Psychiatria Danubina最新文献

We describe Addison's disease, which is the disease caused by Adrenal Gland Insufficiency. Addison's disease is an uncommon endocrine disorder characterised by inadequate production of hormones, predominantly aldosterone and cortisol, by the adrenal glands. This condition occurs due to damage to the adrenal cortex, the region responsible for hormone synthesis. Clinical manifestations of Addison's disease are often insidious and nonspecific, including symptoms such as myasthenia, persistent fatigue, unintentional weight loss, hypotension, and hyperpigmentation of the skin, especially in areas subjected to friction. A number of Neuropsychiatric manifestation, including Depression, and Psychosis can also occur. The aetiology is primarily autoimmune adrenalitis, where the immune system erroneously attacks and destroys adrenal cortical cells. Other aetiologies include infectious agents like Mycobacterium tuberculosis, which can infiltrate and impair the adrenal glands. Hemorrhagic damage to the adrenal cortex can occur secondary to severe stress, trauma, or coagulopathies. Additionally, metastatic neoplasms may involve the adrenal glands, leading to their destruction. Less frequently, genetic disorders such as adrenoleukodystrophy can compromise adrenal function by affecting both the cerebral white matter and adrenal cortex. Adrenal cortex damage can also result from adrenalectomy or the administration of medications that inhibit steroidogenesis. The pathophysiology of Addison's disease involves the disruption of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in cortisol deficiency, which is critical for regulating metabolism, immune function, and stress responses. Aldosterone deficiency leads to dysregulation of sodium and potassium homeostasis, causing hypotension and dehydration. Management of Addison's disease requires lifelong glucocorticoid and mineralocorticoid replacement therapy, typically with hydrocortisone or fludrocortisone, along with ongoing monitoring and dosage adjustments during periods of stress, illness, or surgical interventions. While describing Addison's Disease we describe the illness as experienced by Elizabeth of the Trinity, a Catholic Nun who suffered the illness in the early part of the Twentieth Century, whose illness is described from her letters and eyewitness accounts, taken for her beatification and canonisation findings. We describe how the illness it was viewed then, when it was seen as incurable, with great deficiencies in both diagnosis and treatment, and how the aetiology has changed over the years. Hence we show how the suffering endured by this person had both mental and physical aspects.

The assessment of pain in people with intellectual disabilities (individuals with ID) represents a clinical challenge due to the variability in communicative and cognitive skills. This study explores the feasibility of pain self-reporting in individuals with mild to moderate intellectual disability using validated self-assessment scales. Our findings suggest that, under appropriate conditions, self-reporting can be a reliable and empowering method for pain evaluation in this population. This approach may foster autonomy, improve care, and counteract the undervaluation of subjective pain reports.

Background: In Europe, 14.7% of the population suffer from chronic tinnitus. Regarding pharmacological treatment of tinnitus, there is currently no evidence-based protocol recommendation. Tinnitus Retraining Therapy is the only effective method available in specialized multidisciplinary centers.

Subject and method: By analyzing 116 patients who underwent rehabilitation in a multidisciplinary audiophonology center, we quantified the use of benzodiazepines before and after treatment.

Results: Among patients suffering from chronic tinnitus, there is an over-prescription of benzodiazepines, which can be reduced through proper care.

Conclusion: Better awareness among frontline healthcare professionals about treatment in specialized multidisciplinary centers should be reinforced in order to enable quicker referrals and avoid therapeutic wandering or inappropriate use of benzodiazepines.

This article presents a qualitative study on the use of humour in Self-Help Groups. It investigates four Self- help Groups with different targets, in order to understand what motivates individuals to use humour, whether its perception differs when used by a participant or by the facilitator, and what types of humour are employed, following Martin's classification: Affiliative, Self-Enhancing, Aggressive, and Self-Defeating. The results show that humour serves the function of cohesion, cognitive restructuring, and emotional management. It appears to benefit both the individual and the group as a whole (e.g., reducing anxiety and sadness). No significant differences were found in the perception of humour when used by a participant versus the facilitator.

Background: Children infected with the Human Immunodeficiency Virus (HIV) exhibit the lowest neurodevelopmental scores. Mother-to-child-transmission prevention include perinatally and early antiretroviral therapy (ART) although long-term effects of in utero exposure to ART on neurodevelopment remain unclear. It was difficult to determine whether these reported neurodevelopmental scores were a direct result of HIV.

Methods: A systematic search was conducted to identify the environmental and neurobiological factors associated with HIV infection and their impact on neurodevelopment. It was carried out across four electronic databases: Scopus, PubMed, ProQuest and Cochrane Database of Systematic Reviews. We selected 15 articles published between 2012 and 2024.

Results: Regarding ART, 4 articles reported a positive effect of ART regardless of the age of initiation and duration. We couldn't identify caregiver distress as a risk factor.

Conclusions: Further research should include large cohort studies assessing long term consequences of ART exposition on children's neurodevelopment and impact of caregiver distress on child neurodevelopmental outcomes.

Geschwind Syndrome (GS) comprises a constellation of behavioural traits traditionally associated with temporal lobe epilepsy. These include hyper-religiosity, hypergraphia, altered sexuality, and circumstantial thought processes. Increasingly, GS features are also observed in other neuropsychiatric conditions. We present a 26-year-old female with bipolar affective disorder in remission who developed GS-like features such as hyper-religiosity, compulsive writing, and atypical romantic ideation, without evidence of seizures, abnormal EEG, or MRI findings. She showed limited response to aripiprazole and partial improvement with behavioural interventions. This case highlights the need for increased recognition of GS features in psychiatric populations, independent of structural or seizure-related pathology.

While the relationship between post-traumatic stress disorder (PTSD) and chronic pain is increasingly highlighted, the link between childhood traumas (CT) and chronic pain in adulthood remains underexplored. Yet, it is well established that early adverse experiences (ACES) are more damaging than those experienced later in life due to ongoing neurological and psychological development. Furthermore, survivors of childhood traumas may develop more complex and multifaceted reactions than those observed in PTSD, potentially leading to Complex PTSD (CPTSD). A scoping review was conducted to explore the association between childhood traumas and chronic pain in adulthood, with a focus on identifying the psychological and biological mechanisms involved. Following PRISMA-ScR guidelines, 20 peer-reviewed articles were selected and thematically analyzed. Inclusion criteria covered empirical studies involving adult populations, published between 2005 and 2025. A strong association was found between cumulative ACEs and chronic pain, which supports the additional impacts of CPTSD compared to PTSD in chronic pain. Only three studies included focused on the specific impact of each CT and showed that emotional neglect and emotional abuse had the most persistent impact. Key mechanisms mainly included central sensitization, emotional dysregulation and affective disorders. Further studies are needed to investigate the differential impact of each childhood trauma type, including emotional neglect and abuse, and various pain conditions. These findings support the hypothesis of a specific emotional pathway from early adversity to pain chronification.

"FareAssieme" is a recovery-oriented community psychiatry model that has been implemented by the Mental Health Service of Trento since 1999. The approach is grounded in the active involvement of users and family members, with particular emphasis on experiential knowledge - the insights derived from lived experience of mental illness and recovery - as a resource for improving the quality of care and rehabilitation processes. At its core, the model involves the structured integration of Peer Support Experts (ESPs, Esperti in Supporto tra Pari), individuals with personal or familial experience of psychological distress who have attained a stable life balance and developed effective coping strategies. ESPs are embedded across all domains of the mental health service (SSM), including community teams, crisis services (territorial and hospital-based), residential settings, and front-office activities. Their role is to support others in their recovery journeys through narrative sharing and emotional proximity. ESPs have contributed to enhanced user engagement, improved service climate, and increased trust in providers. They have proven particularly effective in engaging individuals initially resistant to treatment, thereby facilitating stronger therapeutic alliances. The model also fostered the creation of the Participatory Planning Group (GPP), a deliberative body comprising users, families, ESPs, and professionals, which has developed several Operational Guidelines to standardize and disseminate shared practices within the SSM. "FareAssieme" stands as a validated model of participatory, recovery-oriented psychiatry. It highlights the transformative value of experiential knowledge within mental health services and makes a meaningful contribution to anti-stigma efforts and the co-construction of inclusive care pathways.