Background and objective. Women with polycystic ovary syndrome (PCOS) present with multiple risk factors for cardiovascular diseases at a young age, including obesity and chronic low-grade inflammation. Since depression is common in PCOS, this study aimed to address whether depression correlates with indices of chronic low-grade inflammation beyond the association with obesity.Methods. Serum concentrations of IL-6, the stimulated production of IFN-gamma, TNF-alpha, IL-2, IL-4, IL-5, and IL-10, leukocyte numbers, and hsCRP were analyzed in 57 PCOS patients and 28 healthy women, together with clinical parameters, including body mass index (BMI), testosterone, and insulin resistance (HOMA-IR), and psychological parameters, including Beck Depression Inventory (BDI) and health-related quality-of-life (SF-36) scores.Results. PCOS patients demonstrated significantly increased hsCRP, IL-6, and leukocyte numbers. Group differences in IL-6 and leukocyte numbers, but not hsCRP, disappeared after controlling for BMI. The stimulated production of IFN-gamma, TNF-alpha, IL-2, IL-4, and IL-5 was significantly decreased, irrespective of BMI. In PCOS, hsCRP, IL-6, and leukocyte numbers were correlated with BMI, HDL, diastolic blood pressure, and with insulin resistance. On the other hand, no correlations were found with depression scores or with PCOS-specific endocrine abnormalities. In regression models, BMI was a significant predictor of the key immune markers, and explained a large amount of variance, whereas BDI was not included in either model.Conclusions. These data confirm that obesity plays a pivotal role in inflammatory processes relevant to cardiovascular risk in women with PCOS. However, even lean PCOS patients may display subtle alterations in specific aspects of immunity. Our findings did not support a correlation of depression with chronic low-grade inflammation in PCOS. (C) 2007 Elsevier Inc. All rights reserved.

It has been demonstrated that Interferon alpha and IL-2 treatment could worsen depressive symptoms in melanoma patients and that the initial mood/affective state of patients before cytokine therapy is a critical condition for the devel- opment of cytokine induced clinical depressive symptoms. It is important to assess psychosocial characteristics of patients at the time of the diagnosis in order to select sub- groups of patients that could more easily develop psycholo- gical disturbances during the course of cytokine therapy for melanoma or whose psychological distress could deteriorate the compliance to treatment and follow up schedules. Anxiety, alexythymia, depression and other psychological characteristics have been variably correlated with several cytokines such as IL-1 beta and alpha-MSH (anxiety), IL-4 and TNF-alpha (alexithymia), IL-1beta, IL-18 and IL-6 (depression). In order to investigate a relationship between particular cytokine pattern and psychological characteristics in melanoma patients we submitted a battery of self- administered questionnaires to patients receiving the diagnosis of melanoma and correlated it with serum concentration for IL-1beta, IL-4, TNF-alpha, IL-18, alpha- MSH and IL-6. The questionnaires were dealing with Qual- ity of life (SF36, Skindex 29), Psychological variables such as depression (BDI), alexithymia (TAS-20), general mental health (SCL-90, GHQ-12), Anxiety and rage (STAI, STAX- I), and some psychosocial variables such as Self-esteem (RSES), social support (MSPSS), hypochondriasis (WIH) and coping strategies (Brief Cope). We confirmed the rela- tionship between some cytokines pattern and psychological conditions or preconditions that could affect patient's response to treatment.

Psychological, psychopathological characteristics and cytokine pattern in melanoma patients P. Amerio, F. Gambi, C. Iarlori, M. Reale, G. Vianale, M. Auriemma, R. Muraro and A. Tulli Section of Dermatology, Department of Oncology and Neuroscience; Section of Psychiatry, Department of Oncology and Neuroscience; Section of Pathology, Department of Oncology and Neuroscience, University of Chieti-Pescara, Chieti, Italy

Psychological, psychopathological characteristics and cytokine pattern in melanoma patients P. Amerio, F. Gambi, C. Iarlori, M. Reale, G. Vianale, M. Auriemma, R. Muraro and A. Tulli Section of Dermatology, Department of Oncology and Neuroscience; Section of Psychiatry, Department of Oncology and Neuroscience; Section of Pathology, Department of Oncology and Neuroscience, University of Chieti-Pescara, Chieti, Italy

Objectives: The psychological implications of polycystic ovary syndrome (PCOS) include emotional distress and reduced quality-of-life, which is particularly pronounced in obese patients. The goal of this study was to assess the effect of obesity on stress-induced neuroendocrine responses in PCOS patients compared to healthy controls.

Learning abilities are present in infancy, as they are critical for adaptation. From simple habituation and novelty responses to stimuli, learning capacities evolve throughout the lifespan. During development, learning abilities become more flexible and integrated across sensory modalities, allowing the encoding of more complex information, and in larger amounts. In turn, an increasing knowledge base leads to adaptive changes in behavior, making responses and actions more precise and effective. The objective of this chapter is to review the main behavioral manifestations of human learning abilities in early development and their biologic underpinnings, ranging from the cellular level to neurocognitive systems and mechanisms. We first focus on the ability to learn from repetitions of stimuli and how years of research in this field have recently contributed to theories of fundamental brain mechanisms whose implications for cognitive development are under study. The ability to memorize associations between different items and events is addressed next as we review the variety of contexts in which this associative memory and its neurologic bases come into play. Together, repetition-based learning and associative memory provide powerful means of understanding the surrounding environment, not only through the gathering and consolidation of specific types of information, but also by continually testing and adjusting stored information to better adapt to changing conditions.

BACKGROUND:The goals were to analyse the incidence of mental distress in women with untreated polycystic ovary syndrome (PCOS) using self-report measures, to characterize PCOS patients at risk for psychiatric disease with regard to sociodemographic and clinical characteristics, and to assess the impact of emotional distress on quality of life.METHODS AND RESULTS:Complete metabolic, hormonal, clinical and self-report psychological data [emotional distress, Symptom Check List 90 (SCL-90-R); quality of life, Short-Form Health Survey 36 (SF-36); sexual satisfaction, visual analogue scales; sociodemographic data] were obtained from n = 143 untreated women with PCOS. Prior psychiatric diagnoses were exclusionary. Twenty-two patients (15.4%) had a possible psychological disorder, based on SCL-90-R global severity index (GSI) scores > or =63 (SCL cases). SCL cases had significantly elevated body mass index (BMI), but did not differ from SCL non-cases in other clinical, endocrine, metabolic or sociodemographic variables. Stepwise multiple regression analyses identified GSI as a significant predictor of SF-36 Psychological Sum score, along with age and current wish to conceive (R2 = 0.47); the SF-36 Physical Sum score was predicted by BMI and education (R2 = 0.27), but not GSI.CONCLUSIONS:Psychiatric illness may go undetected in a proportion of PCOS patients. Although the majority of patients exhibit subclinical levels of psychological disturbances, emotional distress together with obesity lead to large decrements in quality of life in PCOS.

BACKGROUNDIn polycystic ovary syndrome (PCOS), changes in physical appearance, menstrual disturbances and infertility result in psychological distress and reduced quality-of-life. Metformin improves biochemical, clinical and reproductive parameters in PCOS women. In a prospective, observational study, we analysed the effects of metformin treatment on health-related quality-of-life (HRQL), emotional well-being and sexuality in PCOS. No placebo-treated control group was included.METHODSBefore, during and after 6 months of treatment, changes in clinical and endocrine parameters, quality-of-life, psychological disturbances and sexuality were assessed in 64 PCOS patients using validated questionnaires (SF-36, SCL-90-R) and visual analogue scales. Patients were also compared with published normative data for the validated questionnaires.RESULTSDuring treatment, HRQL, particularly the psychosocial aspects (indicated by significant increases in SF-36 scales Vitality, Social Function, Emotional Role Function, Mental Health, Psychological Sum scale) and emotional well-being (reflected by significant lowering of SCL-90-R scales) improved. These improvements in HRQL were significantly correlated with a reduction in body weight and significantly more pronounced in patients with normalized menstrual cycles. In addition, PCOS women were significantly more satisfied with their sex life and reported higher frequencies of sexual intercourse following treatment.CONCLUSIONTreatment can improve the psychosocial, emotional and psychosexual situation of PCOS patients. Although at least some of these effects may be related to the reduction of individual clinical symptoms (i.e. weight loss, normalization of menstrual disturbances, improvement of acne), this observational study does not allow us to clearly discern the role of symptom constellation and does not preclude non-specific and/or placebo effects. Nevertheless, emotional distress and reduced quality-of-life are clearly not an inevitable consequence of PCOS and should be considered as adjunct treatment goals in future studies.

Hyperandrogenism, irregular menses, infertility and the threat of long term complications associated with obesity cause a major reduction in the quality of life and sexual satisfaction of PCOS women. However, little is known about the individual contribution of clinical and biochemical disturbances to the psychological problems. In 120 untreated PCOS patients (mean age 27 years) complete metabolic (BMI, insulin resistance), hormonal (androgens) and clinical (menstrual irregularity, acne, hirsutism) data were obtained. For psychological variables, health-related quality of life was measured by SF-36, psychological disturbances with the SCL, and sexual satisfaction by visual analogue scales. Correlation analyses, regression models and t-tests for statistical evaluation were computed with the SPSS software. In PCOS patients, BMI and hirsutism scores were most strongly associated with physical quality of life scales and sexual functioning, while acne was not associated with any psychological variable. Specifically, significant correlation was found between BMI and SF-36 scales Physical Function, SCL scale Somatization, sexual attractiveness, and difficulty forming social contacts. Hirsutismus was significantly correlated with SCL scale Somatization, sexual attractiveness, difficulty forming social contacts, and impact of body hair on sexuality. While 35% of the variance in the SF-36 Physical Function scale was accounted for by BMI, no other variables explaining the marked decreases in the psychological scales of the SF-36 were detected. Associations between hormonal and psychological data were weak and inconsistent. No clear effect of androgens on sexual satisfaction was detected. Similarly, menstrual cycle disturbance had no impact on psychological well-being. In conclusion, changes in physical appearance, particularly obesity and excessive body hair, are the most important determinants of psychological problems in PCOS. On the other hand, the role of endocrine and metabolic parameters as well as menstrual cyclicity and infertility appears to be less important.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterised by menstrual irregularities and hyperandrogenism, affecting approximately 5% of premenopausal women. An association of PCOS with peripheral insulin resistance (IR) as the cause of its predisposition to develop a metabolic syndrome (MS) has been established. Therefore, early screening for metabolic parameters is of great importance regarding the prevention of cardiovascular diseases (CVD). In 259 PCOS women (age 27±5.9 years) cardiovascular risk factors were evaluated by physical examination, blood testing and a personal interview. MS was defined according to the NCEP ATP III criteria. The 10-year estimated CVD risk was determined by the Framingham score and projected to the age of 60. In PCOS patients 34.7% were smokers and 47% exercised frequently. Obesity was found in 49.6%, waist-circumference >88cm in 55.6%, IR in 58.8%, impaired glucose tolerance in 6.2%, type 2 diabetes mellitus (DM) in 3.5%, increased total cholesterol in 52.6%, LDL cholesterol ≥ 115mg/dl in 59.5%, low HDL in 48.3%, elevated triglycerides in 24.2% and an increased sensitive CRP in 46.4% of PCOS subjects. MS was present in 33.6% of PCOS patients. Family history of obesity was found in 71.1%, DM in 50.0%, apoplexy in 42.7%, peripheral vascular disease in 29.7% and coronary heart disease in 47.9% of affected women. The average calculated risk at the age of 60 to suffer an acute coronary event in the next ten years was 12.9%, provided that no additional risk factors develop. In conclusion, a third of our PCOS cohort fulfilled the ATP III criteria of MS before the age of 30. It is unclear whether the high incidence of cardiovascular risk factors also leads to greater expectation of morbidity and mortality.

Objective: Polycystic ovary syndrome (PCOS) has been shown to cause a reduction in quality of life. This study examines the extent of different PCOS symptoms on quality-of-life, psychosocial wellbeing and sexual satisfaction.Methods: Complete metabolic, hormonal, clinical and psychosocial data were obtained from a total of 120 women with PCOS. Patients were compared with 50 healthy women to establish reductions in quality-of-life and emotional well-being. In addition, the correlation between psychosocial variables and the major clinical PCOS features obesity (body mass index (BMI)), excessive body hair (hirsutism score), acne, hyperandrogenism (serum testosterone levels), disturbed insulin regulation (area under the insulin response curve and homeostasis model assessment of insulin resistance), menstrual cycle disturbances and infertility were analyzed.Results: PCOS patients showed significant reductions in quality-of-life, increased psychological disturbances, and decreased sexual satisfaction when compared with healthy controls. BMI and hirsutism scores, but not the presence of acne, were associated with physical aspects of quality-of-life and sexual satisfaction. No clear effect of androgens or insulin resistance on psychosocial variables was detected. Similarly, the type of menstrual cycle disturbances or infertility had no impact on psychological well-being.Conclusion: In PCOS, changes in appearance, particularly obesity and hirsutism, reduce physical dimensions of quality-of-life and decrease sexual satisfaction. The role of biochemical, endocrine and metabolic parameters as well as menstrual irregularities and infertility appeared to be less important. Clinicians should pay attention to the psychosocial dimensions of PCOS on an individual basis, regardless of symptom severity or treatment response.

Hintergrund: Das Polyzystische Ovarsyndrom betrifft ca. 5% aller Frauen im gebärfähigen Alter. Charakteristisch sind Oligo- bzw. Amenorrhoe und Hyperandrogenämie. Das äußere Erscheinungsbild ist durch Adipositas, Akne und Hirsutismus verändert, oft besteht Infertilität. Im Vergleich zu Gesunden weisen PCOS Patientinnen erhebliche Beeinträchtigungen der gesundheitsbezogenen Lebensqualität und der Sexualität auf (1).