Minerva Psichiatrica最新文献

Genetic studies are transforming the way we diagnose, evaluate and treat patients. The era of genome-wide association studies promised to discover common risk variants in heterogeneous disorders where previous small-scale association studies had on the whole failed. However, as we enter the post-association era a degree of disappoint is felt regarding the lack of risk factors with large effect for a number of disorders including vascular disease. Vascular disorders are sporadic by nature, though a familial component has been observed. This review will focus on vascular dementia, the genetic risk factors for vascular disorders and highlight how new technologies may overcome the limitations of genome-wide association and nominate those genes that influence disease risk.

The authors have examined the currently accepted methods to face a chronic disease like diabetes. The person affected by this illness should learn to accept his/her limits and find a new identity. The aim of technical and scientific medicine is to teach the patient how to cope with the disease. However, in spite of the progress of the scientific research in this field, diabetes remains a poorly treated disease. A review of the literature shows that there is a deep interaction between diabetes and psychological states. Psychological disorders like depression and anxiety might be associated with the origin of diabetes and can affect its course. It seems that emotional factors have a more important role than education in diabetes care. The psychological aspect becomes even more important during adolescence, as the chronic illness can affect the normal development of the teen-ager who will deny it to protect himself. If the patient does not collaborate, his behaviour may be unconsciously aggressive and destructive. Some patients can use diabetes as a tool to act out aggressive feelings against themselves or the environment. Diabetes bad management becomes then the expression of their destructive narcissism which prevents them from finding a new identity. The collaboration of medical and psychological operators should help these patients to find a new identity which includes diabetes as an integrating part of their personality and enables them to cope with it under the guidance of the diabetes team.

Aim of this paper, based on data collected at the General Hospital Psychiatric Unit of Pavia (Italy), is to study comorbidity between alcohol abuse/dependence and other mental illness. Thirty-five out of 188 patients admitted during the study period received a (DSM-III-R) diagnosis of alcohol abuse/ dependence and an other psychiatric diagnosis. Data were collected through a questionnaire, from patients and relatives, about history of dependence, psychiatric history both in patients and relatives, about life style and drinking opinions. Psycho-diagnostic (Wechsler, Rorschach) informations were obtained for 29 patients. Results show the importance of a complex treatment for both psychiatric and alcoholic problems.

Eighty patients aged between 20-65 years and suffering from bipolar disease according to DSM IV criteria, were treated with paroxetine for os at the single dosage of 20-40 mg/die. At regular intervals psychometric reagents were administered for the evaluation and the variations in the bipolar disease. Tolerability was excellent and side-effects mild, with a tendency to regress after the second week of therapy. The clinical assessment and the psychometric findings both suggest that paroxetina has a useful action on the bipolar disease.

The aim of this paper is to describe intellectual performances in children and adolescents with cerebral palsy and with Duchenne muscular dystrophy. Three different forms of cognitive analysis are proposed: a quantitative analysis with the Wechsler scales; a qualitative analysis of reasoning in different levels of development, in a piagetian framework; an analysis of learning processes and school performances.

In this paper we attempted to review the concept of déjà vu. Déjà vu is a common experience in life and it is largely described in psychopathology and in artistic literature. Starting descriptions of writers like Camus, D'Annunzio, Simeon, Bunuel, Schnitzler, Dickens we propose a first phenomenological way of reading of déjà vu experience referring to the different hypotheses in psychopathology: a memory disorder, perception disorder, attentional disorder, considering the phenomenon as a consciousness disorder according to Ey's theories. Secondly we attempted to compare the consciousness disorder hypothesis to a psychoanalytic reading according Freud and Matte Blanco studies.

Aim of the present study is the evaluation of psychopathological and clinical features of these outpatients followed by the Outpatient Clinic of the Section of Metabolic Diseases and Diabetes, University of Florence. 84 obese patients and 217 non-obese control subjects were studied using the Structured Clinical Interview for DSM-III-R (SCID), and applying DSM-IV criteria for Binge Eating Disorder. BITE self-reported questionnaire, STAI inventory and Ham-D rating scale were also used. Lifetime prevalence of Binge Eating Disorder in obese patient was 11.9%, markedly lower than that reported in studies on North American samples. Prevalence of depressive disorder (Major Depression and Dysthymia) was significantly higher (p < 0.005) in obese patients than in control subjects. This confirms the important relationships between eating and mood disorders. The prevalence of subclinical eating disorders resulted to be significantly higher in obese patients (p < 0.01) when compared with control subjects. Significant correlations (p < 0.01) of BITE scores were observed with STAI and Ham-D scores, but not with body mass index. These results underline the need for an accurate psychopathological assessment in obese patients, in order to formulate a correct diagnosis and plan adequate therapeutical interventions.

We assessed the safety and therapeutic efficacy of bromperidol decanoate in a six-month open trial on 21 patients (13 males and 8 females), mean age 41.3 years, who were no longer in the acute phase and were being treated as outpatients. The recommended initial dosage was 150 mg bromperidol (one 3 ml ampoule), and this did not in fact have to be increased during the trial. The scores for psychotic symptom rating scales (SAPS, SANS, BPRS, HAM-D and social adaptation scale) were analysed by analysis of variance, which indicated that bromperidol decanoate was effective on almost all parameters. Adverse reactions were reported for 14.3% of the patients, indicating that the drug was very well tolerated; only three patients complained of a total of seven adverse events. In conclusion, bromperidol decanoate was effective in the treatment of residual schizophrenia, with significant differences between before and after treatment ratings for symptoms. The drug was well tolerated, only one patient dropping out on account of adverse reactions.

The authors propose to group some clinical entities as Delusional hypochondria, Dysmorphophobia, Nervous Anorexia, under the term of Body Psychosis. These are considered as psychoses endowed in the body (naturally we are speaking not about the anatomical body, but the phenomenological one, the personal experienced body). The specific clinical frame is justified by the following considerations: 1) in a psychopathological light all the disorders imply an altered relationship with the personal experienced body; 2) in a prognostic light the "experienced body" involvement given specific and common features; 3) clinically a one-other manifestation change is always possible; 4) relationally the human contact (and the medical one too) with this kind of patient got very specific features that often provoke dramatic and perverse changes in the same relation, especially in a sadomasochistic sense. The personal nosological frame is stressed within the actual psychiatric diagnostic classification (ICD 10, DSM IV).

Delusional depression is characterised by the presence of symptoms such as hallucinations (typically auditory) and delusions either mood congruent and incongruent. Most commonly the content of delusions is consistent with the depressive themes: guilt, unworthlessness, poverty, death. Hallucinations, when present, are not elaborate and may involve voices that berate the patient for shortcomings or sins. Mood incongruent psychotic symptoms include persecutory delusions, delusions of thought insertion or thought broadcasting. Several pharmacological studies have demonstrated a differential response pattern in delusional depression and in nondelusional depression. Delusional depressives in fact, have a much lower response rate to tricyclic antidepressant treatment alone (20-25%) than nondelusional depressives (70-80%). The combination treatment with tricyclic and neuroleptic drugs leads to a dramatic improvement in the response rate in these patients (68-95%). The drugs most widely used are, for tricyclics, amitryptiline (150-215 mg/day) and desipramine (150-200 mg/day), and for neuroleptics, perphenazine (30-50 mg/day), but good results have also been reported with haloperidol (8-20 mg/day). The better results obtained with the tricyclic-neuroleptic association seem to be related to 3 factors: an increased tricyclic plasma level due to a competitive hynibition in the hepatic hydroxilation processes caused by neuroleptic agents: a dopaminergic blockade and an increased serotonergic and noradrenergic activity. Treatment with neuroleptics alone improves the symptomatology only in 19-50% of the patients. If the patient does not show a good response to the combination of tricyclics and neuroleptics, lithium augmentation (600-1200 mg/day) notably ameliorates the rates of clinical response (80-90% of cases). The treatment of delusional depressive patients with amoxapine leads to positive results in 70-80% of cases. Very good results have also been noted with bupropione (300-750 mg/day) after only a week of therapy. A complete symptomatological remission has been observed with 1-Dopa (1000 mg/day). The relatively low number of delusional depressive patients treated with SSRI to date does not allow to draw any consistent and definite conclusion on their real efficacy in this severe form of depression. For the continuation treatment it is recommended to continue the tricyclic-neuroleptic treatment for at least 6 months, at the lowest neuroleptic dosage which allows a long lasting clinical remission. Once the clinical remission is complete, the neuroleptic agent can be gradually tapered in some months, unless the patient had previous recurrence with the tricyclic agent alone. To the patients who show a symptomatological re-exacerbation during neuroleptic tapering, must be given again the combination treatment. In these cases it is important to assess more often and carefully the patient because of the increased risk of tardive diskinesia. Inconsistent re