Biomedical subjects

Stefano Pallanti

Publications and source records attributed to Stefano Pallanti.

At least 19 recordsLinked to original sources

PubMed2006

Resistant social anxiety disorder response to Escitalopram.

BACKGROUND: Social Anxiety Disorder (SAD) is a common disorder and its high prevalence and lifelong chronicity are such that it represents a substantial public health problem. The observation that serotonergic agents appear to be effective for its treatment suggests that patients may have abnormal serotonergic neurotransmission within the central nervous system. We investigated the efficacy of Escitalopram in treatment resistant patients with SAD. METHOD: Twenty-nine adult outpatients participated in a 12-week open-label trial of escitalopram. All the subjects had a primary diagnosis of SAD and had failed at least one previous adequate trial of paroxetine. Escitalopram was orally administered starting with a dose of 10 mg/day following a 1-week titration. RESULTS: The escitalopram treatment was characterized by good tolerability (drop-out rate due to intolerance: 10.3%), and 24 subjects completed the study trial. At the end of the 12-week treatment period, 14 subjects (48.3%) were considered as responders on the basis of the Clinical Global Impression-Improvement (CGI-I) (much or very much improved) scale and the Liebowitz Scale for Social Anxiety (LSAS) (reduction >35% compared to baseline). We observed a significant mean reduction in the Sheehan Disability Scale Work (p < .05) and Social (p < .05) subscores, but not in the Family subscore. CONCLUSION: These data suggest escitalopram has a role in the treatment of resistant SAD, especially in view of the favourable tolerability profile observed in the patients. Controlled studies are required to further investigate these findings and to compare escitalopram with other treatments for this disorder.

Journal Article↗

PubMed2006

Positron emission tomography imaging of risperidone augmentation in serotonin reuptake inhibitor-refractory patients.

We studied 15 nondepressed patients with obsessive-compulsive disorder (OCD) who were nonresponders to serotonin reuptake inhibitors with an additive trial of risperidone. Positron emission tomography with (18)F-deoxyglucose and magnetic resonance imaging was obtained at baseline and following 8 weeks of either risperidone or placebo in a double-blind parallel group design. Risperidone treatment was associated with significant increases in relative metabolic rate in the striatum, cingulate gyrus, the prefrontal cortex, especially in the orbital region, and the thalamus. Four of 9 patients who received risperidone showed clinical improvement (CGI score of 1 or 2 at 8 weeks) while none of the 6 patients who received placebo showed improvement. Patients with low relative metabolic rates in the striatum and high relative metabolic rates in the anterior cingulate gyrus were more likely to show a clinical response. These metabolic predictors of clinical response are consistent with earlier PET studies showing similar prediction when either neuroleptics or serotonin reuptake inhibitor treatments are administered individually. Our results are consistent with a frontostriatal circuit change related to both dopaminergic and serotonergic systems and with the presence of psychopharmacological subtypes within OCD.

Adult↗

PubMed2006

Treatment-refractory obsessive-compulsive disorder: methodological issues, operational definitions and therapeutic lines.

While controlled trials with SRIs have demonstrated a selective efficacy in obsessive-compulsive disorder (OCD), up to 40-60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of non-responsive patients, and they are difficult to cluster due to ambiguities in diagnostic criteria, possibility of subtypes and a high rate of comorbidity. Moreover, the findings of current studies of "so-called" non-responsive cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of the research in this area are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multisite data collection for future research trials. The authors reviewed also the more recent therapeutic pharmacological and psychological lines for the treatment of refractoriness in OCD.

Combined Modality Therapy↗

PubMed2006

Serotonin dysfunction in pathological gamblers: increased prolactin response to oral m-CPP versus placebo.

OBJECTIVE: Acute administration of the partial serotonin (5-HT) agonist meta-chlorophenylpiperazine (m-CPP), that is used also as a street drug, has been reported to induce a "high" and craving response in various impulsive and substance addiction disorders. INTRODUCTION: To clarify altered 5-HT metabolism in pathological gamblers and to explore the specific role of serotonergic system in non-substance addictions, we assessed behavioral ("high" and "craving") and neuroendocrine (prolactin and cortisol) responses to an oral single dose of m-CPP and placebo in pathological gamblers and matched controls. Moreover, the relationship between neuroendocrine outcome and clinical severity has been assessed. METHOD: Twenty-six pathological gamblers and 26 healthy control subjects enter a double-blind, placebo-controlled-crossed administration of orally dose m-CPP 0.5 mg/kg. Outcome measures included prolactin and cortisol levels, gambling severity, mood, craving and "high" scales. RESULTS: Pathological gamblers had significantly increased prolactin response compared to controls at 180 minutes and at 210 minutes post-administration. Greater pathological gamblers severity correlated with increased neuroendocrine responsiveness to m-CCP, suggesting greater 5-HT dysregulation. Pathological gambling patients had a significantly increased "high" sensation after m-CPP administration compared with control. CONCLUSION: These results provide additional evidence for 5-HT disturbance in pathological gamblers and they support the hypotheses that the role of the 5-HT dysfunction related to the experience of "high" might represent the pathway that leads to dyscontrolled behavior in pathological gamblers. Furthermore, the "high" feeling induced by m-CPP in pathological subjects may represent a marker of vulnerability to both behavioral and substance addictions.

Adult↗

PubMed2006

The Shorter PROMIS Questionnaire and the Internet Addiction Scale in the assessment of multiple addictions in a high-school population: prevalence and related disability.

OBJECTIVE: Taking into account the importance of act prevention on the development of addictions, we assessed the presence of multiple addictions in an adolescent high-school population, also assessing the prevalence of Internet abuse and the impact on disability. INTRODUCTION: Adolescence seems to be a critical period of addiction vulnerability, based on social but also neurobiological factors. The earlier onset of behavioral/substance dependence seems to predict greater addiction severity, morbidity, and multiple addictive disorders. METHODS: Data were collected from a sample of 275 students in Florence, Italy, high schools through surveys distributed in classes. The sample had an average age of 16.67+/-1.85 years (52.4% males, 47.6% females). To assess multiple addiction we used the 16 subscales of the Shorter PROMIS Questionnaire, to assess Internet addiction prevalence we used the Internet Addiction Scale, and to quantify disability symptoms, we used the Sheehan Disability Scale. RESULTS: Caffeine abuse, sex, relationship submissive, gambling, food starving, and food bingeing have raised highest scores. 5.4% of the students were found to be Internet addicted similar to other countries. Disability seemed strongly correlated to the subscale of alcohol, gambling, sex, tobacco, food starving and food bingeing, shopping, exercise, and Internet addiction. Gambling, sex, caffeine abuse, compulsive help dominant, work, Internet addiction, relationship dominant, and relationship submissive in this sample were strongly related to substance dependence. CONCLUSION: Level of concerns unexpected compared to the level reported in other countries for the behavioral compulsions, have been highlighted. Behavioral addictions are multiple, a source of disability, and they are related to substance abuse. It has yet to be clarified if they are a temporary phenomenon occurring in adolescents or if they are a stable trait, accounting as marker for the development of substance abuse.

Adolescent↗

PubMed2005

Short report: Autistic gastrointestinal and eating symptoms treated with secretin: a subtype of autism.

Pervasive Developmental Disorders (PDD) are chronic, lifelong disorders for which there is as yet no effective cure, and medical management remains a challenge for clinicians. The current report describes two patients affected by autistic disorder with associated gastrointestinal symptoms. They received multiple doses of intravenous secretin for a six-month period and were assessed with several specific outcome measures to evaluate drug effect. The administration of secretin led to some significant and lasting improvement in only one case. Gastroesophageal reflux may contribute to some of the behavioural problems and explain the effect of secretin since its suppressive effect on gastric secretion is well known. It is also true that autistic children with gastroesophageal reflux and a higher IQ could constitute a subtype which responds to secretin administration and that could be labelled as a "gastrointestinal subtype".

Journal Article↗

PubMed2005

Fronto-thalamo-striatal gray and white matter volumes and anisotropy of their connections in bipolar spectrum illnesses.

BACKGROUND: Neurons in the basal ganglia are connected to areas of prefrontal cerebral cortex involved in higher cognitive functions, and these connections occur primarily via the thalamus. In patients with bipolar disorder, regardless of age, neuroimaging studies have consistently reported an increased number of white matter hyperintensities, indicating possible alterations in striatum-thalamus and thalamus-prefrontal cortex connections. METHODS: In the current study, we acquired high-resolution magnetic resonance imaging (MRI) and diffusion tensor (DT) scans of 40 patients with bipolar spectrum (BPS) illnesses (bipolar type I = 17, bipolar type II = 7, cyclothymia = 16) and 36 sex- and age-matched control subjects. Two researchers, without knowledge of diagnosis, outlined the caudate, putamen, and thalamus on contiguous axial MRI slices. We measured the volumes of the basal ganglia, thalamus, and gray/white matter of the frontal cortex. RESULTS: Bipolar spectrum patients as a single group did not differ from control subjects in thalamus and the basal ganglia volumes, but the cyclothymia patients had reductions in the volumes of putamen and the thalamus compared with control subjects. The BPS patients had significantly reduced volume of the white and the gray matter of the frontal cortex. Furthermore, compared with control subjects, BPS patients as a group showed alterations in anisotropy of the internal capsule adjacent to the striatum and thalamus and the frontal white matter. CONCLUSIONS: Our findings indicate that BPS patients may have distinct anatomical alterations in brain structures involved in the regulation of mood and cognition, as well as alterations in these structures' connection to related brain areas.

Adult↗

PubMed2005

Pharmacological treatments of pathological gambling.

Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.

Antidepressive Agents, Second-Generation↗

PubMed2005

Reliability and validity of the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS).

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.

Adult↗

PubMed2005

Psychoneuroimmunodermatology of atopic dermatitis: from empiric data to the evolutionary hypothesis.

Atopic dermatitis is a pruritic skin disease affecting predominantly young people. There is evidence that psychologic stress constitutes an increased risk for atopy and influences the disease's clinical course. This risk is believed mediated by the effects of stress on neuroimmunoregulation, which in turn modulates the hypersensitivity response and involves immunoglobulin E-mediated inflammation, helper T-cell 2 predominance, and eosinophilia. This article examines theoretic perspectives and other behavioral dimensions, such as maternal caring behavior, infant response to stress, temperament, and the so-called "hygiene hypothesis." The Darwinian framework and the mental scenario are examined. These processes may be akin to the generation of antibodies by the immune system.

Dermatitis, Atopic↗

PubMed2005

Psychosomatic factors in dermatology.

Psychosomatics describes any aspect of dermatology with psychologic or psychiatric elements. Dermatologists know that a significant proportion of their practice involves patients for whom psychologic elements either partially or sometimes entirely dominate their presenting chief complaints. This article explores the role of psychosomatic factors in dermatologic disorders. The authors discuss the clinical interface between psychiatry, psychology and dermatology and the interpretation of possible relationships between cutaneous diseases, the role of the mind, and psychotherapeutic interventions.

Dermatology↗

PubMed2005

Imaging monetary reward in pathological gamblers.

We acquired two 18F-deoxyglucose positron emisssion tomography (PET) scans on seven unmedicated pathological gamblers, at least 7 days apart. Following an injection of 5 mCi FDG, subjects carried out a computer blackjack task for 35 min under two different reward conditions: monetary reward and computer game points only. Relative FDG metabolic rate was obtained from regions of interest in the prefrontal cortex, cingulate, striatum and visual cortex. Monetary reward blackjack was associated with significantly higher relative metabolic rate in the primary visual cortex (Brodmann area 17), the cingulate gryus (Brodmann area 24), the putamen and prefrontal areas 47 and 10, compared to blackjack playing for points only. No area tested showed a significant decrease. This pattern suggests heightened limbic and sensory activation in the gambling for money condition with increased emotional valence and greater risk and reward, and confirms the salience of monetary reward in the development of pathological gambling.

Adult↗

PubMed2005

Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders?

OBJECTIVE: Selective serotonin reuptake inhibitors may be effective for some patients with pathological gambling, but those with comorbid conditions, such as bipolar spectrum disorders, may relapse during treatment. To the authors' knowledge, this is the first placebo-controlled treatment study in pathological gamblers with bipolar spectrum disorders; it compares sustained-release lithium carbonate to placebo. METHOD: Forty pathological gambling patients with bipolar spectrum disorders entered a 10-week randomized, double-blind, placebo-controlled treatment study of sustained-release lithium carbonate. Outcome measures included gambling severity, mood, anxiety, and impulsivity scales. RESULTS: Pathological gambling patients with bipolar spectrum disorders significantly improved while taking sustained-release lithium carbonate compared to placebo on total pathological gambling scores on the Yale-Brown Obsessive Compulsive Scale, including both thoughts/urges and behavior, as well as on the Clinical Global Impression severity of pathological gambling scale. Affective instability (the Clinician-Administered Rating Scale for Mania score) was also lower in the group treated with sustained-release lithium carbonate compared to placebo. Ten (83%) of 12 completers were rated as responders in the sustained-release lithium group versus five (29%) of 17 in the placebo group. Of note, improvement in gambling severity was significantly correlated with improvement in mania ratings. CONCLUSIONS: Sustained-released lithium may be an effective treatment in reducing both gambling behavior and affective instability in pathological gamblers with bipolar spectrum disorder. This study highlights the need to identify subgroups of pathological gambling patients with bipolar spectrum conditions because this may have important treatment implications.

Adult↗

PubMed2004

Social anxiety in outpatients with schizophrenia: a relevant cause of disability.

OBJECTIVE: Social anxiety is a frequent but often unrecognized feature in schizophrenia and is associated with a severe level of disability. To precisely define the assessment, impact, clinical correlates, and consequences of social anxiety in schizophrenia, the authors conducted a survey of schizophrenia patients and a comparison cohort of patients with social anxiety disorder. METHOD: A consecutively enrolled group of 80 outpatients with DSM-IV schizophrenia and a consecutive comparison group of 27 patients with social anxiety disorder were recruited from an institutional psychiatric practice and assessed with the Liebowitz Social Anxiety Scale, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, Social Adjustment Scale, and the Medical Outcomes Study 36-item Short-Form Health Survey. RESULTS: Social anxiety scores of schizophrenia patients with comorbid social anxiety disorder (N=29, 36.3%) did not differ from those of subjects with social anxiety disorder as their primary diagnosis. Schizophrenia patients without social anxiety disorder had significantly lower total scores on the Liebowitz Social Anxiety Scale and lower social and performance anxiety subscale scores than did the other two groups. No differences in negative and positive symptom rates were found between schizophrenia patients with and without social anxiety disorder. Schizophrenia patients with social anxiety disorder had a higher lifetime rate of suicide attempts, greater lethality of suicide attempts, more past substance/alcohol abuse disorder, lower social adjustment, and lower overall quality of life. CONCLUSIONS: Social anxiety is a highly prevalent, disabling condition in outpatients with schizophrenia that is unrelated to clinical psychotic symptoms. The Liebowitz Social Anxiety Scale appeared adequate and reliable in assessing social anxiety disorder in patients with schizophrenia. If these data are confirmed, this study will make a contribution to the search for operational guidelines and adequate next-step treatments for social anxiety disorder in schizophrenia patients.

Adult↗

PubMed2004

Response acceleration with mirtazapine augmentation of citalopram in obsessive-compulsive disorder patients without comorbid depression: a pilot study.

BACKGROUND: Therapeutic action of selective serotonin reuptake inhibitors (SSRIs) is delayed from 8 to 12 weeks in patients with obsessive-compulsive disorder (OCD). Several different agents have been tested to reduce the SSRI therapeutic latency time. Mirtazapine, an antagonist at alpha2-adrenoceptors, does not enhance serotonin (5-HT) neurotransmission directly but disinhibits the norepinephrine activation of 5-HT neurons and thereby increases 5-HT neurotransmission by a mechanism that may not require a time-dependent desensitization of receptors. The present study was undertaken to determine whether the mirtazapine-citalopram combination could induce an earlier and/or greater effect on the 5-HT system in OCD subjects than citalopram alone. METHOD: Forty-nine patients with OCD (DSM-IV) without comorbid depression were randomly assigned to a 2-tailed, single-blind, 12-week clinical trial with citalopram (20-80 mg/day) plus placebo or citalopram plus mirtazapine (15-30 mg/day). Assessments were performed weekly with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Hamilton Rating Scale for Depression, and the Clinical Global Impressions scale. Data were collected from November 2001 to July 2003. RESULTS: The citalopram plus mirtazapine group achieved a reduction of at least 35% in YBOCS score and a "much improved" or "very much improved" rating on the Clinical Global Impressions-Improvement scale from the fourth week, while the citalopram plus placebo group obtained these results only from the eighth week. The number of responders was higher in the citalopram plus mirtazapine group at the fourth week of treatment, while no difference between groups in the response rate was noted at the eighth and twelfth weeks of treatment. CONCLUSIONS: We found an earlier onset of response action in OCD symptoms and reduced undesired side effects when mirtazapine was added to citalopram. This augmentation strategy deserves clinical and research consideration through further double-blind, placebo-controlled studies.

Adult↗

PubMed2004

A qualitative analysis of nonresponse: management of treatment-refractory obsessive-compulsive disorder.

Serotonin reuptake inhibitors (SRIs), especially potent ones given at high doses over long periods of time, are often effective in the treatment of obsessive-compulsive disorder (OCD). However, a large percentage of patients do not respond to treatment with SRIs, and those who do respond often do not fully remit, which should be the standard goal of treatment in OCD. If a patient has been treated for several months and has not yet responded to treatment with several SRIs, the physician should perform a careful assessment of resistant and/or residual clinical symptoms and any comorbid conditions to determine which next-step treatment would be the most appropriate. One strategy for patients who have not responded to treatment with an SRI is to switch them to a serotonin-norepinephrine reuptake inhibitor, because some patients may respond better to agents that target multiple systems. Another promising approach is the augmentation of SRIs with neuroleptics. In addition, open trials have shown that intravenous (IV) clomipramine and IV citalopram may be effective in the treatment of resistant OCD. Novel pharmacotherapeutic treatments and electroconvulsive therapy have been attempted, with mixed success. Recently, researchers have been studying repetitive transcranial magnetic stimulation, vagal nerve stimulation, and neurosurgical approaches such as gamma knife capsulotomy and deep brain stimulation to learn if these procedures are effective in treating treatment-resistant OCD. Repetitive transcranial magnetic stimulation has possibilities not only as a therapy but also as an instrument that can help researchers describe the neurocircuitries involved in OCD. More results are needed before the effectiveness of the nonpharmacologic treatments for OCD can be determined.

Adrenergic Uptake Inhibitors↗

PubMed2003

Diagnosis and treatment of pathologic gambling.

Pathologic gambling (PG) is an impulse control disorder characterized by recurrent and maladaptive gambling behaviors that significantly disrupt the patient's functioning in the personal, familial, or vocational spheres. Pathologic gambling is estimated to currently affect 1% to 3.4% of the adult US population and is frequently comorbid with substance abuse or dependence, attention-deficit/hyperactivity disorder (ADHD), and affective disorders. Studies show evidence for the involvement of the serotonergic, noradrenergic, and dopaminergic systems in the etiology of PG. Medication treatment studies performed in PG patients demonstrated the short-term efficacy of various serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers in a subsample of adult pathologic gamblers who seek treatment. This review focuses on recent research examining the neurobiology and treatment of PG.

Adult↗

PubMed2003

Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study.

This double-blind, placebo-controlled trial was performed to determine the efficacy and tolerability of 8 wk of risperidone augmentation of serotonin reuptake inhibitor (SRI) treatment in adult subjects with treatment-resistant obsessive-compulsive disorder (OCD) (failure of at least two SRI trials). Sixteen adult treatment-resistant OCD patients were randomly assigned to augmentation with 8 wk of either risperidone (n=10) (0.5-3.0 mg/d) or placebo (n=6) following at least 12 wk of SRI treatment. Four patients on risperidone (40%) and none (0%) on placebo were responders with both a Clinical Global Impression - Improvement (CGI-I) score of 1 or 2 and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decrease >/=25%. Risperidone was generally well tolerated: there were 3 dropouts, 1 on risperidone and 2 on placebo. Better Y-BOCS insight score at baseline significantly correlated with a greater CGI-I score at endpoint on risperidone augmentation. Risperidone may be an effective and well-tolerated augmentation strategy in treatment-resistant OCD subjects, but larger sample size studies are required to demonstrate this.

Adult↗