Lo sviluppo di disturbi psichiatrici in pazienti hcv+ sottoposti a terapia antivirale: L'impatto dei nuovi farmaci

Introduzione:l’interferone (IFN) usato per l’eradicazione del virus dell’Epatite C, induce effetti collaterali anche riferibili alla sfera psichica. I dati sugli eventi avversi di tipo psichiatrico dei nuovi farmaci antivirali (DAA) sono limitati. Lo scopo di questo studio è di valutare lo sviluppo di effetti collaterali di tipo psichiatrico in corso di due distinti schemi di trattamento: IFN-peghilato e ribavirina [terapia duplice (standard o SOC)]; DAA in associazione a IFN-peghilato e ribavirina (terapia triplice). Metodi: pazienti HCV+ consecutivi seguiti presso l’Ambulatorio delle Epatiti Croniche della Semeiotica Medica del Dipartimento di Scienze Mediche e Chirurgiche dell’Università di Bologna in procinto di intraprendere un trattamento antivirale a base di IFN, sottoposti ad esame psicodiagnostico composto da intervista clinica semistrutturata e test autosomministrati: BDI, STAXI-2, Hamilton Anxiety Scale, MMPI – 2. Risultati: Sono stati arruolati 84 pazienti, 57/84 (67.9%) nel gruppo in triplice e 27/84 nel gruppo SOC. Quasi tutti i pazienti arruolati hanno eseguito l’intervista clinica iniziale (82/84; 97.6%), mentre scarsa è stata l’aderenza ai test (valori missing>50%). Ad eccezione dell’ansia, la prevalenza di tutti gli altri disturbi (irritabilità, astenia, disfunzioni neurocognitive, dissonnia) aumentava in corso di trattamento. In corso di terapia antivirale 43/84 (51.2%) hanno avuto bisogno di usufruire del servizio di consulenza psichiatrica e 48/84 (57.1%) hanno ricevuto una psicofarmacoterapia di supporto, senza differenze significative fra i due gruppi di trattamento. Conclusioni : uno degli elementi più salienti dello studio è stata la scarsa aderenza ai test psicodiagnostici, nonostante l’elevata prevalenza di sintomi psichiatrici. I risultati di questo studio oltre ad evidenziare l’importanza dei sintomi psichiatrici in corso di trattamento e la rilevanza della consulenza psicologica e psichiatrica per consentire di portare a termine il ciclo terapeutico previsto (migliorandone l’efficacia), ha anche dimostrato che occorre ripensare gli strumenti diagnostici adattandoli probabilmente a questo specifico target.

Cerebral connectivity and psychotic personality traits : A diffusion tensor imaging study

This study aims to investigate the relationship between regional connectivity in the brain white matter and the presence of psychotic personality traits, in healthy subjects with psychotic traits. Thirteen healthy controls were administered the MMPI-2, to assess psychotic traits and, according to MMPI results, a dichotomization into a group of "high-psychotic" and "low-psychotic" was performed. Diffusion tensor imaging (DTI) was used as a non-invasive measure, in order to obtain information about the fractional anisotropy (FA), an intravoxel index of local connectivity and, by means of a voxelwise approach, the between-group differences of the FA values were calculated. The "high-psychotic" group showed higher FA in the left arcuate fasciculus. Subjects with low scores for psychotic traits had significantly higher FA in the corpus callosum, right arcuate fasciculus, and fronto-parietal fibers. In line with previous brain imaging studies of schizophrenia spectrum disorders, our results suggest that psychotic personality traits are related to altered connectivity and brain asymmetry.

Critical indicators associated with negative performance in a selectively manned unit

Introduction. Selectively manned units have a long, international history, both military and civilian. Some examples include SWAT teams, firefighters, the FBI, the DEA, the CIA, and military Special Operations. These special duty operators are individuals who perform a highly skilled and dangerous job in a unique environment. A significant amount of money is spent by the Department of Defense (DoD) and other federal agencies to recruit, select, train, equip and support these operators. When a critical incident or significant life event occurs, that jeopardizes an operator's performance; there can be heavy losses in terms of training, time, money, and potentially, lives. In order to limit the number of critical incidents, selection processes have been developed over time to “select out” those individuals most likely to perform below desired performance standards under pressure or stress and to "select in" those with the "right stuff". This study is part of a larger program evaluation to assess markers that identify whether a person will fail under the stresses in a selectively manned unit. The primary question of the study is whether there are indicators in the selection process that signify potential negative performance at a later date. ^ Methods. The population being studied included applicants to a selectively manned DoD organization between 1993 and 2001 as part of a unit assessment and selection process (A&S). Approximately 1900 A&S records were included in the analysis. Over this nine year period, seventy-two individuals were determined to have had a critical incident. A critical incident can come in the form of problems with the law, personal, behavioral or family problems, integrity issues, and skills deficit. Of the seventy-two individuals, fifty-four of these had full assessment data and subsequent supervisor performance ratings which assessed how an individual performed while on the job. This group was compared across a variety of variables including demographics and psychometric testing with a group of 178 individuals who did not have a critical incident and had been determined to be good performers with positive ratings by their supervisors.^ Results. In approximately 2004, an online pre-screen survey was developed in the hopes of preselecting out those individuals with items that would potentially make them ineligible for selection to this organization. This survey has aided the organization to increase its selection rates and save resources in the process. (Patterson, Howard Smith, & Fisher, Unit Assessment and Selection Project, 2008) When the same prescreen was used on the critical incident individuals, it was found that over 60% of the individuals would have been flagged as unacceptable. This would have saved the organization valuable resources and heartache.^ There were some subtle demographic differences between the two groups (i.e. those with critical incidents were almost twice as likely to be divorced compared with the positive performers). Upon comparison of Psychometric testing several items were noted to be different. The two groups were similar when their IQ levels were compared using the Multidimensional Aptitude Battery (MAB). When looking at the Minnesota Multiphasic Personality Inventory (MMPI), there appeared to be a difference on the MMPI Social Introversion; the Critical Incidence group scored somewhat higher. When analysis was done, the number of MMPI Critical Items between the two groups was similar as well. When scores on the NEO Personality Inventory (NEO) were compared, the critical incident individuals tended to score higher on Openness and on its subscales (Ideas, Actions, and Feelings). There was a positive correlation between Total Neuroticism T Score and number of MMPI critical items.^ Conclusions. This study shows that the current pre-screening process is working and would have saved the organization significant resources. ^ If one was to develop a profile of a candidate who potentially could suffer a critical incident and subsequently jeopardize the unit, mission and the safety of the public they would look like the following: either divorced or never married, score high on the MMPI in Social Introversion, score low on MMPI with an "excessive" amount of MMPI critical items; and finally scores high on the NEO Openness and subscales Ideas, Feelings, and Actions.^ Based on the results gleaned from the analysis in this study there seems to be several factors, within psychometric testing, that when taken together, will aid the evaluators in selecting only the highest quality operators in order to save resources and to help protect the public from unfortunate critical incidents which may adversely affect our health and safety.^

RELATIONSHIP OF ANTISOCIAL PERSONALITY SYNDROME IN BOYS TO PARENTAL ALCOHOL/DRUG DEPENDENCY

The study focused on the relationship between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency. The population studied was case records of 101 boys coming to a private psychiatrist from 1966 through 1979. The boys were predominantly white and from middle to upper income families.^ A boy was determined to have antisocial personality syndrome if he exhibited antisocial behaviors in four or five major categories, did not exhibit a brain syndrome, and did not exhibit a thought disorder. The five major behavior categories were: (1) self-control (i.e., temper tantrums or hyperactivity), (2) behavior at home (i.e., disobedience or lying), (3) behavior at school (i.e., truancy or cheating), (4) behavior toward peers (i.e., bullying, fighting, or tattling), and (5) behavior against property (i.e., destructiveness or stealing). A boy was determined to be a control if he exhibited antisocial behaviors in two or less behavior categories.^ A parent was determined to have alcohol/drug dependency if s/he exhibited a score above the established threshold (1) for the MacAndrew Alcoholism Scale (28 or above), and (2) for the Holmes Alcoholism Scale (35 or above) which are used with the MMPI. A parent was classified not alcohol/drug dependent if s/he had scores below set thresholds (22 on the MacAndrew Alcoholism Scale and 28 on the Holmes Alcoholism Scale).^ For the final sample (N = 10), there was no reason to believe a relationship exists between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency (Fisher's Exact Test {FET} P = 1.0). The small sample size primarily occurred as a result of 88.12% of the parents being classified in a questionable category in terms of alcohol/drug dependency.^ The sample was suggestive of a relationship between the fathers' Psychopathic Deviate (Pd) Scale scores as a measure of antisocial tendencies and the boy having antisocial personality syndrome (N = 75; P = .12). There was no evidence of such a relationship for mothers (N = 75; P = .97). ^

Measure of Maturity: The Montana Adolescent Maturity Assessment

The construct of maturity is often discussed in the realm of adolescent development; however, relatively little research has been devoted to developing a comprehensive, reliable, and valid measure with which to assess it. The purpose of this study was to investigate the concurrent validity of the Montana Adolescent Maturity Assessment - III (MAMA-III), a proxy measure completed by clinicians regarding an adolescent's functioning, with the immaturity scale (IMM) of the MMPI-A. To provide more specified results, a factor analysis of the IMM was undertaken. Results yielded a low but significant correlation between the MAMA-III and the IMM, as well as significant convergent correlations between individual factors of the MAMA and IMM scales. Correlations among the MAMA-III factors, the IMM factors, and the ten clinical scales of the MMPI-A were also analyzed with the goal of better understanding what each measures. Implications are discussed regarding the clinical distinctions between the two measures, and the prospect of a more comprehensive understanding of the construct of maturity.

Macrophages and lymphocyte responiveness to mitogen

Purified B-cells fail to proliferate in response to the strong thymus-independent (TI) antigen Lipopolysaccharide (LPS) in the absence of macrophages (Corbel and Melchers, 1983). The fact that macrophages, or factors derived from them are required is supported by the inability of marginal zone B-cells in infants to respond to highly virulent strains of bacteria such as Neisseria meningitidis and Streptococcus pneumoniae (Timens, 1989). This may be due to the lack of CD21 expression on B-cells in infants which could associate with its co-receptor (C3d) on adjacent macrophages. It is not clear whether cell surface contacts and/or soluble products are involved in lymphocyte-macrophage interactions in response to certain antigens. This thesis describes the importance of the macrophage in lymphocyte responses to T-dependent (TD) and TI antigens. The major findings of this thesis were as follows: (1). Macrophages were essential for a full proliferative response to a range of T - and B-cell mitogens and TI-1 and TI-2 antigens, including Concanavalin A, LPS, Pokeweed mitogen (PWM), Dextran sulphate, Phytohaemagglutinin-P (PHA-P) and Poly[I][C]. (2). A ratio of 1 macrophage to 1000 lymphocytes was sufficient for the mitogens to exert their effects. (3). The optimal conditions were established for the activation of an oxidative burst in cells of the monocyte/macrophage lineage as measured by luminometry. The order of ability was OpZ >PMA/lonomycin >f-MLP >Con A >DS >PHA >Poly[I][C] >LPS >PWM. Responses were only substantial and protracted with OpZ and PMA. Peritoneal macrophages were the most responsive cells, whereas splenic and alveolar macrophages were significantly less active and no response could be elicited with Kupffer cells, thus demonstrating heterogeneity between macrophages. (4). Activated macrophages that were then fixed with paraformaldehyde were unable to restore mitogenic responsiveness, even with a ratio of 1 macrophage to 5 lymphocytes. (5). Although highly purified T- and B-cells could respond to mitogen provided live macrophages were present, maximum activation was only observed when all 3 cell types were present. (6). Supernatants from purified macrophage cultures treated with a range of activators were able to partially restore lymphocyte responses to mitogen in macrophage-depleted splenocyte cultures, and purified T - and B-cell cultures. In fact supernatants from macrophages treated with LPS for only 30 minutes could restore responsiveness. Supernatants from OpZ treated macrophages were without effect. (7). Macrophage supernatants could not induce proliferation in the absence of mitogen. They therefore provide a co-mitogenic signal required by lymphocytes in order to respond to mitogen. (8). Macrophage product profiles revealed that LPS and Con A-treated macrophage supernatants showed elevated levels of IL-1β, TNF -α L TB4 and TXB2. These products were therefore good candidates as the co-mitogenic factor. The possible inhibitory factors secreted by OpZ-treated macrophages were PGE2, IL-10 and NO. (9). The removal of cytokines, eicosanoids and TNF-α from LPS-treated macrophage supernatants using Cycloheximide, Dexamethasone and an MMPI respectively, resulted in the inability of these supernatants to restore macrophage-depleted lymphocyte responses to mitogen. (10). rIL-1β and rTNF-α are co-mitogenic factors, as macrophage-depleted lymphocytes incubated with rIL-1β and rTNF-α can respond to mitogen.

Using the Big -Five personality factors in the Minnesota Multiphasic Personality Inventory, California Psychological Inventory, and Inwald Personality Inventory to predict police performance

The purpose of this study was to determine the degree to which the Big-Five personality taxonomy, as represented by the Minnesota Multiphasic Personality Inventory (MMPI), California Psychological Inventory (CPI), and Inwald Personality Inventory (IPI) scales, predicted a variety of police officer job performance criteria. Data were collected archivally for 270 sworn police officers from a large Southeastern municipality. Predictive data consisted of scores on the MMPI, CPI, and IPI scales as grouped in terms of the Big-Five factors. The overall score on the Wonderlic was included in order to assess criterion variance accounted for by cognitive ability. Additionally, a psychologist's overall rating of predicted job fit was utilized to assess the variance accounted for by a psychological interview. Criterion data consisted of supervisory ratings of overall job performance, State Examination scores, police academy grades, and termination. Based on the literature, it was hypothesized that officers who are higher on Extroversion, Conscientiousness, Agreeableness, Openness to Experience, and lower on Neuroticism, otherwise known as the Big-Five factors, would outperform their peers across a variety of job performance criteria. Additionally, it was hypothesized that police officers who are higher in cognitive ability and masculinity, and lower in mania would also outperform their counterparts. Results indicated that many of the Big-Five factors, namely, Neuroticism, Conscientiousness, Agreeableness, and Openness to Experience, were predictive of several of the job performance criteria. Such findings imply that the Big-Five is a useful predictor of police officer job performance. Study limitations and implications for future research are discussed. ^