Sexual masochism disorder with asphyxiophilia: a deadly yet underrecognized disease

DSM-5 distinguishes between paraphilias and paraphilic disorders. Paraphilias are defined as atypical, yet not necessarily disordered, sexual practices. Paraphilic disorders are instead diseases, which include distress, impairment in functioning, or entail risk of harm one's self or others. Hence, DSM-5 new approach to paraphilias demedicalizes and destigmatizes unusual sexual behaviors, provided they are not distressing or detrimental to self or others. Asphyxiophilia, a dangerous and potentially deadly form of sexual masochism involving sexual arousal by oxygen deprivation, are clearly described as disorders. Although autoerotic asphyxia has been associated with estimated mortality rates ranging from 250 to 1000 deaths per year in the United States, in Italy, knowledge on this condition is very poor. Episodes of death caused by autoerotic asphyxia seem to be underestimated because it often can be confounded with suicide cases, particularly in the Italian context where family members of the victim often try to disguise autoerotic behaviors of the victims. The current paper provides a review on sexual masochism disorder with asphyxiophilia and discusses one specific case as an example to examine those conditions that may or may not influence the likelihood that death from autoerotic asphyxia be erroneously reported as suicide or accidental injury

A modified Volterra series approach for nonlinear dynamic systems modeling

This paper describes a modeling approach for nonlinear dynamic systems based on a modified Volterra series; by comparing the truncation error of this series with that of the classical Volterra one, we outlined that, under the assumption of short-term nonlinear memory effects, the modified series enables a single-fold nonlinear convolution integral to be adopted also in the presence of strong nonlinearities. The measurement-based identification of the first terms of the modified Volterra series is described; experimental and simulation results which confirm the theoretical considerations are also provided

Molecular alterations of the TLR4-signaling cascade in canine epilepsy

Background: Cumulating evidence from rodent models points to a pathophysiological role of inflammatory signaling in the epileptic brain with Toll-like receptor-4 signaling acting as one key factor. However, there is an apparent lack of information about expression alterations affecting this pathway in canine patients with epilepsy. Therefore, we have analyzed the expression pattern of Toll-like receptor 4 and its ligands in brain tissue of canine patients with structural or idiopathic epilepsy in comparison with tissue from laboratory dogs or from owner-kept dogs without neurological diseases. Results: The analysis revealed an overexpression of Toll-like receptor-4 in the CA3 region of dogs with structural epilepsy. Further analysis provided evidence for an upregulation of Toll-like receptor-4 ligands with high mobility group box-1 exhibiting increased expression levels in the CA1 region of dogs with idiopathic and structural epilepsy, and heat shock protein 70 exhibiting increased expression levels in the piriform lobe of dogs with idiopathic epilepsy. In further brain regions, receptor and ligand expression rates proved to be either in the control range or reduced below control levels. Conclusions: Our study reveals complex molecular alterations affecting the Toll-like receptor signaling cascade, which differ between epilepsy types and between brain regions. Taken together, the data indicate that multi-targeting approaches modulating Toll-like receptor-4 signaling might be of interest for management of canine epilepsy. Further studies are recommended to explore respective molecular alterations in more detail in dogs with different etiologies and to confirm the role of the pro-inflammatory signaling cascade as a putative target

Repeated shocks and preferences for redistribution

Abstract A society that believes wealth to be determined by random “luck” rather than by merit, demands more redistribution. The theoretical literature shows that any increase in the volatility of income caused by unpredictable adverse shocks implies a higher support for redistribution. We present evidence of this behavior by exploiting a natural experiment provided by the L’Aquila earthquake in 2009, which hit a large area of Central Italy through a series of destructive shakes over eight days. Matching detailed information on the ground acceleration registered during each shock with survey data about individual opinions on redistribution we show that the average intensity of the shakes is associated with subsequent stronger beliefs that, for a society to be fair, income inequalities should be levelled by redistribution. The shocks, however, are not all alike. We find that only the last three shakes - occurred on the fourth and the eighth day of the earthquake - have a statistically significant impact. Overall, we find that the timing and repetition of the shock play a role in shaping redistributive preferences

Repeated shocks and preferences for redistribution

Abstract A society that believes wealth to be determined by random “luck” rather than by merit, demands more redistribution. The theoretical literature shows that any increase in the volatility of income caused by unpredictable adverse shocks implies a higher support for redistribution. We present evidence of this behavior by exploiting a natural experiment provided by the L’Aquila earthquake in 2009, which hit a large area of Central Italy through a series of destructive shakes over eight days. Matching detailed information on the ground acceleration registered during each shock with survey data about individual opinions on redistribution we show that the average intensity of the shakes is associated with subsequent stronger beliefs that, for a society to be fair, income inequalities should be levelled by redistribution. The shocks, however, are not all alike. We find that only the last three shakes - occurred on the fourth and the eighth day of the earthquake - have a statistically significant impact. Overall, we find that the timing and repetition of the shock play a role in shaping redistributive preferences

Natural disasters and demand for redistribution: lessons from an earthquake

Abstract The literature shows that when a society believes that wealth is determined by random “luck” rather than by merit, it demands more redistribution. Adverse shocks, like earthquakes, strengthen the belief that random “bad luck” can frustrate the outcomes achieved with merit. We theoretically illustrate that individuals react to such shocks by raising support for redistribution. We then present evidence of this behavior by exploiting a natural experiment provided by one of the strongest seismic events that occurred in Italy in the last three decades, the L’Aquila earthquake in 2009. We assemble a novel dataset by matching information on the ground acceleration registered throughout the National Strong Motion Network during the earthquake with survey data about individual opinions on redistribution collected a few months later. The empirical analysis illustrates that the intensity of the shakes is associated with subsequent stronger beliefs that, for a society to be fair, income inequalities should be levelled by redistribution

Protective but Not Anticonvulsant Effects of Ghrelin and JMV-1843 in the Pilocarpine Model of Status epilepticus.

In models of status epilepticus ghrelin displays neuroprotective effects mediated by the growth hormone secretagogue-receptor 1a (GHS-R1a). This activity may be explained by anticonvulsant properties that, however, are controversial. We further investigated neuroprotection and the effects on seizures by comparing ghrelin with a more effective GHS-R1a agonist, JMV-1843. Rats were treated either with ghrelin, JMV-1843 or saline 10 min before pilocarpine, which was used to induce status epilepticus. Status epilepticus, developed in all rats, was attenuated by diazepam. No differences were observed among the various groups in the characteristics of pilocarpine-induced seizures. In saline group the area of lesion, characterized by lack of glial fibrillary acidic protein immunoreactivity, was of 0.45\ub10.07 mm2 in the hippocampal stratum lacunosum-moleculare, and was accompanied by upregulation of laminin immunostaining, and by increased endothelin-1 expression. Both ghrelin (P<0.05) and JMV-1843 (P<0.01) were able to reduce the area of loss in glial fibrillary acidic protein immunostaining. In addition, JMV-1843 counteracted (P<0.05) the changes in laminin and endothelin-1 expression, both increased in ghrelin-treated rats. JMV-1843 was able to ameliorate neuronal survival in the hilus of dentate gyrus and medial entorhinal cortex layer III (P<0.05 vs saline and ghrelin groups). These results demonstrate diverse protective effects of growth hormone secretagogues in rats exposed to status epilepticus

L'impatto della pandemia Covid-19 sulle nuove strutture psichiatrico-forensi in Italia

After the closure of Psychiatric Hospitals (OPs), in 2012 the Italian Government decided to close the High Security Psychiatric Hospitals (OPGs). Law 81/2014 established that each region would provide smaller forensic psychiatry facilities, theREMS (Residence for the Execution of the Security Measures), to accommodate socially dangerous NGRI (Not Guilty by Reason of Insanity) offenders. The main characteristic of a REMS is that it is purely therapeutic and rehabilitative in naturewhile remaining a custodial safety measure. The COVID-19 pandemic undoubtedly tested the organization of these new Italian forensic psychiatry facilities whose practices were not yet fully established, forcing them to ensure patient safety during lockdown amidst the epidemic. The Chapter V Constitutional reform which assigned each region exclusive competence for health policies in its own territory, once the prerogative of the central government, was also put to the test. To assess the impact of the pandemic on the new forensic care system in Italy, we conducted a semi-structured interview with REMS health professionals from various regions with differing levels of contagion: the Poli REMS di Castiglione delle Stiviere; the REMS of Volterra; the REMS of Carovigno and the REMS of Pisticci. The interview assessed how the rehabilitation objectiveshad been met notwithstanding the serious operational limitations consequent to COVID-19 related decisions by the authorities.Dopo la chiusura degli Ospedali Psichiatrici (OP), nel 2012 il Governo Italiano ha deciso di chiudere gli Ospedali Psichiatrici Giudiziari, gli OPG. La legge 81/2014 stabiliva che ogni regione avrebbe dovuto prevedere l’istituzione di strutture psichiatrico-forensi più piccole, le REMS (Residenze per la Esecuzione delle Misure di Sicurezza), per accogliere gli autori di reatonon imputabili, socialmente pericolosi. La caratteristica principale delle REMS è quella di avere una natura prettamente terapeutica e riabilitativa pur rimanendo una misura di sicurezza detentiva. Non c’è dubbio che la pandemia COVID-19 abbia messo alla prova l’organizzazione delle nuove strutture psichiatrico-forensi italiane, con prassi ancora non del tutto consolidate, costringendo le REMS durante il lock-down ad adoperarsi per gestire l’epidemia, garantendo al tempo stesso la sicurezza dei pazienti. In questo contesto è stata messa alla prova anche la riforma del Capitolo V della Costituzione, che assegnava a ciascuna Regione la competenza esclusiva per le politiche sanitarie del proprio territorio, un tempo prerogativa del governo centrale. Alla luce di ciò, per valutare l’impatto della pandemia sul nuovo sistema di assistenza forense in Italia, abbiamo condotto un’intervista strutturata con gli operatori sanitari delle REMS di diverse regioni con diversi livelli di diffusione della malattia: la Poli REMS di Castiglione delle Stiviere; la REMS di Volterra; la REMS di Carovigno e la REMS di Pisticci. L’intervista ha valutato come gli obiettivi riabilitativi fossero stati garantiti nonostante i gravi limiti operativi conseguenti alle decisioni delle autorità determinate dal COVID-19

Drinking wine to "get high": the influence of awareness of the negative effects among young adults.

Introduction In a group of university students, the current study investigated the relationship between drinking wine to get high and the awareness about its characteristics, composition, positive and negative effects on health. Methods Through a web-based survey, 1685 students at the University of Siena completed a self-report questionnaire to assess consumption behaviours, knowledge about wine and the awareness about its effects. Results Seventy-three percent reported drinking wine. Males were more frequently wine consumers (p = 0.037). Among the students who reported drinking, 69.3% engaged this habit during the weekend. Almost 12% reported drinking wine to get high. Drinking wine to get high correlated with the consideration of its consumption: using this beverage to get high was strongly associated with considering wine like other spirits (p = 0.033). Conclusions Older age, female gender, and considering wine as a part of the diet were found to be protective factors against wine drinking-to get high. In contrast with some literature, awareness of the negative effects correlated with higher propensity to use wine to get high. Potential interpretations and limitations are addressed