compared to healthy controls. No difference was found between clinical groups. 20.5% (n=22) of bipolar disorder subjects and 24.5% (n=21) of major depressed subjects showed a significant reduction in hedonic capacity (SHAPS total score >= 3), compared to 7.5% (n=8) of healthy controls (chi(2)=12.03; p=.002).Limitations: Limitations include heterogeneity with respect to pharmacological status and longitudinal course (i.e., 'single' vs. 'recurrent' affective episodes).Conclusions: The major finding of our study is that euthymic bipolar patients and remitted major depressed patients display residual anhedonic symptoms. This suggests that, in affective disorder patients, altered hedonic capacity could represent an enduring trait and that, possibly, dysfunctions in the neurobiological mechanisms underlying hedonic response and reward processing persist, irrespective of mood state. (C) 2012 Elsevier B.V. All rights reserved.

There is increasing consensus on the notion of addiction as a brain disorder characterized by longstanding changes in cognitive functioning, especially in so-called executive functions. Recent evidences indicate that specific components of executive functions, considered the domain of the frontal lobes, including dysfunctional impulsivity, could be considered a hallmark of addiction. Aim of the present study was to explore the domain of executive functions in abstinent non comorbid alcohol dependent subjects, in comparison with matched non clinical controls. Any relationship with impulsivity and drinking behaviour (binge drinking) was also investigated. We used a selective battery of neuropsychological tests designed to assess several components of executive functions, including fluency, working memory, analogical reasoning, interference and cognitive flexibility, attention, concentration, problem solving strategy and abstract reasoning. BIS-11 was also administered to explore impulsivity levels. Significant differences in many of the domains explored between alcohol dependent patients and controls have been founded. Intriguingly, impulsivity in alcoholics seems to not inhibit cognitive performance. Data about binge drinking will be also presented. Our results show that alcohol dependent patients present a weaker performance in all the domains referable to executive functions when compared to controls. Disruptions in inhibitory control are central to many theories of addiction; the inhibitory activities of the Frontal and Prefrontal Cortex, are particularly important when an individual needs to over-ride a reflexive response, such as a craving response to drug-related cues.

A significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders has been consistently reported in adults. Less data regarding the role of personality traits and the influence of ADHD co-occurrence on clinical characteristics and outcome of mood disorders are currently available. One hundred and six remitted major depressed, 102 euthymic bipolar subjects, and 120 healthy controls, homogeneous with respect to demographic characteristics, were included in the study. ADHD diagnosis was based on DSM-IV-TR criteria. Childhood and adult ADHD features were measured with the Wender Utah Rating Scale, the Adult ADHD Self-rating Scale, and the Brown Attention-Deficit Disorder Scale. The Revised NEO Personality Inventory was also administered to the clinical groups, in order to investigate personality dimensions. The occurrence of adult ADHD in subjects with bipolar disorders (BD) or major depressive disorder (MDD) was 15.7 and 7.5 %, respectively, compared to 3.3 % in healthy controls (HC). Significant associations (p < .001) between personality traits (neuroticism, conscientiousness, and extraversion) and ADHD features were observed. Logistic regression analysis of all clinical subjects (n = 208) showed that those with lower levels of neuroticism (OR = 1.031; p = .025) had a lower frequency of ADHD comorbidity. The present study emphasizes the close relationship between affective disorders, especially BD, and ADHD in adults. Our findings support the need to assess subjects with mood disorders in the clinical setting for possible coexisting ADHD and to further investigate personality traits to better understand the etiology of affective disorders and ADHD co-occurrence.

INTRODUCTION:Craving is commonly thought to play a crucial role both in the transition from controlled drinking to alcohol dependence and in the mechanism underlying relapse. However there is no consensus on its definition, and on its correct assessment. Another significant hindrance is that craving is almost certainly a multi-faceted construct. To this respect a three pathway psychobiological model able to differentiate craving into a reward, relief, and obsessive component has been suggested. METHODS:CTQ was administered to 547 control subjects and to 100 alcohol dependent patients. The dimensional structure of the questionnaire, through the principal component analysis, the reliability and the threshold values were evaluated in both the control and clinical sample. RESULTS:The results showed and confirmed that the CTQ is composed of three dimensions. Cronbach's alpha coefficients suggest that the questionnaire is reliable. Alcohol-dependent subjects had a significantly higher mean score as compared to the normative sample in both Reward, Relief, Obsessive craving. Younger age correlated with higher scores on Reward craving (r=0.38; p<0.001) and males reported significantly higher scores than women on Reward craving (t=4.36; p<0.001). DISCUSSION:CTQ showed to be a reliable and valid questionnaire to distinguish a normative sample from pathological individuals. The average scores obtained represent the first normative data available for this questionnaire. Identifying a craving type may represent an important predicting or matching variable for anti-craving psychotropics. More research is needed with respect to CTQ's external validity, i.e. correlations with phenotypic, endophenotypic and genetic indicators of relief, reward and obsessive drinking.

Background:A significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders has been consistently reported in adults. Less data regarding the role of personality traits, and the influence of ADHD co-occurrence on clinical characteristics and outcome of mood disorders are currently available.Methods:The sample consisted of 296 subjects, divided into three homogeneous groups according to demographic characteristics: 106 subjects diagnosed with major depressive disorder, 92 with bipolar disorders and 98 healthy controls. ADHD diagnosis was based on DSM-IV-TR criteria. Childhood and adult ADHD features were measured with the Wender Utah Rating Scale (WURS), the Adult ADHD Self-rating Scale (ASRS) and the Brown Attention Deficit Disorder Scale (ADD). The Hospital Anxiety and Depression Scale (HAD) and the Revised NEO Personality Inventory (NEO-PI-R) were also administered to the clinical groups, in order to investigate depressive/anxious symptoms and personality dimensions.Results:The prevalence of adult ADHD in subjects with bipolar disorders or major depressive disorder was 22.0% and 8.5% respectively (p < .001), compared to 3.1% in healthy controls. Significant associations between personality traits, depressive/anxious symptoms and ADHD features were found.Discussion:The present study emphasises the close relationship between affective disorders, especially bipolar disorders, and ADHD in adults. Our findings support the need to assess subjects with mood disorders in the clinical setting for possible co-existing ADHD and to further investigate personality traits to better understand the etiology of affective disorders and ADHD co-occurrence.

The aim of this pilot study is to assess, in a sample of patients with chemical (alcohol) and behavioural (gambling) dependence, the specifical association between core symptoms and Separation Anxiety Disorder, both in Childhood and in Adulthood. After a stabilization period of three months, outpatients with alcohol dependence (n = 30), patological gambling (n = 30) and a control group of anxiety disorders (n = 30) will be assessed with the following psychometric battery: SCI-SAS (Structured Clinical Interview for Separation Anxiety) Child and Adult SASI (Separation Anxiety Symptom Inventory) ASA-27 (Adult Separation Anxiety Questionnaire) TCI-R (Temperament anc Character Inventory Revised) GAF (Global Assess of Functioning) SCL-90-R (Symptom Checklist Revised) SOGS (South Oaks Gambling Scale) ADS (Alcohol Dependence Scale) HAM-A (Hamilton Anxiety Rating Scale) A preliminary analisys of collected datas (n = 33) shows a strong inter-reliability of the Separation Anxiety Scales (SCI-SAS, SASI and ASA-27) with a p = 0.001 and an association between levels of functioning (GAF) and ASA-27 and SASI scores (p = 0.010 and p = 0,001). It shows a statistical correlation between ASA-27 and TCI-R: inverse proportion with Self Directness (SD) (p = 0.004) and direct relation with Self Trascendency (ST) (p = 0.003). Even if the sample is still limited we found an interesting trend between Separation Anxiety symptoms, TCI-R dimensions and core symptoms of dependance. We should focus better, when the study will be over, on narrow and specific sub-analisys that should lead us to a better understanding of the disorders.

There is increasing consensus on the notion of addiction as a brain disorder characterized by longstanding changes in cognitive functioning, especially in so-called executive functions. Recent evidences indicate that specific components of executive functions, considered the domain of the frontal lobes, including dysfunctional impulsivity, could be considered a hallmark of addiction. Aim of the present study was to explore the domain of executive functions in abstinent non comorbid alcohol dependent subjects in comparison with matched non clinical controls. Any relationship with impulsivity and anger was also investigated. Thirty Alcohol Dependent outpatients with diagnosis of Alcohol Dependence (DSM-IV-TR) and thirty matched control subjects participated to the study. We used a selective battery of neuropsychological tests designed to assess several components of executive functions, including fluency, working memory, analogical reasoning, interference and cognitive flexibility, attention, concentration, problem solving strategy and abstract reasoning (FAS for verbal fluency; Semantic Fluency; Digit span; Spatial span; Similarities; Stroop test; Wisconsin Card Sorting Test; TMT Making Test Parts A & B; Digit Symbol). BIS-11 and STAXI I and II were also administered to explore impulsivity and anger levels. Significant differences in many of the domains explored between alcohol dependent patients and controls have been founded. Furthermore, a correlation between the performance at neuropsychological tests and the score at the instruments designed to assess impulsivity and anger have been deducted. Alcohol dependence is associated with a significant impairment on executive domain. Impulsivity and anger levels, both dimensions linked with the executive capacity, seem to be altered as well.

Neuroactive steroids, like allopregnanolone (A) and pregnanolone (P), bind to specifics sites on the GABAA receptor complex and modulate receptor function. They are capable to inhibit or stimulate the binding of GABAA receptor-specific ligands, like t-butyl-bicyclophosphorothionate, flunitrazepam and muscimol. We have previously characterized a set of oxygen-bridged synthetic steroids (SS) analogs to A or P using synaptosomes. Considering that the subunit composition of the GABAA receptor throughout the central nervous system affects the magnitude of the modulation of the GABAA receptor by NAS, we evaluated the action of two selected SS, in brain sections containing the cerebral cortex (CC) and hippocampus (HC) using quantitative receptor autoradiography. Both SS affected the binding of the three ligands in a similar way to A and P, with some differences on certain CC layers according to the ligand used. One of the SS, the 3α-hydroxy-6,19-epoxypregn-4-ene-20-one (compound 5), behaved similarly to the natural neuroactive steroids. However, significant differences with compound 5 were observed on the HC CA2 region, making it steroid suitable for a specific action. Those differences may be related to structural conformation of the SS and the subunits’ composition present on the receptor complex.

Comorbid conditions are frequent in bipolar disorder (BD) and may complicate the treatment and course of illness. We investigated the role of substance use disorder (SUD), axis II personality disorders (PD) and continuous personality traits on the medium-term outcome (6 months) of treatment for bipolar depression. One hundred and thirty-nine BD patients meeting criteria for a depressive episode were included in the study. SUD and PD were diagnosed according to structured interviews. Personality dimensions were evaluated by the Temperament and Character Inventory. Depressive severity over time was evaluated by the Hamilton Rating Scale for Depression. Neither PD nor SUD influenced the outcome of depression. Variables independently associated with a poor outcome were a high baseline severity and high scores for the temperamental trait of Harm Avoidance. Though several limitations characterize the present study, neurotic personality traits seem to be associated with a slower recovery from depressive symptoms in BD, independently from their initial severity.

Non-benzodiazepine anticonvulsant agents have been shown to be efficacious treatments for the prevention of alcohol relapse although the FDA has yet approved none of these agents. Several studies have demonstrated topiramate's efficacy in improving drinking behavior and maintaining abstinence. The objective of the present randomised, parallel, placebo-controlled trial was to compare topiramate at low dosage with placebo on alcohol drinking indices and craving in detoxified alcohol dependent subjects. Psychiatric symptomatology, quality of life and clinical global improvement have also been investigated. Sixty detoxified Alcohol Dependent (DSM-IV-TR) outpatients were recruited and randomly assigned to receive topiramate low dosage (n = 30) or placebo (n = 30). Patients have been evaluated after 30, 90 and 180 days of treatment. Withdrawal symptomatology was determined by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar); craving for alcohol was evaluated by a 10-cm Visual Analogue Scale (VASc) and the Obsessive and Compulsive Drinking Scale (OCDS). Psychiatric symptoms were evaluated with the Symptom Check List 90-Revised (SCL-90-R), quality of life with the QL-INDEX; the Clinical Global Impression (CGI) was also administered. As to our results, topiramate is more efficacy than placebo on both the improvement of withdrawal symptomatology and the reduction of relapses. Furthermore, it has resulted effective in reducing craving, the severity of global psychopathology and the quality of life. The data of this pilot study investigate and suggest a possible role for the anticonvulsants agents in the treatment of alcohol dependence. Topiramate could be an alternative option beyond the already approved agents for the treatment of alcohol dependence.

OBJECTIVES:To compare two samples of Bipolar (BD) patients presenting "pure" (D) and mixed (Mx) depression to assess any difference in terms of clinical outcome, social functioning and quality of life during a 1-year follow-up.METHODS:A total of 114 depressed outpatients (HDRS > 13) were included. "Pure" depressed (D, n = 76) were divided from "mixed" depressed (Mx, n = 38) by the number of concomitant manic symptoms. All patients were evaluated by the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Young Mania Rating Scale (YMRS), the Global Assessment of Functioning (GAF), the Social Adjustment Self-reported Scale (SASS) and the Quality of Life Scale (QoL), at baseline and after 1, 3, 6 and 12 months of treatment.RESULTS:Mx patients were significantly younger at the onset of BD. Manic features persisted significantly higher in Mx than in D patients all over the follow-up period. Axis I comorbidities had a negative impact on the course of social functioning over the medium term period, while Mx patients showed a faster improvement in social adjustment than "pure" depressed patients.CONCLUSIONS:Mixed features may persist relatively stable throughout a depressive episode, having a negative impact over clinical and functional outcome, but not on social adjustment.

BACKGROUND:It is difficult to establish whether people who are prone to psychosis are drawn to cannabis use or whether cannabis use truly increases the incidence of psychotic experiences.OBJECTIVES:The aim of our study was to evaluate, in a sample of healthy high school and university students, the presence and level of subjective experiences (SEs) and their relation to cannabis use.METHODS:A total of 502 voluntary subjects were recruited; an anamnestic interview was administered to obtain socio-demographic information, cannabis use data, and psychiatric familial history. SEs were assessed using the Italian version of the Frankfurt Complaint Questionnaire (FCQ).RESULTS:One hundred and fourteen subjects declared the use of cannabis: 20.5% smoked more than 1 joint per week, and 71.9% used cannabis for a period of more than 1 year. Cannabis users did not differ from the cannabis-free group in any of the 10 FCQ dimensions. Higher FCQ total scores were found in cannabis users with a familial history of psychiatric disorders respective to those without a psychiatric load (p<.05).CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE:In our study, SE intensity was not influenced by the use of cannabis. With regard to familial data, this is the first study to explore the relationship between SE and the presence of psychiatric problems in first-degree relatives. The association between FCQ intensity and psychiatric familial load may confirm the independence of these phenomena from the use of cannabis.

BACKGROUND:Mixed mood states, even in their sub-threshold forms, may significantly affect the course and outcome of bipolar disorder (BD).AIM:To compare two samples of BD patients presenting a major depressive episode and a sub-threshold mixed state in terms of global functioning, clinical outcome, social adjustment and quality of life during a 1-year follow-up.METHODS:The sample was composed by 90 subjects (Group 1, D) clinically diagnosed with a major depressive episode and 41 patients (Group 2, Mx) for a sub-threshold mixed state. All patients were administered with a pharmacological treatment and evaluated for depressive, anxious and manic symptoms by common rating scales. Further evaluations included a global assessment of severity and functioning, social adjustment and quality of life. All evaluations were performed at baseline and after 1, 3, 6 and 12 months of treatment.RESULTS:The two groups were no different for baseline as well as improvement in global severity and functioning. Though clearly different for symptoms severity, the amount of change of depressive and anxiety symptoms was also no different. Manic symptoms showed instead a trend to persist over time in group 2, whereas a slight increase of manic symptoms was observed in group 1, especially after 6 months of treatment. Moreover, in group 1, some manic symptoms were also detected at the Young Mania Rating Scale (n = 24, 26.6%). Finally, improvement in quality of life and social adjustment was similar in the two groups, though a small trend toward a faster improvement in social adjustment in group 1.CONCLUSIONS:Sub-threshold mixed states have a substantial impact on global functioning, social adjustment and subjective well-being, similarly to that of acute phases, or at least major depression. In particular, mixed features, even in their sub-threshold forms, tend to be persistent over time. Finally, manic symptoms may be still often underestimated in depressive episodes, even in patients for BD.

Objective: Aim of this randomized, double-blind, placebo-controlled study was to evaluate the efficacy of Acetyl-L-Carnitine (ALC), at different dosages, on specific anhedonic symptoms in detoxified alcohol dependent subjects. Secondary endpoints were the effect of ALC on melancholic and negative symptoms.Method: Sixty-four anhedonic alcohol dependent patients with minor or absent withdrawal symptoms were randomized: 23 received ALC at a dosage of 3 g/day, 21 received ALC at a dosage of 1 g/day, and 20 were given placebo. ALC was given intravenously for 10 days, followed by 80 days of oral treatment plus a follow-up period of 45 days. The presence of anhedonic symptoms was determined by the SHAPS (Snaith-Hamilton Pleasure Scale) and the VASa (Visual Analogue Scale for Anhedonia); negative and melancholic symptoms were evaluated by the SANS (Scale for the Assessment of Negative Symptoms), and the BRMS (Bech-Rafaelsen Melancholia Scale).Results: The natural course of anhedonia in the placebo group showed a decline until day 30 and remains stable for the rest of the study. Intravenously ALC accelerated the improvement of anhedonia reaching constant low levels early, on day 10. At this step levels of anhedonia (SHAPS, VASa) and melancholic symptoms (BRMES) resulted significantly reduced (p<0.05) in both the ALC 3 g and ALC 1 g groups with respect to placebo; SANS scores significantly reduced only in the ALC 1 g respect to placebo (p = 0.014). During oral treatment with ALL anhedonia scores did not differ from placebo.Conclusion: Intravenously ALC was effective in accelerating the abstinence-associated improvement of anhedonia, melancholic and negative symptoms, whereas oral ALC treatment starting on day 10 showed no further improvements. Accordingly, in alcohol dependent subjects, ALC may be considered as a new potentially useful drug for the treatment of anhedonia. (C) 2011 Elsevier Inc. All rights reserved.