Unit of Psychodiagnostics and Clinical Psychology

We read with great interest the article by Unfer et al. , which focused on the inositol isoforms' physiological role in glycemic and hormonal homeostasis and their possible rationale in gynecological practice, with particular attention on the polycystic ovary syndrome (PCOS) therapy. Indeed, we appreciated the clarity of the reported information, which leads the readers to have a complete overview of the topic and guide them to an evidence-based use of both inositol isoforms. In this view, we take the opportunity to stress several points which would let us further realize the mechanisms behind inositol's pleiotropic actions in PCOS. Although it is widely accepted that insulin resistance and compensatory hyperinsulinemia play an important pathogenic role in the hyperandrogenism and anovulation of women affected by PCOS, accumulating evidence suggests that this syndrome could be considered as the result of concurrent endocrinological alterations: first of all obesity, which often correlates with PCOS, seems to play a key role in increasing circulating androgens; high levels of luteinizing hormone (LH), reactive species of oxygen and proinflammatory cytokines within the ovary, typical of PCOS patients, could inhibit of the physiological process of ovarian follicular maturation; finally, hyperandrogenism acts synergistically with LH to enhance androgen production of theca cells and reduces circulating sex hormone binding globulin, which in turn increases the level of free testosterone. Regarding metabolic profile, we recently suggested [3] that D-Chiro-Inositol (DCI) and Myo-Inositol (MI) metabolic derivatives work in synergy with each other: MI induces glucose transporter type 4 translocation to the cell membrane, thus enhancing cellular uptake of glucose; DCI stimulates pyruvate dehydrogenase, thus supporting adenosine triphosphate production through the Krebs' cycle; both MI and DCI stimulate glycogen synthase, thus supporting glucose conversion to glycogen stored inside cells; finally, MI derivatives inhibits adenylate cyclase enzyme, which controls free fatty acid release. Reflecting these elements on the clinical management, we recently showed MI beneficial effects on semen parameters before in vitro fertilization and that both the isoforms of inositol and combined therapy were effective in improving ovarian function and metabolism in patients with PCOS, although MI showed the most marked effect on the metabolic profile, whereas DCI reduced hyperandrogenism better . Although Unfer et al. proposed MI:DCI ratio of 40:1 as the most appropriate, we solicit further studies to establish the best therapeutic strategies based on patient's clinical condition, also in combination with other nutraceuticals .

We read with great interest the article by Ko et al. 1 about sexual function in women with stress urinary incontinence (SUI) and in their partners after midurethal sling procedure. We agree that SUI is an adverse factor for sexual function of women affected and that urinary symptoms negatively influence sexual activity within the couple. 2 -4 For this reason, it is important to investigate the effects of treatments for SUI on sexual function of both women and their partners.

IMPORTANCE:
Fifteen percent to 20% of pregnant women suffer from mental disorders, and 86% of them are not treated due to potential teratogenic risks for the fetus. Several drugs seem to be safe during pregnancy but knowledge regarding risks of antenatal exposure to drugs is still limited.
OBJECTIVE:
The aim of this article is to provide a review of literature, data, and a clinical guideline concerning the treatment and management of mental disorders during pregnancy and lactation.
EVIDENCE ACQUISITION:
Bibliographical research was carried out using Medline and Pubmed (from 2005 until 2015) and articles, books and Websites were consulted.
RESULTS:
Regarding antidepressants, only paroxetine seems to lead to an increased risk of malformations, whereas fluoxetine, fluvoxamine, sertraline, citalopram, escitalopram and venlafaxine do not appear to increase this risk. The use of duloxetine is associated with an increased risk of miscarriage during pregnancy but not with an increased risk of adverse events, such as birth defects. There is no clear evidence of malformation risk associated with the use of antipsychotics, whereas a risk associated with pregnancy and newborn outcome has been detected. All mood stabilizers are associated with risks of birth defects and perinatal complications.
CONCLUSIONS AND RELEVANCE:
Taking psychoactive drugs is possible during pregnancy, but it is important to consider various effects of the drugs. Future research should focus on prospective and longitudinal studies with an adequate evaluation of confounding variables. This should be followed by long-term studies to obtain accurate measures of child development.

The aim of this work is to comment on the study about disability, psychiatric symptoms and quality of life in infertile women of Turkey that was published in this Journal. We suggest that future studies use larger samples, consider the influence of factors such as cause of infertility and assisted reproductive techniques (ARTs) and, last but not least, exclude other comorbidities which may influence the data analysis.

The prevalence of obesity and metabolic diseases (such as type 2 diabetes mellitus, dyslipidaemia, and cardiovascular diseases) has increased in the last decade, in both industrialized and developing countries. This also coincided with our observation of a similar increase in the prevalence of cancers. The aetiology of these diseases is very complex and involves genetic, nutritional, and environmental factors. Much evidence indicates the central role undertaken by peroxisome proliferator-activated receptors (PPARs) in the development of these disorders. Due to the fact that their ligands could become crucial in future target-therapies, PPARs have therefore become the focal point of much research. Based on this evidence, this narrative review was written with the purpose of outlining the effects of PPARs, their actions, and their prospective uses in metabolic diseases and cancers.

Endometriosis is one of the most common gynaecological diseases and has an incidence of about 6%-10% in women of reproductive age. It has been estimated that 50% of women with fertility problems have endometriosis. The management of infertility associated with endometriosis is difficult and controversial and it is important to provide a multidisciplinary approach in order to reduce the impact of these diseases on psychological and emotive well-being of affected women, as much as possible.