Type D personality impairs quality of life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation.

Background: Type D personality represents a risk factor for adverse outcome and impaired Quality of Life (QoL) in CHD patients. Only few studies investigated Type D patients following cardiac rehabilitation (CR). No study investigated Type D personality in Italian patients attending a CR program of 4 weeks.

Psychoanalysis and art: artistic representations in patients' dreams.

The authors explore the psychic passages that were opened up within a patient, Ada, thanks to her contact with two works of art, Signorelli's frescoes in Orvieto and Picasso's painting La Nageuse--their themes, formal structures, and the conventions governing their creation. A work of art can be considered as a kind of window that allows one to look upon the imaginary world created by the artist. One can peer out of this window from the other side, permitting a look at the viewer (the patient), who is caught in a web of associations that are yet to be explored.

Recurrent renal colic in young people: abdominal Munchausen syndrome--a diagnosis not to forget.

The Munchausen's syndrome (MHS) is a rare psychiatric disorder classified among the self-manipulated diseases. Incidence of Munchausen syndrome peaks in young-to-middle-aged adults, but it has been reported in patients of all ages (ie, childhood through advanced age). Diagnosing Munchausen syndrome is very difficult, but early diagnosis could to a considerable extent prevent the iatrogenic risks.

Social anxiety and premorbid personality disorders in paranoid schizophrenic patients treated with clozapine.

The concept of anxiety as a distinct comorbid disorder in schizophrenia has recently been rediscovered after having been neglected for a long period of time due to both theoretical and clinical approaches adopted from the appearance of the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1950. This rediscovery was accentuated by the fact that the concept of comorbidity in various psychiatric disorders has recently won widespread favor within the scientific community, and that the use of atypical neuroleptic medication to treat patients with schizophrenia has been reported to lead to the emergence of anxiety symptoms. Of the atypical neuroleptic medications used to treat schizophrenia, clozapine has most frequently been reported to induce anxiety symptoms.

Delusion, narrative, and affects.

Delusions and narrations have very different communicative characteristics. Delusion, when reported, places itself outside of a shared communication, of an interactive field; it is presented as an absolute, non-modifiable, saturated truth, that can only be believed or refuted. A clinical vignette is an example on the possibility that psychoanalytic treatments might be sometime able to at least partly transform a delusion into an account narrated in an interactive situation.

A setting including psychotherapy and psychopharmacological treatment in a case of anorexia nervosa with obsessive compulsive disorder comorbidity.

In this case report we describe the therapy followed with a patient affected by atypical anorexia purging, in a setting that includes both psychotherapy and psychopharmacological treatment. The aim of this presentation is to show how the patient's ambivalence towards the treatment was faced, and how this work both rendered effective the pharmacological therapy and enabled the progression of the psychotherapy. There is a discussion of the interaction between psychotherapy and pharmacological therapy and their possible beneficial action on the symptomatology.

Attachment processes in eating disorders.

Anxious and insecure attachment, fear of abandonment and difficulties with autonomy differentiate young women with eating disorders from their normal peers. This paper uses the Adult Attachment Interview (AAI) as the correlation between eating disorders and state of mind regarding attachment (7 females and 6 males) with anorexia nervosa and EDNOS. There was a higher frequency of dismissing or entangled states of mind.

Dysphoria and aloneness in borderline personality disorder.

A close examination of dysphoria, anger and aloneness (three main characteristics of the borderline syndrome) provides a theoretical model of reference for the therapist. Dysphoria results from the cyclical emotional oscillation between hope for stability and disappointment in its inattainability; a dependent-anaclitic depression arises from the mixture of anger, aloneness and inner emptiness which is so characteristic of the borderline syndrome. The tendency to be immersed in the here-and-now, an intra-festum mentality, exacerbates the sense of isolation, causing more irritation, mute frustration and, consequently, anger.

The emergence of social phobia during clozapine treatment and its response to fluoxetine augmentation.

Background: The underlying neurochemical basis of social phobia has yet to be fully explained, but there are suggestions of serotonergic and dopaminergic dysfunction. The atypical neuroleptic clozapine has been reported to induce anxiety symptoms, probably owing to its effect on serotonergic pathways. We report 12 cases of schizophrenic patients who developed social phobia during clozapine treatment.

Basic symptoms and P300 abnormalities in young schizophrenic patients.

Among the reasons for the relatively limited number of investigations of self-knowledge phenomena should be included, in addition to theoretical motives, the difficulties regarding the use of instruments available for this kind of approach and their content validity. This study investigates the relationship between subjective and objective deficits in schizophrenia, taking into account subjective experiences of cognitive impairment, clinical symptoms, and cognitive evoked potentials (P300 component). A group of 36 young schizophrenic patients (29 on neuroleptic treatment and seven drug-naive) were considered, together with a comparison group of 36 healthy subjects.

Effects of clozapine on awareness of illness and cognition in schizophrenia.

Awareness of illness is a crucial factor in schizophrenia, both for clinical management and psychopathological modeling. To date, there has been relatively little investigation of the influence of treatment with conventional versus atypical neuroleptics in relation to awareness and cognitive functions. The effect of clozapine treatment, compared with conventional neuroleptics, was studied in 22 schizophrenic patients in a crossover study.

Awareness of illness and subjective experience of cognitive complaints in patients with bipolar I and bipolar II disorder.

Objective: The authors' goal was to investigate the awareness of illness and subjective cognitive complaints of patients with either bipolar I disorder or bipolar II disorder during a phase of clinical stabilization.

Method: They used a structured clinical interview, the Frankfurt Complaints Questionnaire, to determine subjective cognitive complaints, and the Scale of Unawareness of Mental Disorder to assess 57 consecutively enrolled patients with bipolar I or bipolar II disorder.

Results: Patients with bipolar II disorder had significantly less insight and a higher level of subjective complaints of stimulus overload than patients with bipolar I disorder.

Relapse in young paranoid schizophrenic patients: a prospective study of stressful life events, P300 measures, and coping.

Objective: The authors investigated the relationship of cognitive and coping characteristics to stressful life events at the time of relapse in patients with recent-onset paranoid schizophrenia.

Method: Over 6 years, the authors collected data on 41 schizophrenic outpatients aged 18-28 years at recruitment. The patients were rated prospectively every 2 weeks with the Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, Global Assessment of Functioning Scale, and life events measures.

No evidence of linkage between schizophrenia and D2 dopamine receptor gene locus in Italian pedigrees.

Our purpose was to test the dopamine D2 receptor gene (DRD2), the tyrosine hydroxylase (TH) gene and the monoamino oxydase A (MAO-A) gene for linkage to schizophrenia and bipolar disorders. We have analyzed seven Italian families with schizophrenia and four families with bipolar disorders for a total of 68 individuals; 32 individuals were affected. Diagnoses were made using the structured clinical interview Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L).

The psychosis of fatherhood: a clinical study.

The psychosis of fatherhood is classified as an acute delusional disorder. It has been psychodynamically correlated with preoedipal conflicts. Common elements were identified in 6 men who were about to become fathers for the first time.

Absence of APP713 mutation in Italian and Russian families with schizophrenia.

A recent study has shown a mutation at codon 713 of the amyloid precursor protein (APP) gene in a schizophrenic patient. We have analyzed the MaeIII restriction site caused by that mutation in Italian and Russian families with schizophrenia. No mutations were observed suggesting that the APP713 mutation is unlikely to be linked to the pathogenesis of such a psychiatric disorder.

Puerperal psychoses: a clinical case study with follow-up.

Thirty cases of post-partum psychotic disorders occurred between 1973 and 1987 and hospitalized at the Psychiatric Ward of Florence University were studied and followed up. A structured diagnostic interview was used, which explored DSM Ill-R diagnosis both for mood disorders and for psychotic features. The psychotic symptoms had started within 8 weeks of parturition in all cases.

Depressive relapses and incomplete recovery from index episode.

Of 101 patients suffering from primary unipolar depression who were followed up for at least 1 year after recovery from the index episode, 51 relapsed into a new depressive episode within the year of recovery. Only those variables related to the period immediately after discharge distinguished nonrelapsers from relapsers; relapsers showed higher levels of residual symptoms, inferior social adaptation, a more pathological mean personality profile, and lower tricyclic plasma levels, despite similar dosage. The data are consistent with the hypothesis of an incomplete recovery from the index episode as a risk factor for relapse within 1 year.

[Psychopathologic decompensation in paternity and the couvade syndrome].

Paternity, like maternity, provides an occasion for profound modifications of an individual's social role and internal world. Such modifications may be defined as "the job of becoming a parent". The authors examine psychological symptoms that appear at the advent of paternity, with special attention given to acute disorders and the couvade syndrome.

[The task of becoming a parent: problems and failures].

The reactions of father and/or mother at the time of the birth of the first son are here analysed (post partum "blue", "couvade", paternal acting and neurotic depressions). These manifestations are considered as masked depressive states. Analogies between the freudian concept of the mourning work and the work of becoming parents are seen as an internal process for both parents to consider all their losses (the role of the son, the privileged role of the pregnant woman, the exclusive relationship with the partner .

Clinical response and tricyclic plasma levels during treatment with clomipramine.

Fifty depressed in-patients at two psychiatric units, one in Italy the other in England, were treated with clomipramine, either orally, or intravenously and orally. A comparison of clinical response with plasma levels of clomipramine and its metabolite, desmethylclomipramine, showed clear relationships especially in the case of desmethylclomipramine. In the intravenously-treated group this was linear, in the orally-treated group it was curvilinear.

[Some problems of psychiatric care unit in a general hospital I: Concerning decision of admission to hospital (author's transl)].

Over a thousand patients a year request hospitalization at the Psychiatric Admission Unit of the Region General Hospital of Santa Maria Nuova in Florence. About five hundred are actually hospitalized, less than half. Decision to hospitalize depends on several factors: a) factors relating to the patient (the psychopathological picture, the severity of his condition, his family background etc.

[Some problems of a psychiatric care unit in a general hospital. II: Compulsory health treatments (author's transl)].

The new italian law regulating psychiatric treatments (number 180/78) does away with hospitalization for mental diseases in Psychiatric Hospitals. When required, hospitalization occurs only in Psychiatric Care Units attached to General Hospitals. Compulsory Health Treatments (T.

Psychopharmacological prospectives in the treatment of dementia.

1. Dementias have a complex etiology and pathogenesis which should be carefully evaluated in order to attempt a medical treatment. 2.