Can there be delusions of pain?

Abstract: Jennifer Radden argues that there cannot be delusional pain in depression, putting forward three arguments: the argument from falsehood, the argument from epistemic irrationality, and the argument from incongruousness. Whereas delusions are false, epistemically irrational, and incongruous with the person’s experience, feeling pain from the first-person perspective cannot be false or irrational, and is congruous with the person’s experience in depression. In this commentary on Radden’s paper, we share her scepticism about the notion of delusional pain, but we find the arguments from falsehood and incongruousness ultimately unconvincing, given that delusions are not always false or incongruous. Rather, we develop the argument from epistemic irrationality, suggesting that, although some aspects of pain (its cognitive and emotional components) may exhibit informational plasticity and other characteristics shared by mental states that can be assessed for their rationality, the sensory component of pain does not.Keywords: Delusion; Pain; Epistemic Irrationality; Incongruousness; Falsity; Depression Riassunto: Jennifer Radden sostiene che non può esserci dolore delirante nella depressione, proponendo tre argomentazioni che si basano sulla falsità, l'irrazionalità epistemica e l'incongruenza. Mentre i deliri sono falsi, epistemicamente irrazionali e incongruenti con l'esperienza della persona, provare dolore in prima persona non può essere falso o irrazionale ed è congruo con l'esperienza di una persona che è depressa. In questo commento all’articolo di Radden, condividiamo il suo scetticismo nei confronti della nozione di dolore delirante, ma troviamo le argomentazioni basate sulla falsità e l’incongruenza in ultima analisi non del tutto convincenti, dato che i deliri non sono sempre falsi o incongrui. Piuttosto, sviluppiamo l’argomentazione basata sull’irrazionalità epistemica, suggerendo che, sebbene alcuni aspetti del dolore (le sue componenti cognitive ed emotive) possano esibire plasticità e altre caratteristiche condivise da stati mentali che vengono valutati per la loro razionalità, la componente sensoriale del dolore non lo fa.Parole chiave: Delirio; Dolore; Irrazionalità epistemica; Incongruenza; Falsità; Depression

Neuroactive Steroids in First-Episode Psychosis: A Role for Progesterone?

Neuroactive steroids may play a role in the pathophysiology of psychotic disorders, but few studies examined this issue. We compared serumlevels of cortisol, testosterone, dehydroepiandrosterone, and progesterone between a representative sample of firstepisode psychosis (FEP) patients and age- and gender-matched healthy subjects. Furthermore, we analyzed the associations between neuroactive steroids levels and the severity of psychotic symptom dimensions.Male patients had lower levels of progesterone than controls

A public early intervention approach to first-episode psychosis: treated incidence over 7 years in the Emilia-Romagna region.

Aim: To estimate the treated incidence of individuals with first-episode psychosis (FEP) who contacted the Emilia-Romagna public mental healthcare system (Italy); to examine the variability of incidence and user characteristics across centres and years. Methods: We computed the raw treated incidence in 2013–2019, based on FEP users aged 18–35, seen within or outside the regional program for FEP. We modelled FEP incidence across 10 catchment areas and 7 years using Bayesian Poisson and Negative Binomial Generalized Linear Models of varying complexity. We explored associations between user characteristics, study centre and year comparing variables and socioclinical clusters of subjects. Results: Thousand three hundred and eighteen individuals were treated for FEP (raw incidence: 25.3 / 100.000 inhabitant year, IQR: 15.3). A Negative Binomial location-scale model with area, population density and year as predictors found that incidence and its variability changed across centres (Bologna: 36.55; 95% CrI: 30.39–43.86; Imola: 3.07; 95% CrI: 1.61–4.99) but did not follow linear temporal trends or density. Centers were associated with different user age, gender, migrant status, occupation, living conditions and cluster distribution. Year was associated negatively with HoNOS score (R = 0.09, p < .001), duration of untreated psychosis (R = 0.12, p < .001) and referral type. Conclusions: The Emilia-Romagna region presents a relatively high but variable incidence of FEP across areas, but not in time. More granular information on social, ethnic and cultural factors may increase the level of explanation and prediction of FEP incidence and characteristics, shedding light on social and healthcare factors influencing FEP

The body of evidence of late-life depression: the complex relationship between depressive symptoms, movement, dyspnea and cognition

Background: Physical symptoms play an important role in late-life depression and may contribute to residual symptomatology after antidepressant treatment. In this exploratory study, we examined the role of specific bodily dimensions including movement, respiratory functions, fear of falling, cognition, and physical weakness in older people with depression.Methods: Clinically stable older patients with major depression within a Psychiatric Consultation-Liaison program for Primary Care underwent comprehensive assessment of depressive symptoms, instrumental movement analysis, dyspnea, weakness, activity limitations, cognitive function, and fear of falling. Network analysis was performed to explore the unique adjusted associations between clinical dimensions.Results: Sadness was associated with worse turning and walking ability and movement transitions from walking to sitting, as well as with worse general cognitive abilities. Sadness was also connected with dyspnea, while neurovegetative depressive burden was connected with activity limitations.Discussion: Limitations of motor and cognitive function, dyspnea, and weakness may contribute to the persistence of residual symptoms of late-life depression

Exercise as antidepressant treatment: Time for the transition from trials to clinic?

editorial - non presente abstrac

Psichiatria e formazione in psicogeriatria: criticit\ue0 e prospettive

L\u2019et\ue0 della popolazione europea sta aumentando rapidamente e con essa la diffusione di patologie di interesse psicogeriatrico. Tuttavia, esistono vaste aree di incertezza sulle modalit\ue0 ed i contenuti della formazione psicogeriatrica. \uc8 possibile che questo dipenda da una tendenza all\u2019isolamento della psichiatria italiana rispetto alle altre discipline, storicamente e culturalmente determinata. Nonostante ci\uf2, le recenti riforme dell\u2019Ordinamento delle Scuole di Specializzazione testimoniano chiaramente un cambiamento di paradigma in atto: la formazione in psichiatria viene indicata come orientata alla cura di pazienti di tutte le fasce di et\ue0. Inoltre, le recenti acquisizioni in tema di neuroscienze possono ulteriormente promuovere il rinnovamento della psichiatria in senso multidisciplinare, attenta ai bisogni dell\u2019anziano fragile

Psichiatria e formazione in psicogeriatria: criticità e prospettive

L’età della popolazione europea sta aumentando rapidamente e con essa la diffusione di patologie di interesse psicogeriatrico. Tuttavia, esistono vaste aree di incertezza sulle modalità ed i contenuti della formazione psicogeriatrica. È possibile che questo dipenda da una tendenza all’isolamento della psichiatria italiana rispetto alle altre discipline, storicamente e culturalmente determinata. Nonostante ciò, le recenti riforme dell’Ordinamento delle Scuole di Specializzazione testimoniano chiaramente un cambiamento di paradigma in atto: la formazione in psichiatria viene indicata come orientata alla cura di pazienti di tutte le fasce di età. Inoltre, le recenti acquisizioni in tema di neuroscienze possono ulteriormente promuovere il rinnovamento della psichiatria in senso multidisciplinare, attenta ai bisogni dell’anziano fragile

Subthreshold depression in the elderly: a primary care survey

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