BACKGROUND Following the development of the coronavirus disease-2019(COVID-19)pandemic in Italy,a strict lockdown was imposed from March 9 to May 5,2020.The risks of self-medication through alcohol or psychoactive sub...BACKGROUND Following the development of the coronavirus disease-2019(COVID-19)pandemic in Italy,a strict lockdown was imposed from March 9 to May 5,2020.The risks of self-medication through alcohol or psychoactive substance abuse were increased,as well as the tendency to adopt pathological behaviors,such as gambling and internet addiction.AIM To evaluate the impact of the COVID-19 pandemic and associated containment measures on craving in a group of patients suffering from substance use disorder and/or gambling disorder who were in treatment in outpatient units or in residency programs as inpatients.METHODS One hundred and fifty-three patients completed a structured questionnaire evaluating craving and other behaviors using a visual analogue scale(VAS).Forty-one subjects completed a pencil and paper questionnaire during the interview.The clinician provided an online questionnaire to 112 patients who had virtual assessments due to lockdown restrictions.Statistical analyses were performed using Statistica version 8.0.Quantitative parameters are presented as the mean±SD and qualitative parameters as number and percentage per class.The Kolmogorov-Smirnov test was used to check for normality of distributions.Analysis of variance and Duncan post hoc test were employed to analyze differences among subgroup means.The associations between variables were measured using Pearson's correlation.A P value of<0.05 was considered significant.RESULTS The variation in craving between the present and the month before showed VASrelated reductions of craving in 57%,increases in 24%,and no significant change in 19%of the sample.The level of craving was significantly higher(F=4.36;P<0.05)in outpatients(n=97;mean=3.8±3.1)living in their own home during the quarantine compared with inpatients(n=56;mean=2.8±2.8)in residential programs.Craving for tetrahydrocannabinol was the greatest(4.94,P<0.001)among various preferred substances.CONCLUSION The unexpected result of this study may be explained by a perceived lack of availability of substances and gambling areas and/or decreased social pressure on a subject usually excluded and stigmatized,or the acquisition of a new social identity based on feelings of a shared common danger and fate that overshadowed the sense of exclusion and rejection in the abuser.展开更多
BACKGROUND Nowadays there is an increasing use of transcranial magnetic stimulation(TMS)both in neurological and psychiatric fields.After Food and Drug Administration approval of TMS for the therapy of treatment-resis...BACKGROUND Nowadays there is an increasing use of transcranial magnetic stimulation(TMS)both in neurological and psychiatric fields.After Food and Drug Administration approval of TMS for the therapy of treatment-resistant depression,TMS has been widely used in the context of mood disorders(MD).However,growing reports regarding the possibility of developing hypomanic/manic switch(HMS)have generated concern regarding its use in MDs.AIM To investigate the actual risk of developing HMS due to TMS in the treatment of MD.METHODS We led our research on PubMed,Scopus and Web of Science on March 22,2020,in accordance to the PRISMA guidelines for systematic review.Only double blind/single blind studies,written in English and focused on the TMS treatment of MD,were included.A meta-analysis of repetitive TMS protocol studies including HMS was conducted using RevMan 5.4 software.The assessment of Risk of Bias was done using Cochrane risk of bias tool.This protocol was registered on PROSPERO with the CRD42020175811 code.RESULTS Twenty-five studies were included in our meta-analysis:Twenty-one double blind randomized controlled trials(RCT)and four single blind-RCT(no.of subjects involved in active stimulation=576;no.of subjects involved in sham protocol=487).The most frequently treated pathology was major depressive episode/major depressive disorder,followed by resistant depression,bipolar depression and other MD.The majority of the studies used a repetitive TMS protocol,and the left dorsolateral prefrontal cortex was the main target area.Side effects were reported in eight studies and HMS(described as greater energy,insomnia,irritability,anxiety,suicidal attempt)in four studies.When comparing active TMS vs sham treatment,the risk of developing HMS was not significantly different between conditions.CONCLUSION Applying the most usual protocols and the appropriate precautionary measures,TMS seems not to be related to HMS development.展开更多
Anhedonia can be defined as a condition in which the hedonic capacity is totally or partially lost. From a psychobiological perspective, several researchers proposed that anhedonia has a putative neural substrate, the...Anhedonia can be defined as a condition in which the hedonic capacity is totally or partially lost. From a psychobiological perspective, several researchers proposed that anhedonia has a putative neural substrate, the dopaminergic mesolimbic and mesocortical reward circuit, which involves the ventral tegmental area, the ventral striatum and part of the prefrontal cortex. Anhedonia is, besides depressed mood, one of the two core symptoms of depression;furthermore it is one of the most important negative symptom in schizophrenia. Anhedonia is also present in substance use disorders as part of the abstinence symptomatology, and interrelations between hedonic capability, craving and protracted withdrawal have been found, particularly in opiate-dependent subjects. Although anhedonia is regarded as an important symptom in psychopathology, so far it has received relatively little attention. In general, two main approaches have been utilized to investigate and assess anhedonia or hedonic capacity: laboratory-based measures and questionnaires. Among measurement scales, the most commonly used are the Snaith-Hamilton Pleasure Scale (SHAPS), the Fawcett-Clark Pleasure Scale (FCPS), and the Revised Chapman Physical Anhedonia Scale (CPAS). Nevertheless, other measurement scales, particularly used within broader psychopathological dimensions, are the Anhedonia-Asociality subscale (SANSanh) of the Scale for the Assessment of Negative Symptoms (SANS) and the Bech-Rafaelsen Melancholia Scale (BRMS). In this paper we analyze these different scales, individuating their strengths and limits and their current clinical applications.展开更多
文摘BACKGROUND Following the development of the coronavirus disease-2019(COVID-19)pandemic in Italy,a strict lockdown was imposed from March 9 to May 5,2020.The risks of self-medication through alcohol or psychoactive substance abuse were increased,as well as the tendency to adopt pathological behaviors,such as gambling and internet addiction.AIM To evaluate the impact of the COVID-19 pandemic and associated containment measures on craving in a group of patients suffering from substance use disorder and/or gambling disorder who were in treatment in outpatient units or in residency programs as inpatients.METHODS One hundred and fifty-three patients completed a structured questionnaire evaluating craving and other behaviors using a visual analogue scale(VAS).Forty-one subjects completed a pencil and paper questionnaire during the interview.The clinician provided an online questionnaire to 112 patients who had virtual assessments due to lockdown restrictions.Statistical analyses were performed using Statistica version 8.0.Quantitative parameters are presented as the mean±SD and qualitative parameters as number and percentage per class.The Kolmogorov-Smirnov test was used to check for normality of distributions.Analysis of variance and Duncan post hoc test were employed to analyze differences among subgroup means.The associations between variables were measured using Pearson's correlation.A P value of<0.05 was considered significant.RESULTS The variation in craving between the present and the month before showed VASrelated reductions of craving in 57%,increases in 24%,and no significant change in 19%of the sample.The level of craving was significantly higher(F=4.36;P<0.05)in outpatients(n=97;mean=3.8±3.1)living in their own home during the quarantine compared with inpatients(n=56;mean=2.8±2.8)in residential programs.Craving for tetrahydrocannabinol was the greatest(4.94,P<0.001)among various preferred substances.CONCLUSION The unexpected result of this study may be explained by a perceived lack of availability of substances and gambling areas and/or decreased social pressure on a subject usually excluded and stigmatized,or the acquisition of a new social identity based on feelings of a shared common danger and fate that overshadowed the sense of exclusion and rejection in the abuser.
文摘BACKGROUND Nowadays there is an increasing use of transcranial magnetic stimulation(TMS)both in neurological and psychiatric fields.After Food and Drug Administration approval of TMS for the therapy of treatment-resistant depression,TMS has been widely used in the context of mood disorders(MD).However,growing reports regarding the possibility of developing hypomanic/manic switch(HMS)have generated concern regarding its use in MDs.AIM To investigate the actual risk of developing HMS due to TMS in the treatment of MD.METHODS We led our research on PubMed,Scopus and Web of Science on March 22,2020,in accordance to the PRISMA guidelines for systematic review.Only double blind/single blind studies,written in English and focused on the TMS treatment of MD,were included.A meta-analysis of repetitive TMS protocol studies including HMS was conducted using RevMan 5.4 software.The assessment of Risk of Bias was done using Cochrane risk of bias tool.This protocol was registered on PROSPERO with the CRD42020175811 code.RESULTS Twenty-five studies were included in our meta-analysis:Twenty-one double blind randomized controlled trials(RCT)and four single blind-RCT(no.of subjects involved in active stimulation=576;no.of subjects involved in sham protocol=487).The most frequently treated pathology was major depressive episode/major depressive disorder,followed by resistant depression,bipolar depression and other MD.The majority of the studies used a repetitive TMS protocol,and the left dorsolateral prefrontal cortex was the main target area.Side effects were reported in eight studies and HMS(described as greater energy,insomnia,irritability,anxiety,suicidal attempt)in four studies.When comparing active TMS vs sham treatment,the risk of developing HMS was not significantly different between conditions.CONCLUSION Applying the most usual protocols and the appropriate precautionary measures,TMS seems not to be related to HMS development.
文摘Anhedonia can be defined as a condition in which the hedonic capacity is totally or partially lost. From a psychobiological perspective, several researchers proposed that anhedonia has a putative neural substrate, the dopaminergic mesolimbic and mesocortical reward circuit, which involves the ventral tegmental area, the ventral striatum and part of the prefrontal cortex. Anhedonia is, besides depressed mood, one of the two core symptoms of depression;furthermore it is one of the most important negative symptom in schizophrenia. Anhedonia is also present in substance use disorders as part of the abstinence symptomatology, and interrelations between hedonic capability, craving and protracted withdrawal have been found, particularly in opiate-dependent subjects. Although anhedonia is regarded as an important symptom in psychopathology, so far it has received relatively little attention. In general, two main approaches have been utilized to investigate and assess anhedonia or hedonic capacity: laboratory-based measures and questionnaires. Among measurement scales, the most commonly used are the Snaith-Hamilton Pleasure Scale (SHAPS), the Fawcett-Clark Pleasure Scale (FCPS), and the Revised Chapman Physical Anhedonia Scale (CPAS). Nevertheless, other measurement scales, particularly used within broader psychopathological dimensions, are the Anhedonia-Asociality subscale (SANSanh) of the Scale for the Assessment of Negative Symptoms (SANS) and the Bech-Rafaelsen Melancholia Scale (BRMS). In this paper we analyze these different scales, individuating their strengths and limits and their current clinical applications.
