Revue d&'apos;Electroencéphalographie et de Neurophysiologie Clinique, 1976
On sait que des tableaux électroencéphalographiques semblables ou superposables à ceux retenus co... more On sait que des tableaux électroencéphalographiques semblables ou superposables à ceux retenus comme quasi pathognomoniques du syndrome de Creutzfeldt-Jakob peuvent etre retrouvés dans certains états pathologiques lésant le cerveau de façon diffuse. Par contre des lésions encéphaliques localisées sont rarement à l'origine de tels aspects électroencéphalographiques (BLANC et al., 1962 ; GACHES et al., 1971). L' observation rapportée en constitue un nouvel exemple.
MedNet (Mediterranean Network) is a network of very broad band seismic stations installed in coun... more MedNet (Mediterranean Network) is a network of very broad band seismic stations installed in countries surrounding the Mediterranean Sea. The project started in 1987, with the aim of providing high quality real-time data to the comprehension of one of the most active seismic regions of the World. Its main objectives were mapping the structure of the Mediterranean region, studying the
Sleep state misperception (SSM) is a term used in the International Classification of Sleep Disor... more Sleep state misperception (SSM) is a term used in the International Classification of Sleep Disorders to indicate people who mistakenly perceive their sleep as wakefulness. SSM is a form of primary insomnia. The aim of this study was to record psychological functioning measures (anxiety, depression, ability to feel pleasure, obsessive-compulsive traits) in a population of patients with primary insomnia and to evaluate the relationship between these measures and the patients' perception of their sleep. Seventy-six consecutive patients with primary insomnia were enrolled: 34 men and 42 women, mean age 53.9 ± 13.1. Sleep study included the following: Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Berlin's Questionnaire and home-based polysomnography. Psychometric evaluation included the following: Self-Administered Anxiety Scale, Beck's Depression Inventory, Maudsley's Obsessive Compulsive Inventory, Snaith-Hamilton Pleasure Scale, Eating Attitude Test. All patients with insomnia had psychometric scores higher than the general population, but very few patients, in both groups, had anxiety or depression scores consistent with severe mood or anxiety disorders. Comparisons between subjective and objective scores confirmed that most sleep parameters were underestimated. Patients with SSM had lower anxiety scores as compared to patients without SSM. The study did not succeed in identifying any predictor of sleep misperception. We speculate that a group of patients, rather than being extremely worried by their insomnia, may have a sort of agnosia of their sleep.
Objective: A high prevalence of sleep disorders is reported in patients affected by Mucopolysacch... more Objective: A high prevalence of sleep disorders is reported in patients affected by Mucopolysaccharidosis III (Sanfilippo syndrome). These disorders have never been investigated by prolonged, objective, and instrumental evaluations. The present work is based on sleep duration and structure in Sanfilippo patients. Study design: The features of sleep/wake cycle in 6 Sanfilippo patients and 6 healthy controls were evaluated by means of sleep diaries and 48 hour ambulatory EEG and polygraphic recordings. Statistical analysis was performed by means of the U-test (Mann-Whitney). Results: Four out of six Sanfilippo patients, the oldest patients in our sample, showed an extremely irregular sleep pattern, with several sleep episodes of inconstant duration, irregularly distributed along 24 hours. The two younger patients showed sleep maintenance insomnia with several nocturnal awakenings. Conclusions: These results suggest that sleep disruption in Sanfilippo syndrome consists of an irregular ...
OBJECTIVES:In the evaluation of the biological basis of psychotherapeutic changes many researches... more OBJECTIVES:In the evaluation of the biological basis of psychotherapeutic changes many researches have noticed potential effects of psychotherapeutic interventions on the neural correlates of mental illness. In a psychotherapeutic setting, modifications in individual thoughts and feelings can restore brain functioning at physiological levels. This paper gives an overview about neurobiological methods and their potential to support psychotherapy research and to examine psychotherapy effects across a number of psychiatric disorders. METHODS: Relevant informations are identified through searches of MEDLINE and Current Contents/Clinical Medicine. RESULTS: Studies demonstrate that it is important to consider putative neural mechanisms of psychotherapy, changes in the brain associated with psychotherapy on a global and molecular level, intervention-specific effects and prediction of outcome. Pharmacotherapy and psychotherapy converge in a common change of neuronal functions that might be detected by imaging technique and be detected by imaging techniques and might resemble correlates of clinical improvement.
Conclusions. Neuroimaging techniques applied to psychotherapy
research are relevant for further understanding neurobiological underpinnings
of psychotherapy processes and predicting treatment outcome
in order to improve clinical decision-making and treatment.
Key words: functional magnetic resonance imaging (fMRI), neural
mechanisms, neuroimaging, photon emission computed tomography
(SPECT), positron emission tomography (PET)
Schizophrenia is a brain disease that represents a not rare condition, in fact the lifetime risk ... more Schizophrenia is a brain disease that represents a not rare condition, in fact the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100. Schizophrenia clinically manifests with acute episodes which are associated with hallucinations, delirium, behavioral disorders and a variable range of chronic persistent symptoms, which can be debilitating. The causes of schizophrenia are not clearly understood. It seems that genetic factors may produce a vulnerability to schizophrenia, along with environmental factors that contribute in a different way from individual to individual. In this context schizophrenia constitutes the outcome of a complex interaction between multiple genes and environmental risk factors, none of which on its own causes the disorder itself. Antipsychotic medications represent the first line of psychiatric treatment for schizophrenia. But there is a growing body of evidence that omega-3 fatty acids can prevent the disease or at least mitigate...
The important role of cerebral blood flow (CBF) in Alzheimer disease (AD) has been increasingly r... more The important role of cerebral blood flow (CBF) in Alzheimer disease (AD) has been increasingly recognized in recent years. An abundance of data (The Rotterdam Study, see text) has shown the decline of CBF velocity with transcranial Doppler, confirming earlier data obtained with the xenon133 method. In spite of these data, AD is still considered a neurodegenerative disorder with secondary CBF changes. This work is a critical evaluation of earlier literature because of cogent reasons for the adoption of a new concept of AD as a primary ischemic disorder. Reports of lacking correlation between severity of CBF defi cit and degree of tissue damage or clinical fi ndings serve as evidence for primary ischemia because of the incompatibility with the concept of secondary ischemia.The CBF defi cit is thought to be due to the human upright gait in here dopredisposed individuals. As to therapy and prevention, a very simple, cheap and promising treatment is suggested (head-down-therapy).
Orexin, sleep and appetite regulation: a review Since 1998, two research groups independently rep... more Orexin, sleep and appetite regulation: a review Since 1998, two research groups independently reported the discovery of two novel hypothalamic neuropeptides, called hypocretin-1 and hypocretin-2, respectively many studies have been carried out about their possible functions. One group named these new peptides orexins (A and B) after the Greek word for appetite, since they found that central administration of orexins potently increased food intake in rats. However hypocretins/ orexins are involved in various hypothalamic mechanisms, such as energy homeostasis, neuroendocrine functions, appetite and satiety regulation, vigilance and defence behaviour, sleep and wake regulation. Here is a review of the recent literature, showing some recent discoveries about the link between orexin system, sleep regulation and appetite regulation.
Electroencephalography and Clinical Neurophysiology/Evoked Potentials Section, 1992
Four patients with subacute combined degeneration were studied through upper and lower limb SEPs ... more Four patients with subacute combined degeneration were studied through upper and lower limb SEPs recorded with a non-cephalic reference montage and through cortical and spinal magnetic stimulation. Clinical signs were confined to the lower limbs in 3 patients; the remaining patient presented only paraesthesiae in 4 limbs. Median nerve SEPs showed a normal cervical N13 response with a significant increase of central conduction time concerning exclusively the P9-P14 interpeak interval. Central motor conduction to upper and lower limb muscles was abnormal. Nerve conduction studies provided no evidence of peripheral nerve involvement. These electrophysiological findings suggest that in vitamin B12 deficiency the higher segments of the cervical cord are usually affected first and that central sensory and motor conduction studies are sensitive methods for detecting such damage.
Mood disorders represent the most widespread prevalent and expensive psychiatric disorders. For a... more Mood disorders represent the most widespread prevalent and expensive psychiatric disorders. For a long time, the neuroendocrine system and the distribution of hormones through the brain and their modulatory role and influence in behavior and mood have been studied. The most important changes associated with mood disorders concern the hypothalamic-pituitary-adrenal (HPA), the hypothalamic-pituitary-thyroid (HPT), the hypothalamic-pituitary-GH (HP-GH) and the hypothalamic-pituitary-gonadal (HPGn) axes. The intriguing data obtained from studies focusing on central neuropeptidergic circuits and peripheral hormone systems have been very useful in understanding the pathophysiology of mood disorders, although additional researches are needed to confirm these findings. All these data underline the importance of neuroendocrine dysfunctions in both pathophysiology of mood disorders and in the development of new pharmacotherapies.
Introduction: This study aims to evaluate napping in patients with insomnia compared with two con... more Introduction: This study aims to evaluate napping in patients with insomnia compared with two control groups and to investigate the relationships between psychometric measures and napping habitude. Methods: Sixty-eight adult patients with chronic primary insomnia were enrolled; 27 men and 41 women, mean age 53.6 ± 13. All patients underwent 24 h ambulatory polysomnography (A-PSG). Prevalence of napping behavior in Insomnia Patients (I-group) was compared with Obstructive Sleep Apnea Syndrome (OSAS) patients (OSAS-group) and epilepsy patients (Ep-group). Patients were evaluated with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Berlin Questionnaire. Psychometric evaluation included Self-Administered Anxiety Scale (SAS #54), Beck Depression Inventory (BDI), Maudsley’s Obsessive Compulsive Inventory (MOCI), Snaith-Hamilton Pleasure Scale (SHAPS), and Eating Attitude Test (EAT-26). Results: No significant differences resulted in prevalence and duration of naps in the three groups. In the comparison between nappers (Nþ, subject with at least one nap in A-PSG) and non-nappers (N-, subject with no naps in A-PSG) we observed significant differences in PSQI scores (Nþ¼14.1 ± 2.7; N¼11.9 ± 3.3; Whitney U-test ¼ 341.0; p¼0.004) and in EAT score (Nþ¼ 9.8 ± 9.7; N¼4.4 ± 5.6; Whitney U-test ¼ 313.5, p¼0.0.14); no significant differences were measured in other psychometric parameters and in sleep macrostructural indexes. Conclusions: Our data are in accordance with previous findings outlining that Nþinsomniacs have higher PSQI scores than N-. Our results do not confirm the suggested association between napping and depressive or obsessive-compulsive symptoms. Conversely, we found a statistically significant difference (p¼0.0014) in EAT scores in Nþand N-. Hyperarousal and REM sleep instability in insomniac patients may create an unbalance of the neuroendocrine hypothalamic regulation leading to an appetite alteration.
La comorbidità tra sintomi depressivi, ansiosi ed epilessia è comune e spesso sottodiagnosticata ... more La comorbidità tra sintomi depressivi, ansiosi ed epilessia è comune e spesso sottodiagnosticata (1). Infatti, nella pratica clinica solo un terzo di questi pazienti è individuato e sottoposto a trattamento farmacologico. In particolare le cause dei sintomi depressivi ed ansiosi nei soggetti affetti da epilessia sono probabilmente multifattoriali, in quanto comprendono caratteristiche cliniche (frequenza delle crisi, tipi di crisi e localizzazione dei foci, durata dell'epilessia, età d'insorgenza) e fattori psicosociali (qualità della vita, eventi stressanti, tipo d'impiego, stato sociale) (2). Sicuramente questi fattori non bastano a spiegare l'elevata prevalenza di depressione nei pazienti epilettici, soprattutto dal momento che i sintomi depressivi ricorrono nei casi d'epilessia con maggiore frequenza e severità che in tutte le altre patologie neurologiche o condizioni mediche a decorso cronico (3) e la prevalenza di depressione è decisamente più elevata nei soggetti affetti da epilessia rispetto alla popolazione generale (dal 2% al 9% per quanto riguarda la popolazione femminile e dall'1% al 3% per quanto riguarda la popolazione maschile) (4). La presenza di depressione o sintomi depressivi è stata riportata nel 30% dei soggetti con epilessia, sia in fase peri-ictale che in fase inter-ictale. Il sesso maschile è più colpito, anche se la letteratura non ha ancora raggiunto risultati concordi a tale proposito (5, 6). Anche gli studi riguardanti la familiarità per disturbi psichici in pazienti epilettici non sono privi di pareri dissonanti (6, 7). Altri disturbi psichici che si manifestano negli epilettici sono i disturbi ansiosi, diversi disturbi di personalità, episodi maniacali, disturbi schizoaffettivi (8, 9, 10). Il rischio suicidario risulta in questi pazienti evidentemente elevato: intorno al 5% rispetto al 1,4% della popolazione generale (11). La letteratura riguardante modelli animali di epilessia ha mostrato che una diminuita attività di neurotrasmettitori cerebrali ed in particolare serotonina, norepinefrina, dopamina e GABA favorisce il processo di kindling dei foci epilettici, oltre ad aumentare la severità e la ricorrenza delle crisi
Revue d&'apos;Electroencéphalographie et de Neurophysiologie Clinique, 1976
On sait que des tableaux électroencéphalographiques semblables ou superposables à ceux retenus co... more On sait que des tableaux électroencéphalographiques semblables ou superposables à ceux retenus comme quasi pathognomoniques du syndrome de Creutzfeldt-Jakob peuvent etre retrouvés dans certains états pathologiques lésant le cerveau de façon diffuse. Par contre des lésions encéphaliques localisées sont rarement à l'origine de tels aspects électroencéphalographiques (BLANC et al., 1962 ; GACHES et al., 1971). L' observation rapportée en constitue un nouvel exemple.
MedNet (Mediterranean Network) is a network of very broad band seismic stations installed in coun... more MedNet (Mediterranean Network) is a network of very broad band seismic stations installed in countries surrounding the Mediterranean Sea. The project started in 1987, with the aim of providing high quality real-time data to the comprehension of one of the most active seismic regions of the World. Its main objectives were mapping the structure of the Mediterranean region, studying the
Sleep state misperception (SSM) is a term used in the International Classification of Sleep Disor... more Sleep state misperception (SSM) is a term used in the International Classification of Sleep Disorders to indicate people who mistakenly perceive their sleep as wakefulness. SSM is a form of primary insomnia. The aim of this study was to record psychological functioning measures (anxiety, depression, ability to feel pleasure, obsessive-compulsive traits) in a population of patients with primary insomnia and to evaluate the relationship between these measures and the patients' perception of their sleep. Seventy-six consecutive patients with primary insomnia were enrolled: 34 men and 42 women, mean age 53.9 ± 13.1. Sleep study included the following: Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Berlin's Questionnaire and home-based polysomnography. Psychometric evaluation included the following: Self-Administered Anxiety Scale, Beck's Depression Inventory, Maudsley's Obsessive Compulsive Inventory, Snaith-Hamilton Pleasure Scale, Eating Attitude Test. All patients with insomnia had psychometric scores higher than the general population, but very few patients, in both groups, had anxiety or depression scores consistent with severe mood or anxiety disorders. Comparisons between subjective and objective scores confirmed that most sleep parameters were underestimated. Patients with SSM had lower anxiety scores as compared to patients without SSM. The study did not succeed in identifying any predictor of sleep misperception. We speculate that a group of patients, rather than being extremely worried by their insomnia, may have a sort of agnosia of their sleep.
Objective: A high prevalence of sleep disorders is reported in patients affected by Mucopolysacch... more Objective: A high prevalence of sleep disorders is reported in patients affected by Mucopolysaccharidosis III (Sanfilippo syndrome). These disorders have never been investigated by prolonged, objective, and instrumental evaluations. The present work is based on sleep duration and structure in Sanfilippo patients. Study design: The features of sleep/wake cycle in 6 Sanfilippo patients and 6 healthy controls were evaluated by means of sleep diaries and 48 hour ambulatory EEG and polygraphic recordings. Statistical analysis was performed by means of the U-test (Mann-Whitney). Results: Four out of six Sanfilippo patients, the oldest patients in our sample, showed an extremely irregular sleep pattern, with several sleep episodes of inconstant duration, irregularly distributed along 24 hours. The two younger patients showed sleep maintenance insomnia with several nocturnal awakenings. Conclusions: These results suggest that sleep disruption in Sanfilippo syndrome consists of an irregular ...
OBJECTIVES:In the evaluation of the biological basis of psychotherapeutic changes many researches... more OBJECTIVES:In the evaluation of the biological basis of psychotherapeutic changes many researches have noticed potential effects of psychotherapeutic interventions on the neural correlates of mental illness. In a psychotherapeutic setting, modifications in individual thoughts and feelings can restore brain functioning at physiological levels. This paper gives an overview about neurobiological methods and their potential to support psychotherapy research and to examine psychotherapy effects across a number of psychiatric disorders. METHODS: Relevant informations are identified through searches of MEDLINE and Current Contents/Clinical Medicine. RESULTS: Studies demonstrate that it is important to consider putative neural mechanisms of psychotherapy, changes in the brain associated with psychotherapy on a global and molecular level, intervention-specific effects and prediction of outcome. Pharmacotherapy and psychotherapy converge in a common change of neuronal functions that might be detected by imaging technique and be detected by imaging techniques and might resemble correlates of clinical improvement.
Conclusions. Neuroimaging techniques applied to psychotherapy
research are relevant for further understanding neurobiological underpinnings
of psychotherapy processes and predicting treatment outcome
in order to improve clinical decision-making and treatment.
Key words: functional magnetic resonance imaging (fMRI), neural
mechanisms, neuroimaging, photon emission computed tomography
(SPECT), positron emission tomography (PET)
Schizophrenia is a brain disease that represents a not rare condition, in fact the lifetime risk ... more Schizophrenia is a brain disease that represents a not rare condition, in fact the lifetime risk of developing schizophrenia is widely accepted to be around 1 in 100. Schizophrenia clinically manifests with acute episodes which are associated with hallucinations, delirium, behavioral disorders and a variable range of chronic persistent symptoms, which can be debilitating. The causes of schizophrenia are not clearly understood. It seems that genetic factors may produce a vulnerability to schizophrenia, along with environmental factors that contribute in a different way from individual to individual. In this context schizophrenia constitutes the outcome of a complex interaction between multiple genes and environmental risk factors, none of which on its own causes the disorder itself. Antipsychotic medications represent the first line of psychiatric treatment for schizophrenia. But there is a growing body of evidence that omega-3 fatty acids can prevent the disease or at least mitigate...
The important role of cerebral blood flow (CBF) in Alzheimer disease (AD) has been increasingly r... more The important role of cerebral blood flow (CBF) in Alzheimer disease (AD) has been increasingly recognized in recent years. An abundance of data (The Rotterdam Study, see text) has shown the decline of CBF velocity with transcranial Doppler, confirming earlier data obtained with the xenon133 method. In spite of these data, AD is still considered a neurodegenerative disorder with secondary CBF changes. This work is a critical evaluation of earlier literature because of cogent reasons for the adoption of a new concept of AD as a primary ischemic disorder. Reports of lacking correlation between severity of CBF defi cit and degree of tissue damage or clinical fi ndings serve as evidence for primary ischemia because of the incompatibility with the concept of secondary ischemia.The CBF defi cit is thought to be due to the human upright gait in here dopredisposed individuals. As to therapy and prevention, a very simple, cheap and promising treatment is suggested (head-down-therapy).
Orexin, sleep and appetite regulation: a review Since 1998, two research groups independently rep... more Orexin, sleep and appetite regulation: a review Since 1998, two research groups independently reported the discovery of two novel hypothalamic neuropeptides, called hypocretin-1 and hypocretin-2, respectively many studies have been carried out about their possible functions. One group named these new peptides orexins (A and B) after the Greek word for appetite, since they found that central administration of orexins potently increased food intake in rats. However hypocretins/ orexins are involved in various hypothalamic mechanisms, such as energy homeostasis, neuroendocrine functions, appetite and satiety regulation, vigilance and defence behaviour, sleep and wake regulation. Here is a review of the recent literature, showing some recent discoveries about the link between orexin system, sleep regulation and appetite regulation.
Electroencephalography and Clinical Neurophysiology/Evoked Potentials Section, 1992
Four patients with subacute combined degeneration were studied through upper and lower limb SEPs ... more Four patients with subacute combined degeneration were studied through upper and lower limb SEPs recorded with a non-cephalic reference montage and through cortical and spinal magnetic stimulation. Clinical signs were confined to the lower limbs in 3 patients; the remaining patient presented only paraesthesiae in 4 limbs. Median nerve SEPs showed a normal cervical N13 response with a significant increase of central conduction time concerning exclusively the P9-P14 interpeak interval. Central motor conduction to upper and lower limb muscles was abnormal. Nerve conduction studies provided no evidence of peripheral nerve involvement. These electrophysiological findings suggest that in vitamin B12 deficiency the higher segments of the cervical cord are usually affected first and that central sensory and motor conduction studies are sensitive methods for detecting such damage.
Mood disorders represent the most widespread prevalent and expensive psychiatric disorders. For a... more Mood disorders represent the most widespread prevalent and expensive psychiatric disorders. For a long time, the neuroendocrine system and the distribution of hormones through the brain and their modulatory role and influence in behavior and mood have been studied. The most important changes associated with mood disorders concern the hypothalamic-pituitary-adrenal (HPA), the hypothalamic-pituitary-thyroid (HPT), the hypothalamic-pituitary-GH (HP-GH) and the hypothalamic-pituitary-gonadal (HPGn) axes. The intriguing data obtained from studies focusing on central neuropeptidergic circuits and peripheral hormone systems have been very useful in understanding the pathophysiology of mood disorders, although additional researches are needed to confirm these findings. All these data underline the importance of neuroendocrine dysfunctions in both pathophysiology of mood disorders and in the development of new pharmacotherapies.
Introduction: This study aims to evaluate napping in patients with insomnia compared with two con... more Introduction: This study aims to evaluate napping in patients with insomnia compared with two control groups and to investigate the relationships between psychometric measures and napping habitude. Methods: Sixty-eight adult patients with chronic primary insomnia were enrolled; 27 men and 41 women, mean age 53.6 ± 13. All patients underwent 24 h ambulatory polysomnography (A-PSG). Prevalence of napping behavior in Insomnia Patients (I-group) was compared with Obstructive Sleep Apnea Syndrome (OSAS) patients (OSAS-group) and epilepsy patients (Ep-group). Patients were evaluated with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Berlin Questionnaire. Psychometric evaluation included Self-Administered Anxiety Scale (SAS #54), Beck Depression Inventory (BDI), Maudsley’s Obsessive Compulsive Inventory (MOCI), Snaith-Hamilton Pleasure Scale (SHAPS), and Eating Attitude Test (EAT-26). Results: No significant differences resulted in prevalence and duration of naps in the three groups. In the comparison between nappers (Nþ, subject with at least one nap in A-PSG) and non-nappers (N-, subject with no naps in A-PSG) we observed significant differences in PSQI scores (Nþ¼14.1 ± 2.7; N¼11.9 ± 3.3; Whitney U-test ¼ 341.0; p¼0.004) and in EAT score (Nþ¼ 9.8 ± 9.7; N¼4.4 ± 5.6; Whitney U-test ¼ 313.5, p¼0.0.14); no significant differences were measured in other psychometric parameters and in sleep macrostructural indexes. Conclusions: Our data are in accordance with previous findings outlining that Nþinsomniacs have higher PSQI scores than N-. Our results do not confirm the suggested association between napping and depressive or obsessive-compulsive symptoms. Conversely, we found a statistically significant difference (p¼0.0014) in EAT scores in Nþand N-. Hyperarousal and REM sleep instability in insomniac patients may create an unbalance of the neuroendocrine hypothalamic regulation leading to an appetite alteration.
La comorbidità tra sintomi depressivi, ansiosi ed epilessia è comune e spesso sottodiagnosticata ... more La comorbidità tra sintomi depressivi, ansiosi ed epilessia è comune e spesso sottodiagnosticata (1). Infatti, nella pratica clinica solo un terzo di questi pazienti è individuato e sottoposto a trattamento farmacologico. In particolare le cause dei sintomi depressivi ed ansiosi nei soggetti affetti da epilessia sono probabilmente multifattoriali, in quanto comprendono caratteristiche cliniche (frequenza delle crisi, tipi di crisi e localizzazione dei foci, durata dell'epilessia, età d'insorgenza) e fattori psicosociali (qualità della vita, eventi stressanti, tipo d'impiego, stato sociale) (2). Sicuramente questi fattori non bastano a spiegare l'elevata prevalenza di depressione nei pazienti epilettici, soprattutto dal momento che i sintomi depressivi ricorrono nei casi d'epilessia con maggiore frequenza e severità che in tutte le altre patologie neurologiche o condizioni mediche a decorso cronico (3) e la prevalenza di depressione è decisamente più elevata nei soggetti affetti da epilessia rispetto alla popolazione generale (dal 2% al 9% per quanto riguarda la popolazione femminile e dall'1% al 3% per quanto riguarda la popolazione maschile) (4). La presenza di depressione o sintomi depressivi è stata riportata nel 30% dei soggetti con epilessia, sia in fase peri-ictale che in fase inter-ictale. Il sesso maschile è più colpito, anche se la letteratura non ha ancora raggiunto risultati concordi a tale proposito (5, 6). Anche gli studi riguardanti la familiarità per disturbi psichici in pazienti epilettici non sono privi di pareri dissonanti (6, 7). Altri disturbi psichici che si manifestano negli epilettici sono i disturbi ansiosi, diversi disturbi di personalità, episodi maniacali, disturbi schizoaffettivi (8, 9, 10). Il rischio suicidario risulta in questi pazienti evidentemente elevato: intorno al 5% rispetto al 1,4% della popolazione generale (11). La letteratura riguardante modelli animali di epilessia ha mostrato che una diminuita attività di neurotrasmettitori cerebrali ed in particolare serotonina, norepinefrina, dopamina e GABA favorisce il processo di kindling dei foci epilettici, oltre ad aumentare la severità e la ricorrenza delle crisi
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Papers by Salvatore Mazza
Conclusions. Neuroimaging techniques applied to psychotherapy
research are relevant for further understanding neurobiological underpinnings
of psychotherapy processes and predicting treatment outcome
in order to improve clinical decision-making and treatment.
Key words: functional magnetic resonance imaging (fMRI), neural
mechanisms, neuroimaging, photon emission computed tomography
(SPECT), positron emission tomography (PET)
groups and to investigate the relationships between psychometric measures and napping habitude.
Methods: Sixty-eight adult patients with chronic primary insomnia were enrolled; 27 men and 41
women, mean age 53.6 ± 13. All patients underwent 24 h ambulatory polysomnography (A-PSG).
Prevalence of napping behavior in Insomnia Patients (I-group) was compared with Obstructive Sleep
Apnea Syndrome (OSAS) patients (OSAS-group) and epilepsy patients (Ep-group). Patients were evaluated
with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Berlin
Questionnaire. Psychometric evaluation included Self-Administered Anxiety Scale (SAS #54), Beck
Depression Inventory (BDI), Maudsley’s Obsessive Compulsive Inventory (MOCI), Snaith-Hamilton
Pleasure Scale (SHAPS), and Eating Attitude Test (EAT-26).
Results: No significant differences resulted in prevalence and duration of naps in the three groups. In
the comparison between nappers (Nþ, subject with at least one nap in A-PSG) and non-nappers (N-,
subject with no naps in A-PSG) we observed significant differences in PSQI scores (Nþ¼14.1 ± 2.7;
N¼11.9 ± 3.3; Whitney U-test ¼ 341.0; p¼0.004) and in EAT score (Nþ¼ 9.8 ± 9.7; N¼4.4 ± 5.6;
Whitney U-test ¼ 313.5, p¼0.0.14); no significant differences were measured in other psychometric
parameters and in sleep macrostructural indexes.
Conclusions: Our data are in accordance with previous findings outlining that Nþinsomniacs have
higher PSQI scores than N-. Our results do not confirm the suggested association between napping
and depressive or obsessive-compulsive symptoms. Conversely, we found a statistically significant difference
(p¼0.0014) in EAT scores in Nþand N-. Hyperarousal and REM sleep instability in insomniac
patients may create an unbalance of the neuroendocrine hypothalamic regulation leading to an appetite
alteration.
Conclusions. Neuroimaging techniques applied to psychotherapy
research are relevant for further understanding neurobiological underpinnings
of psychotherapy processes and predicting treatment outcome
in order to improve clinical decision-making and treatment.
Key words: functional magnetic resonance imaging (fMRI), neural
mechanisms, neuroimaging, photon emission computed tomography
(SPECT), positron emission tomography (PET)
groups and to investigate the relationships between psychometric measures and napping habitude.
Methods: Sixty-eight adult patients with chronic primary insomnia were enrolled; 27 men and 41
women, mean age 53.6 ± 13. All patients underwent 24 h ambulatory polysomnography (A-PSG).
Prevalence of napping behavior in Insomnia Patients (I-group) was compared with Obstructive Sleep
Apnea Syndrome (OSAS) patients (OSAS-group) and epilepsy patients (Ep-group). Patients were evaluated
with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Berlin
Questionnaire. Psychometric evaluation included Self-Administered Anxiety Scale (SAS #54), Beck
Depression Inventory (BDI), Maudsley’s Obsessive Compulsive Inventory (MOCI), Snaith-Hamilton
Pleasure Scale (SHAPS), and Eating Attitude Test (EAT-26).
Results: No significant differences resulted in prevalence and duration of naps in the three groups. In
the comparison between nappers (Nþ, subject with at least one nap in A-PSG) and non-nappers (N-,
subject with no naps in A-PSG) we observed significant differences in PSQI scores (Nþ¼14.1 ± 2.7;
N¼11.9 ± 3.3; Whitney U-test ¼ 341.0; p¼0.004) and in EAT score (Nþ¼ 9.8 ± 9.7; N¼4.4 ± 5.6;
Whitney U-test ¼ 313.5, p¼0.0.14); no significant differences were measured in other psychometric
parameters and in sleep macrostructural indexes.
Conclusions: Our data are in accordance with previous findings outlining that Nþinsomniacs have
higher PSQI scores than N-. Our results do not confirm the suggested association between napping
and depressive or obsessive-compulsive symptoms. Conversely, we found a statistically significant difference
(p¼0.0014) in EAT scores in Nþand N-. Hyperarousal and REM sleep instability in insomniac
patients may create an unbalance of the neuroendocrine hypothalamic regulation leading to an appetite
alteration.