Valenti R, Pescini F, Antonini S, Castellini G, Poggesi A, Bianchi S, Inzitari D, Pallanti S, Pantoni L. Major depression and bipolar disorders in CADASIL: a study using the DSM-IV semi-structured interview.

Acta Neurol Scand. 2011 Mar 24.

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Berlin HA, Koran LM, Jenike MA, Shapira NA, Chaplin W, Pallanti S, Hollander E. Double-blind, placebo-controlled trial of topiramate augmentation in treatment-resistant obsessive-compulsive disorder.

J Clin Psychiatry. 2010 Aug 10.

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Kooij SJ, Bejerot S, Blackwell A, Caci H, Casas-Brugue M, Carpentier PJ, Edvinsson D, Fayyad J, Foeken K, Fitzgerald M, Gaillac V, Ginsberg Y, Henry C, Krause J, Lensing M, Manor I, Niederhofer H, Nunes-Filipe C, Ohlmeier MD, Oswald P, Pallanti S, Pehlivanidis A, Ramos-Quiroga JA, Rastam M, Ryffel-Rawak D, Stes S, Asherson P. European consensus statement on diagnosis and treatment of adult ADHD: the European Network adult ADHD.

BMC Psychiatry. 2010 Sep 3;10(1):67

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Pallanti S, Problematic Internet use: is it more compulsory than rewarding or mood driven?

World Psychatry Journal 2010 Jun;9(2):96-97

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Pallanti S, Haznedar MM, Hollander H, Licalzi EM, bernardi S, Newmark R, Buchsbaum MS, Basal Ganglia activity in pathological gambling: a fluorodeoxyglucose- positron emission tomography study.

World Neuropsychobiol. 2010 Jun30;62(2):132-138):96-97

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Schlaepfer TE, Lisanby SH, Pallanti S, Separating hope from hipe: some ethical implications of the development of deep brain stimulation in psychiatric research and treatment.

CNS Spectr. 2010 May; 15(5):285-77

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Pallanti S, Unique contributions of brain stimulation to the study of consciousness: where neuroscience meets philosophy.

CNS Spectr. 2010 Mar;15(3):154-6

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Cecchelli C, Grassi G, Pallanti S. Aripiprazole Improves Depressive Symptoms and Immunological Response to Antiretroviral Therapy in an HIV-Infected Subject with Resistant Depression.

Case Report Med. 2010;2010:836214.

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Bernardi S, Cortese S, Solanto M, Hollander E, Pallanti S. Bipolar disorder and comorbid attention deficit hyperactivity disorder. A distinct clinical phenotype? Clinical characteristics and temperamental traits.

World J Biol Psychiatry. 2010 Mar 30.

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Pallanti S, Borgheresi A, Pampaloni I, Giovannelli F, Bernardi S, Cantisani A, Zaccara G, Cincotta M. Motor cortex excitability correlates with novelty seeking in social anxiety: a transcranial magnetic stimulation investigation.

J Neurol. 2010 Mar 30.

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Pallanti S, Bernardi S, Raglione LM, Marini P, Ammannati F, Sorbi S, Ramat S. Complex repetitive behavior: Punding after bilateral subthalamic nucleus stimulation in Parkinson’s disease.

Parkinsonism Relat Disord. 2010 Mar 24.

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Pallanti S, Di Rollo A , Bernardi S, Antonini S, Quercioli L. Unilateral low frequency versus sequential bilateral rTMS: is simpler better for treatment of resistant depression?

Neuroscience 2010, May 5; 167 (2): 323-8.

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Pallanti S, Bernardi S, Antonini S, Singh N, Hollander E. Ondansetron augmentation in treatment resistant OCD: a preliminary single-blind prospective study.

CNS Drug 2009 Dec 1; 23(12): 1047-55

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Lisanby SH, Pallanti S, Schlaepfer TE. FDA considers classification of ECT.

CNS Spectr. 2009 Dec;14(12):668-70.

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Bernardi S, Pallanti S. Internet addiction: a descriptive clinical study focusing on comorbidities and dissociative symptoms.

Compr. Psychiatry 2009 Nov-Dec; 50(6):510-6

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Pallanti S, Bernardi S, Allen A, Hollander E. Serotonin function in pathological gambling: blunted growth hormone response to Sumatriptan

J. Psychopharmacol. 2009 Oct. 13

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Potenza MN, Koran LM, Pallanti S. The relationship between impulse-control disorders and obsessive-compulsive disorder: a current understanding and future research directions

Psychiatry Res. 2009 Nov 30; 170(1):22-31

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Pallanti S, Castellini G, Chamberlain SR, Quercioli L, Fineberg NA. Cognitive event-related potentials differentiate schizophrenia with obsessive compulsive disorder (schizo-OCD) from OCD and schizophrenia without OC symptoms.

Psychiatric Research 2009 Nov 30; 170(1):52-60

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Pallanti S, Bernardi S Neurobiology of repeated transcranial magnetic stimulation in the treatment of anxiety: a critical review

Int Clin Psychopharmacol 2009 Jul; 24(4):163-73

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Berlin, H. A., Koran, L. M., Jenike, M. A., Shapira, N., Chaplin, W., Pallanti, S., Hollander, E. Double-blind, placebo-controlled trial of topiramate augmentation in the treatment of obsessive-compulsive disorder, Conference Information: 63rd Annual Convention of the Society-of-Biological-Psychiatry, 2008 Washington, DC,

Biological Psychiatry, 2008, 63, 7: 170S-170S   Suppl. S

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Bernardi, S., Ramat, S., Raglione, L., Marini, P., Sorbi, S., Aminannati, F., Pallanti, S. Punding after bilateral subthalamic nucleus stimulation in le Parkinson’ disease,

European Psychiatry, 2008, 23, 2, S351-S351, Suppl. 2.

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Hollander, E., Buchsbaum, M. S., Haznedar, M. M., Berenguer, J., Berlin, H. A., Chaplin, W., Goodman, C. R., LiCalzi, E. M., Newmark, R., Pallanti, S.FDG-PET Study in Pathological Gamblers

Neuropsychobiology. 2008;58(1):37-47.

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Pallanti S, Bernardi S, Allen A, Chaplin W, Watner D, DeCaria CM, Hollander E. Noradrenergic Function in Pathological Gambling: Blunted Growth Hormone Response to Clonidine.

Jurnal f Psychpharmacol. 2008 Nov 21.

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Pallanti S, Hollander E,. Obsessive-Compulsive Disorders Spectrum as a Scientific “Metaphor”.

CNS Spectrum 2008 Sep; 13(9 Suppl 14): 6-15. Review.

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Pallanti S. Successful duloxetine treatment of a binge-eating disorder: a case report.

Journal of Psychopharmacol. 2008 Nov 14.

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Hollander E, Buchsbaum MS, Mehmet Haznedar M, Berenguer J, Berlin H, Chaplin W, Goodman CR, LiCalzi EM, Newmark R, Pallanti S.

FDG-PET Study in Pathological Gamblers. Neuropsychobiology 205 (in press).

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Pallanti S. Brain plasticity and brain stimulation in neuropsychiatry: toward individualized medicine.

CNS Spectr. 2008 Apr; 13(4):287-92.

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Pallanti S, Masetti S, Bernardi S, Innocenti A, Markella M, Hollander E. Obsessive compulsive disorder comorbidity in DBA.

Clin Pract Epidemol Ment Health. 2008 Mar; 10; 4:6.

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Pallanti S. Transcultural observations of obsessive-compulsive disorder.

Am J Psychiatry. 2008 Feb; 165(2):169-70.

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91. Pallanti S. Masetti S, Bernardi S, Innocenti A, Fineberg NA, Pampaloni I, Pallanti S, Ipser J, Stein DJ. Sustained response versus relapse: the pharmacotherapeutic goal for obsessive-compulsive disorder.

Int Clin Psychopharmacol. 2007 Nov;22(6):313-22.

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La Malfa G, Lassi S, Bertelli M, Pallanti S, Albertini G.
Detecting attention-deficit/hyperactivity disorder (ADHD) in adults with intellectual disability The use of Conners’ Adult ADHD Rating Scales (CAARS).

Res Dev Disabil 2007 Apr 6 PMID: 17416484 [PubMed – as supplied by publisher]

Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy; SIRM-Italian Society for the Study of Mental Retardation, Firenze, Italy.

There is an increasing interest in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adulthood. It is also thought that ADHD is more prevalent in the field of intellectual disability (ID) than in the general population, but there are not many experimental studies. Since ADHD diagnosis in adults is more difficult, specific rating scales correlated to the main diagnostic systems have been created but have not been applied to people with ID. This work presents an application of an ADHD screening rating scale, the Conners’ Adult ADHD Rating Scales (CAARS) screening version to 46 adults with ID. The resulting prevalence of “ADHD-positive” was 19.6%. These data are in accord with results reported in the general adult literature. Our data suggest that ID and attention disorders can co-occur. Therefore, not only can ADHD be a valid psychiatric diagnosis for a child with ID but for an adult with ID as well. The CAARS can be considered a useful clinical instrument to survey ADHD in ID.

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Hollander E, Kim S, Khanna S, Pallanti S.
Obsessive-compulsive disorder and obsessive-compulsive spectrum disorders: diagnostic and dimensional issues.

CNS Spectr. 2007 Feb;12(2 Suppl 3):5-13. PMID: 17277719 [PubMed – in process]

Department of Psychiatry, the Mount Sinai School of Medicine, New York, NY, USA

Although obsessive-compulsive disorder (OCD) is classified as an anxiety disorder in the DSM-IV, recent considerations for a reclassification into an obsessive-compulsive spectrum disorders (OCSDs) cluster are gaining prominence. Similarities in symptomatology, course of illness, patient population, and neurocircuitry of OCD and OCSD are supported by comorbidity, family, and neurological studies, which also offer a critical re-evaluation of the relationship between OCD and anxiety disorders. This review examines potential classifications of OCD among the wider spectrum of affective disorders and at the interface between affective disorders and addiction. In addition, it has been suggested that the categorical diagnostic approach would be enhanced by an additional dimensional approach, including parameters such as stability of mood and ability to sustain attention. With further studies, it is ultimately the goal to define OCD and related disorders based on endophenotypes. Despite efforts in this field, there are several fundamental unresolved issues, including the question of which disorders should be grouped together in this category and which characteristics to include as their shared common features. A reclassification of OCD among the OCSDs would allow for better scrutiny of distinct obsessive-compulsive symptoms, as currently this disorder often goes undetected in patients who complain of a broad symptom of anxiety. Advantages and disadvantages of establishing OCSDs and its implications for diagnosis, treatment, and research are discussed.

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Rucci P, Rossi A, Mauri M, Maina G, Pieraccini F, Pallanti S, Camilleri V, Montagnani MS, Endicott J; Gruppo Equip.
[Validity and reliability of Quality of Life, Enjoyment and Satisfaction Questionnaire, Short Form]

Epidemiol Psichiatr Soc. 2007 Jan-Mar;16(1):79-89 PMID: 17427608 [PubMed – in process]

Deipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotechnologie, Universita di Pisa.

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Pallanti S., Quercioli L.
Resistant social anxiety disorder response to Escitalopram. Clin Pract Epidemol Ment Health.

2006 Dec 13;2(1):35 [Epub ahead of print]

ABSTRACT: BACKGROUND: Social Anxiety Disorder (SAD) is a common disorder and its high prevalence and lifelong chronicity are such that it represents a substantial public health problem. The observation that serotonergic agents appear to be effective for its treatment suggests that patients may have abnormal serotonergic neurotransmission within the central nervous system. We investigated the efficacy of Escitalopram in treatment resistant patients with SAD. METHOD: Twenty-nine adult outpatients participated in a 12-week open-label trial of escitalopram. All the subjects had a primary diagnosis of SAD and had failed at least one previous adequate trial of paroxetine. escitalopram was orally administered starting with a dose of 10 mg/day following a 1-week titration. RESULTS: The escitalopram treatment was characterized by good tolerability (drop-out rate due to intolerance: 10.3%), and 24 subjects completed the study trial. At the end of the 12-week treatment period, 14 subjects (48.3%) were considered as responders on the basis of the Clinical Global Impression-Improvement (CGI-I) (much or very much improved) scale and the Liebowitz Scale for Social Anxiety (LSAS) (reduction >35% compared to baseline). We observed a significant mean reduction in the Sheehan Disability Scale Work (p<.05) and Social (p<.05) subscores, but not in the Family subscore. CONCLUSIONS: These data suggest ecitalopram has a role in the treatment of resistant SAD, especially in view of the favourable tolerability profile observed in the patients. Controlled studies are required to further investigate these findings and to compare escitalopram with other treatments for this disorder.

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Pallanti S, Bernardi S, Quercioli L.
The Shorter PROMIS Questionnaire and the Internet Addiction Scale in the Assessment of Multiple Addictions in a High-School Population: Prevalence and Related Disability.

CNS Spectr. 2006 Dec;11(12):966-74.

Objective: Taking into account the importance of act prevention on the development of addictions, we assessed the presence of multiple addictions in an adolescent high-school population, also assessing the prevalence of Internet abuse and the impact on disability. Introduction: Adolescence seems to be a critical period of addiction vulnerability, based on social but also neurobiological factors. The earlier onset of behavioral/substance dependence seems to predict greater addiction severity, morbidity, and multiple addictive disorders. Methods: Data were collected from a sample of 275 students in Florence, Italy, high schools through surveys distributed in classes. The sample had an average age of 16.67+/-1.85 years (52.4% males, 47.6% females). To assess multiple addiction we used the 16 subscales of the Shorter PROMIS Questionnaire, to assess Internet addiction prevalence we used the Internet Addiction Scale, and to quantify disability symptoms, we used the Sheehan Disability Scale. Results: Caffeine abuse, sex, relationship submissive, gambling, food starving, and food bingeing have raised highest scores. 5.4% of the students were found to be Internet addicted similar to other countries. Disability seemed strongly correlated to the subscale of alcohol, gambling, sex, tobacco, food starving and food bingeing, shopping, exercise, and Internet addiction. Gambling, sex, caffeine abuse, compulsive help dominant, work, Internet addiction, relationship dominant, and relationship submissive in this sample were strongly related to substance dependence. Conclusion: Level of concerns unexpected compared to the level reported in other countries for the behavioral compulsions, have been highlighted. Behavioral addictions are multiple, a source of disability, and they are related to substance abuse. It has yet to be clarified if they are a temporary phenomenon occurring in adolescents or if they are a stable trait, accounting as marker for the development of substance abuse.

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Pallanti S, Bernardi S, Quercioli L, Decaria C, Hollander E.
Serotonin Dysfunction in Pathological Gamblers: Increased Prolactin Response to Oral m-CPP Versus Placebo.

CNS Spectr. 2006 Dec;11(12):956-64.

Objective: Acute administration of the partial serotonin (5-HT) agonist meta-chlorophenylpiperazine (m-CPP), that is used also as a street drug, has been reported to induce a “high” and craving response in various impulsive and substance addiction disorders. Introduction: To clarify altered 5-HT metabolism in pathological gamblers and to explore the specific role of serotonergic system in non-substance addictions, we assessed behavioral (“high” and “craving”) and neuroendocrine (prolactin and cortisol) responses to an oral single dose of m-CPP and placebo in pathological gamblers and matched controls. Moreover, the relationship between neuroendocrine outcome and clinical severity has been assessed. Method: Twenty-six pathological gamblers and 26 healthy control subjects enter a double-blind, placebo-controlled-crossed administration of orally dose m-CPP 0.5 mg/kg. Outcome measures included prolactin and cortisol levels, gambling severity, mood, craving and “high” scales. Results: Pathological gamblers had significantly increased prolactin response compared to controls at 180 minutes and at 210 minutes post-administration. Greater pathological gamblers severity correlated with increased neuroendocrine responsiveness to m-CCP, suggesting greater 5-HT dysregulation. Pathological gambling patients had a significantly increased “high” sensation after m-CPP administration compared with control. Conclusion: These results provide additional evidence for 5-HT disturbance in pathological gamblers and they support the hypotheses that the role of the 5-HT dysfunction related to the experience of “high” might represent the pathway that leads to dyscontrolled behavior in pathological gamblers. Furthermore, the “high” feeling induced by m-CPP in pathological subjects may represent a marker of vulnerability to both behavioral and substance addictions.

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Buchsbaum MS, Hollander E, Pallanti S, Baldini Rossi N, Platholi J, Newmark R, Bloom R, Sood E.
Positron emission tomography imaging of risperidone augmentation in serotonin reuptake inhibitor-refractory patients.

Neuropsychobiology. 2006;53(3):157-68. Epub 2006 May 16.

We studied 15 nondepressed patients with obsessive-compulsive disorder (OCD) who were nonresponders to serotonin reuptake inhibitors with an additive trial of risperidone. Positron emission tomography with (18)F-deoxyglucose and magnetic resonance imaging was obtained at baseline and following 8 weeks of either risperidone or placebo in a double-blind parallel group design. Risperidone treatment was associated with significant increases in relative metabolic rate in the striatum, cingulate gyrus, the prefrontal cortex, especially in the orbital region, and the thalamus. Four of 9 patients who received risperidone showed clinical improvement (CGI score of 1 or 2 at 8 weeks) while none of the 6 patients who received placebo showed improvement. Patients with low relative metabolic rates in the striatum and high relative metabolic rates in the anterior cingulate gyrus were more likely to show a clinical response. These metabolic predictors of clinical response are consistent with earlier PET studies showing similar prediction when either neuroleptics or serotonin reuptake inhibitor treatments are administered individually. Our results are consistent with a frontostriatal circuit change related to both dopaminergic and serotonergic systems and with the presence of psychopharmacological subtypes within OCD. Copyright (c) 2006 S. Karger AG, Basel.

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Pallanti S, Quercioli L.
Treatment-refractory obsessive-compulsive disorder: methodological issues, operational definitions and therapeutic lines. Prog Neuropsychopharmacol Biol Psychiatry.

2006 May;30(3):400-12. Epub 2006 Feb 28. Review.

While controlled trials with SRIs have demonstrated a selective efficacy in obsessive-compulsive disorder (OCD), up to 40-60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of non-responsive patients, and they are difficult to cluster due to ambiguities in diagnostic criteria, possibility of subtypes and a high rate of comorbidity. Moreover, the findings of current studies of “so-called” non-responsive cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of the research in this area are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multisite data collection for future research trials. The authors reviewed also the more recent therapeutic pharmacological and psychological lines for the treatment of refractoriness in OCD.

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Rossi A, Rucci P, Mauri M, Maina G, Pieraccini F, Pallanti S, Endicott J; (For the EQUIP group).
Validity and reliability of the Italian version of the Quality of Life, Enjoyment and Satisfaction Questionnaire.

Qual Life Res. 2005 Dec;14(10):2323-8.

The Quality of Life, Enjoyment and Satisfaction Questionnaire (Q-LES-Q) is increasingly used in psychiatry because it gives emphasis to the subjective perspective of patients on physical, psychological and social domains. This paper reports on the validation of the Italian version of the Q-LES-Q in a large multicenter study (EQUIP) conducted at five Italian sites on outpatients in treatment for anxiety disorders. Study participants underwent a broad assessment of psychopathology including the MINI-International Neuropsychiatric Interview, the Symptom Checklist (SCL-90) and the Clinical Global Impression (CGI). Cronbach’s alpha was used to determine the internal consistency of the Q-LES-Q areas and Pearson’s r was used to analyze the correlation between the areas of Q-LES-Q and those of the other instruments. The internal consistency of the Q-LES-Q proved to be substantial (>0.80 in each of the areas) as well as the test-retest reliability. The convergent validity of the Q-LES-Q vs. the Work and Social Adjustment Scale was examined. High correlations were found between scales measuring similar constructs in the two instruments and lower correlation between scales measuring different constructs. In conclusion, the Italian version of the Q-LES-Q proved to be as valid and reliable as the original English version.

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Pallanti S, Decaria CM, Grant JE, Urpe M, Hollander E.
Reliability and Validity of the Pathological Gambling Adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS)

J Gambl Stud. 2005 Winter;21(4):431-43.

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.

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Pallanti S, Lassi S, La Malfa G, Campigli M, Di Rubbo R, Paolini G, Cesarali V.
Short report: Autistic gastrointestinal and eating symptoms treated with secretin: a subtype of autism.

Clin Pract Epidemol Ment Health. 2005 Nov 15;1:24.

Pervasive Developmental Disorders (PDD) are chronic, lifelong disorders for which there is as yet no effective cure, and medical management remains a challenge for clinicians. The current report describes two patients affected by autistic disorder with associated gastrointestinal symptoms. They received multiple doses of intravenous secretin for a six-month period and were assessed with several specific outcome measures to evaluate drug effect. The administration of secretin led to some significant and lasting improvement in only one case. Gastroesophageal reflux may contribute to some of the behavioural problems and explain the effect of secretin since its suppressive effect on gastric secretion is well known. It is also true that autistic children with gastroesophageal reflux and a higher IQ could constitute a subtype which responds to secretin administration and that could be labelled as a “gastrointestinal subtype”.

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Hollander E, Pallanti S, Baldini Rossi N, Sood E, Baker BR, Buchsbaum MS.
Imaging monetary reward in pathological gamblers.

World J Biol Psychiatry. 2005;6(2):113-20.

We acquired two 18F-deoxyglucose positron emisssion tomography (PET) scans on seven unmedicated pathological gamblers, at least 7 days apart. Following an injection of 5 mCi FDG, subjects carried out a computer blackjack task for 35 min under two different reward conditions: monetary reward and computer game points only. Relative FDG metabolic rate was obtained from regions of interest in the prefrontal cortex, cingulate, striatum and visual cortex. Monetary reward blackjack was associated with significantly higher relative metabolic rate in the primary visual cortex (Brodmann area 17), the cingulate gryus (Brodmann area 24), the putamen and prefrontal areas 47 and 10, compared to blackjack playing for points only. No area tested showed a significant decrease. This pattern suggests heightened limbic and sensory activation in the gambling for money condition with increased emotional valence and greater risk and reward, and confirms the salience of monetary reward in the development of pathological gambling.

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Pallanti S, Lotti T, Urpe M.
Psychoneuroimmunodermatology of atopic dermatitis: from empiric data to the evolutionary hypothesis.

Dermatol Clin. 2005 Oct;23(4):695-701. Review.

Atopic dermatitis is a pruritic skin disease affecting predominantly young people. There is evidence that psychologic stress constitutes an increased risk for atopy and influences the disease’s clinical course. This risk is believed mediated by the effects of stress on neuroimmunoregulation, which in turn modulates the hypersensitivity response and involves immunoglobulin E-mediated inflammation, helper T-cell 2 predominance, and eosinophilia. This article examines theoretic perspectives and other behavioral dimensions, such as maternal caring behavior, infant response to stress, temperament, and the so-called “hygiene hypothesis.” The Darwinian framework and the mental scenario are examined. These processes may be akin to the generation of antibodies by the immune system.

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Urpe M, Pallanti S, Lotti T.
Psychosomatic factors in dermatology.

Dermatol Clin. 2005 Oct;23(4):601-8. Review.

psychiatric elements. Dermatologists know that a significant proportion of their practice involves patients for whom psychologic elements either partially or sometimes entirely dominate their presenting chief complaints. This article explores the role of psychosomatic factors in dermatologic disorders. The authors discuss the clinical interface between psychiatry, psychology and dermatology and the interpretation of possible relationships between cutaneous diseases, the role of the mind, and psychotherapeutic interventions.

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Haznedar MM, Roversi F, Pallanti S, Baldini-Rossi N, Schnur DB, Licalzi EM, Tang C, Hof PR, Hollander E, Buchsbaum MS.
Fronto-thalamo-striatal gray and white matter volumes and anisotropy of their connections in bipolar spectrum illnesses.

Biol Psychiatry. 2005 Apr 1;57(7):733-42.

BACKGROUND: Neurons in the basal ganglia are connected to areas of prefrontal cerebral cortex involved in higher cognitive functions, and these connections occur primarily via the thalamus. In patients with bipolar disorder, regardless of age, neuroimaging studies have consistently reported an increased number of white matter hyperintensities, indicating possible alterations in striatum-thalamus and thalamus-prefrontal cortex connections. METHODS: In the current study, we acquired high-resolution magnetic resonance imaging (MRI) and diffusion tensor (DT) scans of 40 patients with bipolar spectrum (BPS) illnesses (bipolar type I = 17, bipolar type II = 7, cyclothymia = 16) and 36 sex- and age-matched control subjects. Two researchers, without knowledge of diagnosis, outlined the caudate, putamen, and thalamus on contiguous axial MRI slices. We measured the volumes of the basal ganglia, thalamus, and gray/white matter of the frontal cortex. RESULTS: Bipolar spectrum patients as a single group did not differ from control subjects in thalamus and the basal ganglia volumes, but the cyclothymia patients had reductions in the volumes of putamen and the thalamus compared with control subjects. The BPS patients had significantly reduced volume of the white and the gray matter of the frontal cortex. Furthermore, compared with control subjects, BPS patients as a group showed alterations in anisotropy of the internal capsule adjacent to the striatum and thalamus and the frontal white matter. CONCLUSIONS: Our findings indicate that BPS patients may have distinct anatomical alterations in brain structures involved in the regulation of mood and cognition, as well as alterations in these structures’ connection to related brain areas.

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Hollander E, Sood E, Pallanti S, Baldini-Rossi N, Baker B.
Pharmacological treatments of pathological gambling.

J Gambl Stud. 2005 Spring;21(1):99-108.

Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.

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Hollander E, Pallanti S, Allen A, Sood E, Baldini Rossi N.
Does sustained-release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders?

Am J Psychiatry. 2005 Jan;162(1):137-45.

OBJECTIVE: Selective serotonin reuptake inhibitors may be effective for some patients with pathological gambling, but those with comorbid conditions, such as bipolar spectrum disorders, may relapse during treatment. To the authors’ knowledge, this is the first placebo-controlled treatment study in pathological gamblers with bipolar spectrum disorders; it compares sustained-release lithium carbonate to placebo. METHOD: Forty pathological gambling patients with bipolar spectrum disorders entered a 10-week randomized, double-blind, placebo-controlled treatment study of sustained-release lithium carbonate. Outcome measures included gambling severity, mood, anxiety, and impulsivity scales. RESULTS: Pathological gambling patients with bipolar spectrum disorders significantly improved while taking sustained-release lithium carbonate compared to placebo on total pathological gambling scores on the Yale-Brown Obsessive Compulsive Scale, including both thoughts/urges and behavior, as well as on the Clinical Global Impression severity of pathological gambling scale. Affective instability (the Clinician-Administered Rating Scale for Mania score) was also lower in the group treated with sustained-release lithium carbonate compared to placebo. Ten (83%) of 12 completers were rated as responders in the sustained-release lithium group versus five (29%) of 17 in the placebo group. Of note, improvement in gambling severity was significantly correlated with improvement in mania ratings. CONCLUSIONS: Sustained-released lithium may be an effective treatment in reducing both gambling behavior and affective instability in pathological gamblers with bipolar spectrum disorder. This study highlights the need to identify subgroups of pathological gambling patients with bipolar spectrum conditions because this may have important treatment implications.

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Pallanti S, Hollander E, Goodman WK.
A qualitative analysis of nonresponse: management of treatment-refractory obsessive-compulsive disorder. J Clin Psychiatry. 2004;65 Suppl 14:6-10. Review.

Serotonin reuptake inhibitors (SRIs), especially potent ones given at high doses over long periods of time, are often effective in the treatment of obsessive-compulsive disorder (OCD). However, a large percentage of patients do not respond to treatment with SRIs, and those who do respond often do not fully remit, which should be the standard goal of treatment in OCD. If a patient has been treated for several months and has not yet responded to treatment with several SRIs, the physician should perform a careful assessment of resistant and/or residual clinical symptoms and any comorbid conditions to determine which next-step treatment would be the most appropriate. One strategy for patients who have not responded to treatment with an SRI is to switch them to a serotonin-norepinephrine reuptake inhibitor, because some patients may respond better to agents that target multiple systems. Another promising approach is the augmentation of SRIs with neuroleptics. In addition, open trials have shown that intravenous (IV) clomipramine and IV citalopram may be effective in the treatment of resistant OCD. Novel pharmacotherapeutic treatments and electroconvulsive therapy have been attempted, with mixed success. Recently, researchers have been studying repetitive transcranial magnetic stimulation, vagal nerve stimulation, and neurosurgical approaches such as gamma knife capsulotomy and deep brain stimulation to learn if these procedures are effective in treating treatment-resistant OCD. Repetitive transcranial magnetic stimulation has possibilities not only as a therapy but also as an instrument that can help researchers describe the neurocircuitries involved in OCD. More results are needed before the effectiveness of the nonpharmacologic treatments for OCD can be determined.

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Pallanti S, Quercioli L, Bruscoli M.
Response acceleration with mirtazapine augmentation of citalopram in obsessive-compulsive disorder patients without comorbid depression: a pilot study.

J Clin Psychiatry. 2004 Oct;65(10):1394-9.

BACKGROUND: Therapeutic action of selective serotonin reuptake inhibitors (SSRIs) is delayed from 8 to 12 weeks in patients with obsessive-compulsive disorder (OCD). Several different agents have been tested to reduce the SSRI therapeutic latency time. Mirtazapine, an antagonist at alpha2-adrenoceptors, does not enhance serotonin (5-HT) neurotransmission directly but disinhibits the norepinephrine activation of 5-HT neurons and thereby increases 5-HT neurotransmission by a mechanism that may not require a time-dependent desensitization of receptors. The present study was undertaken to determine whether the mirtazapine-citalopram combination could induce an earlier and/or greater effect on the 5-HT system in OCD subjects than citalopram alone. METHOD: Forty-nine patients with OCD (DSM-IV) without comorbid depression were randomly assigned to a 2-tailed, single-blind, 12-week clinical trial with citalopram (20-80 mg/day) plus placebo or citalopram plus mirtazapine (15-30 mg/day). Assessments were performed weekly with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Hamilton Rating Scale for Depression, and the Clinical Global Impressions scale. Data were collected from November 2001 to July 2003. RESULTS: The citalopram plus mirtazapine group achieved a reduction of at least 35% in YBOCS score and a “much improved” or “very much improved” rating on the Clinical Global Impressions-Improvement scale from the fourth week, while the citalopram plus placebo group obtained these results only from the eighth week. The number of responders was higher in the citalopram plus mirtazapine group at the fourth week of treatment, while no difference between groups in the response rate was noted at the eighth and twelfth weeks of treatment. CONCLUSIONS: We found an earlier onset of response action in OCD symptoms and reduced undesired side effects when mirtazapine was added to citalopram. This augmentation strategy deserves clinical and research consideration through further double-blind, placebo-controlled studies.

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Pallanti S, Quercioli L, Hollander E.
Social anxiety in outpatients with schizophrenia: a relevant cause of disability.

Am J Psychiatry. 2004 Jan;161(1):53-8.

schizophrenia and is associated with a severe level of disability. To precisely define the assessment, impact, clinical correlates, and consequences of social anxiety in schizophrenia, the authors conducted a survey of schizophrenia patients and a comparison cohort of patients with social anxiety disorder. METHOD: A consecutively enrolled group of 80 outpatients with DSM-IV schizophrenia and a consecutive comparison group of 27 patients with social anxiety disorder were recruited from an institutional psychiatric practice and assessed with the Liebowitz Social Anxiety Scale, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, Social Adjustment Scale, and the Medical Outcomes Study 36-item Short-Form Health Survey. RESULTS: Social anxiety scores of schizophrenia patients with comorbid social anxiety disorder (N=29, 36.3%) did not differ from those of subjects with social anxiety disorder as their primary diagnosis. Schizophrenia patients without social anxiety disorder had significantly lower total scores on the Liebowitz Social Anxiety Scale and lower social and performance anxiety subscale scores than did the other two groups. No differences in negative and positive symptom rates were found between schizophrenia patients with and without social anxiety disorder. Schizophrenia patients with social anxiety disorder had a higher lifetime rate of suicide attempts, greater lethality of suicide attempts, more past substance/alcohol abuse disorder, lower social adjustment, and lower overall quality of life. CONCLUSIONS: Social anxiety is a highly prevalent, disabling condition in outpatients with schizophrenia that is unrelated to clinical psychotic symptoms. The Liebowitz Social Anxiety Scale appeared adequate and reliable in assessing social anxiety disorder in patients with schizophrenia. If these data are confirmed, this study will make a contribution to the search for operational guidelines and adequate next-step treatments for social anxiety disorder in schizophrenia patients.

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Hollander E, Baldini Rossi N, Sood E, Pallanti S.
Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study.

Int J Neuropsychopharmacol. 2003 Dec;6(4):397-401.

This double-blind, placebo-controlled trial was performed to determine the efficacy and tolerability of 8 wk of risperidone augmentation of serotonin reuptake inhibitor (SRI) treatment in adult subjects with treatment-resistant obsessive-compulsive disorder (OCD) (failure of at least two SRI trials). Sixteen adult treatment-resistant OCD patients were randomly assigned to augmentation with 8 wk of either risperidone (n=10) (0.5-3.0 mg/d) or placebo (n=6) following at least 12 wk of SRI treatment. Four patients on risperidone (40%) and none (0%) on placebo were responders with both a Clinical Global Impression – Improvement (CGI-I) score of 1 or 2 and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decrease >/=25%. Risperidone was generally well tolerated: there were 3 dropouts, 1 on risperidone and 2 on placebo. Better Y-BOCS insight score at baseline significantly correlated with a greater CGI-I score at endpoint on risperidone augmentation. Risperidone may be an effective and well-tolerated augmentation strategy in treatment-resistant OCD subjects, but larger sample size studies are required to demonstrate this.

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Sood ED, Pallanti S, Hollander E.
Diagnosis and treatment of pathologic gambling.

Curr Psychiatry Rep. 2003 May;5(1):9-15. Review.

Pathologic gambling (PG) is an impulse control disorder characterized by recurrent and maladaptive gambling behaviors that significantly disrupt the patient’s functioning in the personal, familial, or vocational spheres. Pathologic gambling is estimated to currently affect 1% to 3.4% of the adult US population and is frequently comorbid with substance abuse or dependence, attention-deficit/hyperactivity disorder (ADHD), and affective disorders. Studies show evidence for the involvement of the serotonergic, noradrenergic, and dopaminergic systems in the etiology of PG. Medication treatment studies performed in PG patients demonstrated the short-term efficacy of various serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers in a subsample of adult pathologic gamblers who seek treatment. This review focuses on recent research examining the neurobiology and treatment of PG.

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Pallanti S, Baldini Rossi N, Sood E, Hollander E.
Nefazodone treatment of pathological gambling: a prospective open-label controlled trial.

J Clin Psychiatry. 2002 Nov;63(11):1034-9.

BACKGROUND: Pathological gambling is a disabling and highly prevalent impulse-control disorder not otherwise specified (NOS). According to the hypothesis of abnormal serotonin function in the pathophysiology of poor impulse control and pathological gambling, we assessed the efficacy and tolerability of nefazodone, a 5-HT antagonist reported to be effective in other impulse-control disorders NOS, in the treatment of pathological gambling. METHOD: Fourteen outpatients who met DSM-IV criteria for pathological gambling were enrolled in a prospective 8-week open-label oral nefazodone trial. Nefazodone was initiated at 50 mg/day and titrated upward to a maximum of 500 mg/day based on patient’s response and side effects, with a minimum daily dose of 100 mg. Improvement in gambling was assessed via the pathological gambling modifications of the Yale-Brown Obsessive Compulsive Scale (PG-YBOCS), the Clinical Global Impressions-Improvement scale (PG-CGI-I), and self-rated gambling scales. Response was defined a priori as both a 25% reduction in PG-YBOCS score and a score of 1 (very much improved) or 2 (much improved) on the PG-CGI-I scale. RESULTS: Twelve subjects completed the study, and 2 subjects were early dropouts who did not receive the minimum required dose. Significant improvements were noted in all gambling outcome measures, as well as in depression and anxiety ratings (which did not significantly correlate with gambling reduction). Nine (75%) of 12 patients were rated as responders according to a priori criteria. Side effects (dry mouth and sedation) of moderate severity occurred in 4 subjects. CONCLUSION: These preliminary results suggest that nefazodone may be effective in reducing symptoms of pathological gambling and is well tolerated.

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Pallanti S, Quercioli L, Koran LM.
Citalopram intravenous infusion in resistant obsessive-compulsive disorder: an open trial.

J Clin Psychiatry. 2002 Sep;63(9):796-801.

BACKGROUND: Treatment with intravenous clomipramine is rapidly effective in some obsessive-compulsive disorder (OCD) patients unresponsive to orally administered serotonin reuptake inhibitors (SRIs). The selective serotonin reuptake inhibitor citalopram is effective for OCD when administered orally. We investigated whether intravenous citalopram would rapidly benefit OCD patients unresponsive to orally administered SRIs. METHOD: Thirty-nine adult outpatients participated in a 3-week open-label trial of intravenous citalopram. Eligible patients had moderate-to-severe DSM-IV OCD of > or = 1 year’s duration, a baseline Yale-Brown Obsessive Compulsive Scale (YBOCS) score > or = 25, and no other active Axis I diagnosis and had failed at least 2 adequate oral SRI trials, excluding citalopram. Intravenous citalopram was administered daily for 21 days, followed by oral citalopram until treatment day 84. Intravenous citalopram was started at 20 mg/day and was increased to 40 to 80 mg/day as tolerated. RESULTS: Intravenous citalopram was well tolerated even at higher doses (dropout rate = 2.6%). At day 21, 23 (59%) of the 39 patients had YBOCS score decreases of > or = 25%, of whom 4 had decreases of > or = 35%. Twenty-seven patients with YBOCS score decreases of > or = 20% were allowed to continue on treatment with oral citalopram, and by day 84, all had substantial further improvement. All 27 patients also showed significant improvement in several dimensions of quality of life. CONCLUSION: Intravenous citalopram was safe and rapidly effective in a group of treatment-resistant OCD patients. The early onset of response suggests a means of accelerating OCD symptom relief and predicting response to oral citalopram treatment. Double-blind, double-dummy, placebo-controlled trials of intravenous versus oral citalopram in patients with treatment-resistant OCD are indicated.

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Pallanti S, Quercioli L, Sood E, Hollander E.
Lithium and valproate treatment of pathological gambling: a randomized single-blind study.

J Clin Psychiatry. 2002 Jul;63(7):559-64.

OBJECTIVE: The aim of the present study was to evaluate the efficacy and safety of lithium and valproate in nonbipolar pathological gamblers. METHOD: Forty-two subjects with DSM-IV-defined pathological gambling entered a 14-week single-blind trial with lithium (N = 23) or valproate (N = 19). A total of 15 subjects on lithium treatment and 16 patients on valproate treatment completed the 14-week protocol. RESULTS: At the end of the 14-week treatment period, both the lithium and the valproate groups showed significant (p <.01) improvement in mean score on the Yale-Brown Obsessive Compulsive Scale modified for pathological gambling. This improvement did not significantly differ between groups. Fourteen (60.9%) of the 23 patients taking lithium and 13 (68.4%) of the 19 patients taking valproate were responders based on a Clinical Global Impressions-Improvement score of much or very much improved. CONCLUSION: Findings from the present study suggest the efficacy of both lithium carbonate and valproate in the treatment of pathological gambling. This is the first controlled trial of the efficacy of mood stabilizers in pathological gambling. A double-blind, placebo-controlled trial is required to confirm these findings.

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Pallanti S, Hollander E, Bienstock C, Koran L, Leckman J, Marazziti D, Pato M, Stein D, Zohar J; International Treatment Refractory OCD Consortium.
Treatment non-response in OCD: methodological issues and operational definitions.

Int J Neuropsychopharmacol. 2002 Jun;5(2):181-91. Review.

While controlled trials with SRIs have demonstrated a selective efficacy in obsessive-compulsive disorder (OCD), up to 40-60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of non-responsive patients, and they are difficult to cluster due to ambiguities in the diagnostic criteria, possibility of subtypes, and a high rate of comorbidity. Moreover, the findings of current studies of so-called ‘non-responsive’ cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of this paper are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multi-site data collection for future research trials.

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Hollander E, Bienstock CA, Koran LM, Pallanti S, Marazziti D, Rasmussen SA, Ravizza L, Benkelfat C, Saxena S, Greenberg BD, Sasson Y, Zohar J.
Refractory obsessive-compulsive disorder: state-of-the-art treatment.

J Clin Psychiatry. 2002;63 Suppl 6:20-9. Review.

Nonresponse to treatment in obsessive-compulsive disorder is common, associated with substantial impairment, and understudied. Little practical advice is available to clinicians on next-step treatment strategies for patients who have not responded well to 2 trials of selective serotonin reuptake inhibitors (SSRIs). Available options include continuation of SSRI treatment, switching to another SSRI or selective serotonin-norepinephrine reuptake inhibitor, augmenting with atypical neuroleptics or cognitive-behavioral therapy, or utilizing novel treatment approaches. The authors synthesize state-of-the-art treatment and give practical advice for clinicians.

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Presta S, Marazziti D, Dell’Osso L, Pfanner C, Pallanti S, Cassano GB.
Kleptomania: clinical features and comorbidity in an Italian sample.

Compr Psychiatry. 2002 Jan-Feb;43(1):7-12.

Kleptomania, listed in DSM-IV as an impulse control disorder not elsewhere classified, is a psychiatric condition still poorly understood and subject of only a few systematic studies. The aim of this research was, therefore, to evaluate the clinical features and comorbidity of Italian patients with a DSM-IV diagnosis of kleptomania. Twenty outpatients with a lifetime diagnosis of kleptomania by DSM-IV criteria, were included in the study and underwent a specially designed semistructured interview and the Family History Research Diagnostic Criteria. The majority of patients reported an early and abrupt onset and an episodic course of the disorder, with no gender preponderance. Lifetime comorbidity for other axis I disorders was high, in particular for mood, anxiety, and impulse control disorders. Family history also showed a high prevalence of psychiatric disorders. Our study indicates clear connections between kleptomania and different psychiatric disorders, the exact nature of which has yet to be clarified. Copyright 2002 by W.B. Saunders Company

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Ramacciotti A, Sorbello M, Pazzagli A, Vismara L, Mancone A, Pallanti S.
Attachment processes in eating disorders.

Eat Weight Disord. 2001 Sep;6(3):166-70.

Anxious and insecure attachment, fear of abandonment and difficulties with autonomy differentiate young women with eating disorders from their normal peers. This paper uses the Adult Attachment Interview (AAI) as the correlation between eating disorders and state of mind regarding attachment (7 females and 6 males) with anorexia nervosa and EDNOS. There was a higher frequency of dismissing or entangled states of mind. The sample is far too small to allow statistical inferences to be drawn about differences between men and women in the style of state of mind regarding attachment. An inference is none the less made with regard to the role of psychotherapy in these results.

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Hollander E, Pallanti S.
5-HT(1D) function and repetitive behaviors.

Am J Psychiatry. 2001 Jun;158(6):972-3. No abstract available.

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Koran LM, Pallanti S, Quercioli L.
Sumatriptan, 5-HT(1D) receptors and obsessive-compulsive disorder.

Eur Neuropsychopharmacol. 2001 Apr;11(2):169-72.

BACKGROUND: After considering the effects of 5-HT receptor agonists with different binding profiles on the symptoms of obsessive-compulsive disorder (OCD), Zohar and Kindler hypothesized that the 5-HT(1D) receptor was implicated in this disorder’s pathophysiology. METHODS: We explored the 5-HT(1D) hypothesis in a 5-day, random, double-blind, placebo-controlled trial of oral sumatriptan 100 mg/day in medication-free adults with OCD. We hypothesized that sumatriptan, a 5-HT(1D) agonist, would diminish 5-HT release, thereby worsening OCD symptoms. We further hypothesized that by beginning to desensitize 5-HT(1D) receptors, sumatriptan pretreatment would promote a faster response or an increased likelihood of response to subsequent treatment with a selective serotonin reuptake inhibitor. RESULTS: The five sumatriptan subjects’ OCD symptom worsening, as measured by the Yale-Brown scale ( upward arrow 17.6% (S.D. 14.6)), was significant when compared to the slight symptom decrease in the five placebo subjects ( downward arrow 5.2% (S.D. 4.9), P<0.015). The sumatriptan group did not exhibit a faster response or greater likelihood of response to a 90-day, open label trial of paroxetine. CONCLUSIONS: Longer term studies of the effects of 5-HT(1D) agonists on OCD symptoms are indicated. Zolmitriptan, a potent 5-HT(1D) receptor agonist with better penetration of the blood-brain barrier, may be a preferred challenge agent.

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Rossi A, Arduini L, Stratta P, Pallanti S.
Subjective experience and subjective response to neuroleptics in schizophrenia.

Compr Psychiatry. 2000 Nov-Dec;41(6):446-9.

Although several studies have addressed the issue of the relationship between the subjective response to neuroleptics and drug compliance, very little attention has been given to the study of the subjective experience of psychosis and drug attitudes. The present study was therefore undertaken to examine the relationship between the subjective experience of psychosis as assessed by the Frankfurter Beschwerde-Fragebogen (FBF) and subjective response (SR) to neuroleptics as assessed by the Drug Attitude Inventory (DAI) in a group of schizophrenic patients. Significant correlations were found between the total scores on the FBF and DAI (r= .46, P< .01). The DAI total score also correlated with all four factors (central cognitive disturbances, perception and motility, depressivity, and internal and external overstimulation) on the FBF. This finding suggests that the SR neuroleptics is partly explained by a “positive” subjective experience of psychosis.

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Di Russo F, Zaccara G, Ragazzoni A, Pallanti S.
Abnormal visual event-related potentials in obsessive-compulsive disorder without panic disorder or depression comorbidity.

J Psychiatr Res. 2000 Jan-Feb;34(1):75-82.

Visual event-related potentials and spline map topography during a discriminative response task (DRT) were studied in 8 obsessive-compulsive disorder (OCD) patients without comorbidity for panic disorder or depression and in 12 age-matched controls. In the DRT task (like in a go/no-go task) the subject had to press a button when the target stimuli appeared and had to retain the response when the non-target stimulus appeared (vertical bars were intermixed with an equal probability of horizontals). OC patients had greater N1 latency than controls and their N1 and P3 amplitude was larger for the target stimuli, but not for non-target stimuli. In the normals, non-target stimuli (no-go task) produced a larger activation than target stimuli (go task). In the OCD patients the target stimuli produced the same large activation as the non-target. These findings are consistent with theories that consider OCD to be an attentional disorder deriving from a misallocating of cognitive resources. Moreover, spline map topography confirmed that P3 hyperactivation is localised principally on the frontal lobes.

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Pini S, Dell’Osso L, Mastrocinque C, Marcacci G, Papasogli A, Vignoli S, Pallanti S, Cassano G.
Axis I comorbidity in bipolar disorder with psychotic features.

Br J Psychiatry. 1999 Nov;175:467-71.

BACKGROUND: Axis I comorbidities are prevalent among patients with severe bipolar disorder but the clinical and psychopathological implications are not clear. AIMS: To investigate characteristics of four groups of patients categorised as follows: substance abuse only (group 1), substance abuse associated with other Axis I disorders (group 2), non-substance-abuse Axis I comorbidity (group 3), no psychiatric comorbidity (group 4). METHOD: Consecutive patients with bipolar disorder with psychotic features (n = 125) were assessed using the Structured Clinical Interview for DSM-III-R–patient version, and several psychopathological scales. RESULTS: By comparison with group 4, group 1 had a higher risk of having mood-incongruent delusions, group 2 had an earlier age at onset of mood disorder, a more frequent onset with a mixed state and a higher risk of suicide, and group 3 had more severe anxiety and a better awareness of illness. CONCLUSIONS: Substance abuse, non-substance-abuse Axis I comorbidity and their reciprocal association are associated with different characteristics of bipolar disorder.

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Pallanti S, Quercioli L, Rossi A, Pazzagli A
The emergence of social phobia during clozapine treatment and its response to fluoxetine augmentation

Journal of Clinical Psychiatry 1999, 60 (12): 819-823

BACKGROUND: The underlying neurochemical basis of social phobia has yet to be fully explained, but there are suggestions of serotonergic and dopaminergic dysfunction. The atypical neuroleptic clozapine has been reported to induce anxiety symptoms, probably owing to its effect on serotonergic pathways. We report 12 cases of schizophrenic patients who developed social phobia during clozapine treatment. METHOD: Patients were assessed using the Structured Clinical Interview for DSM-III-R, Patient Version, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, the Liebowitz Social Phobia Scale, and the Brief Psychiatric Rating Scale. They were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. RESULTS: In 8 of the 12 cases, symptoms responded (> or = 35% reduction in Liebowitz Social Phobia Scale score) with an adjunctive regimen of fluoxetine. CONCLUSION: Data are discussed in light of neurochemical mechanisms and cognitive adaptations that could explain the onset of anxiety spectrum disorders (such as social phobia) in clozapine-treated schizophrenic subjects during remission of psychotic symptoms.

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Marazziti D, Pallanti S.
Effectiveness of olanzapine treatment for severe obsessive-compulsive disorder.

Am J Psychiatry. 1999 Nov;156(11):1834-5. No abstract available.

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Pallanti S, Quercioli L, Paiva RS, Koran LM.
Citalopram for treatment-resistant obsessive-compulsive disorder.

Eur Psychiatry. 1999 Apr;14(2):101-6.

We investigated the comparative efficacy of citalopram vs. c