Case Report: Atypical psychotic onset of type I Arnold-Chiari malformation

Introduction: We report a case of type I Arnold-Chiari malformation that is very peculiar because of its particular onset especially characterized by psychiatric symptoms. These symptoms were so prevailing that, for fifteen years, they masked the neurological aspects and the patient was treated with high doses of psychotropic drugs without any benefit. If the Arnold-Chiari malformation had been diagnosed before the development of severe hydro-syringomyelia, the patient could have underwent decompressive neurosurgery which may have improved her quality of life. It is worthwhile to highlight that psychotic symptoms may be caused by this congenital malformation, that typically has an aspecific onset. Therefore it\u2019s important to consider an eventual organic etiology while challenging a resistant clinical picture with unusual presentation. Case description: A 51-year-old woman reported neurological symptoms consisting of headaches, blurred vision, diplopia, tinnitus, vertigo and psychiatric symptoms including obsessive ideas about the fear of killing her son, auditory and visual pseudo-hallucinations. The symptoms had developed suddenly at the age of 35 years and persisted thereafter. She underwent multiple hospitalizations in psychiatric units and was treated with a variety of psychopharmacological approaches without substantial improvement. We performed a brain MRI that identified a type I Arnold-Chiari malformation. We assessed psychiatric symptoms using the Structured Clinical Interview for DSM IV Axis I Disorders, the Brief Psychiatric Rating Scale, and the Yale-Brown Obsessive-Compulsive Scale. A tailored psychopharmacological therapy led to a partial improvement in mood and anxiety but not in hallucinations. Discussion: We want to highlight how important is, in everyday psychiatric clinical practice, not to focus only on psychiatric aspects but consider the patient globally, because in this case psychiatric problems were the onset presentation of a rare neurological syndrome

Alexithymia and psychopathology in patients suffering from inflammatory bowel disease : arising differences and correlations to tailoring therapeutic strategies

Comorbidity with anxiety or depression is common in patients with Inflammatory Bowel Disease (IBD) as Crohn Disease (CD) and Ulcerative Colitis (UC). Data suggest that the cognitive construct of alexithymia has high prevalence in people suffering from anxiety and mood disorders and even in people with IBD. Most studies have investigated mainly anxiety and depression, considering IBD population as a homogeneous group of patients. Little evidence shows the impact of alexithymia on the course of IBD. We evaluated a broad spectrum of psychopathological symptoms and alexithymia levels in a group of outpatients affected by IBD in clinical remission, comparing CD and UC and investigating the relationship with clinical and socio-demographic variables. One hundred and seventy IBD outpatients were screened by using the Hospital Anxiety Depression Scale (HADS), the Self-report Symptom Inventory-90-Revised (SCL-90-R) and the Toronto Alexithymia Scale (TAS-20). A high prevalence of anxious and depressive symptoms (42.35 and 25.8% respectively) together with alexithymia (31.76%) was confirmed. CD patients experienced high levels of depression (HADS Depression 35.2% p = 0.034; SCL-90-R mean 1.39 p < 0.001), somatisation (SCL-90-R mean 1.04 p < 0.001), obsessive-compulsive symptoms (SCL-90-R mean 1.2 p < 0.001), and global severity (SCL-90-R mean 1.15 p < 0.001). There is no statistical difference in the prevalence of alexithymia in both subpopulations. The levels of alexithymia are correlated to the levels of anxiety (HADS Anxiety rs = 0.516 p < 0.001), depression (HADS Depression rs = 0.556 p < 0.001; SCL-90-R rs = 0.274 p = 0.001), somatisation (SCL-90-R rs = 0.229 p = 0.005), obsessive-compulsive symptoms (SCL-90-R rs = 0.362 p < 0.001), and global severity (SCL-90-R rs = 0.265 p = 0.001). Furthermore, alexithymia is associated with a delay of diagnosis of IBD, poly-therapies and greater IBD extension. Older age, female gender, greater IBD extension, surgery, and delay of diagnosis seem to be related to a high prevalence of psychopathological symptoms such as anxiety, depression, somatisation, and obsessive-compulsive symptoms. Psychopathological symptoms and high levels of alexithymia are frequent in IBD patients and seem to be related to a high risk of poor clinical outcome. CD patients could be considered at higher risk of mental comorbidity. A more comprehensive psychiatric assessment, including alexithymia, and an integrated treatment of underlying conditions, must be taken into account in order to improve the global prognosis of the disease

Using network analysis to explore cognitive domains in patients with unipolar versus bipolar depression: a prospective naturalistic study

OBJECTIVE: Despite growing evidence in the field of cognitive function in mood disorders, the neurocognitive profiles of patients with unipolar and bipolar depression still need further characterization. In this study, we applied network analysis, hypothesizing this approach could highlight differences between major depressive disorder (MDD) and bipolar disorder (BD) from a cognitive perspective. METHODS: The cognitive performance of 109 patients (72 unipolar and 37 bipolar depressed outpatients) was assessed through the Montreal Cognitive Assessment (MoCA), and a series of clinical variables were collected. Differences in cognitive performance between MDD and BD patients were tested using non-parametric tests. Moreover, a network graph representing MoCA domains as nodes and Spearman's rho correlation coefficients between the domains as edges was constructed for each group. RESULTS: The presence of mild cognitive impairment was observed in both MDD and BD patients during depression. No statistical significant difference was found between the two groups in terms of overall cognitive performance and across single domains. Nonetheless, network analytic metrics demonstrated different roles of memory and executive dysfunction in MDD versus BD patients: in particular, MDD network was more densely interconnected than BD network, and memory was the node with the highest betweenness and closeness centrality in MDD, while executive function was more central in BD. CONCLUSIONS: From a network analytic perspective, memory impairment displays a central role in the cognitive impairment of patients with unipolar depression, whereas executive dysfunction appears to be more central in bipolar depression. Further research is warranted to confirm our results

La formazione al lavoro con le famiglie

Intervento presentato nella sessione: Psicoeducazione, interventi famigliari, advocacy e auto mutuo aiut