AIMS:This study aims to compare some behavioural characteristics related to circadian functions in healthy subjects, in patients with major depressive disorder (MDD) and panic disorder (PD) during adulthood (disease period) and during the premorbid age (between 12 and 20 years old). METHODS:132 adult patients with MDD, 144 with PD and 151 adult healthy controls were enrolled in the study. All subjects completed a retrospective questionnaire. RESULTS:Several behaviours (such as falling asleep, awakening, having, appetite, perceiving energy and cognitive functioning) showed a phase delay or a phase advance in MDD and PD patients compared to healthy controls. Behavioural differences where found in patients even before the clinical onset of the disease. CONCLUSIONS:Circadian profiles of MDD and PD patients diverge from those of healthy controls not only during the disorder but also in the ages preceding its clinical onset. The analysis of these circadian patterns may aid physicians to early identify subjects with specific psychiatric vulnerabilities.

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.

AIM:Alterations of biological rhythms are well recognized to play a crucial role in the origin and maintenance of depression, but little is known about the profile of circadian rhythms at a premorbid age in adult depressed patients. The present study was aimed at investigating the association, if any, of depressive disorders with biological and behavioural rhythm modifications both at the time of observation and at an earlier age than the clinical onset of depression. The hypothesis was that such modifications could be an early biological index of vulnerability to the illness. SUBJECTS AND METHODS:One hundred and seventy-eight patients affected by DSM-IV Major Depressive Disorder were examined/observed, compared to a group of 178 matched healthy subjects. All the included subjects were asked to fill in a retrospective questionnaire reporting time of awakening and falling asleep and time of subjective peaks of appetite, energy and cognitive function during "Adolescence" (12-15 years), "Youth" (16-20 years) and "Present condition" periods. RESULTS:An advance of awakening time by about 20 minutes during "Adolescence" was reported in the depressed subjects as compared to the controls. Awakening is also reported as significantly (P<0.001) advanced by about 36 minutes during "Youth" in depressed patients, while time of falling asleep at the same age in the patients group shows 19 minutes delay. Regarding "Present condition" an advance of awakening time (33 minutes) in depressed patients was reported, in association with a delay of the subjective peak of cognitive functioning (62 minutes). DISCUSSION:Depressed patients show clear-cut differences in sleep pattern as compared to controls, consisting in a constant and significant advance of awakening time, while the time of sleep onset never reaches any statistical difference between the groups throughout ages. CONCLUSIONS:The results are consistent with the hypothesis that early alterations of the general circadian profile can contribute to the onset of adult life Major Depressive Disorders.

Obsessive-compulsive disorder is a disabling disorder. Genetic predisposing factors may have an important role in the onset of the symptoms, but is not been individualized any specific gene yet. In the last years it has been demonstrated that obsessive-compulsive disease and/or tic syndromes may be triggered by an antecedent infection especially with group A beta-hemolytic streptococci. On the basis of recent studies has been postulated that in genetically predisposed individuals, certain streptococcal antigens trigger antibodies which, through a process of molecular mimicry, cross-react with epitopes on the basal ganglia. According to such hypothesis, the acronym PANDAS has been used to describe a subset of children with abrupt onset or exacerbations of OCD or tics, or both, following streptococcal infections. Neuroimaging studies reveal increased basal ganglia volumes, and the proposed cause involves the cross-reaction of streptococcal antibodies with basal ganglia tissue. The hypothesis of a possible involvement of the immunitary system seems justified from quantitative alterations of TNF-alpha, IL-6 and IL-1 in the patients' serum with such syndrome. Echotomographic studies on cardiac valves have not yet demonstrated the parallels between PANDAS and Sydenham's chorea. The use of treatment strategies, such as therapeutic plasmapheresis or intravenous immunoglobulin, has been proposed to explain the autoimmune process responsible for the pathogenesis of PANDAS. Further research is still necessary in order to understand the role of streptococcal infection in the pathogenesis of PANDAS.

Si riporta il caso clinico di un paziente anziano, ricoverato presso il Servizio Psichiatrico di Diagnosi e Cura (SPDC), che presenta un disturbo caratterizzato da delirio di gelosia accompagnato da un episodio maniacale. Tale sintomatologia si sarebbe sovrapposta a un quadro premorboso di personalità. Durante la raccolta anamnestica i familiari riportano un aumento dell’introito alcolico nel mese precedente il ricovero, contemporaneo allo sviluppo del delirio di gelosia; i familiari, inoltre, sottolineano come il carattere del paziene sia progressivamente andato incontro a un cambiamento, concomitante all’eccessiva assunzione di alcol. Durante il ricovero si formulano le diagnosi di mania episodio singolo in asse I e di disturbo istrionico di personalità in asse II, seguendo i criteri diagnostici del DSM-IV. Alla dimissione viene prescritta una terapia a base di amisulpride e acido valproico, affidando, inoltre, il paziente alle cure del CSM di competenza affinché sia mantenuta la condotta terapeutica avviata presso il SPDC.

The aim of this pilot study was to investigate whether light therapy improves healthy subjects' neurocognitive performance of attention, memory, and language. Ten subjects were treated with white bright light for 5 days and a control group of 10 with no treatment were assessed with a battery of neurocognitive tests which included the Stroop Colour Word Interference Test, the Verbal Fluency Test, the Story Recall Test, and the Word Pairs Recall Test. Analysis showed improvements in cognitive scores in both groups, although on all the cognitive tests the mean difference scores between baseline and endpoint were significantly larger in the light-treated group. These preliminary results suggest that short-term bright light may exert beneficial effects on cognitive functions.

This report describes a case of an elderly patient, admitted to the Psychiatric Diagnosis and Cure Services (SPDC), who presented a jealousy delirium with manic episode symptoms. Such symptomatology was related to a premorbid personality picture. During the anamnesis, relatives referred to an abuse of alcohol during the month before his admittance, contemporary to the jealousy delirium development. Furthermore, there was noted a character change with the patient associated with excessive alcohol use. During the hospitalization, according to DSM-IV criteria, a diagnosis of a Single Manic Episode in Axis I and of Histrionic Personality Disorder in Axis 11 was made. The patient was prescribed a psychopharmacological treatment with Valproic Acid and Amisulpride; moreover, in order to support the therapeutic intervention started in the SPDC, the patient was transferred to the Mental Health Services department.

Cannabis is the most widely used illicit substance and has been associated with several psychiatric disorders, such as substance abuse or dependence, personality disorders and schizophrenia. The aim of this paper is to examine the evidence on the association between cannabis and depression and evaluate possible explanations of that relationship. Results from epidemiologic studies are illustrated in the first part. Cross-sectional surveys have reported a high rate of comorbidity between regular cannabis use and depression. As demonstrated by longitudinal studies, in most of cases cannabis use has preceded the onset of depression, while little evidence has been found of an increased risk of later cannabis use among depressed people. This association is reduced, and in some cases disappears, after controlling for shared risk factors such as other substance use or sociodemographic variables. These factors, then, may have a role in determining the observed relationship. Twin studies, moreover, have raised the possibility that common genetic predispositions to use cannabis or become depressed may explain the comorbidity between them. In the second part of the review, results supporting the hypothesis of a neurobiological link between cannabis and depression are examined. Studies on animal models suggest that cannabis use may cause changes in neurotransmitter systems like those observed in depression; nevertheless, data are too scarce to support definitively this possibility. Therefore, although the relation between cannabis and depression seems to be ascertained, further researches are needed to make the reason of this association more clear.

Smith-Magenis syndrome (SMS) is a microdeletion syndrome characterized by physical and neurobehavioural features. This report describes the case of a 27 year old female affected by SMS associated with a diagnosis, according to DSMIV criteria, of Mood Disorder N.O.S. and Intermittent Explosive Disorder. To our knowledge, the association of SMS with mood shifts has never been reported. Considering the genetic alterations that characterizes the SMS, further investigations on the region of the chromosome 17p11.2 could help produce more information on the role of melatonin in the genesis of mood disorder.

Objective Observations on the neuroanatomic and neurobiologic systems of the cognitive functions reveal the different involvement of the serotoninergic and noradrenergic transmissions, which would appear to be stimulated by Light Therapy. However, there is no evidence in the literature concerning the range of these possible interactions. Aims of this pilot study were: – evaluation of the action of Light Therapy in the immediateand short-term, on the neurocognitive performances of attention, memory, and language in healthy subjects; – evaluation of the time trend of the effects of Light Therapy on the cognitive functions explored; – evaluation of the effect of Light Therapy, independently of the emotional variables of the subjects.

Objectives There is increasing evidence that regular cannabis use and depression occur together more often than it might be expected by chance, whereas there does not appear to be an association between depressive disorders and infrequent cannabis use. Several studies have been performed to evaluate possible explanations for this high rate of comorbidity. Cross-sectional studies and longitudinal studies have provided mixed evidence. Cross-sectional studies have suggested that the relationship can be explained by common risk factors. Most of the longitudinal studies have found that regular early-onset cannabis use is associated with an increased risk of later depression, while they have failed to find a significant association between depression and later cannabis use. Aims of this study were to explore the temporal relationship between the beginning of cannabis use and the onset of depressive disorders and to assess the impact of substance consumption on clinical manifestations.

Cognitive deficits have been reported in a large number of schizophrenic patients, and they appear to play an important role as predictors of poorer social functioning and worse clinical as well as functional outcome. Conventional neuroleptics, although they significantly improve positive symptoms of schizophrenia, appear unable to induce favourable effects on cognitive impairment associated with this illness. Many evidence, instead, seems to provide encouraging results about improvement on various neuropsychological performances following treatment with atypical antipsychotics. In the present work we reviewed the literature on the effects of clozapine, risperidone, olanzapine and quetiapine on cognitive functioning in schizophrenic patients. Reported data for each drug are reviewed separately in order to explore the hypothesis that the various atypical antipsychotics, on the basis of their different profiles of receptorial action, could also show different patterns of neuropsychological effects.