RICERCA ITALIANA     

Research program

Genetic and neural imaging aspects of antidepressant response

University Co-ordinator

Università degli Studi di PALERMO - NEUROLOGIA, OFTALMOLOGIA, OTORINOLARINGOIATRIA E PSICHIATRIA - PALERMO(PA)

Research Unit Leader

Maurizio Giuseppe GUARNERI

Description

The study will evaluate the personality features and the grade of expression of the symptoms before and after antidepressants treatments (SSRI) in patients suffering from mood disorders.
The sample will be made by 20 patients (in- patents and out-patients) with Mood Disorder.
Subjects suffering from bipolar disorders and major depression will included, excluding disthymia, cyclothimia and singular episode of major depression. Comorbility with substances addiction or important neurological and medical will be exclusion criterion.

Methods
Methodology for collecting informations about recruited patients:
Clinical evaluation: The clinical evaluation will be done by psychiatrists and psychologists experts in the mood disorders field; the evaluation will foresee the require of anamnesis informations, a psychic objects exam according to the DSM IV TR criteria, tests and the formulation of a cathegorial and functional diagnosis of the personality.
ANAMNESTIC INFORMATION: for each patient will be collected the following:
A-Identificative Code - Date of the informed consensus – date of Psychological test Valuation - Demographic Features: Gender, date and place of birth; B- personal anamnesis.
C- Psychiatric Anamnesis: Presence of the pre morbility personality disorders.
D- features of the Axis 1 Psychiatric Disease: - Clinical diagnosis, -Triggering factors of the first episode the, - Course of disorder (the age of onset of first symptoms, age of the first hospitalization, age of the first treatment, way of the beginning, number of admissions and their total time - features of the episodes (description of every episode: kind, severity, duration, treatment and outcome).
The analyses will estimate the features of personality of the patients with Mood Disorder and the clinical answer to the treatment with SSRI, with the aim of identifying specific therapeutic interventions for each patient.
The methodology foresees the evaluation of all the patients before the beginning of the study through Hamilton Scale for the Depression (HAM-D-21) (Hamilton, 1976), Hamilton Scale for anxiety (HARS-21) (Hamilton, 1967), with an answer criterion; the criterion of the answer is a score lower then 8; the SWAP-200 for the evaluation for Personality Disorders (Drew Western, J Shedler, V. Lingiardi- R. Cortina Ed., 2003).
Hamilton scales consent the evaluation of the grade of depression and anxiety.
The MMPI-2 provides personality profiles worthy from psychopatological point of view. It's useful for an initial assessment and for diagnostic screening.
The questionnaire provides a profile, based on self-descriptions, which has some important elements for clinical inquire such as self- imagine, depression linked with self-esteem social adaptation, the sensibility for the opinion of the others, anxiety, compulsions, disorientation, deterioration of the logical processes and mental confusion.
The Shedler-Western Assessment Procedure- SWAP-200 (Western and Shedler, 1999) is an instrument based on the Q-sort method, one of the most widespread and successful method for studying normal personality. This method apply to personality disorders is made a series of sentences related to various personality aspects and to the psychological functioning. Ev ery sentence can well, partially, or not describe several aspects of the personality and the psychological functions.
Every sentence can well, partially or at all describe a patient. A clinician who knows the patient well divides the charts in different categories, according to how much the sentence can desribe the patient . Q-sort is based therefore on the judgment of the clinician and not on the self- valuation of the patient.
The SWAP-200 is an evaluation instrument based on the Q-sort method, it is composed by 200 describe which describe personality; the clinician must subdivide in eight categories in connection with the degree of applicability to the subject, from before, with score zero, that it contains affirmations that the clinician considers insignificant or inapplicable for that patient, to eighth, with score 7, that it highly contains affirmations described you of the patient.
The measurement of the changes in the course of the treatment will be carried out through re-test of the psychological instruments just described.
Many experimental data underline that the clinic variety observed in the answer to the pharmacological treatment for mood disorders and anxiety can depend on genetic factors which will be evaluated in the study

After informing the patients about the studies they will study an informed consensus, then it will be taken a blood sample for pharmacogenetic studies. The aim is identifying the treatment answer profile considering the genetic features with the purpose of finding specific therapeutic interventions
If we have no answer to the treatment of six weeks, we will change drug. It would be possible the contemporary treatment with benzodiazepines and stabilizing drug