Publications by authors named "Donatella Marazziti"

218 Publications

Decreased Plasma Oxytocin Levels in Patients With PTSD.

Front Psychol 2021 1;12:612338. Epub 2021 Jul 1.

Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.

Introduction: Although the pathophysiology of post-traumatic stress disorder (PTSD) is still unclear, growing preclinical evidences suggest that oxytocin (OT), a pleiotropic hormone, is possibly involved. However, direct studies on OT levels or clinical trials with this exogenous hormone in patients with PTSD led to inconsistent findings. Therefore, the aim of the present study was at exploring and comparing the plasma OT levels in a group of patients with PTSD and matched healthy subjects as the control group.

Materials And Methods: Twenty-six outpatients (13 men, 13 women, mean age: 40.3 ± 11.5 years) suffering from PTSD, according to the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5), and 26 healthy subjects (13 men, 13 women, mean age: 43.8 ± 12.7 years) were included. The patients were assessed through the structured clinical interview for DSM-5 research version, patient edition (SCID-I/P), and the Impact for Event Scale revised (IES-R). All fasting subjects underwent three venous blood samples for the subsequent oxytocin radioimmunoassay. We used unpaired Student's to assess OT levels and the intergroup difference of demographic characteristics, while anxiety, avoidance, and hyperarousal scores were compared among groups adjusting for the effect of gender and age by means of analysis of covariance (ANCOVA). The correlations between different variables were investigated by Pearson's method.

Results: The most common traumatic events of patients with PTSD were the following: severe car accident, physical violence, sexual violence, sudden death of a loved one, and natural disaster. The IES total score was 55 ± 15. Student's -test revealed that the patients showed significantly lower OT levels (mean ± SD, pg/ml) than healthy control subjects (4.37 ± 1.61 vs 5.64 ± 2.17, < 0.001). We detected no correlation between the IES total score, subscales, or single items and OT plasma levels. Again, no difference between men and women was detected in the patients' group, while healthy control women showed higher OT levels than men.

Discussion: Our study, while reporting the presence of decreased plasma OT levels in outpatients with PTSD of both sexes, as compared with healthy control subjects, would support the possible involvement of OT in the pathophysiology of PTSD. However, given the complexity of the clinical picture, future investigations are necessary to better deepen the role and level of OT in PTSD.
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http://dx.doi.org/10.3389/fpsyg.2021.612338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280334PMC
July 2021

Compulsive Hoarding Symptoms and the Role of Mindfulness Skills During Social Distancing for the COVID-19 Pandemic: An Exploratory Survey.

Front Psychiatry 2021 14;12:634454. Epub 2021 Jun 14.

Department of Health Sciences, University of Florence, Florence, Italy.

People reporting compulsive hoarding symptoms (CHS) have lower mindfulness skills than those without such symptoms. Mindfulness skills can have the role of a protective buffer against stressful periods. The quarantine imposed to contain the COVID-19 spread had a negative impact on daily habits and healthy behaviors (including social interactions). An increased attachment to objects might be one of the under-recognized psychological consequences of these difficult times, yet no study focused on CHS. Through an online survey in men who were on quarantine during the pandemic, this exploratory survey examined the prevalence of men reporting CHS during this period and explored the role of mindfulness skills on CHS controlling for anxious-depressive/stress symptoms. Forty-three men from the general population completed the Obsessive Compulsive Inventory-Revised (OCI-R), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) and Depression Anxiety Stress Scales-21 (DASS-21). Twenty-eight percent reported CHS. No differences on the scores of the questionnaires emerged between men with and without CHS, except on CAMS-R Attention scores. In a logistic regression analysis lower CAMS-R Attention scores predicted CHS (β = -0.34, = 0.03). This is the first, yet preliminary investigation on CHS during quarantine. The prevalence of CHS appears higher than the rates (4%) reported in the last years before the COVID-19 outbreak. Perhaps people showed more intense hoarding tendencies during quarantine/social distancing, and this pattern should be monitored. Larger samples, longitudinal designs and clinician-rated instruments are needed to support or not our findings.
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http://dx.doi.org/10.3389/fpsyt.2021.634454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236584PMC
June 2021

Compulsive Hoarding Symptoms and the Role of Mindfulness Skills During Social Distancing for the COVID-19 Pandemic: An Exploratory Survey.

Front Psychiatry 2021 14;12:634454. Epub 2021 Jun 14.

Department of Health Sciences, University of Florence, Florence, Italy.

People reporting compulsive hoarding symptoms (CHS) have lower mindfulness skills than those without such symptoms. Mindfulness skills can have the role of a protective buffer against stressful periods. The quarantine imposed to contain the COVID-19 spread had a negative impact on daily habits and healthy behaviors (including social interactions). An increased attachment to objects might be one of the under-recognized psychological consequences of these difficult times, yet no study focused on CHS. Through an online survey in men who were on quarantine during the pandemic, this exploratory survey examined the prevalence of men reporting CHS during this period and explored the role of mindfulness skills on CHS controlling for anxious-depressive/stress symptoms. Forty-three men from the general population completed the Obsessive Compulsive Inventory-Revised (OCI-R), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) and Depression Anxiety Stress Scales-21 (DASS-21). Twenty-eight percent reported CHS. No differences on the scores of the questionnaires emerged between men with and without CHS, except on CAMS-R Attention scores. In a logistic regression analysis lower CAMS-R Attention scores predicted CHS (β = -0.34, = 0.03). This is the first, yet preliminary investigation on CHS during quarantine. The prevalence of CHS appears higher than the rates (4%) reported in the last years before the COVID-19 outbreak. Perhaps people showed more intense hoarding tendencies during quarantine/social distancing, and this pattern should be monitored. Larger samples, longitudinal designs and clinician-rated instruments are needed to support or not our findings.
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http://dx.doi.org/10.3389/fpsyt.2021.634454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236584PMC
June 2021

Compulsive Hoarding Symptoms and the Role of Mindfulness Skills During Social Distancing for the COVID-19 Pandemic: An Exploratory Survey.

Front Psychiatry 2021 14;12:634454. Epub 2021 Jun 14.

Department of Health Sciences, University of Florence, Florence, Italy.

People reporting compulsive hoarding symptoms (CHS) have lower mindfulness skills than those without such symptoms. Mindfulness skills can have the role of a protective buffer against stressful periods. The quarantine imposed to contain the COVID-19 spread had a negative impact on daily habits and healthy behaviors (including social interactions). An increased attachment to objects might be one of the under-recognized psychological consequences of these difficult times, yet no study focused on CHS. Through an online survey in men who were on quarantine during the pandemic, this exploratory survey examined the prevalence of men reporting CHS during this period and explored the role of mindfulness skills on CHS controlling for anxious-depressive/stress symptoms. Forty-three men from the general population completed the Obsessive Compulsive Inventory-Revised (OCI-R), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) and Depression Anxiety Stress Scales-21 (DASS-21). Twenty-eight percent reported CHS. No differences on the scores of the questionnaires emerged between men with and without CHS, except on CAMS-R Attention scores. In a logistic regression analysis lower CAMS-R Attention scores predicted CHS (β = -0.34, = 0.03). This is the first, yet preliminary investigation on CHS during quarantine. The prevalence of CHS appears higher than the rates (4%) reported in the last years before the COVID-19 outbreak. Perhaps people showed more intense hoarding tendencies during quarantine/social distancing, and this pattern should be monitored. Larger samples, longitudinal designs and clinician-rated instruments are needed to support or not our findings.
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http://dx.doi.org/10.3389/fpsyt.2021.634454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236584PMC
June 2021

Response to the Letter to the Editor "Psychiatry's undeclared identity crisis in a changing world" by Richard Skaff.

CNS Spectr 2021 May 31:1-2. Epub 2021 May 31.

Department of Psychiatry, University of California, San Diego, California, USA.

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http://dx.doi.org/10.1017/S1092852921000559DOI Listing
May 2021

The price of love: an investigation into the relationship between romantic love and the expression of obsessive-compulsive disorder.

CNS Spectr 2021 May 27:1-8. Epub 2021 May 27.

Brain & Mental Health Research Hub, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.

Background: The present study explored the influence of romantic love on the expression of several obsessive-compulsive disorder (OCD) characteristics, including symptom severity, symptom dimensions, age at onset, sensory phenomena (SP), and developmental course, as well as other related comorbid disorders. It was hypothesized that love-precipitated OCD would be associated with a set of distinct characteristics and exhibit greater rates of comorbid disorders.

Methods: The analyses were performed using a large sample (n = 981) of clinical patients with a primary diagnosis of OCD (Females = 67.3%, M age = 35.31).

Results: Love-precipitated OCD was associated with greater severity of SP and later age at onset of obsessions. However, symptom severity, symptom dimension, developmental course, and psychiatric comorbidities were not associated with love-precipitated OCD.

Conclusion: It was concluded that romantic love does shape the expression of OCD, especially with regard to SP and onset age. These findings encourage further exploration to determine its clinical significance as a phenotype.
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http://dx.doi.org/10.1017/S1092852921000444DOI Listing
May 2021

Space missions: psychological and psychopathological issues.

CNS Spectr 2021 May 24:1-5. Epub 2021 May 24.

Department of Radiation Psychoneurology, Institute for Clinical Radiology, State Institution, National Research Centre for Radiation Medicine, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.

Exploring space is one of the most attractive goals that humanity ever set, notwithstanding, there are some psychological and psychopathological risks that should be considered. Several studies identified some possible hazards of space travels and related physical and psychological consequences on astronauts. If some psychological reactions are obviously inherent to the characteristics of the spaceships (habitability, confinement, psychological, and interpersonal relationships), other (disturbances of sleep-wake cycle, personality changes, depression, anxiety, apathy, psychosomatic symptoms, neurovestibular problems, alterations in cognitive function, and sensory perception) represent a clear warning of possible central nervous system (CNS) alterations, possibly due to microgravity and cosmic radiation. Such conditions and eventual CNS changes might compromise the success of missions and the ability to cope with unexpected events and may lead to individual and long-term impairments. Therefore, further studies are needed, perhaps, requiring the birth of a novel branch of psychology/psychiatry that should not only consider the risks related to space exploration, but the implementation of targeted strategies to prevent them.
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http://dx.doi.org/10.1017/S1092852921000535DOI Listing
May 2021

[Cariprazine: from receptor affinities to therapeutic effects. Review in schizophrenic spectrum disorders and expert opinion].

Riv Psichiatr 2021 Mar-Apr;56(2):10-17

Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa.

Introduction: Schizophrenia is a very disabling condition that may result in a significant impairment of individual, professional and social adjustments. Antipsychotics (APs) are the first-line treatment for schizophrenia that may modify the course of the disease in most cases, by decreasing the institutionalization risk, although they may induce severe side effects. It is worth noting that APs may well control positive symptoms, while their efficacy on negative and cognitive symptoms is low. Cariprazine is one of the latest third-generation APs acting as a partial agonist at dopamine receptor of the type 2 and 3 with a broader spectrum of activities, recently approved for the treatment of adult schizophrenia.

Aim: The aim of this paper was to review and comment on the available literature on the effectiveness and tolerability of cariprazine in schizophrenia, with a main focus on possibly specific symptoms, as well as in those peculiar patients' populations that could mostly benefit from this latest AP, when compared with previous APs.

Discussion: The current literature would indicate that cariprazine is significantly more effective on both acute and maintenance treatment of schizophrenia, and in improving positive, negative and cognitive symptoms, than other APs. In any case, cariprazine has a good safety and tolerability profile, with akathisia being its most common side effect. Although further independent studies are needed to clarify its advantages over other APs, cariprazine appears to represent a promising treatment for schizophrenic spectrum disorders.
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http://dx.doi.org/10.1708/3606.35843DOI Listing
May 2021

Lifetime evolution of ADHD treatment.

J Neural Transm (Vienna) 2021 Jul 15;128(7):1085-1098. Epub 2021 May 15.

Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, Pisa, Italy.

Attention-deficit hyperactivity disorder (ADHD), has been traditionally considered a neurodevelopmental disorder affecting children and adolescents characterized by inattention, hyperactivity, disruptive behavior, and impulsivity. Although still debated, it is evident that ADHD is also present in adulthood, but this diagnosis is rarely carried out, mainly for the frequent comorbidity with other psychiatric and/or substance abuse disorders. Given the need to shed more light on the pharmacological treatment of ADHD, we performed a naturalistic review to review and comment on the available literature of ADHD treatment across the lifespan. Indeed, stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants, although requiring some weeks to be fully effective, are useful when a substance abuse history is detected. In any case, the pharmacological management of ADHD appears to be still largely influenced by the individual experience of the clinicians. Further longitudinal studies with a careful and detailed characterization of participants across different phases of the lifespan are also required to provide relevant confirmations (or denials) regarding pharmacological treatments amongst the different age groups.
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http://dx.doi.org/10.1007/s00702-021-02336-wDOI Listing
July 2021

Protracted Hiccups Induced by Aripiprazole and Regressed after Administration of Gabapentin.

Case Rep Psychiatry 2021 22;2021:5567152. Epub 2021 Apr 22.

Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 57, 56100 Pisa, Italy.

Hiccups are sudden, repeated, and involuntary contractions of the diaphragm muscle (myoclonic contraction). It involves a reflex arc that, once activated, causes a strong contraction of the diaphragm immediately followed by the closure of the glottis translating into the classic "hic" sound. Hiccups can be short, persistent, and intractable depending on the duration. The most disabling hiccups often represent the epiphenomenon of a medical condition such as gastrointestinal and cardiovascular disorders; central nervous system (CNS) abnormalities; ear, nose, and throat (ENT) conditions or pneumological problems; metabolic/endocrine disorders; infections; and psychogenic disorders. Some drugs, such as aripiprazole, a second-generation antipsychotic, can induce the onset of variable hiccups. We describe herein the cases of three hospitalized patients who developed insistent hiccups after taking aripiprazole and who positively responded to low doses of gabapentin. It is probable that aripiprazole, prescribed at a low dosage (<7.5 mg/day), would act as a dopamine agonist by stimulating D and D receptors at the "hiccup center" level-located in the brain stem-thus triggering the hiccup. On the other hand, gabapentin led to a complete regression of the hiccup probably by reducing the nerve impulse transmission and modulating the diaphragmatic activity. The present case series suggests the use of low doses of gabapentin as an effective treatment for aripiprazole-induced hiccups. However, our knowledge of the neurotransmitter functioning of the hiccup reflex arc is still limited, and further research is needed to characterize the neurotransmitters involved in hiccups for potential novel therapeutic targets.
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http://dx.doi.org/10.1155/2021/5567152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084681PMC
April 2021

Climate change, environment pollution, COVID-19 pandemic and mental health.

Sci Total Environ 2021 Jun 21;773:145182. Epub 2021 Jan 21.

Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy. Electronic address:

Converging data would indicate the existence of possible relationships between climate change, environmental pollution and epidemics/pandemics, such as the current one due to SARS-CoV-2 virus. Each of these phenomena has been supposed to provoke detrimental effects on mental health. Therefore, the purpose of this paper was to review the available scientific literature on these variables in order to suggest and comment on their eventual synergistic effects on mental health. The available literature report that climate change, air pollution and COVID-19 pandemic might influence mental health, with disturbances ranging from mild negative emotional responses to full-blown psychiatric conditions, specifically, anxiety and depression, stress/trauma-related disorders, and substance abuse. The most vulnerable groups include elderly, children, women, people with pre-existing health problems especially mental illnesses, subjects taking some types of medication including psychotropic drugs, individuals with low socio-economic status, and immigrants. It is evident that COVID-19 pandemic uncovers all the fragility and weakness of our ecosystem, and inability to protect ourselves from pollutants. Again, it underlines our faults and neglect towards disasters deriving from climate change or pollution, or the consequences of human activities irrespective of natural habitats and constantly increasing the probability of spillover of viruses from animals to humans. In conclusion, the psychological/psychiatric consequences of COVID-19 pandemic, that currently seem unavoidable, represent a sharp cue of our misconception and indifference towards the links between our behaviour and their influence on the "health" of our planet and of ourselves. It is time to move towards a deeper understanding of these relationships, not only for our survival, but for the maintenance of that balance among man, animals and environment at the basis of life in earth, otherwise there will be no future.
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http://dx.doi.org/10.1016/j.scitotenv.2021.145182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825818PMC
June 2021

The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability.

J Clin Med 2021 Apr 10;10(8). Epub 2021 Apr 10.

Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy.

Endometriosis is a chronic inflammatory condition, which is distinguished by the presence of the endometrial-like glands and stroma outside the uterine cavity. Pain and infertility are the most commonly expressed symptoms, occurring in 60% and 40% of cases, respectively. Women with endometriosis, especially those with pelvic pain, also have a greater vulnerability to several psychiatric disorders. There is, in particular, a tendency to contract affective or anxiety disorders as well as panic-agoraphobic and substance use disorders. Endometriosis with pelvic pain, infertility and psychic vulnerability usually leads to disability and a markedly lower quality of life for women of reproductive age. Thus, the burden of endometriosis is not limited to the symptoms and dysfunctions of the disease; it extends to the social, working and emotional spheres, leading to a severe impairment of global functioning. An analysis of scientific literature revealed a close relationship between specific temperamental traits, the expression of several psychiatric symptoms, chronicity of pain, risk of substance use and lower probability of a positive outcome. Endometriosis symptoms and the impact of related psychological consequences, increased vulnerability and the possible onset of psychiatric symptoms may influence coping strategies and weaken resilience, so triggering a vicious cycle leading to a marked deterioration in the quality of life. A multidisciplinary approach consisting of a medical team composed of gynecologists, psychologists, psychiatrists, experts in Dual Disorder, algologists and sexologists, would guarantee the setting of a target and taking the best decision on a personalized treatment plan. That approach would allow the prompt detection of any psychopathological symptoms and improve the endometriosis-related physical symptoms, bringing a healthier quality of life and a greater likelihood of a positive outcome.
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http://dx.doi.org/10.3390/jcm10081616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069439PMC
April 2021

Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder.

Psychiatry Res 2021 06 31;300:113916. Epub 2021 Mar 31.

University of Siena, Department of Medical Sciences, Surgery and Neurosciences, Italy.

Mourning is a coping-with-loss stage that prevents grief from becoming pathologic, i.e., complicated grief (CG) syndrome and persistent complex bereavement disorder (PCBD), recently included in international classification systems. During the COVID-19 pandemic, to contain virus spread, several countries adopted/adopt the prohibition of mourning rituals (funeral ceremonies/visiting to cemeteries), so that people were/are unable to give their hospitalized relatives the latest goodbye. Such measures can lead vulnerable individuals to develop CG and PCBD. We critically discuss literature-based risk factors for and protective resources against the onset of these conditions since the start of the pandemic and analyze prevention strategies to inform public health programs.
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http://dx.doi.org/10.1016/j.psychres.2021.113916DOI Listing
June 2021

Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder.

Psychiatry Res 2021 06 31;300:113916. Epub 2021 Mar 31.

University of Siena, Department of Medical Sciences, Surgery and Neurosciences, Italy.

Mourning is a coping-with-loss stage that prevents grief from becoming pathologic, i.e., complicated grief (CG) syndrome and persistent complex bereavement disorder (PCBD), recently included in international classification systems. During the COVID-19 pandemic, to contain virus spread, several countries adopted/adopt the prohibition of mourning rituals (funeral ceremonies/visiting to cemeteries), so that people were/are unable to give their hospitalized relatives the latest goodbye. Such measures can lead vulnerable individuals to develop CG and PCBD. We critically discuss literature-based risk factors for and protective resources against the onset of these conditions since the start of the pandemic and analyze prevention strategies to inform public health programs.
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http://dx.doi.org/10.1016/j.psychres.2021.113916DOI Listing
June 2021

A Pilot Study of Gender Differences in Sexual Arousal of Patients With OCD: The Moderator Roles of Attachment and Contamination Symptoms.

Front Psychiatry 2020 10;11:609989. Epub 2021 Feb 10.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Sexual arousal is often impaired in patients with obsessive-compulsive disorder (OCD). However, little is known about the factors related to this impairment: no study focused on the role of gender-based effects of attachment styles and contamination symptoms. The Dual Control Model assumes three processes driving sexual arousal: sexual excitation (SE), sexual inhibition (SI) due to threat of performance failure, and SI due to threat of performance consequences (e.g., getting contaminated with sexually transmitted diseases). In a group of OCD patients, we hypothesized that (a) women report lower SE and higher SI than men; (b) patients with insecure (both anxious and avoidant) attachment styles show lower SE and higher SI; (c) attachment styles moderate the relation between gender and sexual arousal (respectively, for women, higher attachment anxiety, and for men higher attachment avoidance were related to impaired sexual arousal (higher SE and SI) controlling for OCD severity); and (d) contamination symptoms moderate the relation between gender and sexual impairment (women with contamination symptoms show impaired sexual arousal). Seventy-two OCD patients (37.50% women) completed the Obsessive-Compulsive Inventory-Revised, Attachment Styles Questionnaire and Sexual Inhibition/Sexual Excitation Scales. In contrast with our hypotheses, women reported higher SE and lower SI due to threat of performance consequences than men. Patients with higher attachment avoidance (discomfort with intimacy) but also confidence in self and others had higher SE. Women with attachment avoidance (i.e., discomfort with intimacy) had lower SE, while women with attachment anxiety (i.e., preoccupations with relationships) had higher SI due to negative performance consequences. Women with contamination symptoms had higher SI due to performance failure but lower SI due to performance consequences. The present preliminary findings suggest that sexual arousal impairment should be evaluated during the assessment of OCD patients, and gender-based effects of attachment styles and contamination symptoms should be considered during personalized treatment planning.
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http://dx.doi.org/10.3389/fpsyt.2020.609989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902707PMC
February 2021

Remote W.A.R.A. Compared With Face-to-Face W.A.R.A.: A Pilot Study.

Front Psychol 2020 15;11:620027. Epub 2021 Jan 15.

Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.

Background: Since the outbreak of the COVID-19 pandemic and its social restriction measures, online therapy is a life-saving possibility for patients with acute stress. Wiring Affect with ReAttach (W.A.R.A.) is a brief psychological intervention aiming to decrease negative affect, that can be offered online.

Methods: We assessed the effect of remote W.A.R.A. on negative affect in 37 patients. Consequently, we compared the effect of remote W.A.R.A. versus face-to-face W.A.R.A on negative affect in a cross-sectional design.

Results: W.A.R.A. remote therapy provoked a significant reduction of negative affect with a large effect size ( = 3.08, < 0.001). However, the reduction on negative affect was smaller than with W.A.R.A. face-to-face. We found a substantial difference between W.A.R.A. remote therapy and W.A.R.A. face-to-face in decrease of negative affect ( = 1.36, < 0.001).

Limitations: The major limitation of the pilot-study is the sample size of 37 patients. Besides, we designed a numeric rating scale for evaluating negative affect. We investigated the impact on negative affect by assessing "unpleasant feelings." This conceptualization of negative affect might still be a point of discussion.

Conclusion: The study's findings indicated that W.A.R.A. remote therapy significantly reduced negative affect, but to a lesser extent than W.A.R.A. face-to-face. Nevertheless, W.A.R.A. remote therapy might offer a fast relief, especially when personal contact is difficult.
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http://dx.doi.org/10.3389/fpsyg.2020.620027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844207PMC
January 2021

Remote W.A.R.A. Compared With Face-to-Face W.A.R.A.: A Pilot Study.

Front Psychol 2020 15;11:620027. Epub 2021 Jan 15.

Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.

Background: Since the outbreak of the COVID-19 pandemic and its social restriction measures, online therapy is a life-saving possibility for patients with acute stress. Wiring Affect with ReAttach (W.A.R.A.) is a brief psychological intervention aiming to decrease negative affect, that can be offered online.

Methods: We assessed the effect of remote W.A.R.A. on negative affect in 37 patients. Consequently, we compared the effect of remote W.A.R.A. versus face-to-face W.A.R.A on negative affect in a cross-sectional design.

Results: W.A.R.A. remote therapy provoked a significant reduction of negative affect with a large effect size ( = 3.08, < 0.001). However, the reduction on negative affect was smaller than with W.A.R.A. face-to-face. We found a substantial difference between W.A.R.A. remote therapy and W.A.R.A. face-to-face in decrease of negative affect ( = 1.36, < 0.001).

Limitations: The major limitation of the pilot-study is the sample size of 37 patients. Besides, we designed a numeric rating scale for evaluating negative affect. We investigated the impact on negative affect by assessing "unpleasant feelings." This conceptualization of negative affect might still be a point of discussion.

Conclusion: The study's findings indicated that W.A.R.A. remote therapy significantly reduced negative affect, but to a lesser extent than W.A.R.A. face-to-face. Nevertheless, W.A.R.A. remote therapy might offer a fast relief, especially when personal contact is difficult.
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http://dx.doi.org/10.3389/fpsyg.2020.620027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844207PMC
January 2021

Insomnia, sleep loss, and circadian sleep disturbances in mood disorders: a pathway toward neurodegeneration and neuroprogression? A theoretical review.

CNS Spectr 2021 Jan 11:1-11. Epub 2021 Jan 11.

Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

The present paper aims at reviewing and commenting on the relationships between sleep and circadian phasing alterations and neurodegenerative/neuroprogressive processes in mood disorder. We carried out a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, in PubMed, PsycINFO, and Embase electronic databases for literature related to mood disorders, sleep disturbances, and neurodegenerative/neuroprogressive processes in relation to (1) neuroinflammation, (2) activation of the stress system, (3) oxidative stress, (4) accumulation of neurotoxic proteins, and (5) neuroprotection deficit. Seventy articles were collectively selected and analyzed. Experimental and clinical studies revealed that insomnia, conditions of sleep loss, and altered circadian sleep may favor neurodegeneration and neuroprogression in mood disorders. These sleep disturbances may induce a state of chronic inflammation by enhancing neuroinflammation, both directly and indirectly, via microglia and astrocytes activation. They may act as neurobiological stressors that by over-activating the stress system may negatively influence neural plasticity causing neuronal damage. In addition, sleep disturbances may favor the accumulation of neurotoxic proteins, favor oxidative stress, and a deficit in neuroprotection hence contributing to neurodegeneration and neuroprogression. Targeting sleep disturbances in the clinical practice may hold a neuroprotective value for mood disorders.
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http://dx.doi.org/10.1017/S1092852921000018DOI Listing
January 2021

Characteristics of Internet Use amongst Italian University Students.

Psychiatr Danub 2020 Autumn - Winter;32(3-4):411-419

Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Via Roma 67, 56100 Pisa, Italy,

Background: Problematic Internet use (PIU), that may be defined as the inability to control one's use of Internet with negative consequences in daily life, is an emerging problem involving primarily, but not only young generations. Different studies have shown that students are particularly vulnerable to PIU. Given the paucity of information on PIU in our country, the aim of this paper was at investigating the characteristics of PIU amongst Italian University students.

Subjects And Methods: A self-assessment questionnaire, referred by the acronym QUNT ("Questionario sull'Utilizzo delle Nuove Tecnologie"), composed by 101 items grouped together to identify a series of factors, was developed and sent through e-mail invitation to several students from three Italian Universities.

Results: The returned questionnaires were 3324, out of a total of 51,304 sent, with no difference between the two sexes. On the contrary, the distribution of the QUNT factors was different in the two sexes, in people living alone and in overweight subjects. Men resulted to be more involved in online recreational activities, whereas women seemed more attracted to instant messaging and generally to social networks. PIU was significantly more present in men than women. The comparisons of QUNT factor scores in the four BMI categories showed that the greater the BMI the greater the score of some factors.

Conclusions: The findings of the present study indicate that the use of Internet through new technologies may exceed its real utility amongst Italian university student, with some sex-related differences. Men seem more prone to use Internet for passing time and women for social relationships. Men are also at risk of developing PIU. Again, Internet use might be a basic vulnerability factor of increasing weight gain and obesity amongst young people.
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http://dx.doi.org/10.24869/psyd.2020.411DOI Listing
January 2021

Radiation Risk Analysis of Neuropsychiatric Disorders in Ukrainian Chornobyl Catastrophe Liquidators.

Front Psychiatry 2020 17;11:553420. Epub 2020 Nov 17.

State Institution "National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine.

To explore the possible impact of ionizing radiation in the pathophysiology of neuropsychiatric disorders amongst clean-up workers of the Chornobyl catastrophe (liquidators). Retrospective-prospective study (1987-2015) of liquidators from the State Register of Ukraine (SRU) with radiation doses records and Clinical-Epidemiological Register (CER) of the State Institution ≪National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine≫ (NRCRM). Moreover, cohort and cross-sectional studies of the randomized sample of liquidators from the CER (exposed group, 198 subjects) were examined. Internal control group included the liquidators irradiated in doses <50.0 mSv (42 persons). All subjects were assessed by a detailed clinical examination and a battery of standardized neuropsychiatric scales, psychometric, and neuropsychological tests. Descriptive and variation statistics, non-parametric criteria, regression-correlation analysis, survival analysis by Kaplan & Meier, and risk analysis were used. Exposed group vs. control group showed cognitive disorders in 99 (50.0%) vs. 20 (18.1%), ( = 0.04); affective disorders in 96 (48.3%) vs. 36 (32.7%) ( = 0.007), and stress-related disorders in 115 (58.4%) vs. 8 (7.3%) ( < 0.001). In the main group exposed to ≥50 mSv vs. internal control group (exposed to <50 mSv), affective disorders were present, respectively, in 89 (56.4%) vs. 7 (19.1%) ( < 0.001), and stress-related disorders in 98 (62.8%) vs. 17 (40.4%) ( = 0.009). Relative risks (RR) and 95% confidential intervals (95%CI) of Incidence of some neuropsychiatric disorders in liquidators of 1986-1987 related to internal control (doses <50 mSv) were as follows: organic psychosis (RR = 3.15; 95% CI: 2.6; 3.7); non-psychotic organic brain damage (RR = 1.99; 95% CI: 1.6; 2.5); acute (RR = 1.40, 95% CI: 1.3; 1.5), and chronic cerebrovascular disorders (RR = 1.23; 95% CI 1.0;1.5). Neuropsychiatric diseases show a strong, increasing, and approximately quadratic statistically significant ( < 0.001) relationship with individual dose, yielding an estimated excess relative risk ERR = 2.76 Sv (95% CI 1.06-7.15). Liquidators have an excess of cognitive, affective, and stress-related disorders. The risk of diseases rises with radiation dose. Radiation risks are revealed for organic psychoses, non-psychotic organic brain damage, acute and chronic cerebrovascular pathology.
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http://dx.doi.org/10.3389/fpsyt.2020.553420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704427PMC
November 2020

Vitamin D: A Pleiotropic Hormone with Possible Psychotropic Activities.

Curr Med Chem 2021 ;28(19):3843-3864

Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy.

Background: After the recognition of the efficacy of cod-liver oil in rickets at the end of the eighteenth century, and the isolation and synthesis of the liposoluble vitamin D in 1931, its mode of actions and functions were deeply explored. Biochemical studies permitted to identify five forms of vitamin D, called D1, D2, D3, D4 and D5, differing in ultrastructural conformation and origin, with vitamin D2 (ergocalciferol) and D3 (cholecalciferol) representing the active forms. In the last decades especially, a constantly increasing bulk of data highlighted how vitamin D could regulate several activities and processes.

Aims: The aim of the present paper was to review and comment on the literature on vitamin D, with a focus on its possible role in the pathophysiology of neuropsychiatric disorders.

Discussion: Available literature indicates that vitamin D regulates a variety of processes in humans and in the central nervous system. Vitamin D deficiency is associated with an enhanced pro-inflammatory state, and formation of Aβ oligomers that might contribute to the cognitive decline typical of the elderly age and, perhaps, dementia. More in general, vitamin D is supposed to play a crucial role in neuroinflammation processes that are currently hypothesized to be involved in the pathophysiology of different psychiatric disorders, such as major depression, bipolar disorders, obsessive-compulsive disorders and psychosis.

Conclusion: It is conceivable that vitamin D supplementation might pave the way towards "natural" treatments of a broad range of neuropsychiatric disorders, or at least be useful to boost response to psychotropic drugs in resistant cases.
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http://dx.doi.org/10.2174/0929867328666201210104701DOI Listing
June 2021

The impact of the early phase of the COVID-19 pandemic on mental-health services in Europe.

World J Biol Psychiatry 2020 Dec 23:1-10. Epub 2020 Dec 23.

Agence de Coopération Scientifique Afrique-Luxembourg et Europe et LEPS, Laboratoire Education et Pratiques en Santé, Paris 13, Université Sorbonne Paris Nord, Paris, France.

Purpose: The current COVID-19 pandemic confronts psychiatric patients and mental health services with unique and severe challenges.

Methods: In order to identify these trans-national challenges across Europe, an survey was conducted among 23 experts, each answering for one European or aligned country.

Results: A number of important themes and issues were raised for the impact of COVID-19 on mental health and mental health services, barriers to service provision and future consequences. A number of key issues were reported by colleagues across several jurisdictions, even though these were at different stages of their national epidemics.

Conclusions: Based on these findings, we articulate some important learnings from the early stages of the COVID-19 European pandemic, and highlight key considerations for all countries' mental health services as the current pandemic develops and for future pandemics.
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http://dx.doi.org/10.1080/15622975.2020.1844290DOI Listing
December 2020

Cariprazine as a therapeutic option for schizophrenia: a drug evaluation.

Expert Opin Pharmacother 2021 Mar 6;22(4):415-426. Epub 2021 Jan 6.

Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena Italy.

: Schizophrenia is a very disabling condition that may result in a significant impairment of individual, professional, and social adjustments. Antipsychotics (APs), the first-line treatment for schizophrenia, in many cases modify the course of the disease, by reducing the institutionalization risk, at the price of severe and invalidating side effects. Cariprazine is one of the latest second-generation APs (SGAs) acting as a partial agonist of type 2 and 3 dopamine receptors, which was recently approved for the treatment of adult schizophrenia.: The authors provide a critical review and commentary on the currently available data on the effectiveness and tolerability of cariprazine in schizophrenic patients, with a particular focus on its specific target symptoms.: Cariprazine appears significantly effective on both acute and maintenance treatment of schizophrenia, and in improving positive, negative, and cognitive symptoms, slightly more than other SGAs. It shows a good safety and tolerability profile, with akathisia being its most common side effect. Although further independent studies are needed to clarify its precise advantages over other SGAs, cariprazine seems a promising compound not only in schizophrenia, but also in a broad range of psychiatric conditions, including perhaps bipolar and addictive disorders.
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http://dx.doi.org/10.1080/14656566.2020.1845315DOI Listing
March 2021

Is there a relationship between morphological and functional platelet changes and depressive disorder?

CNS Spectr 2020 Oct 23:1-34. Epub 2020 Oct 23.

Geriatric Psychiatry Department, Nathan Kline Institute, Orangeburg, New York, USA.

Background: Blood platelets, due to shared biochemical and functional properties with presynaptic serotonergic neurons, constituted, over the years, an attractive peripheral biomarker of neuronal activity. Therefore, the literature strongly focused on the investigation of eventual structural and functional platelet abnormalities in neuropsychiatric disorders, particularly in depressive disorder. Given their impact in biological psychiatry, the goal of the present paper was to review and critically analyze studies exploring platelet activity, functionality, and morpho-structure in subjects with depressive disorder.

Methods: According to the PRISMA guidelines, we performed a systematic review through the PubMed database up to March 2020 with the search terms: (1) platelets in depression [Title/Abstract]"; (2) "(platelets[Title]) AND depressive disorder[Title/Abstract]"; (3) "(Platelet[Title]) AND major depressive disorder[Title]"; (4) (platelets[Title]) AND depressed[Title]"; (5) (platelets[Title]) AND depressive episode[Title]"; (6) (platelets[Title]) AND major depression[Title]"; (7) platelet activation in depression[All fields]"; and (8) platelet reactivity in depression[All fields]."

Results: After a detailed screening analysis and the application of specific selection criteria, we included in our review a total of 106 for qualitative synthesis. The studies were classified into various subparagraphs according to platelet characteristics analyzed: serotonergic system (5-HT2A receptors, SERT activity, and 5-HT content), adrenergic system, MAO activity, biomarkers of activation, responsivity, morphological changes, and other molecular pathways.

Conclusions: Despite the large amount of the literature examined, nonunivocal and, occasionally, conflicting results emerged. However, the findings on structural and metabolic alterations, modifications in the expression of specific proteins, changes in the aggregability, or in the responsivity to different pro-activating stimuli, may be suggestive of potential platelet dysfunctions in depressed subjects, which would result in a kind of hyperreactive state. This condition could potentially lead to an increased cardiovascular risk. In line with this hypothesis, we speculated that antidepressant treatments would seem to reduce this hyperreactivity while representing a potential tool for reducing cardiovascular risk in depressed patients and, maybe, in other neuropsychiatric conditions. However, the problem of the specificity of platelet biomarkers is still at issue and would deserve to be deepened in future studies.
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http://dx.doi.org/10.1017/S1092852920001959DOI Listing
October 2020

The complex interactions among serotonin, insulin, leptin, and glycolipid metabolic parameters in human obesity.

CNS Spectr 2020 Sep 14:1-10. Epub 2020 Sep 14.

Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy.

Objective: To provide evidence to the link between serotonin (5-HT), energy metabolism, and the human obese phenotype, the present study investigated the binding and function of the platelet 5-HT transporter (SERT), in relation to circulating insulin, leptin, and glycolipid metabolic parameters.

Methods: Seventy-four drug-free subjects were recruited on the basis of divergent body mass index (BMIs) (16.5-54.8 Kg/m2). All subjects were tested for their blood glycolipid profile together with platelet [3H]-paroxetine ([3H]-Par) binding and [3H]-5-HT reuptake measurements from April 1st to June 30th, 2019.

Results: The [3H]-Par Bmax (fmol/mg proteins) was progressively reduced with increasing BMIs (P < .001), without changes in affinity. Moreover, Bmax was negatively correlated with BMI, waist/hip circumferences (W/HC), triglycerides (TD), glucose, insulin, and leptin, while positively with high-density lipoprotein (HDL) cholesterol (P < .01). The reduction of 5-HT uptake rate (Vmax, pmol/min/109 platelets) among BMI groups was not statistically significant, but Vmax negatively correlated with leptin and uptake affinity values (P < .05). Besides, [3H]-Par affinity values positively correlated with glycemia and TD, while [3H]-5-HT reuptake affinity with glycemia only (P < .05). Finally, these correlations were specific of obese subjects, while, from multiple linear-regression analysis conducted on all subjects, insulin (P = .006) resulting negatively related to Bmax independently from BMI.

Conclusions: Present findings suggest the presence of a possible alteration of insulin/5-HT/leptin axis in obesity, differentially impinging the density, function, and/or affinity of the platelet SERT, as a result of complex appetite/reward-related interactions between the brain, gut, pancreatic islets, and adipose tissue. Furthermore, they support the foremost cooperation of peptides and 5-HT in maintaining energy homeostasis.
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http://dx.doi.org/10.1017/S1092852920001820DOI Listing
September 2020

Can intravenous oxytocin infusion counteract hyperinflammation in COVID-19 infected patients?

World J Biol Psychiatry 2021 06 11;22(5):387-398. Epub 2020 Sep 11.

Department of Animal Environment and Health, Swedish University of Agricultural Sciences, Skara, Sweden.

Objectives: Based on its well-documented anti-inflammatory and restorative properties we propose trials with the natural hormone oxytocin for treatment of hospitalised Covid-19 patients.

Methods: We searched for, retrieved, and commented on specific literature regarding multiple functions of oxytocin with a special focus on its modulation of inflammatory, immune, and restorative functions.

Results: Available data gathered in animals and humans support the anti-inflammatory properties of oxytocin. The multiple anti-inflammatory effects of oxytocin have been demonstrated in vitro and in vivo in various animal models and also in humans in response to intravenous infusion of oxytocin. Furthermore, oxytocin has been documented to activate several types of protective and restorative mechanisms and to exert positive effects on the immune system.

Conclusions: In addition, to being anti-inflammatory, it may be hypothesised, that oxytocin may be less suppressive on adaptive immune systems, as compared with glucocorticoids. Finally, by its restorative effects coupled with its anti-stress and healing properties, oxytocin may shorten the recovery period of the Covid-19 patients.
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http://dx.doi.org/10.1080/15622975.2020.1814408DOI Listing
June 2021

Randomized comparison of W.A.R.A. (Wiring Affect with ReAttach) versus distraction: A pilot study assessing the efficacy of an ultrafast transdiagnostic intervention.

Heliyon 2020 Aug 9;6(8):e04660. Epub 2020 Aug 9.

Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.

Background: Generally, neuropsychiatric patients share different symptoms across nosological categories, such as, amongst other, psychological distress, mood alterations, anxiety, and self-regulation disturbances.ReAttach is a novel psychological intervention with its key elements being external affect and arousal regulation, stimulation of multiple sensory processing, conceptualization, affective mentalization, and associative memory processing. ReAttach has been hypothesized to be effective in reducing symptom severity in different psychiatric conditions. Given the limited information currently available, the present study aimed to investigate the effect of main ReAttach elements called "Wiring Affect with ReAttach" (W.A.R.A.) on negative affect (N.A.), and to compare it with "Distraction," another well-established affect-regulating strategy.

Methods: We used a single-blind, randomized controlled crossover equivalence design to compare the efficacy on N.A. regulation of W.A.R.A. versus Distraction in 101 patients with different neuropsychiatric disorders.

Results: The results showed a significant difference (p < 0.001) in response to W.A.R.A. vs. Distraction, with W.A.R.A. being significantly more effective in regulating N.A., with a large effect size (dRMpooled = 2.38) and a high probability (95%) of success.

Limitations: The heterogeneity of the study population makes generalization and clear recommendations for specific patient groups difficult. The Numeric Rating Scale might have prevented detection of increased N.A. when the baseline scores were high. More in-depth research is needed to explore the W.A.R.A. technique and the extent of confounding variables such as the placebo effect.

Conclusions: The findings suggest that W.A.R.A. may be an effective, accessible, and brief intervention reducing negative affect. Although premature, these first results are encouraging.
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http://dx.doi.org/10.1016/j.heliyon.2020.e04660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419587PMC
August 2020

Sexual response in obsessive-compulsive disorder: the role of obsessive beliefs.

CNS Spectr 2020 Jul 15:1-10. Epub 2020 Jul 15.

Department of Health Sciences, University of Florence, Florence, Italy.

Background.: Sexual response in obsessive-compulsive disorder (OCD) research and practice is overlooked. According to the Dual Control Model, satisfactory sexual response is based upon a balance of sexual excitation and inhibition. The assessment of sexual response in OCD may have clinical implications, such as the integration of sex therapy in psychotherapeutic intervention. The present study was aimed at comparing sexual excitation and inhibition levels between OCD patients and matched control subjects, and investigating whether obsessive beliefs might predict sexual excitation/inhibition.

Methods.: Seventy-two OCD patients (mean age ± standard deviation [SD]: 34.50 ± 10.39 years) and 72 matched control subjects (mean age ± SD: 34.25 ± 10.18) were included (62.50% men and 37.50% women in both groups). The Obsessive Compulsive Inventory-Revised (OCI-R), the Obsessive Beliefs Questionnaire-46 (OBQ-46), and the Sexual Inhibition/Sexual Excitation Scales (SIS/SES) were administered.

Results.: Patients with OCD showed significantly higher levels of sexual excitation, inhibition due to threat of performance failure, and inhibition due to threat of performance consequences than the controls. In addition, the patients with more severe symptoms showed lower excitation than those with less severe symptoms, and those with higher perfectionism had stronger inhibition due to threat of performance failure than those with lower perfectionism.

Conclusions.: This is the first study exploring sexual response in OCD according to the Dual Control Model. Sexual response is an impaired quality of life outcome in OCD that should be assessed in routine clinical practice. These findings support the importance of addressing specific obsessive beliefs to improve sexuality in OCD patients.
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http://dx.doi.org/10.1017/S1092852920001649DOI Listing
July 2020

Negative Air Ions in Neuropsychiatric Disorders.

Curr Med Chem 2021 ;28(13):2521-2539

Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy.

Background: Air ions (AIs) are clusters of ionized particles present in the atmosphere, carrying an electrical charge of negative or positive polarity. Past speculations suggested that exposure to positive air ions may be harmful, while exposure to negative air ions (NAIs) may be associated with beneficial health effects. Increasing attention has been directed towards investigating the potential effect of NAIs on human brain activities since initial observations of their beneficial effects on some cognitive processes and mood.

Aims: Given the paucity and scattered literature, our paper aims to review the available studies on potential positive effects of NAIs exposure on cognitive performances and depression.

Discussion: The review of the literature seems to confirm the effects of NAIs on several brain functions. Indeed, a significant association between NAIs exposure and both well-being and high cognitive performances has been described. Furthermore, exposure to high concentrations of NAIs could be related to the improvement of depressive symptoms.

Conclusion: A growing evidence of data, although not yet conclusive, would suggest that NAIs might improve cognitive processes. These findings require specific and urgent controlled trials adopting systems based on AIs release to possibly prevent and treat cognitive dysfunctions present in a broad range of neuropsychiatric conditions.
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http://dx.doi.org/10.2174/0929867327666200630104550DOI Listing
June 2021

What is the impact of pharmacotherapy on psychotherapy for obsessive-compulsive disorder?

Expert Opin Pharmacother 2020 10 16;21(14):1651-1654. Epub 2020 Jun 16.

Department of Biotechnology, Chemistry and Pharmacy, University of Siena , Siena, Italy.

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http://dx.doi.org/10.1080/14656566.2020.1775814DOI Listing
October 2020
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