Pensiero e difese nei disturbi bipolari. Studio clinico e psicopatologico su bipolari I e bipolari II. Thinking organization and defense mechanisms in bipolar disorders. Clinical and psychopathological study on bipolar I and bipolar II.

Obiettivi. Scopo del presente studio è esplorare il funzionamento psichico dei soggetti con disturbo bipolare I e II attraverso l’analisi e il confronto degli stili di pensiero e dei pattern difensivi. Metodi. Nel corso di un intero anno solare (2009-2010), presso la clinica Psichiatrica del Policlinico Universitario di Palermo sono stati reclutati 29 pazienti con disturbo bipolare I e II. È stato somministrato il seguente protocollo: Wechsler Adult Intelligent Scale-R (WAIS-R) per valutare il funzionamento cognitivo generale; Defense Mechanisms Inventory (DMI) per misurare i pattern difensivi. Sono stati quindi ana- lizzati e confrontati i risultati ai due reattivi. Risultati. I soggetti con diagnosi di disturbo bipolare utilizzano modalità cognitive e strategie difensive del tutto peculiari, differenti rispetto alla popolazione normativa. La diagnosi incide sul livello e sul tipo di funzionamento cognitivo nonché sui pattern difensivi. I bipolari I presentano compromissioni cognitive più serie ed estese e un profilo difensivo più rigido dei bipolari II. In generale, i pazienti bipolari manifestano una personalità immatura centrata su funzionamenti arcaici che si riscontrano in tutte le sfere della loro personalità: emozioni, affetti, cognizione, forza dell’Io, adattamento alla realtà. Discussione. Il profilo cognitivo e difensivo del tutto specifico ottenuto conduce a importanti riflessioni sul contributo che le strategie psicologiche possono dare al trattamento “su misura” per questi pazienti.Aim. The aim of this research is to explore the psychical functioning in bipolar I or bipolar II disorder people through the analysis and comparison of their thought styles and defense patterns. Methods. 29 bipolar I and bipolar II peo- ple afferent to Palermo University Policlinical Psychiatric Hospital Department were selected during the whole 2009-2010 year. The following tests were administred: Wechsler Adult Intelligent Scale-R (WAIS-R) in order to measure the general cognitive function; Defense Mechanisms Inventory (DMI) in order to measure defense patterns. Afterwards, the results of the two tests were analysed and compared. Outcome. Bipolar disorder people use cognitive mechanisms and defense strategies that are very different from standard population. Bipolar I subjects show both wider and more serious cognitive deterioration and stricter defense mechanisms than bipolar II subjects. Generally bipolar patients show an immature personality based on ar- chaic mechanisms that can be found in all the spheres of their personality: emotions, cognition, Ego-strength, adaptability to reality. Discussion. The peculiar achieved cognitive and defense profile leads to important considerations about how psychological strategies can contribute to use “bespoke” treatments for these patients

GADA Titer-Related Risk for Organ-Specific Autoimmunity in LADA Subjects Subdivided according to Gender (NIRAD Study 6)

Context: Latentautoimmunediabetes in adults(LADA)includesaheterogeneous population wherein, based on glutamic acid decarboxylase antibody (GADA) titer, different subgroups of subjects can be identified. Objective: The aim of the present study was to evaluateGADAtiter-related risk for-cell and other organ-specific autoimmunity in LADA subjects. Methods: Adult-onsetautoimmunediabetes subjects (n236)andtype 2 diabetes (T2DM) subjects (n 450) were characterized for protein tyrosine phosphatase (IA-2IC and IA-2256–760), zinc transporter 8 (ZnT8), thyroid peroxidase, (TPO), steroid 21-hydroxylase (21-OH), tissue transglutaminase (tTG), and antiparietal cell (APC) antibodies. Results: High GADA titer compared to low GADA titer showed a significantly higher prevalence of IA-2IC, IA-2256–760, ZnT8, TPO, and APC antibodies (P 0.04 for all comparison). 21-OH antibodies were detected in 3.4% of high GADA titer. A significant decreasing trend was observed from high GADA to low GADA and to T2DM subjects for IA-2256–760, ZnT8, TPO, tTG, and APC antibodies (P for trend0.001).TPOwas the only antibody showing a different prevalence between gender; low GADA titer and T2DM female patients had a higher frequency of TPO antibody compared to males (P0.0004 and P0.0006, respectively), where the presence of highGADAtiter conferred an odds ratio of 8.6 for TPO compared to low GADA titer. After subdividing high and low GADA titer subjects according to the number of antibodies, we observed that 73.3% of high GADA titer subjects were positive for at least one or more antibodies, compared to 38.3% of low GADA titer (P 0.0001). Conclusions: In LADA subjects, high GADA titer was associated with a profile of more severe autoimmunity and, in male gender, specifically predisposed to thyroid autoimmunity. A regular screening for other antibodies is recommended in LADA patients according to GADA titer and gender

GADA titer-related risk for organ-specific autoimmunity in LADA subjects subdivided according to gender (NIRAD study 6).

Latent autoimmune diabetes in adults (LADA) includes a heterogeneous population wherein, based on glutamic acid decarboxylase antibody (GADA) titer, different subgroups of subjects can be identified. OBJECTIVE: The aim of the present study was to evaluate GADA titer-related risk for β-cell and other organ-specific autoimmunity in LADA subjects. METHODS: Adult-onset autoimmune diabetes subjects (n=236) and type 2 diabetes (T2DM) subjects (n=450) were characterized for protein tyrosine phosphatase (IA-2IC and IA-2(256-760)), zinc transporter 8 (ZnT8), thyroid peroxidase, (TPO), steroid 21-hydroxylase (21-OH), tissue transglutaminase (tTG), and antiparietal cell (APC) antibodies. RESULTS: High GADA titer compared to low GADA titer showed a significantly higher prevalence of IA-2IC, IA-2(256-760), ZnT8, TPO, and APC antibodies (P≤0.04 for all comparison). 21-OH antibodies were detected in 3.4% of high GADA titer. A significant decreasing trend was observed from high GADA to low GADA and to T2DM subjects for IA-2(256-760), ZnT8, TPO, tTG, and APC antibodies (P for trend≤0.001). TPO was the only antibody showing a different prevalence between gender; low GADA titer and T2DM female patients had a higher frequency of TPO antibody compared to males (P=0.0004 and P=0.0006, respectively), where the presence of high GADA titer conferred an odds ratio of 8.6 for TPO compared to low GADA titer. After subdividing high and low GADA titer subjects according to the number of antibodies, we observed that 73.3% of high GADA titer subjects were positive for at least one or more antibodies, compared to 38.3% of low GADA titer (P<0.0001). CONCLUSIONS: In LADA subjects, high GADA titer was associated with a profile of more severe autoimmunity and, in male gender, specifically predisposed to thyroid autoimmunity. A regular screening for other antibodies is recommended in LADA patients according to GADA titer and gender

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil Fatores associados à realização de cesáreas em uma maternidade pública do Município do Rio de Janeiro, Brasil

Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro. A case-control study was conducted with 231 cesarean sections (cases) and 230 vaginal deliveries (controls). Hierarchical logistic regression analysis was performed, based on a conceptual model. Factors associated with increased odds of cesarean section were: primiparity; mother's age 20-34; last birth by cesarean; cervical dilatation < 3cm at admission; patient request; daytime birth; male attending obstetrician; obstetrician on duty for more than 24 hours a week; obstetrician with private practice; gestational hypertension; non-cephalic presentation; and gestational age > 41 weeks. Factors associated with lower odds of cesarean were: gestational age < 37 weeks; leaving home with signs of labor, use of oxytocin; and amniotomy. In this hospital, interventions aimed to modify the above-mentioned factors can help lower the cesarean rate.<br>O Brasil apresenta uma das maiores proporções de cesáreas do mundo. Fatores contribuintes para este fenômeno incluem organização da prática obstétrica, atitudes dos obstetras, preferências e decisões das mulheres. Com o objetivo de identificar fatores associados à realização de cesáreas, foi realizado estudo de caso-controle em uma maternidade pública do Município do Rio de Janeiro. Incluíram-se 231 partos por cesárea (casos) e 230 partos vaginais (controles). Utilizou-se análise multivariada com regressão logística, as variáveis foram incluídas no modelo obedecendo à ordem hierárquica definida em modelo conceitual. Fatores associados à maior chance de cesárea: primiparidade; idade 20-34 anos; último parto por cesárea; dilatação cervical < 3cm na admissão; preferência da mulher por cesárea; horário diurno; parto realizado por obstetra do sexo masculino; obstetra que trabalha mais de 24 horas semanais de plantão; obstetra com consultório particular; hipertensão; apresentação fetal não-cefálica; e idade gestacional > 41 semanas. Fatores associados à menor chance de cesárea: prematuridade; sinais de trabalho de parto ao sair de casa; uso de ocitocina e amniotomia. Propostas de modificação nos fatores estudados podem contribuir para redução da proporção de cesáreas

GADA titer-related risk for organ-specific autoimmunity in LADA subjects subdivided according to gender (NIRAD study 6).

Latent autoimmune diabetes in adults (LADA) includes a heterogeneous population wherein, based on glutamic acid decarboxylase antibody (GADA) titer, different subgroups of subjects can be identified. OBJECTIVE: The aim of the present study was to evaluate GADA titer-related risk for β-cell and other organ-specific autoimmunity in LADA subjects. METHODS: Adult-onset autoimmune diabetes subjects (n=236) and type 2 diabetes (T2DM) subjects (n=450) were characterized for protein tyrosine phosphatase (IA-2IC and IA-2(256-760)), zinc transporter 8 (ZnT8), thyroid peroxidase, (TPO), steroid 21-hydroxylase (21-OH), tissue transglutaminase (tTG), and antiparietal cell (APC) antibodies. RESULTS: High GADA titer compared to low GADA titer showed a significantly higher prevalence of IA-2IC, IA-2(256-760), ZnT8, TPO, and APC antibodies (P≤0.04 for all comparison). 21-OH antibodies were detected in 3.4% of high GADA titer. A significant decreasing trend was observed from high GADA to low GADA and to T2DM subjects for IA-2(256-760), ZnT8, TPO, tTG, and APC antibodies (P for trend≤0.001). TPO was the only antibody showing a different prevalence between gender; low GADA titer and T2DM female patients had a higher frequency of TPO antibody compared to males (P=0.0004 and P=0.0006, respectively), where the presence of high GADA titer conferred an odds ratio of 8.6 for TPO compared to low GADA titer. After subdividing high and low GADA titer subjects according to the number of antibodies, we observed that 73.3% of high GADA titer subjects were positive for at least one or more antibodies, compared to 38.3% of low GADA titer (P<0.0001). CONCLUSIONS: In LADA subjects, high GADA titer was associated with a profile of more severe autoimmunity and, in male gender, specifically predisposed to thyroid autoimmunity. A regular screening for other antibodies is recommended in LADA patients according to GADA titer and gender