Biomedical subjects

Alberto Siracusano

Publications and source records attributed to Alberto Siracusano.

At least 19 recordsLinked to original sources

PubMed2007

Aripiprazole in the treatment of schizophrenia: a consensus report produced by schizophrenia experts in Italy.

Schizophrenia is generally a chronic and disabling mental illness. Pharmacological therapy, which is used for relief of acute psychotic episodes and prevention of subsequent relapse, is essential for the effective management of schizophrenia. In order to alleviate the positive symptoms of schizophrenia, all antipsychotic agents act on the dopaminergic system. However, strong, high-affinity dopamine D(2)-receptor blockade may also be responsible for debilitating extrapyramidal symptoms (EPS) and hyperprolactinaemia. Unlike conventional antipsychotic agents, atypical antipsychotics also exert activity at other receptors, and it is generally acknowledged that, compared with conventional antipsychotics, atypical agents are associated with a broader spectrum of clinical efficacy and are better tolerated. However, other adverse effects such as weight gain and metabolic changes are cause for concern with some atypical antipsychotics. The novel atypical antipsychotic agent aripiprazole is a partial agonist at D(2) receptors that has been shown in clinical trials to be effective in treating both the positive and the negative symptoms of schizophrenia, and to be well tolerated, with a low propensity for EPS and no clinically significant weight gain, hyperprolactinaemia or corrected QT-interval prolongation. Aripiprazole thus provides clinicians with another treatment option, and in October 2005, schizophrenia experts participated in an expert consensus meeting that aimed to agree on a set of guidelines for best-practice use of aripiprazole in the acute and long-term management of schizophrenia in Italy. This report describes the outcome of the meeting. Our recommendations for dosage and administration of aripiprazole are in agreement with the manufacturer's prescribing information. Ideally, optimal dosing should be evaluated on an individual basis, taking into account patients' characteristics such as the presence or absence of agitation. Overall, in our experience, aripiprazole is generally a well accepted, well tolerated, safe and broadly effective first-line antipsychotic agent. Switching to aripiprazole from maintenance therapy with another antipsychotic also works well, provided the change is made gradually, involving tapering of the original medication.

Antipsychotic Agents↗

PubMed2006

Decreased plasma adiponectin concentration in major depression.

Adiponectin is the most abundant adipose-derived plasma protein. Recently adiponectin levels have been linked to most variables of metabolic syndrome and conventional risk factors for cardiovascular disease. However, its relation with major depression is yet unclear. We evaluated plasma adiponectin levels in 32 first-episode drug-naïve major depression (DSM-IV-TR) patients without conventional risk factors for cardiovascular disease and 32 matched healthy subjects. Major depression patients displayed lower adiponectin plasma levels compared to controls (P<0.01). Adiponectin significantly correlated with depression severity, as assessed by HAM-D (rho=0.83, P<0.001). This study shows decreased plasma adiponectin concentrations in major depression patients and relates adiponectinemia reduction to major depression severity.

Adiponectin↗

PubMed2006

Patterns of adaptation to conflict and schizoid personality scale scores.

A previous investigation gave no evidence of a significant relationship of patterns of adaptation to conflict, as measured with the Serial Color-Word Test, with the Schizoid Personality Scale of the Coolidge Axis II Inventory. As a new scoring algorithm has subsequently been proposed for the latter scale, a replication was done with the modified schizoid scale. A group of 75 consecutive nonpsychotic women outpatients was given the Serial Color-Word Test and Coolidge's inventory. Both multiple and logistic regressions selected two significant predictors of schizoid personality, corresponding to high values of linear change in reading times during Trials 3 and 5 of the Serial Color-Word Test, i.e., to an increasingly rigid and inflexible style of the adaptive process. A multivariate analysis of variance yielded an effect size of .22 (partial eta2).

Adaptation, Psychological↗

PubMed2006

Association between enhanced soluble CD40 ligand and proinflammatory and prothrombotic states in major depressive disorder: pilot observations on the effects of selective serotonin reuptake inhibitor therapy.

OBJECTIVE: Major depressive disorder (MDD) is associated with low-grade inflammation, and it is considered a risk factor for coronary artery disease (CAD). CD40 ligand (CD40L) plays an important role in inflammation, platelet activation, and clotting system activation. We investigated soluble CD40L (sCD40L) expression in MDD and assessed whether it may represent a molecular mechanism that links inflammation and a prothrombotic state and whether this condition may be modified by selective serotonin reuptake inhibitor (SSRI) therapy. METHOD: Levels of sCD40L, interleukin-1beta (IL-1beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble P-selectin (sP-selectin), activated factor VII (FVIIa), and prothrombin fragment 1+2 (F1+2) were measured in 46 drug-naïve, first-episode MDD patients without conventional CAD risk factors and in 46 matched healthy controls. Participants were screened between March 2002 and November 2005. Twenty of the 46 MDD patients were then randomly assigned to either sertraline 100 mg/day (N = 10) or citalopram 20 mg/day (N = 10); the aforementioned variables were measured at baseline and after 6 weeks of treatment. RESULTS: Compared with control subjects, MDD patients had higher baseline levels of sCD40L, IL-1beta, IL-6, TNF-alpha, sP-selectin, FVIIa, and F1+2. In the clinical group, sCD40L levels, HAM-D total scores, and proinflammatory markers were strongly intercorrelated. In contrast, there were no significant correlations in the control group. Mood improvement achieved with SSRI therapy was associated with significant reduction in sCD40L, proinflammatory markers, and prothrombotic markers expression. (All p values < .0001.) CONCLUSIONS: This pilot study shows that CD40/ CD40L pathway up-regulation in MDD patients relates increased levels of sCD40L to a prothrombotic state and, preliminarily, indicates that SSRI therapy may significantly reduce sCD40L and CD40L levels associated with proinflammatory and prothrombotic states.

Adult↗

PubMed2005

Plasma ghrelin in anorexia, bulimia, and binge-eating disorder: relations with eating patterns and circulating concentrations of cortisol and thyroid hormones.

The present study was designed to investigate the relations between plasma ghrelin concentrations, eating patterns, and circulating concentrations of cortisol and thyroid hormones in women with anorexia nervosa, bulimia nervosa, and binge-eating disorder. The patterns of disordered eating behavior were assessed using the Eating Attitudes Test (EAT-26) and the Bulimia Test-Revised (BULIT-R). In women with eating disorders, but not in healthy control women, plasma ghrelin concentrations were negatively correlated with body mass index (BMI) and plasma concentrations of thyreotropin (TSH), free T3 and free T4, and positively correlated with plasma concentrations of cortisol. The ghrelin concentrations of women with binge-eating and purging behavior were significantly lower than those of women with anorexia nervosa, restricting type, and there was a negative relation between the frequency and severity of binge-eating and purging behavior, as measured by the BULIT-R total score, and ghrelin concentrations. In a multivariate regression model controlling for the confounding effects of body mass index (BMI) and age, higher ghrelin concentrations were correlated with lower BULIT-R total scores. The results of this study did not confirm the hypothesis advanced in previous studies that ghrelin concentrations are higher in patients with binge-eating/purging forms of eating disorders. Based on these data, we suggest that, in women with eating disorders, ghrelin concentrations best reflect nutritional status rather than specific patterns of disordered eating behavior.

Adult↗

PubMed2005

Depressive symptoms and insecure attachment as predictors of disability in a clinical population of patients with episodic and chronic migraine.

OBJECTIVES: To define predictors of migraine-related disability in patients with episodic and chronic migraine referred to a specialty migraine clinic, focusing on depressive symptoms and insecure attachment style that, because of their association with responses to pain and physical illness, might be predictive of greater migraine-related disability. BACKGROUND: The Migraine Disability Assessment questionnaire (MIDAS) has proved to be a reliable and easy-to-use instrument to assess migraine-related disability. As clinicians are increasingly using MIDAS in their diagnostic and treatment decisions for patient care, an understanding of the factors influencing migraine-related disability is essential for a rationale use of such an instrument. METHODS: Two-hundred patients suffering from episodic migraine without aura (EM), and chronic migraine (CM) with and without medication overuse, and referred to a specialty headache clinic were evaluated using the MIDAS, the Beck Depression Inventory (BDI), and the Attachment Style Questionnaire (ASQ). Diagnosis of episodic and chronic migraine was operationally defined according to the International Headache Society (IHS) and Silberstein-Lipton criteria. RESULTS: Multiple regression analysis showed that, in the total sample, disability was higher in those patients with CM, more severe depressive symptoms, an insecure style of attachment (as reflected by a lower score on the ASQ confidence scale), and experiencing more severe headache pain intensity. In the subgroup of patients with episodic migraine, an insecure style of attachment emerged as the most significant predictor of disability (other significant predictors were female sex and number of headache days per month). In contrast, in the subgroup of patients with CM, the only significant predictor of the total MIDAS score was a greater severity of depressive symptoms. CONCLUSIONS: Our findings demonstrate the relevance of attachment style, an enduring psychological trait not evaluated in previous studies, in influencing the disability level in patients with migraine and confirm the role of comorbid depressive symptoms in modulating the impact of migraine on every day functioning.

Adolescent↗

PubMed2005

Removing pathogenic memories: a neurobiology of psychotherapy.

Experimental research examining the neural bases of nondeclarative memory has offered intriguing insight into how functional and dysfunctional implicit learning affects the brain. Long-term modifications of synaptic transmission, in particular, are currently considered the most plausible mechanism underlying memory trace encoding and compulsions, addiction, anxiety, and phobias. Therefore, an effective psychotherapy must be directed to erase maladaptive implicit memories and aberrant synaptic plasticity. This article describes the neurobiological bases of pathogenic memory disruption to provide some insight into how psychotherapy works. At least two mechanisms of unwanted memory erasing appear to be implicated in the effects of psychotherapy: inhibition of memory consolidation/reconsolidation and extinction. Behavioral evidence demonstrated that these two ways to forget are profoundly distinct in nature, and it is increasingly clear that their cellular, synaptic, and molecular underpinnings are different. Accordingly, the blockade of consolidation/reconsolidation erases memories by reversing the plasticity associated with memory maintenance, whereas extinction is a totally new form of plasticity that, similar to the plasticity underlying the old memory, requires protein synthesis-dependent synaptic remodeling.

Humans↗

PubMed2005

Dreams and age.

This work evaluated the association of age and dream reports. The verbal reports of 148 dreams of elderly people (M age=75.8 yr.) were compared with 151 dreams of a group of young people (M age=22.0). The dreams were analyzed according to the Jungian vision (which looks at the dream as a text produced by the dreamer's unconscious while sleeping), using processing techniques derived from textual analysis. Significant differences were found between the number of words denoting emotion, with the young people reporting more explicit statements regarding emotional states. Significant differences were found also in use of verb tenses. When older people explicitly expressed an emotional state in a dream text, they shifted between present and past tense more frequently than young people. A significant prevalence in the semantic field of visual sense was evident as younger subjects used more sentences referring to sight than the elderly participants.

Adult↗

PubMed2005

Cortical hyperexcitability in post-traumatic stress disorder secondary to minor accidental head trauma: a neurophysiologic study.

OBJECTIVE: We applied paired transcranial magnetic stimulation (pTMS) to patients with post-traumatic stress disorder (PTSD) secondary to minor accidental head trauma. Our purpose was to determine the potential abnormality of motor cortex excitability in this pathologic condition. METHODS: pTMS stimulation, according to the conditioning-test paradigm employing interstimulus intervals (ISIs) of 1-6 ms, was used to investigate intracortical inhibition in control subjects and patients with PTSD. The study population consisted of 14 patients who had developed PTSD following minor head trauma, 12 healthy volunteers without a clinical history of head trauma and 11 healthy subjects who had reported accidental minor head trauma 1-4 months before the study. This clinical electrophysiologic study was performed at the Department of Neuroscience, University of Rome "Tor Vergata." RESULTS: All patients with PTSD exhibited a significantly lower motor evoked potential (MEP) inhibition than controls at 2 ms, 3 ms and 4 ms ISI. The statistical analysis of the pTMS protocol showed a significant effect (F2,36 = 25.63, p < 0.001) of the factor "group," because patients with PTSD showed a mean conditioned MEP amplitude higher than that observed in both control groups for all 6 ISIs analyzed. The "ISI" factor was also significant (F5,180 = 89.85, Greenhouse-Geisser epsilon = 0.35; p < 0.001), with the mean conditioned MEP amplitude increasing from 22.5% to 127.8% as the ISI increased from 1 ms to 6 ms. Finally, the interaction of group with ISI was also significant (F10,180 = 8.97, p < 0.001), showing that the condition of PTSD secondary to head trauma was able to affect the MEP amplitude at different ISIs. CONCLUSIONS: Our results demonstrate that PTSD can give rise to abnormalities in intracortical inhibition. Our results provide further evidence that alterations in cortical inhibitory circuits may underlie specific forms of neuroticism in humans.

Adolescent↗

PubMed2004

Styles of adaptation in autoimmune thyroiditis and bipolar disorder: a pilot study.

BACKGROUND: A growing body of evidence suggests that styles of adaptation, assessed with the Serial Color-Word Test (S-CWT, a 5-trials Stroop task), are able to differentiate several mental and psychosomatic disorders. Recent findings have confirmed a very high rate of cases of autoimmune thyroiditis (so called Hashimoto disease) among bipolar patients, suggesting an etio-pathogenetic relatedness between the two ailments. Based on the latter relatedness, it was hypothesized that the same styles of adaptation, which are known to differentiate bipolar and control subjects are also characteristic of patients with autoimmune thyroiditis. METHODS: Three groups (autoimmune thyroiditis, fully remitted bipolar I, and nonclinical) of 40 women, matched on age and schooling, were administered the S-CWT. The following variables were considered: (a) early discontinuity (i.e. the summed nonlinear change of the first three trials), (b) late discontinuity (i.e. the summed nonlinear change of the last two trials), (c) across-trials discontinuity (i.e. the nonlinear change of the five measures of nonlinear change). RESULTS: The thyroiditis group had (1) higher values of early discontinuity (P=0.006) and of late discontinuity (P=0.004) compared with nonclinical controls, (2) lower values of early discontinuity (P=0.005) and of across-trials discontinuity (P=0.008) compared with the bipolar group. LIMITATIONS: The study did not include men patients and lacked a quantification of affective symptoms among clinical and nonclinical participants. CONCLUSION: A discontinuous style of adaptation is more marked among remitted bipolar than among thyroiditis patients, and more marked among the latter ones than among nonclinical controls, thus delineating a sort of adaptive continuum.

Adaptation, Psychological↗

PubMed2004

The Project for a Scientific Psychology (1895): a Freudian anticipation of LTP-memory connection theory.

Long-term potentiation (LTP) of synaptic transmission is considered a reliable cellular model of several forms of learning and memory. Described for the first time in 1973, this synaptic phenomenon consists in the enduring facilitation of the communication between two neurons in response to the sustained activation of the synapses by which they are interconnected. In a book of 1895 entitled Project for a Scientific Psychology, Sigmund Freud theorized about the possibility of representing memory at the synaptic level as "a permanent alteration following an event", and anticipated several crucial physiological properties of LTP. In the present article we aim at presenting Freudian theory on the functional organization of the nervous system developed in the Project, with particular respect to his ideas of the cellular bases of memory.

Animals↗

PubMed2004

Self-defeating personality and memories of parents' child-rearing behavior: a replication.

A recent study of correlations of self-defeating personality and memories of parents' child-rearing behaviour has been replicated on a larger sample. Non-clinical volunteers (145 women and 114 men) were administered Schill's Self-defeating Personality Scale and a short version of the EMBU-Egna Minnen Beträffande Uppfostran (own memories of parental education) scale. Replicating previous findings, memories of rejecting or nonsupportive parents were significantly correlated with scores for the Self-defeating Personality Scale for both women (rejecting mother, r = 24; supportive mother, r = -.29; rejecting father, r = .23; supportive father, r = -.36) and men (rejecting mother, r = 40; rejecting father, r = .41; supportive father, r = -.28). Memories of an overinvolved parent were significantly correlated with self-defeating personality scores only among men (mother: r = .41; father: r = .36) as in the original study.

Adult↗

PubMed2003

Behavioural learning-induced increase in spontaneous GABAA-dependent synaptic activity in rat striatal cholinergic interneurons.

Cholinergic striatal interneurons play a crucial role in cognitive aspects of context-dependent motor behaviours. They are considered to correspond to the tonically active neurons (TANs) of the primate striatum, which phasically decrease their discharge at the presentation of reward-related sensory stimuli. The origin of this response is still poorly understood. Therefore, in the present paper, we have investigated whether synaptic changes establish in cholinergic interneurons from young rats that have learned a rewarded, externally cued sensorimotor task. Corticostriatal slices were prepared from both control and trained rats. No significant change in intrinsic membrane properties and evoked synaptic activity was observed in cholinergic interneurons, nor the responsiveness to exogenously applied dopaminergic and glutamatergic agonists was modified. Conversely, an increased occurrence of spontaneous bicuculline-sensitive depolarizing postsynaptic potentials (sDPSP) was recorded. The frequency of the GABAA-mediated sDPSP was increased in comparison to not-conditioned rats. Overall, these results suggest that after learning a rewarded sensorimotor paradigm an increased GABA influence develops on cholinergic interneurons. The origin of this effect might be searched in collaterals of GABAergic output spiny neurons as well as in GABAergic striatal interneurons impinging onto cholinergic interneurons. This intrastriatal mechanism might be involved in the phasic suppression of discharge of TANs at the presentation of reward-related sensory stimuli.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

PubMed2003

Styles of adaptation in panic disorder with and without agoraphobia.

Two groups of women with a main DSM-IV diagnosis of panic disorder, one with and one without agoraphobia (respectively, n = 26 and n = 14) were compared on several clinical variables. Forward logistic regressions were run for the presence of agoraphobia. Age of onset, duration of illness, presence of major depressions, and cluster classification on Axis II did not predict the criterion variable. Diagnosis and scores on avoidant personality disorder led, respectively, to 65% and 72.5% rates of correct classifications. Among panic symptoms, fear of going crazy and palpitations significantly predicted agoraphobia (75% of correct allocations). Three adaptive variables assessed by the Serial Color-Word Test (a serial version of the Stroop task) led to a 90% rate of correct classification. Agoraphobic patients were mainly characterized by an anxious or over-controlling style, which permitted a pseudo-objective mastery of the conflict situation. The findings seem to support the clinical relevance of the Serial Color-Word Test.

Adaptation, Psychological↗

PubMed2003

Patterns of adaptation and personality disorders.

Patterns of adaptation to conflict were explored with the Serial Color-Word Test, and personality disorders were assessed by means of the Coolidge Axis II Inventory in a group of 76 nonpsychotic women volunteers in the age range 18-50 yr. (M=29.1 yr., SD=8.3), who attended a psychiatric outpatients unit. Forward multiple regression analyses were performed to investigate whether patterns of adaptation were associated with personality disorders. 10 out of 13 personality scales, as measured by the Coolidge Axis II Inventory, were significantly predicted by adaptive variables. Some predictors were positive and others were negative. The variable R(AD) was a negative predictor of avoidant and dependent personalities, and a positive predictor of Extraversion, Aggressive personality, and Antisocial personality; this finding suggests that R(AD) may represent the regulative counterpart of a continuum from passive introversion to aggressive extraversion. The results encourage further research on nontrait laboratory correlates of personality disorders.

Adaptation, Psychological↗

PubMed2003

Hostility during admission interview as a short-term predictor of aggression in acute psychiatric male inpatients.

BACKGROUND: A critical step for improving the prediction of on-ward violence is the identification of variables that are not only consistently associated with an increased risk of aggression but also easily evaluated during the admission interview. The goal of this prospective study was to assess the predictive utility of hostility during admission interview. METHOD: The sample consisted of 80 newly admitted male patients with heterogeneous DSM-IV psychiatric diagnoses recruited from the psychiatric ward of an urban public hospital. Psychiatric symptoms at admission were assessed with the Brief Psychiatric Rating Scale (BPRS). Aggressive behavior during the first week of hospitalization was measured with the Modified Overt Aggression Scale. Data were collected between January and June 1998. RESULTS: In a multiple regression model, BPRS items hostility and tension-excitement emerged as significant predictors of verbal aggression, whereas thinking disturbance (high) and suspiciousness-uncooperativeness (low) emerged as significant predictors of aggression against objects. In contrast, when aggression was treated as a binary dependent variable in a logistic model, hostility during the admission interview had no utility in predicting on-ward aggressive behavior. CONCLUSION: This study confirms the importance of distinguishing between different types of aggression to improve the accuracy of predictions of violence. The findings suggest that the question whether hostility is a useful short-term predictor of aggression in psychiatric inpatients cannot be answered conclusively. The predictive utility of hostility was relatively high for predicting verbal aggression but was negligible for predicting other types of aggressive behavior.

Acute Disease↗

PubMed2002

Clinicians' ratings and self-reports of basic symptoms.

A sample of 34 paranoid or undifferentiated schizophrenic outpatients were given the Rome Basic Disorders Scale, a self-rating questionnaire aimed to the assessment of basic symptoms, as defined by the Bonn Scale. These patients were then interviewed on the same 54 basic symptoms explored with the scale, by two independent clinicians blind to the outpatients' data. Self-ratings compared with clinicians' ratings by Student t for dependent samples yielded only one significant difference (p< .01) for the item measuring hypersensitivity to light. Present findings suggest that the Rome Basic Disorders Scale may be safely self-rated even by collaborative schizophrenic patients.

Adult↗

PubMed2002

Sex differences on the serial color-word test.

The Serial Color-Word Test was administered to nonclinical volunteers of three age strata (17-29, 30-45, 46-65 yr.). Sex differences on the 17 variables of the test were explored for each age stratum. Only six significant intersex differences were found. In all age strata women scored significantly higher on linear regression of reading times in one of the last two subtests, i.e., R4 or R5.

Adolescent↗