Psychiatria Danubina最新文献

Background: Cognitive impairment is a core and disabling feature of schizophrenia, with a profound impact on functional outcomes. Female patients often demonstrate better cognitive profiles than males, suggesting a potential modulatory role of sex hormones. Estrogens, particularly estradiol, have been hypothesized to exert neuroprotective effects via modulation of neurotrophic, neurotransmitter, and inflammatory pathways. However, evidence regarding the relationship between sex hormone levels and cognition in schizophrenia remains scattered and inconclusive.

Methods: This scoping review synthesized evidence from clinical and preclinical studies examining the association between endogenous estrogen levels or estrogen-based treatments and cognitive functioning in women with schizophrenia. We included peer-reviewed literature addressing hormonal fluctuations across the menstrual cycle, menopause, and in response to antipsychotic treatment, with specific focus on estradiol and selective estrogen receptor modulators.

Results: Findings suggest that low estrogen levels may be linked to more severe negative symptoms and poorer cognitive performance in female patients. Studies investigating menstrual cycle phases report mixed results, while evidence from animal models indicates potential cognitive benefits of estrogenic compounds. Raloxifene has shown promise in mitigating cognitive deficits when administered during sensitive developmental periods. However, large-scale hormonal interventions in postmenopausal women have produced inconsistent results, likely due to differences in timing, dosage, and individual neurobiological context.

Conclusions: Sex hormone levels, especially estradiol, appear to influence cognitive outcomes in women with schizophrenia, though findings are heterogeneous. Future research should address methodological inconsistencies and explore phase-specific, personalized hormonal strategies. A deeper understanding of hormonal-cognitive interactions may inform more effective, sex-sensitive treatment approaches in schizophrenia.

Background: Recent studies suggest an overlap and mutual influence between Anorexia Nervosa (AN) and psychotic symptoms, with the anorexic voice proposed as a clinically significant marker within this spectrum. This cross-sectional observational study aimed to assess the prevalence and characteristics of psychotic symptoms, focusing on the anorexic voice, in patients with AN. Secondary objectives included exploring associations with dissociation, body image disturbance (BID), sociodemographic and clinical factors.

Subjects and methods: Forty-three patients were recruited from specialized outpatient and inpatient Services. Anamnestic history was collected, participants completed psychometric assessments, including Positive and Negative Syndrome Scale (PANSS), Brown Assessment of Beliefs Scale (BABS/BABS-A), Eating Disorder Examination (EDE-Q), Eating Disorder Inventory (EDI-3), Body Uneasiness Test (BUT), Body Shape Questionnaire (BSQ), Symptom Checklist-90 Revised (SCL-90-R), Dissociative Experience Scale (DES/A-DES), Community Assessment of Psychic Experiences (CAPE-42), Multidimensional Assessment of Interoceptive Awareness (MAIA).

Results: The anorexic voice was significantly associated with clinically relevant dissociation, not with BID. Subthreshold psychotic symptoms were common and significantly linked to body dissatisfaction, eating psychopathology and dissociation. Psychoticism was associated with BID, higher psychiatric comorbidity (especially personality and anxiety disorders), lower ideal BMI and greater general psychopathology. Adolescents showed higher levels of persecutory ideation, interpersonal alienation and general psychopathology.

Conclusions: Psychotic-like symptoms are highly prevalent in AN. The anorexic voice appears more closely related to dissociative processes than psychotic phenomena. Conversely, BID may play a significant role in the onset of predominant ideation about body shape and weight. Larger longitudinal studies are needed to clarify these relationships and their prognostic implications.

Background: Nutritional psychiatry is gaining recognition as a complementary approach to improving mental health. Although evidence supports the role of diet and nutraceuticals in psychiatric care, little is known about their integration into clinical practice by mental health professionals. This study investigates the knowledge, attitudes, and use of nutritional strategies among Italian psychiatrists and psychologists.

Methods: A cross-sectional survey was administered to 110 mental health professionals to assess their knowledge of nutritional psychiatry and the practical application of dietary interventions.

Results: Most participants reported discussing nutrition with patients and using dietary strategies, though inconsistently. Psychiatrists were more frequently engaged in nutritional counseling and in preventive strategies for somatic comorbidities. The Mediterranean diet emerged as the most commonly recommended model. Gender differences were noted, with female psychiatrists reporting significantly higher self-rated knowledge.

Conclusions: Italian mental health professionals show growing interest in nutritional psychiatry, yet its routine adoption remains limited by gaps in training and institutional support. Clear guidelines, accessible education, and interdisciplinary collaboration - including with dietitians - are essential to foster its integration into psychiatric care.

Background: To estimate the relationship between cognitive function of patients with heart arrhythmias and left ventricle (LV) diastolic function.

Materials and methods: In a one-center cross-control study we recruited 28 patients with heart arrhythmias, of whom 14 had 1800 or more premature ventricular contractions (PVCs) per 24 hours and more (group 1), and 14 had paroxysmal AF (group 2). All patients were asymptomatic for heart arrhythmias. Laboratory and instrumental methods included standard investigations: lipidograms, 24 hours ECG monitoring, transthoracic echocardiography (TTE), and, if prescribed, coronary angiography. In the TTE protocol, we followed current clinical recommendations in assessing the LV diastolic function. For cognitive function evaluation, we used the standard Montreal Cognitive Assessment (MoCA) test, with the following scoring: maximum possible score - 30 points; mild cognitive impairment - 22-27 points; moderate cognitive impairment - 10-21 points; severe cognitive impairment - 0-9 points.

Results: The most common heart arrhythmias (frequent PVCs, paroxysmal AF) were associated with cognitive impairment in the preponderance of patients (mean score here).

Conclusions: LV diastolic dysfunction is a predictor for cognitive impairment in patients with frequent PVCs and paroxysmal AF. The MoCA test can be an additional tool for this category of patients to detect the early cognitive impairment.

Background: To evaluate the relationship between cognitive function and the data of volumetric sphygmography and speckle tracking echocardiography in patients with heart arrhythmias.

Materials and methods: Monocentral cohort study with 33 patients. Group 1 - patients with frequent extrasystoles (ES) of II and more class by Lown (n = 12; 47-79 years old), group 2 - with paroxysmal atrial fibrillation (AF) (n = 14; 50-81 years old) and control group - without serious cardiovascular diseases (n = 7; 46-75 years old).

Methods: lipidograms, 24 hours ECG monitoring, TTE, volumetric sphygmography. For cognitive function evaluation, we used the standard MoCA Test.

Results: Post hoc analysis according to Dunn showed that groups 1 and 2 differed in LA volume (p = 0.002, ε² = 0.34) and MoCA (p = 0.007, ε² = 0.30). Differences between groups 2 and control were also significant for LA volume (p = 0.024) and MoCA (p = 0.045). We observed a decreasing of cognitive function in both main groups, mostly in with paroxysmal AF. Statistically significant differences in GLS between 1 and 2 group - it was lower in group 2, characterizing the decreasing of LV systolic function.

Conclusions: In patients with frequent ES and paroxysmal AF, develop a cognitive impairment, mostly in the group with paroxysmal AF. Increased arterial stiffness parameters (R-CAVI, L-CAVI) and LA structural changes (increased LA volume, decreased LA strain) are significant predictors of cognitive impairment. The group of patients with paroxysmal AF differed most significantly from the control group in all key parameters.

We describe Addison's disease, which is the disease caused by Adrenal Gland Insufficiency. Addison's disease is an uncommon endocrine disorder characterised by inadequate production of hormones, predominantly aldosterone and cortisol, by the adrenal glands. This condition occurs due to damage to the adrenal cortex, the region responsible for hormone synthesis. Clinical manifestations of Addison's disease are often insidious and nonspecific, including symptoms such as myasthenia, persistent fatigue, unintentional weight loss, hypotension, and hyperpigmentation of the skin, especially in areas subjected to friction. A number of Neuropsychiatric manifestation, including Depression, and Psychosis can also occur. The aetiology is primarily autoimmune adrenalitis, where the immune system erroneously attacks and destroys adrenal cortical cells. Other aetiologies include infectious agents like Mycobacterium tuberculosis, which can infiltrate and impair the adrenal glands. Hemorrhagic damage to the adrenal cortex can occur secondary to severe stress, trauma, or coagulopathies. Additionally, metastatic neoplasms may involve the adrenal glands, leading to their destruction. Less frequently, genetic disorders such as adrenoleukodystrophy can compromise adrenal function by affecting both the cerebral white matter and adrenal cortex. Adrenal cortex damage can also result from adrenalectomy or the administration of medications that inhibit steroidogenesis. The pathophysiology of Addison's disease involves the disruption of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in cortisol deficiency, which is critical for regulating metabolism, immune function, and stress responses. Aldosterone deficiency leads to dysregulation of sodium and potassium homeostasis, causing hypotension and dehydration. Management of Addison's disease requires lifelong glucocorticoid and mineralocorticoid replacement therapy, typically with hydrocortisone or fludrocortisone, along with ongoing monitoring and dosage adjustments during periods of stress, illness, or surgical interventions. While describing Addison's Disease we describe the illness as experienced by Elizabeth of the Trinity, a Catholic Nun who suffered the illness in the early part of the Twentieth Century, whose illness is described from her letters and eyewitness accounts, taken for her beatification and canonisation findings. We describe how the illness it was viewed then, when it was seen as incurable, with great deficiencies in both diagnosis and treatment, and how the aetiology has changed over the years. Hence we show how the suffering endured by this person had both mental and physical aspects.

The assessment of pain in people with intellectual disabilities (individuals with ID) represents a clinical challenge due to the variability in communicative and cognitive skills. This study explores the feasibility of pain self-reporting in individuals with mild to moderate intellectual disability using validated self-assessment scales. Our findings suggest that, under appropriate conditions, self-reporting can be a reliable and empowering method for pain evaluation in this population. This approach may foster autonomy, improve care, and counteract the undervaluation of subjective pain reports.

Background: In Europe, 14.7% of the population suffer from chronic tinnitus. Regarding pharmacological treatment of tinnitus, there is currently no evidence-based protocol recommendation. Tinnitus Retraining Therapy is the only effective method available in specialized multidisciplinary centers.

Subject and method: By analyzing 116 patients who underwent rehabilitation in a multidisciplinary audiophonology center, we quantified the use of benzodiazepines before and after treatment.

Results: Among patients suffering from chronic tinnitus, there is an over-prescription of benzodiazepines, which can be reduced through proper care.

Conclusion: Better awareness among frontline healthcare professionals about treatment in specialized multidisciplinary centers should be reinforced in order to enable quicker referrals and avoid therapeutic wandering or inappropriate use of benzodiazepines.