Bipolar Patients and Bullous Pemphigoid after Risperidone Long-Acting Injectable: A Case Report and a Review of the Literature

Neuropsychiatric disorders are found to be associated with bullous pemphigoid (BP), an autoimmune subepidermal blistering disease. Antipsychotics have emerged as possible inducing factors of BP. However, large sample studies concerning BP associated with antipsychotics, as well as with specific mental disorders, are still lacking. Our review retrieved a few clinical studies and case reports on the topic, producing controversial results. We report for the first time a bipolar patient case presenting BP following five-month therapy with risperidone long-acting injectable (LAI). We hypothesize that the dermatological event is associated with the medication administered. The issue emerged during psychiatric consultation and was confirmed by histological examination, direct and indirect immunofluorescence studies, plus positive plasma and cutaneous BP180 and BP230 IgG. Neurodegeneration or neuroinflammation might represent a primary process leading to a cross-reactive immune response between neural and cutaneous antigens and contributing to self-tolerance failure. Furthermore, the time sequence of the shared biological mechanisms leading to clinical manifestations of the neuropsychiatric disorder and BP remains undefined. BP comorbid with bipolar disorder might occasionally represent a serious health risk and affect patients’ physical and psychosocial quality of life. Thus, clinicians treating psychiatric patients should consider BP as a possible adverse effect of psychotropic medications

An experience in multi-couple group mediation

In recent years there has been a growing spread of psychosocial interventions characterized by the use of multi-family extended groups, whose application is useful in many clinical fields. The adoption of multi-family settings seems to be dictated by the evidence that this working method combines a low cost with high efficiency. In this case, the identification of problematic areas connected with the phenomenology of separation and divorce and the solicitation of possible resources becomes a practice but also an experimental methodology for network support forms. In particular, the configuration of the multi-couple group, specific operational declination of the extended group, is characterized as an optimized version of the clinical application. Hence, the hypothesis of being able to place within it, a plurality of couples, returning from the emotional and relational experience of a marital crisis, but focused on the inevitable task of being able to keep faith in the parental mandate. On the basis of these considerations, we have tried to hypothesize the possibility of starting a multi-family operative programme including separated couples but united with the intention to maintain the parental function, however harshly proven by the dissolution of the conjugal bond

Le competenze sistemico-relazionali: Analogie e differenze tra due gruppi di terapeuti in formazione

Questo articolo descrive uno studio esplorativo volto ad indagare le principali competenze che gli studenti di psicoterapia sistemica considerano essenziali per il processo terapeutico. Sessantasei studenti che frequentavano due scuole di psicoterapia sistemica italiane (Ecopsys ed Eteropoiesi) hanno compilato un questionario sulle competenze chiave in psicoterapia, mutuato dai position papers di EAP e FIAP, le associazioni europea e italiana di psicoterapia. L'obiettivo dello studio era di evidenziare le somiglianze e le differenze nei programmi di formazione di queste due scuole che hanno la medesima stessa matrice teorica, cioè la psicoterapia sistemico-relazionale, ma focalizzata su diverse tradizioni cliniche. L'indagine si è basata su uno studio esplorativo precedente (Visone et al., 2017). Inoltre, il disegno dello studio mirava a identificare una "linea evolutiva" nella costruzione di abilità sistemiche durante il corso della formazione, attraverso un'analisi dell'intera coorte di studenti nei quattro anni di corso. Viene anche discusso il campo della formazione sistemica in psicoterapia. Il confronto tra gli studenti delle due scuole mostra forti analogie inerenti il modello teorico e clinico sia per gli items scelti che per quelli considerati irrilevanti. Lo studio del campione, distribuito per ogni anno di istruzione, mostra un cambiamento progressivo di enfasi dalle abilità diagnostiche alle abilità relazionali.  This paper describes an exploratory study aimed at investigate the core competencies of trainees in systemic psychotherapy they consider as essential for the therapeutic process. Sixty-sixstudents attending two Italian schools of systemic psychotherapy (Ecopsys and Eteropoiesis) completed a questionnaire on key skills in psychotherapy, drawn up from the position papers of EAP and FIAP, the European and Italian Association of psychotherapy. The focus of the study was to point out the similarities and the differences in the training programs of these two schools stemming from the same theoretical matrix, i.e. the systemic-relational psychotherapy, but focused on different clinical tradition. The survey was based on a previous, exploratory study (Visone et al., 2017). Moreover, the study design was aimed to identify an "evolutionary line" in building systemic skills during the course of training by means of an analysis the whole cohort of students into the four years of the training. The field of systemic psychotherapy training is discussed too. The comparison between the students of the two schools shows strong analogies inherent to the theoretical and clinical model both for the items chosen and for those considered irrelevant. The whole study sample, distributed for each year of education, shows a progressive change of emphasis from the diagnostic skills to the relational ones

Fatigue in inflammatory bowel diseases: Relationship with age and disease activity

A higher rate of patients suffering from inflammatory bowel diseases (IBD) are reported to experience the symptom of fatigue compared with general population. Fatigue can impair quality of life of IBD patients by limiting their daily functioning. However, this problem is poorly understood and addressed. Our aim was to investigate the impact of fatigue in IBD patients compared with controls, and to seek for relation between age and disease activity. IBD patients aged between 16 and 75 years observed at our Unit from June 2011 through June 2012 were evaluated for fatigue. Patients were asked to fill the fatigue impact scale (FIS) questionnaire. A cohort of age- and sex-matched patients observed for other-than-IBD diseases were prospectively enrolled to act as controls. Patients diagnosed with malignancies were excluded from evaluation. Each group included 16 patients, of whom half aged over 65 years. Fatigue was more severe in IBD patients than in controls (p = 0.02), irrespective of age and disease activity. IBD patients with moderate to severe disease activity showed worse fatigue compared with controls at any age (p < 0.0001). Young IBD patients with low disease activity showed a trend toward worse FIS score when compared with old IBD counterparts (p = 0.06). IBD significantly impacted on fatigue in our series. Considering IBD patients in remission, younger patients may experience worse fatigue. Further studies are needed to explore the effects of fatigue on quality of life and the potential of appropriate intervention strategies