Citalopram-Associated Gambling: A Case Report

Pathological gambling behaviour is a side effect of dopaminergic drugs used in Parkinson’s disease, but has seldom been reported with selective serotonin reuptake inhibitors. A 58-years-old woman with somatisation disorder since the age of 20 and recent-onset major depression (at 54 years) received 40 mg/day intravenous citalopram, thereafter switching to the same dose of oral citalopram to treat her comorbid psychiatric disorders after showing poor response to paroxetine for one year. Her anxious and depressive symptoms were moderately reduced after 7 months of oral citalopram, but simultaneously, the patient admitted gambling. We gradually discontinued citalopram and introduced pregabalin and alprazolam; this was followed by a reduction of gambling compulsions, but the somatisation and depressive symptoms did not further improve. Pathological gambling may be mediated by an interplay of 5-HT_1A serotonergic and D₂ dopaminergic mechanisms. Citalopram affects both these mechanisms in areas that were shown to be involved in gambling behaviour, but while dopaminergic effects of citalopram appear to be consistent with the induction of gambling, its serotonergic mechanisms are rather inconsistent. In our patient, mood destabilisation induced by citalopram may have contributed to the first onset of pathological gambling.     

Conservation and enhancement of the green infrastructure as a nature-based solution for Rome’s sustainable development

Urban Ecosystems - Three quarters of the European population live in urban areas, which is expected to increase to over 80% by 2050. The well-being of urban citizens appears to be closely linked to...     

Regulatory Self‐efficacy as a Moderator of Peer Socialization Relating to Italian Adolescents' Alcohol Intoxication

The present study investigated regulatory self‐efficacy (RSE) as a predictor of friendship and adolescent alcohol intoxication and as a moderator of peer socialization processes related to alcohol intoxication. The longitudinal sample included 457 Italian adolescents (262 females and 195 males) ranging in age of 14 to 20 years (M = 16.1 years of age). Sociometric and behavioral data were collected at the beginning and end of the academic school year. Actor‐based models were applied to simultaneously estimate selection and socialization processes accounting for interdependencies among friends' drinking behaviors. The results indicated that adolescents did not select friends with similar levels of alcohol intoxication or RSE, but adolescents did adopt their friends' drinking behaviors. RSE was negatively associated with adolescent drinking behaviors and moderated socialization processes related to alcohol use, with adolescents reporting higher levels of RSE being less likely to adopt their friends' drinking behaviors than adolescents with lower levels of RSE.     

An Assessment of the Psychometric Properties of Italian Version of CPGI

The aim of this study was to adapt to the Italian context a very commonly used international instrument to detect problem gambling, the canadian problem gambling index (CPGI), and assess its psychometric properties. Cross-cultural adaptation of CPGI was performed in several steps and the questionnaire was administered as a survey among Italian general population (n = 5,292). Cronbach’s alpha reliability coefficient was 0.87 and can be considered to be highly reliable. Construct validity was assessed first by means of a principal component analysis and then by means of confirmatory factor analysis, showing that only one factor, problem gambling, was extracted from the CPGI questionnaire (an eigenvalues of 4,684 with percentage of variance 52 %). As far as convergent validity is concerned, CPGI was compared with Lie/Bet questionnaire, a two-item screening tool for detecting problem gamblers, and with both depression and stress scales. A short form DSM-IV CIDI questionnaire was used for depression and VRS scale, a rating scale, was used for rapid stress evaluation. A strong convergent validity with these instruments was found and these findings are consistent with past research on problem gambling, where another way to confirm the validity is to determine the extent to which it correlates with other qualities or measures known to be directly related to problem gambling. In sum, despite the lack of a direct comparison with a classic gold-standard such as DSM-IV, the Italian version of CPGI exhibits good psychometric properties and can be used among the Italian general population to identify at-risk problem gamblers.     

A Bayesian Approach to Model Interdependent Event Histories by Graphical Models

In event history analysis, the problem of modeling two interdependent processes is still not completely solved. In a frequentist framework, there are two most general approaches: the causal approach and the system approach. The recent growing interest in Bayesian statistics suggests some interesting works on survival models and event history analysis in a Bayesian perspective. In this work we present a possible solution for the analysis of dynamic interdependence by a Bayesian perspective in a graphical duration model framework, using marked point processes. Main results from the Bayesian approach and the comparison with the frequentist one are illustrated on a real example: the analysis of the dynamic relationship between fertility and female employment.     

Children in Need in the South of Italy: Features and Distortions in the Deinstitutionalisation of Care

Despite the shift in emphasis from institutional to foster family care, in the south of Italy children in need are mainly looked after by residential services. These are required to provide family‐style care and to place children on a short‐term basis. Using data from research on a 100% sample of day units, residential services and children in care in the Calabria region, this article investigates the functioning of the system of care for vulnerable children at the sub‐national level, describes looked‐after children’s characteristics and life conditions and questions the extent to which a real deinstitutionalisation process has occurred in this area. Finally, some deinstitutionalisation recommendations are given.     

Complex Factors and Behaviors in the Gambling Population of Italy

Gambling has seen significant growth globally, and particularly in Italy: it has rapidly evolved from a simple recreational activity to represent 4% of Italian GDP in 2010.A sample of 4.494 gamblers was drawn from IPSAD-Italia^®2007-2008 (Italian Population Survey on Alcohol and Drugs) in order to examine different gambling patterns (assessed using the Canadian Problem Gambling Index Short form scale).Separate analysis was performed on young adults, age 15–24 (n = 1,241; male 56.2%), and adults, age 25–64 (n = 3,253; male 53.8%): compared with adults, Italian youth, although they gambled less (35.7% vs. 45.3%), appeared to have higher prevalence of low risk gambling (6.9% vs. 5.8%) and moderate risk or problem gambling (2.3% vs. 2.2%). Males are more likely to be moderate-risk or problem gamblers. Those with only a primary education are more likely to be moderate-risk or problem gamblers (young adults: RRR = 5.22; adults: RRR = 3.23) than those with a university education, just like those youth who use depressants, but only among younger (RRR = 3.38).A fundamental issue, “do not disapprove of gambling”, seems to relate to problematic gambling: a specific Italian legislation, the Abruzzi Decree Law, could have influenced the perception that gambling may contribute positively to provide additional funds to the government for social good as well as to add needed jobs. Regardless of such potential social benefits, gambling is a social epidemic and if this association should be confirmed by more focused studies, policy makers should evaluate ways to affect this perception as soon as possible.     

A multilevel Bayesian model for contextual effect of material deprivation

The relationship between socioeconomic factors and health has been studied in many circumstances. Whether the association takes place at individual level only, or also at population level (contextual effect) is still unclear. We present a multilevel hierarchical Bayesian model to investigate the joint contribution of individual and population-based socioeconomic factors to mortality, using data from the census cohort of the general population of the city of Florence, Italy (Tuscany Longitudinal Study, 1991-1995). Evidence supporting a contextual effect of deprivation on mortality at the very fine level of aggregation is found. Inappropriate modelling of individual and aggregate variables could strongly bias effect estimates.Received: 10 January 2002, Revised: 23 June 2003, The research on Tuscany Longitudinal Study (Studio Longitudinale Toscano, SLTo) was supported by the Regione Toscana Servizio Statistica.     

Menopause and sexual desire: the role of testosterone

The present short review underlines the role of testosterone (T) in the motivational and satisfaction components of women's sexuality and critically discusses the strategies to treat hypoactive sexual desire disorder (HSDD), a condition of low desire associated with personal and/or interpersonal difficulties, which is more common in surgical menopausal women. There are multiple ways androgens target the brain regions (hypothalamic, limbic and cortical) involved in sexual function and behaviour. Even though circulating available androgens have been implicated in several domains of sexual response, they seem to be related weakly to symptoms, such as low sexual desire, poor sexual arousal, orgasm and diminished well-being in postmenopausal women. The possibilities of treating low sexual desire/HSDD are multifaceted and should include the combination of pharmacological treatments able to maximize biological signals driving the sexual response, and individualized psychosocial therapies in order to overcome personal and relational difficulties. Transdermal T has been shown to be effective at a dose of 300 μg/day both in surgically and naturally menopausal women replaced with estrogen or not, without any relevant side-effects. However, the decision to treat postmenopausal women with HSDD with T is mainly based on clinical judgement, after informed consent regarding the unknown long-term risks.