Il cinema come test proiettivo e terapia. il fantasma familiare

Attraverso il cinema vengono studiate le varie dinamiche familiari dove la famiglia co-artefice dei destini del paziente può rappresentare un elemento fondamentale per il peggioramento, lo status quo o il miglioramento anche verso la guarigione

La relazione bidirezionale tra osteoporosi e depressione maggiore: un dibattito aperto

L’osteoporosi e la depressione maggiore sono condizioni patologiche croniche che si caratterizzano nella popolazione generale per un notevole impatto su morbilità, mortalità e qualità della vita. Gli studi esistenti sul rapporto tra depressione e osteoporosi sono eterogenei nella selezione del campione clinico e nell’utilizzo di strumenti diagnostici per la patologia depressiva, determinando la presenza in letteratura di risultati contrastanti sulla comorbilità di queste condizioni. Tuttavia, tali studi rivelano una forte associazione tra le due patologie. Dati limitati indicano come l’osteoporosi possa peggiorare la sintomatologia depressiva; studi più numerosi dimostrano come la depressione possa indurre una riduzione della densità ossea e aumentare il rischio di fratture. Tuttavia, né un chiaro nesso di causalità né una connessione fisiopatologica sono stati al momento accertati. Questa revisione riporta i più dibattuti fattori che potrebbero chiarire tale comorbilità; in particolare, si approfondisce il ruolo dell’asse ipotalamo-ipofisi-surrene, del paratormone, del sistema catecolaminergico simpatico e dei fattori immunitari. Infine, si descrive l’effetto dei farmaci antidepressivi sulla densità ossea riportando suggerimenti per la gestione clinica dei pazienti con tale comorbilità.Osteoporosis and depression are two chronic diseases that affect large population groups with great impact on morbidity, mortality and quality of life. Existing studies of the relationship between depression and osteoporosis have been heterogeneous in their design and use of diagnostic instruments for depression, which might have contributed to the different results on the comorbidity of these two conditions. Moreover, the direction of the causative link is still controversial and the etiology remains unclear. Definitely, limited data suggest that osteoporosis may enhance depressive symptoms, while far more studies have shown that depression adversely affects bone density and increases fracture risk. Thus the correlation of these diseases is still under research. This review comments on a plausible causative relationship and underlying mechanisms that might elucidate the link between two very common diseases. We describe the possible impact of osteoporosis on moods and the effect of depression on bone health. In particular, we focus on the role of the hypothalamic-pituitary-adrenocortical and sympathoadrenal axes, of the parathyroid hormone and cytokines. We also describe the effect of the antidepressant drugs as well as lifestyles that may explain this effect

Internet addiction disordre e social network: analisi statistica di correlazione e studio dell'associazione con l'ansia da interazione sociale

INTRODUCTION: Internet Addiction Disorder (IAD) is an emerging psychiatric disorder, assimilable to impulse control problems and related to maladaptive use of new networks and social and virtual technologies. AIM: Our study aims to analyze the presence of IAD among adolescents and to study the correlation with social interaction anxiousness. We investigated also the possibility that the Social Network (SN) represent a source of risk for the development of IAD. MATERIALS AND METHODS: The test group was composed of 250 subjects, aged between 14 and 18 years. They were administered: Young's IAT; IAS (Interaction Anxiousness Scale), AAS (Audience Anxiousness Scale) and SISST (Social Interaction Self-Statement Test) to analyze the dimension of social interaction anxiousness. RESULTS: We found a rate of 2% of the IAD. The SN are the most common use of the Net in our sample, but not the most clicked sites by subjects with IAD. It should be noted, finally, a correlation between social interaction anxiety and IAD, but not a significant difference in scores of social anxiousness scales based on the SN use/non-use. CONCLUSIONS: The use of SN intended as single variable doesn't correlate with increased risk for IAD, or for increased social interaction anxiousness. However, if associated with prolonged use of the net for 5-6 hours or more, or concomitant use of chat rooms and/or net gambling, we find a more significant risk of psychopathology. The data presented require further investigations, in order to guide new pathogenetic models and appropriate intervention strategies

La sindrome di Capgras: cenni storici, aspetti psicopatologici, psicorganici e psicofunzionali

La sindrome di Capgras, molto rara ed inserita nei moderni manuali tra i disturbi psicotici atipici, è la convinzione delirante sull’esistenza di “doppioni” di persone significative nell’ambito della vita del paziente, di “doppioni” del paziente stesso, o di entrambi. Tutto ciò viene generalmente inserito in un delirio persecutorio ed il sosia assume spesso aspetti minacciosi ed ostili. Sono state fatte numerose ipotesi sia biologiche che neuropsicologiche per comprendere questa affascinante patologia. Dal punto di vista psicodinamico diversi autori hanno presupposto che la sindrome di Capgras possa rappresentare una soluzione psicotica a sentimenti di ambivalenza. In pazienti affetti da delirio di Capgras sono stati altresì notati diversi correlati organici: atrofia corticale, intossicazione da farmaci, reazione a scompensi metabolici, rapporti con malattie neurologiche (sclerosi multipla), ecc. A tutt’oggi, comunque, la base neurochimica e l’impegno neuronale che ne permettono la manifestazione rimangono ignoti. Very rare Capgras syndrome, inserted in modern manuals between the atypical psychotic disorders, is the delusional belief of "doubles" existence of significant people in the patient life, "duplication" of the patient, or both. All this is usually inserted in a persecutory delusion and the double takes on aspects often threatening and hostile. Many assumptions both biological and neuropsychological were made to understand this fascinating disease. From the psychodynamic point of view several authors have assumed that Capgras syndrome may be a psychotic solution to feelings of ambivalence. In patients with Capgras delusion were also noted several organic correlations: cortical atrophy, drug intoxication, a reaction to metabolic disorders, relationships with neurological diseases (multiple sclerosis), etc. To date, however, the neurochemical basis and the neuronal commitment that allow the event remain unknown

Acute psychiatric presentation of steroid-responsive encephalopathy: the underrecognized side of autoimmune thyroiditis

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as Hashimoto encephalopathy, represents a rare disorder of presumed autoimmune origins that can be diagnosed when a protean variety of psychiatric symptoms are present in association with elevated titers of anti-thyroid antibodies. Symptoms can have a rapid and complete remission with corticosteroid treatment. A 19-year-old girl, with clinical history of Basedow-Graves disease, has been admitted to our department after presenting acute psychiatric symptomatology. Clinical and serological findings were used to formulate the diagnosis of SREAT, confirmed by subsequent positive response to corticosteroid treatment. SREAT can mimic an acute psychiatric symptomatology, thus it seems extremely relevant for psychiatrists to consider this syndrome in differential diagnosis algorithm, especially in those patients presenting a history of autoimmune thyroid disorder, in order to ensure adequate diagnosis and treatment

Consumo di caffè nei disturbi depressivi: una dose giusta, non per tutti.

Assunzione di caffè nei disturbi depressivi. quadro bifasico degli effetti stimolanti della caffeina: a dosi basso- moderate può correlare con potenziale riduzione del rischio depressivi nei soggetti sani e miglioramento di molti sintomi clinici nei pazienti depressi; l'assunzione invece di alte dosi può indurre disregolazione dell'equilibrio timico, peggiorare i profili circadiani e i sintomi d'ansia e favorire stati affettivi di tipo misto

A novel SCL-90-R six-item factor identifies subjects at risk of early adverse outcomes in public mental health settings

To increase access to treatment, Italy made assessment at community mental health centers (CMHCs) independent of medical referral, resulting in increased numbers of patients to be triaged efficiently. To support this process, we evaluated SCL-90-R item-ratings to identify factors that best predicted adverse early outcomes among persons seeking first-time CMHC care in a 24-month period in Rome. A psychiatric nurse screened subjects with a brief interview and self-administered SCL-90-R and psychiatrists provided CGI ratings and ICD-9 diagnosis. Of 832 screened subjects, 32 (3.85%) were hospitalized or attempted suicide within 90 days. Six SCL-90 items (15,41,55,57,78,88) scored much higher with than without such adverse outcomes; their sum is proposed as a predictive measure (“SCL-6″). In binary multivariable logistic modeling, this factor, but not age, sex, diagnosis, or other SCL-90-derived subscales strongly predicted adverse outcomes. A ROC curve for SCL-6 reflected a strong separation between subjects with versus without adverse outcomes (AUC = 0.76). This simple screening tool may support timely identification of patients at risk of early adverse clinical outcome who require especially close follow-up