Massimo Tusconi, M.D. (2011, University of Cagliari, Italy), Specialization in Psychiatry (2016, University of Cagliari, Italy), Visiting Scientist and Research Collaborator (2016, University of Texas, Houston, TX, U.S.A.). Focus on Biomarkers, Bipolar Disorder, and Psychosis.
Introduction Schizophrenia spectrum disorders are among the most debilitating mental disorders an... more Introduction Schizophrenia spectrum disorders are among the most debilitating mental disorders and evidence on its pathophysiological underpinnings is scant. The brain-derived neurotrophic factor (BDNF) appears to be involved in the pathophysiology of these complex psychiatric disorders. Objectives The present study investigates the longitudinal variation of serum BDNF levels in a 24-month observational cohort study of Sardinian psychotic patients (LABSP). This study assessed the variation in BDNF serum levels and its relationship with psychopathological and cognitive changes. Further, we also examined if genetic variations within the BDNF gene could moderate these relationships. Methods Every six months 105 LABSP patients were assessed for their BDNF serum levels, as well as for a series of psychopathological, cognitive, and drug-related measures. Four tag single nucleotide polymorphisms (SNPs) within the BDNF gene were selected and analyzed using Polymerase Chain Reaction (PCR). L...
Brain-derived neurotrophic factor (BDNF) is a key modulator of neuroplasticity and has an importa... more Brain-derived neurotrophic factor (BDNF) is a key modulator of neuroplasticity and has an important role in determining the susceptibility to severe psychiatric disorder with a significant neurodevelopmental component such as major psychoses. Indeed, a potential association between BDNF serum levels and schizophrenia (SCZ) and schizoaffective disorder (SAD) has been tested in diverse studies and a considerable amount of them found reduced BDNF levels in these disorders. Here, we aimed at testing the association of BDNF serum levels with several demographic, clinical, and psychometric measures in 105 patients with SCZ and SAD, assessing the moderating effect of genetic variants within the BDNF gene. We also verified whether peripheral BDNF levels differed between patients with SCZ and SAD. Our findings revealed that BDNF serum levels are significantly lower in patients affected by SCZ and SAD presenting more severe depressive symptomatology. This finding awaits replication in future ...
The debate on mixed states (MS) has been intense for decades. However, several points remain cont... more The debate on mixed states (MS) has been intense for decades. However, several points remain controversial from a nosographic, diagnostic, and therapeutic point of view. The different perspectives that have emerged over the years have turned into a large, but heterogeneous, literature body. The present review aims to summarize the evidence on MS, with a particular focus on mixed depression (MxD), in order to provide a guide for clinicians and encourage the development of future research on the topic. First, we review the history of MS, focusing on their different interpretations and categorizations over the centuries. In this section, we also report alternative models to traditional nosography. Second, we describe the main clinical features of MxD and list the most reliable assessment tools. Finally, we summarize the recommendations provided by the main international guidelines for the treatment of MxD. Our review highlights that the different conceptualizations of MS and MxD, the v...
Clinical Practice & Epidemiology in Mental Health, 2021
Background: The Diagnostic and Statistical Manual for Mental Disorders (5th edition) introduced t... more Background: The Diagnostic and Statistical Manual for Mental Disorders (5th edition) introduced the specifier “with Mixed Features” to the diagnosis of Major Depressive Episode to designate the presence of (hypo) manic symptoms as part of the clinical presentation. This change has led to renewed attention on the operational definition, diagnosis, and treatment of Mixed Depression. Objective: To investigate the diagnostic and therapeutic approaches towards Mixed Depression among a representative sample of Italian psychiatrists. Methods: Between March and April 2021, 342 psychiatrists working in Italian adult mental health services were invited to participate in an anonymous online survey comprising 32 questions designed to investigate clinical and psychopathological approaches regarding the management of mixed depression in daily psychiatric practice. Results: 83.74% of participants reported having performed a diagnosis of mixed depression in the last five years, with the majority of...
The management of patients with Personality Disorders (PD) is a problem that arises relatively fr... more The management of patients with Personality Disorders (PD) is a problem that arises relatively frequently in Emergency Departments (ED); this could be even more problematic in geriatric patients for their particular condition and comorbidities. Personality disorders tend to be underdiagnosed in clinical settings [1], and it has been well established that patients with some kind of PD, such as Borderline Personality Disorder are often difficult to treat because of the persistence and severity of their symptoms and because of the negative effects of the pathology on the treatment relationship [2].
Introduction: Schizophrenia (SCZ) and schizoaffective disorder (SAD) are severe and complex psych... more Introduction: Schizophrenia (SCZ) and schizoaffective disorder (SAD) are severe and complex psychiatric disorders whose liability threshold is likely modulated by the interplay of biological, mainly genetic, and environmental factors. Consistent evidence has pointed to the role of serum brain-derived neurotrophic factor (BDNF) as a plausible illness biomarker in SCZ-spectrum disorders. There is no consensus, however, on the temporal trajectory of this decline. The decrease of peripheral BDNF could be constant, with premorbid levels roughly similar to those detected in unaffected individuals, linearly declining during the course of the illness. Alternatively, BDNF peripheral levels might fluctuate in association with acute psychopathological phases of the disorder. In this context, we sought to investigate the longitudinal variation of serum BDNF levels over 24 months in a cohort of Sardinian patients [Longitudinal Assessment of BDNF in Sardinian Psychotic patients (LABSP)]. Here, we...
Given the incidence and severity of acute intoxication, this issue is of considerable importance ... more Given the incidence and severity of acute intoxication, this issue is of considerable importance today for the Emergency Departments (ED). The objective of this study was to evaluate acute intoxications by psychopharmacological medications and abuse of drugs for patients managed in an Outpatient Emergency Department. Retrospective analyses were performed on data on admissions to the Emergency Department for the years 2012 and 2013, in Holy Trinity Hospital, Cagliari, Italy; the reference population were outpatients with intoxication reported as the main problem, taken from a total population of outpatients with every kind of medical problem admitted to the ED during the studied period. The sample included patients of all ages with acute intoxication by psychopharmacological medications and drugs of abuse (psychoactive drugs and alcohol). For the year 2012, the number of total Emergency Room (ER) visits because of intoxication amounted to 338 and 243 of these were due to the abuse of...
Background To date, very few nationwide studies addressing the way in which mental health service... more Background To date, very few nationwide studies addressing the way in which mental health services are addressing the current pandemics have been published. The present paper reports data obtained from a survey relating to the Italian mental health system conducted during the first phase of the Covid-19 epidemic. Methods Two online questionnaires regarding Community Mental Health Centres (CMHC) and General Hospital Psychiatric Wards (GHPW), respectively, were sent to the Heads of all Italian Mental Health Departments (MHDs). Statistical analysis was carried out by means of Chi Square test with Yates correction or the Fisher Exact test, as needed. Results Seventy-one (52.9%) of the 134 MHDs and 107 (32.6%) of the 318 GHPWs returned completed questionnaires. Less than 20% of CMHCs were closed and approx. 25% had introduced restricted access hours. A substantial change in the standard mode of operation in CMHCs was reported with only urgent psychiatric interventions, compulsory treatme...
Introduction Schizophrenia spectrum disorders are among the most debilitating mental disorders an... more Introduction Schizophrenia spectrum disorders are among the most debilitating mental disorders and evidence on its pathophysiological underpinnings is scant. The brain-derived neurotrophic factor (BDNF) appears to be involved in the pathophysiology of these complex psychiatric disorders. Objectives The present study investigates the longitudinal variation of serum BDNF levels in a 24-month observational cohort study of Sardinian psychotic patients (LABSP). This study assessed the variation in BDNF serum levels and its relationship with psychopathological and cognitive changes. Further, we also examined if genetic variations within the BDNF gene could moderate these relationships. Methods Every six months 105 LABSP patients were assessed for their BDNF serum levels, as well as for a series of psychopathological, cognitive, and drug-related measures. Four tag single nucleotide polymorphisms (SNPs) within the BDNF gene were selected and analyzed using Polymerase Chain Reaction (PCR). L...
Brain-derived neurotrophic factor (BDNF) is a key modulator of neuroplasticity and has an importa... more Brain-derived neurotrophic factor (BDNF) is a key modulator of neuroplasticity and has an important role in determining the susceptibility to severe psychiatric disorder with a significant neurodevelopmental component such as major psychoses. Indeed, a potential association between BDNF serum levels and schizophrenia (SCZ) and schizoaffective disorder (SAD) has been tested in diverse studies and a considerable amount of them found reduced BDNF levels in these disorders. Here, we aimed at testing the association of BDNF serum levels with several demographic, clinical, and psychometric measures in 105 patients with SCZ and SAD, assessing the moderating effect of genetic variants within the BDNF gene. We also verified whether peripheral BDNF levels differed between patients with SCZ and SAD. Our findings revealed that BDNF serum levels are significantly lower in patients affected by SCZ and SAD presenting more severe depressive symptomatology. This finding awaits replication in future ...
The debate on mixed states (MS) has been intense for decades. However, several points remain cont... more The debate on mixed states (MS) has been intense for decades. However, several points remain controversial from a nosographic, diagnostic, and therapeutic point of view. The different perspectives that have emerged over the years have turned into a large, but heterogeneous, literature body. The present review aims to summarize the evidence on MS, with a particular focus on mixed depression (MxD), in order to provide a guide for clinicians and encourage the development of future research on the topic. First, we review the history of MS, focusing on their different interpretations and categorizations over the centuries. In this section, we also report alternative models to traditional nosography. Second, we describe the main clinical features of MxD and list the most reliable assessment tools. Finally, we summarize the recommendations provided by the main international guidelines for the treatment of MxD. Our review highlights that the different conceptualizations of MS and MxD, the v...
Clinical Practice & Epidemiology in Mental Health, 2021
Background: The Diagnostic and Statistical Manual for Mental Disorders (5th edition) introduced t... more Background: The Diagnostic and Statistical Manual for Mental Disorders (5th edition) introduced the specifier “with Mixed Features” to the diagnosis of Major Depressive Episode to designate the presence of (hypo) manic symptoms as part of the clinical presentation. This change has led to renewed attention on the operational definition, diagnosis, and treatment of Mixed Depression. Objective: To investigate the diagnostic and therapeutic approaches towards Mixed Depression among a representative sample of Italian psychiatrists. Methods: Between March and April 2021, 342 psychiatrists working in Italian adult mental health services were invited to participate in an anonymous online survey comprising 32 questions designed to investigate clinical and psychopathological approaches regarding the management of mixed depression in daily psychiatric practice. Results: 83.74% of participants reported having performed a diagnosis of mixed depression in the last five years, with the majority of...
The management of patients with Personality Disorders (PD) is a problem that arises relatively fr... more The management of patients with Personality Disorders (PD) is a problem that arises relatively frequently in Emergency Departments (ED); this could be even more problematic in geriatric patients for their particular condition and comorbidities. Personality disorders tend to be underdiagnosed in clinical settings [1], and it has been well established that patients with some kind of PD, such as Borderline Personality Disorder are often difficult to treat because of the persistence and severity of their symptoms and because of the negative effects of the pathology on the treatment relationship [2].
Introduction: Schizophrenia (SCZ) and schizoaffective disorder (SAD) are severe and complex psych... more Introduction: Schizophrenia (SCZ) and schizoaffective disorder (SAD) are severe and complex psychiatric disorders whose liability threshold is likely modulated by the interplay of biological, mainly genetic, and environmental factors. Consistent evidence has pointed to the role of serum brain-derived neurotrophic factor (BDNF) as a plausible illness biomarker in SCZ-spectrum disorders. There is no consensus, however, on the temporal trajectory of this decline. The decrease of peripheral BDNF could be constant, with premorbid levels roughly similar to those detected in unaffected individuals, linearly declining during the course of the illness. Alternatively, BDNF peripheral levels might fluctuate in association with acute psychopathological phases of the disorder. In this context, we sought to investigate the longitudinal variation of serum BDNF levels over 24 months in a cohort of Sardinian patients [Longitudinal Assessment of BDNF in Sardinian Psychotic patients (LABSP)]. Here, we...
Given the incidence and severity of acute intoxication, this issue is of considerable importance ... more Given the incidence and severity of acute intoxication, this issue is of considerable importance today for the Emergency Departments (ED). The objective of this study was to evaluate acute intoxications by psychopharmacological medications and abuse of drugs for patients managed in an Outpatient Emergency Department. Retrospective analyses were performed on data on admissions to the Emergency Department for the years 2012 and 2013, in Holy Trinity Hospital, Cagliari, Italy; the reference population were outpatients with intoxication reported as the main problem, taken from a total population of outpatients with every kind of medical problem admitted to the ED during the studied period. The sample included patients of all ages with acute intoxication by psychopharmacological medications and drugs of abuse (psychoactive drugs and alcohol). For the year 2012, the number of total Emergency Room (ER) visits because of intoxication amounted to 338 and 243 of these were due to the abuse of...
Background To date, very few nationwide studies addressing the way in which mental health service... more Background To date, very few nationwide studies addressing the way in which mental health services are addressing the current pandemics have been published. The present paper reports data obtained from a survey relating to the Italian mental health system conducted during the first phase of the Covid-19 epidemic. Methods Two online questionnaires regarding Community Mental Health Centres (CMHC) and General Hospital Psychiatric Wards (GHPW), respectively, were sent to the Heads of all Italian Mental Health Departments (MHDs). Statistical analysis was carried out by means of Chi Square test with Yates correction or the Fisher Exact test, as needed. Results Seventy-one (52.9%) of the 134 MHDs and 107 (32.6%) of the 318 GHPWs returned completed questionnaires. Less than 20% of CMHCs were closed and approx. 25% had introduced restricted access hours. A substantial change in the standard mode of operation in CMHCs was reported with only urgent psychiatric interventions, compulsory treatme...
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