Quaderni Italiani di Psichiatria最新文献

Introduction

The prevalence of psychiatric events in epilepsy remains controversial and difficult to define. Psychiatric disorders are often misdiagnosed in patients with epilepsy, and they may be evaluated differently by neurologists and psychiatrists.

Materials and methods

We conducted a search of PubMed and Embase databases using the keywords “epilepsy” and “psychiatry” or “psychiatric”. The articles that were in our opinion most significant were selected for this review.

Results

Every psychiatric event that occurs in a patient with epilepsy should be classified on the basis of its temporal relation with the seizures; unlike most psychiatric disorders, those associated with epilepsy are not chronic conditions. Psychotic episodes may occur in epilepsy, but they rarely reflect the presence of a chronic psychotic disorder. In other cases, the relationship between epileptic seizures and psychotic episodes is one of alternating events (forced normalization). Depression is the most common psychiatric disorder in patients with epilepsy, although in most cases it is mild and does not require drug therapy. Mood and anxiety disorders are also commonly associated in these patients. Epilepsy is sometimes associated with specific changes in the personality although currently available data are not sufficient to justify the term “epileptic personality”. In patients with epilepsy (but also in those without epilepsy) Psychogenic Non-Epileptic Seizures (PNES) can also occur, and they can often be differentiated from epileptic seizures only by videoEEG findings.

Introduction

Since the last appraisals of international experiences in institutionalized care for persons with intellectual disabilities (ID), the concept of residentiality is once again evolving. The purpose of this article is to review and discuss the most recent and significant literature on this topic.

Materials and methods

The authors, experienced professionals in this field, performed a search of relevant scientific articles published in the last 5 years. These articles were then reviewed and analyzed to produce the present review.

Results

Small apartments within the community and the so-called cluster centres are currently considered the most efficient residential solutions for individuals with ID. However, the criteria for judging the appropriateness of a residence for these persons are heterogeneous, poorly defined, or overly restrictive. Growing attention is being placed on person-related measures, including quality of life, which is one of the most widely used parameter. It reflects the individual relation between attribution of importance and perception of satisfaction in areas of life with qualitative implications for all people.

Conclusions

Research on residential care for people with ID is still limited, quantitatively and qualitatively. Nevertheless, it appears to be capable of identifying some solutions that are more effective than others, at least in terms of certain parameters. The application of new conceptual models seems to support the need for a broad range of residential solutions capable of meeting a variety of individual needs.

Introduction

Executive functions and Theory of Mind play important roles in appropriate responses to unexpected stimuli; the same applies to the functional asymmetry of the brain cortex.

Materials and methods

We reviewed and analyzed recent Medline-indexed research published in the last 5 years, as well as certain older publications (articles, books) that were often cited. The Medline search was carried out with MeSH search terms Theory of Mind, Executive Functions, cerebral asymmetry (and related variants), alone and in conjunction with autism, attention deficit hyperactivity disorder, and schizophrenia.

Results

Recent research suggests that hyperactivation or inappropriate activation of the above-mentioned functions may be the cause of pervasive developmental disorder, schizophrenia, and attention deficit and hyperactivity disorder.

Discussion

We present a hypothesis in which Theory of Mind, Executive Functions, and asymmetric activation of the brain cortex are all part of a comprehensive system, which may have been important, from an evolutionary point of view, in improving the survival of humans. Conversely, pathological hyperactivation or dysregulated activation of this system (secondary to alteration of one or more of its components) may be the biological basis for certain neuropsychiatric disorders. If verified, this model could be used to create specific treatments.

Introduction

Bulimia and obesity are increasing conditions both in prevalence and incidence. The MMPI-2 has been used in a number of studies to investigate the personality profile of both obese patients and bulimics.

The aim of this study was to assess and compare personality profiles of bulimic and obese women through the MMPI-2 and test the Inventory's ability to discriminate between these populations.

Materials and methods

Participants: 103 women, 59 obese (mean age, 39.1 years, age range 19-72 years) and 44 bulimic (mean age, 31.7 years, age range 18-59), followed in an outpatient setting completed the MMPI-2.

Results

Age, weight and educational level were higher in the obese group; purging behaviour was shown by all bulimics than one third of obese patients. Bulimics showed more psychopathology, had a 2/8-8/2 code-type, and scored significantly higher than the obese on the Hs, D, Hy, Pa, Pt, Sc and Si scales of the MMPI-2, but only on the Sc and D scale median scores were in the pathological range.

Conclusions

Bulimic women showed more psychopathology than obese ones; the MMPI-2 does not discriminate between the two disorders.

Introduction

Diagnosis and treatment of Borderline Personality Disorder (BPD) are a matter of great clinical interest and research. Nowadays the atypical antipsychotic drugs (AAP) are frequently prescribed even though their use in the BPD is still off-label.

The aim of this paper is to perform a systematic review of studies focusing on the efficacy and tolerability of AAP in the BPD.

Materials and methods

A comprehensive search from PubMed, Emabse, PsycLIT and Cochrane Library, was conducted from January 1980 to April 2009. Only randomized controlled trials (RCTs) were included in the final analysis.

Results

Nine RCTs were selected from the analyzed studies. Olanzapine is by far the most investigated drug; its efficacy over placebo was well documented in the treatment of anxiety, anger, impulsivity and paranoia, as well as in improving interpersonal relationships. Aripiprazole has been associated with a significant improvement of symptoms like hostility, anger, anxiety and paranoid ideation. For ziprasidone, no significant advantage over placebo was reported. The efficacy of quetiapine, risperidone and clozapine has been supported only by open studies.

Conclusions

AAP are frequently prescribed in BPD, even though RCTs on their efficacy are still scarce. More studies are needed to better assess not only the efficacy of such drugs but also their effectiveness in a long-term treatment.

Introduction

In psychiatry informed consent is an uttermost complex topic, especially when considering the 2006 Code of Medical Ethics/Medical Ethics Code (articles 33 and 35). Informed consent is the foundation of every possible therapeutic choice, although there are some notable exceptions, such as compulsory treatment for psychiatric reasons.

Materials and methods

The current mental health law system has been evaluated. It is noted that informed consent is not the central issue in the reasons for the involuntary admission. The problem of informed consent is subordinated to an ill-defined medical condition such as “psychic alterations that request an urgent intervention”. This ill defined condition leaves a wide array of difficulties open, when the psychiatrist has to propose the compulsory treatment.

Results

We consider that the stratification of different laws about freedom/mental illness interface is not rationally harmonized with the centrality of informed consent in medicine.

Conclusions

It would be appropriate to develop an evaluation of compulsory admission based on the centrality of informed consent (that is, the lack of informed consent). Consent can be viewed as an initial recovery of responsibility for the patient.