Through the analysis of "Luigi Alfredo Ricciardi" the main character of detective series by Maurizio De Giovanni, the structuring of a normal melancholic constitution, which we term the depression-prone style of personality, is reconstructed.

Bipolar disorder (BD) could represent a prodromal state of frontotemporal dementia (FTD). Two patients affected by lifelong BD with a progressive decline of cognitive functions, behavioral, and neurological signs, reached the early diagnosis of FTD before the age of 60. They were diagnosed as affected by primary progressive aphasia and FTD with parkinsonism, respectively. A diagnosis of FTD should therefore be taken into account, in case of unexpected cognitive and behavioral decline in patients with a long history of BD. Follow-up studies with genetic, neuropsychological, and neuroimaging markers of these BD/FTD patients could further explore some of the underlying association, opening new viable therapeutic options.

Asylum Seekers (AS) often experience stressful situations that may lead to psychiatric disorders. Our hypothesis is that the subjective perception of stressors and the resulting psychiatric symptoms may depend on the length of staying, length of the journey, level of education and age. 45 AS, guests of a reception center in Borgo Mezzanone (Foggia, Italy), were assessed by means of: Addiction Severity Index, MINI, SCL-90-R and Davidson Trauma Scale (DTS). We investigated the length of the voyage and the number of nations they passed through before reaching the final destination. 35,6% of the patients reported PTSD, 75,6% current Major Depressive Episode, 90,5% GAD, 2,3% psychotic symptoms, 15,6% alcohol abuse and 11,1% cannabis abuse; moreover, 26,7% attempted suicide at least once. Younger ones were less concerned about physical health and scored higher at most of SCL-90-R subscales. People who have been migrated for less time are more worried about family members left home and have higher scores at DTS subscales intrusion (p=0,02), hyperarousal, frequency, as well as total score. The number of nations they passed through or stayed in during their journey, negatively correlates with DTS hyperarousal and total gravity scores. Migrants with higher education showed lower scores in SCL somatization subscale. younger people seems to have more severe psychiatric symptoms despite minor concerns about health and it seems that concerns about family members and various PTSD symptoms tend to decrease with time. Moreover a higher level of education may be protective from the tendency to somatize.

Asylum Seekers experience different kinds of trauma, such as tortures, threats and loss of family members in the countries of origin, but also desperate journeys and legal concerns in the accepting countries. Our aim is to investigate mental health disorders among AS and to study the importance of torture in the development of their symptoms. We recruited 45 AS (males, age 29±6), guests of a reception center in Borgo Mezzanone (Foggia, Italy). The following instruments were administered: MINI, SCL-90-R and Davidson Trauma Scale (DTS). Pre-migration, migration, and post-migration stressors were assessed using a self-administered scale. 75,6% of our patients reported a Major Depressive Episode currently, while 20% in the past. 35,6% suffered from PTSD, 13,3% agoraphobia. and 88,9% GAD. 2,3% reported psychotic symptoms and 13,3% alcohol or drugs abuse in the last year. Torture showed a correlation with PTSD (p<0,01), while physical injuries correlated with alcohol abuse (p<0,02), but not with other psychiatric disorders. Tortured ones had greater scores in pre-migration stressors scale (p<0,001) and greater DTS avoidance (p=0,03), DTS global gravity (p=0,003) and DTS total score (p=0,04). Both torture and PTSD did not correlate with SCL-90-R scales. most of AS showed depressive and anxious symptoms and one-third had PTSD. All of them experienced different kinds of traumas, but only torture seems to play a major role in developing PTSD, while all kinds of trauma are equally important as to the perceived symptomatology, since both torture and PTSD did not correlate with higher SCL-90-R scores.

The tango brings out the true essence of the individuals, it removes every mask and stops the lies you tells yourself, forcingthe contact with yourself even before with the others. This is the essence on which we relied to propose a course of psychotherapy with basic elements of tango, as a peculiar mode of experiencing oneself. In this paper we analyze how Tango could become an interesting instrument for the cure and the prevention of psychological and physical problems.

To the Editors: Negative symptoms are core manifestations of schizophrenia that remain largely resistant to current treatments. Involvement of dopamine in the pathophysiology of schizophrenia has been hypothesized since the introduction of antipsychotics. These drugs fundamentally act by blocking dopamine D2 receptors. 2 Current antipsychotics are beneficial for treating positive symptoms that may be associated with excess of dopamine release. However, antipsychotics may be less effective in treating cognitive deficits and negative symptoms of schizophrenia. Indeed, even though only weakly correlated, both these symptom clusters may be related to reduced prefrontal dopamine levels. This hypothesis is consistent with imaging findings and with pharmacological data suggesting that dopamine agonists temporarily ameliorate negative symptoms in patients. Moreover, second-generation antipsychotics compared with first-generation antipsychotics seem to have some advantage on negative symptoms and cognitive deficits, possibly by also increasing dopamine levels in the prefrontal cortex. Therefore, pharmacological approaches aimed at further increasing dopamine in the prefrontal cortex may result in additional benefits for prefrontal symptoms in patients with schizophrenia. Mirtazapine is the first of a new class of dual-action compounds, the noradrenergic and specific serotonergic antidepressants. Its activity is related to enhancement of noradrenergic and serotonergic signaling, respectively, by presynaptic >2 antagonism and postsynaptic 5-HT2 and 5-HT3 antagonism. Dopamine projections to prefrontal cortex are subject to tonic inhibition by >2 noradrenergic autoreceptors. Therefore, blockade of >2 receptors may increase dopamine in the prefrontal cortex. Consistent with this hypothesis, 2 studies have shown that noradrenergic neurons from the locus coeruleus projecting to the prefrontal cortex also release dopamine along with noradrenaline and that mirtazapine increases dopamine release in the prefrontal cortex, preventing the effects of stress. The potential use of mirtazapine as an add-on for treatment of negative symptoms of schizophrenia has been already suggested in a double-blind, randomized, placebo-controlled study. This study demonstrated a significant decrease in negative symptoms when mirtazapine was added to haloperidol in a group of schizophrenic patients. More recent studies have also demonstrated consistent results. Based on this background, we designed a double-blind, placebo-controlled study, to assess the efficacy of mirtazapine in addon to an ongoing treatment with olanzapine for treating negative symptoms and working memory deficits in patients with schizophrenia. We enrolled 28 white patients with schizophrenia (mean age, 29.3 [SD, 7.4]; 21 males) from the Psychiatric Inpatient Unit at the Department of Neuroscience and Sense Organs, University of Bari ‘‘Aldo Moro,’’ Italy. Inclusion criteria were diagnosis of schizophrenia with recent exacerbation of psychotic symptoms requiring hospitalization. Exclusion criteria were history of alcohol or drug abuse in the last 12 months and any diagnosable systemic or neurological condition. All patients gave a detailed informed consent for participation to the present protocol that had been approved by the local institutional review board. Starting from the first day of admission to the hospital, patients were enrolled and were treated for 8 weeks with olanzapine in monotherapy (mean dose, 16.5 [SD, 7] mg). After 8 weeks, patients were randomized with a 1:1 ratio into 2 groups in a double-blind fashion. Both groups were treated for another 8 weeks as follows: 1 group received mirtazapine (n = 14) at recommended dosage (30 mg/d), whereas the other group received placebo (n = 14). Olanzapine treatment was held at stable dose level (the dose reached before randomization at the end of the first 8 weeks of the study) during all the second 8-week period. Symptomatology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale (CDS) by a certified psychiatrist (G.C.). Evaluations were performed at times 0 (before starting olanzapine treatment) and after 1, 2, 4, 8 (when treatment with mirtazapine was started, T0), 12 weeks (T1), and 16 weeks (T2) of treatment. Increasing loads of working memory were evaluated with the 1and 2-back conditions within the N-back task at 1, 4, 8 (T0), and 16 weeks (T2), as in earlier reports. At the end of the study, the blind condition was broken, and repeated measures analyses of variance were used to evaluate the effect of treatment with mirtazapine on PANSS total scores and related subscale scores, as well as on CDS scores. t Tests for dependent samples were used for post hoc analyses. As some patients withdrew before study end, the missing psychopathological evaluations were treated with mixed model for repeated measures. Spontaneously reported adverse events were collected during the study, although no laboratory test was systematically collected during and for the purpose of the study. Treatment groups did not differ in terms of sex, age, length of illness, drugfree period before entering the trial, or dose of olanzapine (all P 9 0.1). For demographic and clinical characteristics, see Table 1. Eighteen of the patients concluded the study at 16 weeks (8 patients treated with mirtazapine and 10 with placebo), whereas 2 interrupted the study at 12 weeks (1 treated with mirtazapine and 1 with placebo), thus allowing us to include them in our mixed model for repeated measures analysis. Eight patients dropped out before T1 (5 treated with mirtazapine and 3 with placebo). All the previously mentioned patients interrupted the study for reasons unrelated to treatment. There were no significant differences between treatment groups in terms of PANSS total scores and related subscale scores before olanzapine treatment (all P 9 0.2) as well as at T0 (when placebo/ mirtazapine was added on) (all P 9 0.6). Analysis of variance indicated a significant effect of treatment with mirtazapine on negative symptoms from T0 to T2 (F2,46 = 3.20, P = 0.04). In particular, post hoc analysis performed with t test for dependent samples indicated that the mirtazapine group had a statistically significant reduction of PANSS negative scores from T0 to T2 (t = 3.82, P G 0.002), whereas this effect was not significant in the placebo group (t = 1.22, P 9 0.2). No statistically significant effect was found on PANSS total, positive symptoms, and general psychopathology scores (all P 9 0.3) as well as on CDS score (P = 0.26) as a function of treatment with mirtazapine. No serious adverse events were reported during olanzapine and mirtazapine treatments. No statistically significant difference was found between the 2 treatment groups in terms of accuracy and reaction time (RT) at the working memory loads investigated, 1-back (P = 0.1; P = 0.4) and 2-back (P = 0.8; P = 0.1). In the LETTERS TO THE EDITORS

In the last years cognitive impairment in depression has been widely reported. It is clear that cognitive symptoms persist after remission of psychopathological symptoms but little is known about the pathophysiological events linking depression and cognitive impairment. Novel biological, structural and functional neuroimaging techniques have allowed a better definition of this relation. Depression and cognitive dysfunction share a common neuropathological platform in cortical and sub-cortical brain areas implicated in emotional and cognitive processing which may be under the control of genetic and environmental factors.

Background: The prevalence of bipolar spectrum disorders in the community is under debate and the prescription of antidepressant drugs (ADs) in bipolar depression appears to be an underestimated problem.Objectives: To evaluate the prevalence of bipolar disorders by means of a screening instrument in seven communities within six regions of Italy and evaluate the appropriateness and number of prescriptions for ADs in bipolar depression.Methods: Study design: community survey. Study population: samples randomly drawn, after stratification from the adult population of municipal records. Sample size: 4999 people from seven communities within six regions of Italy. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Mood Disorder Questionnaire (MDQ). Training: interviewers were trained psychologists or medical doctors. Study limitations: the population studied did not represent a nationally representative multistage clustered area probability sample of households.Results: 3398 subjects were interviewed (68% of recruited sample). Positivity at MDQ (MDQ+) was higher in males (3.4% vs. 2.8%) but the difference was not significant (OR = 1.2, P = 0.37). The association between MDQ+ and Major Depressive Disorder (MDD) was statistically significant for both males (OR = 14.9, P<0.0001) and females (OR = 8.3, P<0.001); 30% of subjects with MDQ+ and MDD lifetime diagnosis were taking ADs.Conclusions: These overall rates of being MDQ+ are similar to community surveys conducted within USA and the use of ADs in people with MDQ+ and MDD diagnoses are. (C) 2011 Elsevier B.V. All rights reserved.

Family focused therapy is one of the adjunct psychosocial interventions that have significantly produced positive results in the treatment of bipolar disorders by reducing the burden of illness through the prevention of relapses, the reduction of interepisode symptoms, encourage compliance with medication use, and decrease suicide attempts. The family focused therapy is time limited, focus on the “here and now”, as well as symptoms relief and symptom management. These approaches help build trust with family and provides for a safe support network. It is different from individual therapy because it incorporates family members, by allowing them to help treat the identified patient, especially with those who lack insight about their illness and to improve behavior and social skills. The different models of family interventions will be discussed as well as the challenges and issues with boundaries (e.g. informed consent, the rights of the client, information about disclosure and confidentiality as well as the legality of the therapy) need to be made clear in working with a therapist who is open to restructuring some parts of the therapy process, in order to meet the needs and desires of the particular family. Combining family-focused treatment with medications, provides a better outcome than just medication alone or medication and equally intensive individual therapy.

Working memory (WM) deficits are among the most frequently impaired cognitive domains in patients with Bipolar Disorder (BD), being considered promising cognitive endophenotype of the disorder. However, the related neurobiological correlates still deserve further investigation. The present study was aimed to explore whether dorsolateral prefrontal cortex (DLPFC) activity during WM processing was abnormal in euthymic bipolar patients and may represent a potential trait-related phenotype associated with the disorder.Using 3 Tesla functional Magnetic Resonance Imaging (3T fMRI), we studied 28 euthymic bipolar patients (15 BDI and 13 BDII), and 27 healthy controls (HCs), matched for a series of socio-demographic variables, while performing the N-back task for WM assessment.We found that euthymic bipolar patients showed increased right middle frontal gyrus engagement compared with HCs (FWE-corrected p=1×10−3), regardless of WM load, and in spite of similar WM behavioral performance between groups. In particular, BDI patients had greater BOLD signal change compared to HCs (post-hoc Tukey HSD, p=1×10−3), while BDII patients expressed an intermediate pattern of activation between BDI patients and HCs. No other significant effects were detected in the corrected whole-brain analysis.Sample size, cross-sectional assessment and potential influence of some clinical variables.Results provide direct evidence of a primary physiological abnormality in DLPFC function in BDI and II, even in the absence of behavioral differences with HCs. Such exaggerated fMRI response suggests inefficient WM processing in prefrontal circuitry, and further studies are warranted to investigate whether the dysfunction is related to the genetic risk for the disorder.

In this paper a simple way of computing technical, scale, cost and allocative efficiency scores for homogeneous networks of processes is presented. The system Production Possibility Set (PPS) is formed through the composition of the PPS of the individual processes, which, in turn, are modelled in the conventional, axiomatic way using observed data. Firstly, the overall system scale and technical efficiency are computed using the relational network DEA approach. Local Returns To Scale (RTS) can also be estimated with these models. Secondly, assuming the prices of exogenous inputs are known, a minimum cost network DEA model is solved, from which cost and allocative efficiencies are derived. The proposed approach is illustrated with a two-stage problem from the literature, showing the usefulness of a more detailed problem assessment both in terms of technical and scale efficiency and RTS and in terms of cost and allocative efficiency.

The dopamine D2 receptor (D2R) system has been implicated in emotional processing which is often impaired in neuropsychiatric disorders. The long (D2L) and the short (D2S) isoforms of D2R are generated by alternative splicing of the same gene. To study differential roles of the two D2R isoforms, D2L-deficient mice (D2L−/−) expressing functional D2S were previously generated. In this study the contribution of D2L isoform to emotional response was investigated by examining behaviors that reflect emotionality (exploratory behavior, anxiety-like behavior and learned helplessness) in D2L−/− and (wild-type) WT mice. While the thigmotactic, locomotor and general components of anxiety in zero maze did not differ among the genotypes, D2L−/− mice displayed significantly lower level of exploration in a hole board and zero maze, and significantly higher increase in latency to escape from a foot-shock after the learned helplessness training, compared with WT mice. These results suggest that D2L may play a more prominent role than D2S in mediating emotional response, such as behavioral reactions to novelty and inescapable stress. Our findings contribute to a better understanding of the molecular and cellular mechanisms underlying emotional responses.

Cognitive deficit is an essential feature of schizophrenia. One of the generally used simple cognitive tasks to characterize specific cognitive dysfunctions is the auditory “oddball” paradigm. During this task, two different tones are presented with different repetition frequencies and the subject is asked to pay attention and to respond to the less frequent tone. The aim of the present study was to apply positron emission tomography (PET) to measure the regional brain blood flow changes induced by an auditory oddball task in healthy volunteers and in stable schizophrenic patients in order to detect activation differences between the two groups.Eight healthy volunteers and 11 schizophrenic patients were studied. The subjects carried out a specific auditory oddball task, while cerebral activation measured via the regional distribution of [15O]-butanol activity changes in the PET camera was recorded.Task-related activation differed significantly across the patients and controls. The healthy volunteers displayed significant activation in the anterior cingulate area (Brodman Area – BA32), while in the schizophrenic patients the area was wider, including the mediofrontal regions (BA32 and BA10). The distance between the locations of maximal activation of the two populations were 33 mm and the cluster size was about twice as large in the patient group.The present results demonstrate that the perfusion changes induced in the schizophrenic patients by this cognitive task extends over a larger part of the mediofrontal cortex than in the healthy volunteers. The different pattern of activation observed during the auditory oddball task in the schizophrenic patients suggests that a larger cortical area – and consequently a larger variety of neuronal networks – is involved in the cognitive processes in these patients. The dispersion of stimulus processing during a cognitive task requiring sustained attention and stimulus discrimination may play an important role in the pathomechanism of the disorder.

The aim of this study was to investigate the possible involvement of genetic variation in serotonin receptors in the aetiology of bipolar affective disorder. The 5-HT2A receptor gene was systematically screened for genetic variants by single strand conformation polymorphism (SSCP) methods in subjects with bipolar affective disorder. Four polymorphisms (two structural changes, Thr25Asn and His452Tyr, and two silent polymorphisms, 102-T/C and 516-C/T) which had previously been found in patients with schizophrenia and control subjects were detected. No novel polymorphisms were found in patients with bipolar affective disorder. These polymorphisms were genotyped in a sample of 129 patients and 252 controls of German origin and 176 patients and 182 controls of British origin. No strong associations were found between any of these polymorphisms and bipolar affective disorder. Genetic variation at the 5-HT2A receptor gene does not play a major role in the pathogenesis of the disorder.

BACKGROUND:The increased use of antidepressant drugs (ADs) improved the response to the needs of care although some community surveys have shown that subjects without lifetime psychiatric diagnosis (anxiety/depression) used ADs.OBJECTIVES:To evaluate the appropriateness and amount of prescription of psychotropic drugs in people with lifetime diagnosis of Major Depressive Disorder (MDD) by means of community survey with a semi-structured interview as a diagnostic instrument, administered by clinicians.METHODS:STUDY DESIGN:community survey.STUDY POPULATION:samples randomly drawn, after stratification from the adult population of municipal records.SAMPLE SIZE:4.999 people were drawn in 7 centres of 6 Italian regions.TOOLS:questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview for DSM-IV modified (ANTAS); Training: interviewers were trained psychologists or medical doctors.RESULTS:3.398 subjects were interviewed (68% of the recruited sample). The lifetime prevalence of DSM-IV MDD was 4.3% in males and 11.5% in females; antidepressant drugs were taken by 4.7% of subjects, 2.9% male and 5.9% female. 38% of males and 57% of females with lifetime diagnosis of MDD were taking ADs.CONCLUSIONS:Compared with studies using lay interviewers and structured tools the prevalence of the MDD was quite lower; ADs use was higher and tallied well with the data regarding antidepressant sales in Italy; the correspondence between lifetime diagnosis of MDD and ADs use was closer.

The aim of the study was assessment of a possible relationship between the polymorphisms of the candidate genes participating in the etiology of some neurological and psychiatric disorders and the risk of depression in perimenopausal and postmenopausal women.A total of 167 (54 perimenopausal and 113 postmenopausal) Caucasian women from western Poland, aged 42–67, were recruited as the patient group in the study because of depressive symptoms, and another 321 healthy women (102 perimenopausal and 219 postmenopausal) served as the controls. All study participants were evaluated for climacteric and depressive disorders according to the Kupperman index and Hamilton rating scale for depression (HRSD), respectively. The following candidate genes were selected for the study: 5HTR2A, 5HTR1B, 5HTR2C, TPH1, TPH2, MAOA, COMT, NET, GABRB1, ESR1, MTHFR, MTR and MTHFD1. In each group the frequencies of the polymorphisms were determined using PCR-RFLP analysis.After correcting for Bonferroni multiple tests, we found associations between the MAOA c.1460C > T (SNP 1137070), COMT c.472G > A (SNP 4680), MTHFR c.677C > T (SNP 1801133) and ESR1 454−351 A > G (SNP 9340799) polymorphisms to mild and moderate depressive symptoms in menopausal women. In the perimenopausal and postmenopausal women, genotype association of the MAOA c.1460 CT and c.1460 CT + TT (OR = 1.83; pcorr = 0.009 and OR = 1.85; pcorr = 0.003, resp.), and of the MTHFR c.677 TT and c.677 CT + TT (OR = 3.52; pcorr = 0.00009 and OR = 2.06; pcorr = 0.0006, resp.), as well as of the COMT c.472 GA and COMT c.472 GA + AA genotypes (OR = 2.23; pcorr = 0.03 and OR = 2.17; pcorr = 0.027, resp.) in the postmenopausal women revealed significantly higher frequencies of these variants in depressed female patients than in controls, whereas the ESR1 454−351 AG and 454−351 AG + GG genotypes were associated with lower risk of depression in postmenopausal women (OR = 0.48; pcorr = 0.012, and OR = 0.52; pcorr = 0.015, resp.).Our study substantiates the involvement of the MAOA and MTHFR polymorphisms in climacteric depression and offers evidence that the COMT and ESR1 genes may also play a role in the susceptibility to depressive mood in postmenopausal women.

Background: Some community surveys in Italy have shown that a proportion of subjects without lifetime psychiatric diagnosis (anxiety/depression) used antidepressants. The prescription of AD in bipolar depression appears to be another largely underestimated problem in the clinical practice and is difficult to recognise by means of traditional epidemiological methods (lay interview and structured diagnostic tools). Objectives: The purpose is to use defined and validated international semi-structured interview as diagnostic instrument administered by expert clinicians to evaluate appropriateness and amount of over and under prescription of psychotropic drugs in different Italian community areas. The focus is on general antidepressant use and use in subjects with bipolar disorder and in subsyndromal depression. Methods: Study design: Community survey. Study population: sample randomly drawn, after stratification by sex and age, from the adult population of Municipal records in 6 Italian Regions: about 4000 persons will be interviewed. Tools: Questionnaire on psychotropic drugs consumption, prescription, health services utilisation;diagnostic Structured Clinical Interview np version;Mood Disorders Questionnaire; Short Form Health Survey. Ethical aspects: a signed informed consent for each candidate. The study was approved by the ethical committee of theItalain National Health Institute. Expected results: The study aims to identify the frequency of over and under prescription of psychotropic drugs in different Italian regions and the determinants of prescription related to physicians, patients, comorbidity and symptoms and to establish the basis for a cohort prospective study to assess the future changes.

Earlier imaging studies in schizophrenia have reported abnormal amygdala and prefrontal cortex activity during emotion processing. We investigated with functional magnetic resonance imaging (fMRI) during emotion processing changes in activity of the amygdala and of prefrontal cortex in patients with schizophrenia during 8 weeks of olanzapine treatment. Twelve previously drug-free/naive patients with schizophrenia were treated with olanzapine for 8 weeks and underwent two fMRI scans after 4 and 8 weeks of treatment during implicit and explicit emotional processing. Twelve healthy subjects were also scanned twice to control for potential repetition effects. Results showed a diagnosis by time interaction in left amygdala and a diagnosis by time by task interaction in right ventrolateral prefrontal cortex. In particular, activity in left amygdala was greater in patients than in controls at the first scan during both explicit and implicit processing, while it was lower in patients at the second relative to the first scan. Furthermore, during implicit processing, right ventrolateral prefrontal cortex activity was lower in patients than controls at the first scan, while it was greater in patients at the second relative to the first scan. These results suggest that longitudinal treatment with olanzapine may be associated with specific changes in activity of the amygdala and prefrontal cortex during emotional processing in schizophrenia.