La depressione nel post partum: il ruolo dell'allattamento materno

La maternità rappresenta una delle fasi più critiche nella vita della donna; in particolare, il periodo che segue la nascita di un figlio costituisce un momento di aumentata vulnerabilità allo sviluppo di modificazioni dell’umore in senso depressivo. Con il termine di “depressione post partum” si comprendono tutti gli episodi depressivi maggiori e minori che colpiscono la donna nel periodo che va dalla nascita del bambino fino ad un anno dopo il parto. Benchè recenti revisioni indichino che questa patologia dell'umore colpisce il 6,5-12,9% delle puerpere, solo la metà delle donne affette da tale disturbo ricerca aiuto. Se non diagnosticata e trattata, la depressione nel post partum può avere esiti drammatici, quali disturbi affettivi cronici, scarsa cura del bambino, sviluppo inadeguato della relazione madre-figlio, problemi coniugali, abuso di sostanze, suicidio ed infanticidio. Gli studi sui correlati biologici della depressione nel post partum degli ultimi anni danno sempre più risalto alle modificazioni endocrine, immunitarie e neurotrasmettitoriali, innescate o slatentizzate dagli stressors fisici e soprattutto psicosociali a cui è sottoposta la donna nella gravidanza e nel puerperio. Lo scopo della presente tesi è stato quello di valutare, in un campione di 1066 donne reclutate al terzo mese di gravidanza e seguite periodicamente fino ad un anno dalla nascita del bambino, il ruolo protettivo o meno dell'allattamento materno verso la depressione nel post partum, alla luce dei recenti dati della letteratura che vedono nell'allattamento al seno, in base a meccanismi biologici sempre più definiti, un fattore inversamente correlato all'insorgenza di questa patologia. Le misure di esito utilizzate sono state l'Edinburgh Postnatal Depression Scale (EPDS, Cox et al., 1987), la State-Trait Anxiety Inventory form Y (STAI-Y, Spielberger, 1983) e la Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I, First et al., 1995), al fine di valutare rispettivamente la sintomatologia depressiva, la sintomatologia ansiosa, ed infine la presenza dei criteri per una diagnosi di depressione minore o maggiore secondo il DSM-IV. La SCID-I, in particolare, veniva somministrata per l'eventuale conferma diagnostica di un disturbo depressivo maggiore o minore qualora il punteggio dell'EPDS fosse risultato ≥13. Sono state riscontrate, nelle donne che al primo mese post partum (T3) allattavano al seno (in maniera esclusiva o mista), percentuali inferiori di depressione (minore e maggiore) rispetto alle donne che allattavano artificialmente. Si è visto quindi che queste ultime avevano un rischio di depressione significativamente superiore rispetto alle prime. E' stato rilevato anche che una diagnosi al terzo mese di gravidanza di depressione minore o maggiore (ma non di un qualsiasi altro disturbo mentale di Asse I), era predittiva di un mancato allattamento al seno. Da questi risultati si può quindi evidenziare, oltre il ruolo protettivo dell'allattamento al seno per l'umore materno nel primo mese post partum, l'importanza dello screening e del trattamento precoce della patologia affettiva in gravidanza, anche per i benefici effetti sulla salute del bambino conseguenti ad un allattamento materno condotto con successo

ADULT ATTACHMENT STYLE AND SUICIDALITY

Background: There is evidence in the literature that adverse early attachment experiences and subsequent attachment insecurities during adulthood would lead to pessimism, low self-esteem, hopelessness and, ultimately, to suicide risk. Subjects and methods: This paper aims to review finding on the link between attachment style and suicidality. We searched the literature using the database of the U.S. National Center for Biotechnology Information (NCBI)-MedLine/Pubmed system from January 1992 until December 2016. We started with 1992 because, as far as we know, there are no published studies exploring the relationship between suicide and insecure attachment before that year. We considered reports published on the relationship between attachment style and suicidality. We applied several combinations of the following search terms: attachment, adult attachment style and suicidality, suicide, suicidal ideation, suicidal behavior or suicidal thoughts, and suicide attempts. We selected only English language studies. Results: Research suggests that insecure attachment style, mostly anxious, and unresolved traumas are associated with an increased suicide risk. Few studies prospectively examined clinical course, comorbid psychiatric disorders, familial suicidality or other psychosocial factors. Conclusions: Further research is needed to highlight the nature of the link between attachment and suicidality. The presence of suicidal ideation and attempts might be a consequence of an underlying interaction between the emergence of psychiatrics symptoms, and the long-lasting presence of inadequate patterns of attachment. Within this context, Separation Anxiety Disorder, categorized in the DSM-5 as a condition not confined to childhood but as an anxiety disorder that may occur through the entire lifespan, might be the a key for the comprehension of this link. From a neurobiological point of view, the role of oxytocin remains unclear

Mood Spectrum Model: Evidence reconsidered in the light of DSM-5

AIM: to investigate studies conducted with the Mood Spectrum Structured Interviews and Self-Report versions (SCI-MOODS and MOODS-SR). METHODS: We conducted a review of studies published between 1997 and August 2014. The search was performed using Pubmed and PsycINFO databases. Analysis of the papers followed the inclusion and exclusion criteria recommended by the PRISMA Guidelines, namely: (1) articles that presented a combination of at least two terms, "SCI-MOODS" [all fields] or "MOODS-SR" [all fields] or "mood spectrum" [all fields]; (2) manuscript in English; (3) original articles; and (4) prospective or retrospective original studies (analytical or descriptive), experimental or quasi-experimental studies. Exclusion criteria were: (1) other study designs (case reports, case series, and reviews); (2) non-original studies including editorials, book reviews and letters to the editor; and (3) studies not specifically designed and focused on SCI-MOODS or MOODS-SR. RESULTS: The search retrieved 43 papers, including 5 reviews of literature or methodological papers, and 1 case report. After analyzing their titles and abstracts, according to the eligibility criteria, 6 were excluded and 37 were chosen and included. The SCI-MOODS and the MOODS-SR have been tested in published studies involving 52 different samples across 4 countries (Italy, United States, Spain and Japan). The proposed mood spectrum approach has demonstrated its usefulness mainly in 3 different areas: (1) Patients with the so-called "pure" unipolar depression that might manifest hypomanic atypical and/or sub-threshold aspects systematically detectable with the mood questionnaire; (2) Spectrum features not detected by other instruments are clinically relevant, because they might manifest in waves during the lifespan, sometimes together, sometimes alone, sometimes reaching the severity for a full-blown disorder, sometimes interfering with other mental disorders or complicating the course of somatic diseases; and (3) Higher scores on the MOODS-SR factors assessing "psychomotor disturbances", "mixed instability" and "suicidality" delineate subtypes of patients characterized by the more severe forms of mood disorders, the higher risk for psychotic symptoms, and the lower quality of life after the remission of the full-blown-episode. CONCLUSION: The mood spectrum model help researchers and clinicians in the systematic assessment of those areas of psychopathology that are still neglected by the Diagnostic and Statistical Manual of Mental Disorders 5 classification

Case Report Lifetime Autism Spectrum Features in a Patient with a Psychotic Mixed Episode Who Attempted Suicide

We present a case report of a young man who attempted suicide during a mixed episode with psychotic symptoms. The patient's history revealed the lifetime presence of signs and features belonging to the autism spectrum realm that had been completely overlooked. We believe that this case is representative of an important and barely researched topic: what happens to children with nondiagnosed and nontreated subthreshold forms of autism when they grow old. The issue of early recognition of autism spectrum signs and symptoms is discussed, raising questions on the diagnostic boundaries between autism and childhood onset psychotic spectrums among patients who subsequently develop a full-blown psychotic disorder

Treatment adherence in bipolar disorder: the role of serum-salivary bioequivalence in drug monitoring

Background and aim: Enhancing treatment adherence in bipolar disorders is a complex clinical challenge, owing to the complexity of the concept and difficulty measuring adherence, the number of risk factors to consider and the challenge of extracting strategies to promote adherence. The aim of the present preliminary study was to determine if there is a consistent relationship between quantitative measures of salivary and serum mood stabilizers (bioequivalence), and the usefulness of salivary lithium (Li) and valproate (VPA) monitoring as an indicator of its concentration in blood, in order to improve adherence to medication treatment in bipolar patients. Materials and Methods: Patients affected by DSM-IV-TR bipolar disorder (type I or II) with pre-scheduled, periodic blood analyses for either Li or VPA dosing, were asked to participate and undergo contemporary salivary measurements. Blood levels of both Li and VPA were taken according to standard procedures by the hospital laboratory. Salivary levels of Li were detected with a direct potentiometric method, via an AVL9180 electrolyte analyzer, and measured according to the Nerst equation. Salivary levels of VPA were taken with an immune-assay method based on turbidimetric inhibition, potentiated with competitive homogenous particles. Correlations were calculated with Pearson Product Moment Correlation (Pearson’s r). Statistical analyses were performed with SPSS software (ver 20.0). Results: A total of 45 patients (33 Li-treated and 12 VPA-treated) affected by bipolar disorder were enrolled in the present cross-sectional study. VPA measures did not permit assessing a blood-saliva bioequivalence due to a high variability in salivary measures. Serum Li levels were all in therapeutic range in the sample (mean: 0.72± S.D., 0.24 mEq/L) and salivary Li levels were 2.5 – 3 times serum levels (mean: 2.02±S.D., 0.76 mEq/L). The correlation between serum lithium and salivary lithium in the sample was statistically significant (r= 0.794). Conclusions: The advantages of salivary measures are the quick patient administration and the non-invasive nature of the method. An unexpected Li-salivary control could be a way to enhance patients' adherence, giving clinicians a more reliable estimate of patients’ true adherence status, as compared to the routinely scheduled lab tests. Salivary VPA concentrations did not show to be reliable, therefore VPA-treated patients would not benefit from this easy and quick measurement

A Methodological Reflection on the “Thick Socialism” of Socialism after Hayek

This article discusses the valuable contribution that Ted Burczak's Socialism After Hayek makes to the Marxist theory of socialism by drawing on the Hayekian appreciation of markets as processes of discovery. But the article also critiques the book's acceptance of Hayek's exclusive reliance on markets as a mode of economic organisation. The article reflects on the methodological conditions that might have led the book down a path of market essentialism.efficiency, essentialism, markets, overdetermination,