5 results
Serotonin Dysfunction in Pathological Gamblers: Increased Prolactin Response to Oral m-CPP Versus Placebo
- Stefano Pallanti, Silvia Bernardi, Leonardo Quercioli, Concetta DeCaria, Eric Hollander
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- Journal:
- CNS Spectrums / Volume 11 / Issue 12 / December 2006
- Published online by Cambridge University Press:
- 07 November 2014, pp. 956-965
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Objective
Acute administration of the partial serotonin (5-HT) agonist meta-chlorophenylpi-perazine (m-CPP), that is used also as a street drug, has been reported to induce a “high” and craving response in various impulsive and sub-stance addiction disorders.
IntroductionTo 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.
MethodTwenty-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.
ResultsPathological 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.
ConclusionThese 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 path-way that leads to dyscontrolled behavior in patho-logical gamblers. Furthermore, the “high” feeling induced by m-CPP in pathological subjects may represent a marker of vulnerability to both behav-ioral and substance addictions.
The Shorter PROMIS Questionnaire and the Internet Addiction Scale in the Assessment of Multiple Addictions in a High-School Population: Prevalence and Related Disability
- Stefano Pallanti, Silvia Bernardi, Leonardo Quercioli
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- Journal:
- CNS Spectrums / Volume 11 / Issue 12 / December 2006
- Published online by Cambridge University Press:
- 07 November 2014, pp. 966-974
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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.
IntroductionAdolescence 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.
MethodsData 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.
ResultsCaffeine 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.
ConclusionLevel 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.
Shame and Psychopathology
- Stefano Pallanti, Leonardo Quercioli
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- CNS Spectrums / Volume 5 / Issue 8 / August 2000
- Published online by Cambridge University Press:
- 07 November 2014, pp. 28-43
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The origins of the word “shame” recall the concept of the infraction of integrity both as scandal and as individualization. The human experience of shame stretches along a continuum from modesty to disabling interpersonal terror. Unlike other basic affects, its emergence is a fundamental moment in the process of self-awareness and self-object differentiation. Neglected by psychiatry because it was regarded as a moral concept, today it is possible to hypothesize that it has a biologic basis that one can attempt to describe in terms of corticothalamic pathways. In this respect, like other affects, it could be considered as a cognitive shortcut to activate specific and evolutionally useful behavioral patterns, such as concealment or a request for affiliation. It is fairly ubiquitous in psychopathology, but is clinically much more structured in its abnormal expressions in anxiety disorders, particularly social phobia, obsessive-compulsive disorder, eating disorders, body dysmorphic disorder, and even in bipolar mood disorder. In schizophrenia it has been described as being one stage in the construction of delusion. Its presence is connected to interpersonal relationship (altruism) though it seems absent in autism. The assessment of shame experiences in psychiatric patients could be useful for both pharmacological and psychotherapeutic strategies, and could provide a categorization of a new psychopathology based on abnormal affects.
Social Anxiety and Premorbid Personality Disorders in Paranoid Schizophrenic Patients Treated With Clozapine
- Stefano Pallanti, Leonardo Quercioli, Adolfo Pazzagli
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- Journal:
- CNS Spectrums / Volume 5 / Issue 9 / September 2000
- Published online by Cambridge University Press:
- 07 November 2014, pp. 29-43
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The concept of anxiety as a distinct comorbid disorder in schizophrenia has recently been rediscovered after having been neglected for a long period of time due to both theoretical and clinical approaches adopted from the appearance of the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1950. This rediscovery was accentuated by the fact that the concept of comorbidity in various psychiatric disorders has recently won widespread favor within the scientific community, and that the use of atypical neuroleptic medication to treat patients with schizophrenia has been reported to lead to the emergence of anxiety symptoms. Of the atypical neuroleptic medications used to treat schizophrenia, clozapine has most frequently been reported to induce anxiety symptoms. In this paper, 12 cases of patients with paranoid schizophrenia who developed social phobia during clozapine treatment are reported, and their response to fluoxetine augmentation is assessed. Premorbid personality disorders were also investigated; patients were assessed using the Structured Clinical Interview for DSM-III-R—Patient Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (DSM-III-R=Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). In addition, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Liebowitz Social Anxiety Scale (LSAS), the Frankfurt Beschwerde Fragebogen (Frankfurt Questionnaire of Complaints), and the Brief Psychiatric Rating Scale were used to rate clinical symptomatology. All patients were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. In 8 (66.6%) of the 12 cases, symptoms responded (≥35% LSAS score reduction) to an adjunctive regimen of fluoxetine. Furthermore, in 7 (58.3%) of the 12 cases, an anxious personality disorder (avoidant=33.3%; dependent=25%) was identified, but no significant differences in the prevalence of comorbid personality disorders emerged in comparison with a group of 16 patients with paranoid schizophrenia treated with clozapine who did not show symptoms of social phobia. The clinical relevance of the assessment and treatment of anxiety disorders is discussed in light of a clinical therapeutic approach that overcomes the implicit hierarchy of classification. Considering that the onset of anxiety-spectrum disorders (such as social phobia) can occur during the remission of psychotic symptoms in clozapine-treated patients with schizophrenia, a comprehensive approach to pharmacological therapy for patients with schizophrenia (or, at least for those treated with clozapine) should be adopted.
rTMS age-dependent response in treatment-resistant depressed subjects: a mini-review
- Stefano Pallanti, Andrea Cantisani, Giacomo Grassi, Sarah Antonini, Chiara Cecchelli, Jiulia Burian, Gilla Cauli, Leonardo Quercioli
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- Journal:
- CNS Spectrums / Volume 17 / Issue 1 / 26 April 2012
- Published online by Cambridge University Press:
- 26 April 2012, pp. 24-30
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Background
In old age, depressive syndromes often affect people with chronic medical illnesses, cognitive impairment, and disability, which can worsen the outcomes of other medical disorders and promote disability. Repetitive magnetic transcranial stimulation (rTMS) is a simple and effective treatment in patients with treatment-resistant depression. Therefore the use of rTMS could be of particular potential benefit in treatment-resistant elderly patients, who often cannot tolerate the higher doses of drugs needed or show phenomena of intolerance and interaction. However, several studies assessing the efficacy of rTMS found smaller response rates in elderly patients when compared to younger samples. Nevertheless, the correlation between age and response is still a controversial issue, and there is no strong evidence to date. The aim of our study was to retest the effectiveness and safety of low-frequency rTMS in a 3 weeks active treatment in a group of resistant-depressed patients, and to investigate the role of age in the response to stimulation treatment.
MethodsEnrolled in this study were 102 treatment-resistant depressed patients. The patients were treated with low-frequency rTMS over the right dorso-lateral prefrontal cortex (DLPFC) for 3 weeks with a simple protocol (420 pulses per session for 15 sessions). At baseline, at the end of the second week, and at the end of the third week of treatment, the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A) were administered.
ResultsLow-frequency rTMS on the prefrontal dorsolateral right area resulted in a statistically significant reduction of mean HAM-D scores in the entire group of patients at the end of treatment. The responder's rate in the whole group at the end of the third week was 56.86%. A significant inverse relationship between HAM-D reduction and age was found in the “older” (>60 years old) group, not in the “younger” (<60 years old) group.
ConclusionResults from this study show that low-frequency rTMS over the right DLPFC, with a relatively low number of pulses (420 pulses per session) and a relatively short period of treatment, is effective in the treatment of resistant patients (in a sample also including elderly patients) in a 3-weeks treatment protocol with a low reduction with the progress of age. Furthermore, we found a greater response in younger patients and an inverse correlation between age and treatment response. Adaptations of the protocol according to age are reviewed.