La sindrome di Stoccolma: fenomeno mediatico o patologia psichiatrica?

Cinematography and mass media often use the expression "Stockholm syndrome" to define the relationship which is sometimes established between the victim and the abductor in kidnapping, but according to scientific literature this condition is rare to verify and is not inserted in any international system of psychiatric classification. Furthermore, reverse cases of Stockholm syndrome are documented; in these cases the abductor is so much attached to his prisoner to decide to spare kidnapper’s life and suffering. Although these two forms of Stockholm syndrome look like a mysterious and magical phenomena, they can be explained rationally: they are not conscious behaviour, but unconscious defense mechanisms that help people to overcome high stress conditions. The authors discuss about the psychopathological manifestations of the Syndrome and about the criteria used to diagnose it. They question if some people are predisposed to develop this kind of psychopathology, how long the syndrome lasts and if the victim and the abductor can be recidivist when the emotional bond between them is interrupted. Finally, the authors propose the case (unique) which they identified for a certainty: Cristina (invented name) is 46 years old, rich, married and has two daughters. She is going through a depression period and decides to be treated by a psychotherapist, Paola (invented name). Later Cristina establishes a psychological dependence towards her psychotherapist, so much strong to convince her to give all her money and properties to Paola and her husband. Over the years, Cristina tries to get rid of this dependence, which she lives like a real disease, by developing another dependence towards a violent and quarrelsome man. Only after suffering acts of physical violence the woman finds the strength to react and to break off all relations with her torturers. Paola and her husband were investigated for the offence of circumvention of an incapable and Cristina was subjected to a psychiatric evaluation.Spesso la cinematografia e i media parlano di sindrome di Stoccolma per definire il legame che talora si instaura tra vittima e rapitore nell’ambito di un sequestro ma, secondo la letteratura scientifica, la suddetta condizione è di raro riscontro e non è inserita in nessun sistema internazionale di classificazione psichiatrica. Inoltre sono documentati anche casi di sindrome di Stoccolma inversa, in cui il sequestratore si affeziona così tanto al prigioniero da risparmiargli le sofferenze e la vita. Entrambe le forme di sindrome di Stoccolma, sebbene sembrino fenomeni magici e misteriosi, possono essere così spiegate razionalmente: sono meccanismi di difesa inconsapevoli, non comportamenti deliberati, che permettono all’uomo di superare condizioni ad altissimo stress. Gli Autori discutono delle manifestazioni psicopatologiche della sindrome e dei criteri utilizzati per diagnosticarla. Si interrogano se esistano soggetti predisposti allo sviluppo di tale condizione psicopatologica  su quanto duri e se, una volta rotto il legame emozionale vittima-aguzzino, possano esservi recidive. Infine prsentano il caso (unico) che hanno individuato con certezza e di cui uno di loro si è occupato: Cristina (nome di fantasia) ha 46 anni, è benestante, è sposata ed è madre di due figlie. Ella sta attraversando un periodo di depressione e decide di affidarsi alle cure di una psicoterapeuta, Paola (altro nome di fantasia). Successivamente la donna istaura una forte dipendenza psicologica nei confronti della terapeuta tanto da consegnare a Paola ed al marito di quest’ultima tutto il suo denaro e tutte le sue proprietà. Nel corso degli anni, Cristina cerca di liberarsi da quella dipendenza, che vive come una vera e propria malattia, sviluppandone un’altra, nei confronti di un uomo violento e rissoso. Soltanto quando subisce atti di violenza fisica,la donna trova la forza di reagire e di rompere definitivamente i legami con i suoi aguzzini. Paola e suo marito sono stati indagati per il reato di circonvenzione di persona incapace e Cristina è stata sottoposta a perizia psichiatrica

Physiological tissue-specific and age-related reduction of mouse TDP-43 levels is regulated by epigenetic modifications

The cellular level of TDP-43 (also known as TARDBP) is tightly regulated; increases or decreases in TDP-43 have deleterious effects in cells. The predominant mechanism responsible for the regulation of the level of TDP-43 is an autoregulatory negative feedback loop. In this study, we identified an in vivo cause-effect relationship between Tardbp gene promoter methylation and specific histone modification and the TDP-43 level in tissues of mice at two different ages. Furthermore, epigenetic control was observed in mouse and human cultured cell lines. In amyotrophic lateral sclerosis, the formation of TDP-43-containing brain inclusions removes functional protein from the system. This phenomenon is continuous but compensated by newly synthesized protein. The balance between sequestration and new synthesis might become critical with ageing, if accompanied by an epigenetic modification-regulated decrease in newly synthesized TDP-43. Sequestration by aggregates would then decrease the amount of functional TDP-43 to a level lower than those needed by the cell and thereby trigger the onset of symptoms

Liver Stiffness Measurement Allows Early Diagnosis of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome in Adult Patients Who Undergo Hematopoietic Stem Cell Transplantation: Results from a Monocentric Prospective Study

ABSTRACT Veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is a life-threatening complication affecting patients undergoing hematopoietic stem cell transplantation (HSCT). The survival rate is higher when specific therapy is initiated early; thus, improving early, noninvasive diagnosis of VOD/SOS is an important need. In an adult population undergoing HSCT, we aimed to assess the role of liver stiffness measurement (LSM), evaluated by transient elastography (TE), for diagnosing VOD/SOS. Between April 2016 and March 2018, 78 consecutive adult patients with indications for allogeneic HSCT were prospectively included. LSM was performed before HSCT and at days +9/10, +15/17, and +22/24 post-HSCT. New European Society for Blood and Marrow Transplantation criteria were used to establish VOD/SOS diagnosis. Four patients developed VOD/SOS (5.1%) during the study period, with a median time of +17 days post-HSCT. A sudden increase in LSM compared with previously assessed values and pre-HSCT values, was seen in all patients who developed VOD/SOS. LSM increases occurred from 2 to 12 days before clinical SOS/VOD appearance. The VOD/SOS diagnostic performance of increased LSM over pre-HSCT assessment showed an area under the receiver operating characteristic curve of 0.997 (sensitivity 75%; specificity 98.7%). LSM gradually decreased following successful VOD/SOS-specific treatment. Interestingly, LSM values did not increase significantly in patients experiencing hepatobiliary complications (according to the Common Terminology Criteria) other than VOD/SOS. LSM by TE can be considered a promising method to perform an early, preclinical diagnosis and follow-up of VOD/SOS

Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP)

The irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction. IBS is still associated with areas of uncertainties, especially regarding the optimal diagnostic work-up and the more appropriate management. Experts from 7 Italian Societies conducted a Delphi consensus with literature summary and voting process on 27 statements. Recommendations and quality of evidence were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was defined as >80% agreement and reached for all statements.In terms of diagnosis, the consensus supports a positive diagnostic strategy with a symptom-based approach, including the psychological comorbidities assessment and the exclusion of alarm symptoms, together with the digital rectal examination, full blood count, C- reactive protein, serology for coeliac disease, and fecal calprotectin assessment. Colonoscopy should be recommended in patients with alarm features. Regarding treatment, the consensus strongly supports a dietary approach for patients with IBS, the use of soluble fiber, secretagogues, tricyclic antidepressants, psychologically directed therapies and, only in specific IBS subtypes, rifaximin. A conditional recommendation was achieved for probiotics, polyethylene glycol, antispasmodics, selective serotonin reuptake inhibitors and, only in specific IBS subtypes, 5-HT3 antagonists, 5-HT4 agonists, bile acid sequestrants

Social cognition in people with schizophrenia: A cluster-analytic approach

Background The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. Method A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. Results We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. Conclusions If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person

Neutralizing antibodies to Omicron after the fourth SARS-CoV-2 mRNA vaccine dose in immunocompromised patients highlight the need of additional boosters

IntroductionImmunocompromised patients have been shown to have an impaired immune response to COVID-19 vaccines.MethodsHere we compared the B-cell, T-cell and neutralizing antibody response to WT and Omicron BA.2 SARS-CoV-2 virus after the fourth dose of mRNA COVID-19 vaccines in patients with hematological malignancies (HM, n=71), solid tumors (ST, n=39) and immune-rheumatological (IR, n=25) diseases. The humoral and T-cell responses to SARS-CoV-2 vaccination were analyzed by quantifying the anti-RBD antibodies, their neutralization activity and the IFN-γ released after spike specific stimulation.ResultsWe show that the T-cell response is similarly boosted by the fourth dose across the different subgroups, while the antibody response is improved only in patients not receiving B-cell targeted therapies, independent on the pathology. However, 9% of patients with anti-RBD antibodies did not have neutralizing antibodies to either virus variants, while an additional 5.7% did not have neutralizing antibodies to Omicron BA.2, making these patients particularly vulnerable to SARS-CoV-2 infection. The increment of neutralizing antibodies was very similar towards Omicron BA.2 and WT virus after the third or fourth dose of vaccine, suggesting that there is no preferential skewing towards either virus variant with the booster dose. The only limited step is the amount of antibodies that are elicited after vaccination, thus increasing the probability of developing neutralizing antibodies to both variants of virus.DiscussionThese data support the recommendation of additional booster doses in frail patients to enhance the development of a B-cell response directed against Omicron and/or to enhance the T-cell response in patients treated with anti-CD20