Adolfo Pazzagli

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. The P300 component of the event-related potential and scores on the Scale for Unawareness of Mental Disorder (SUMD), the Extrapyramidal Side Effects Scale (EPS), and Andreasens Scales for the Assessment of Positive (SAPS) and Negative Symptoms (SANS) were studied at time 1 (conventional neuroleptic treatment) and time 2 (after 6 months of treatment with clozapine, in patients who interrupted the previous conventional regimen). Significantly increased P300 amplitudes were associated with clozapine treatment, together with heightened insight and reduced involuntary movements. The results confirm the effectiveness of clozapine not only in enhancing neurocognitive function, but also in increasing awareness of illness in schizophrenic patients.

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. The sample is far too small to allow statistical inferences to be drawn about differences between men and women in the style of state of mind regarding attachment. An inference is none the less made with regard to the role of psychotherapy in these results.

THE RELATION OF PROTEOLIPIDS AND PHOSPHATIDOPEPTIDES TO TISSUE ELEMENTS IN THE BOVINE NERVOUS SYSTEM

EWALD and KUEHNE (1877) first detected neurokeratin histologically in the white matter of mammalian brain and in peripheral nerve: they described it as composed of two membranes, one located on the outer part of the myelin sheath, the other on the inner part, and joined by bridges of the same material. They distinguished ‘neurokeratin’ from ‘myelin’ which was “the material extractable with alcohol, ether, benzene or carbon disulphide”. At the present time the name neurokeratin is used loosely for the protein network of the myelin sheath. Since the work of KUEHNE and CHITTENDEN (1890), neurokeratin has been studied also from a biochemical point of view. Various preparations of neurokeratin have shown considerable differences in elementary composition, and there has therefore been some doubt as to Ghether neurokeratin was a real constituent of nervous tissue (BLOCK, 1951): but work carried out in recent years has clarified the problem. In an attempt to develop a method for the preparation of neurokeratin less drastic than the classical procedure, LEBARON and FOLCH (1956) obtained a trypsin-resistant protein fraction (TRPR) which was similar in composition to the classical neurokeratin except that it contained 1.8 per cent phosphorus and over 3 per cent inositol. Further experiments showed that the phosphorus and inositol could be removed from the TRPR by treatment with acidified chloroform: methanol (2:l). It was therefore suggested that neurokeratin might be an artefact derived from the TRPR. However the quantitative differences which previous authors had found in the neurokeratin content of gray and white matter was not found for TRPR: gray and white matter showed in fact the same TRPR content. On the other hand the fraction extracted with ch1oroform:methanol:conc. HCl was found to be a mixture of phosphatides of a new type, the phosphatidopeptides (FOLCH and LEBARON, 1959). Phosphatidopeptides, which contain a lipid moiety and a peptide moiety, were found to be present in highest concentration in the TRPR from central white matter, the phosphatidopeptides content of white matter being about ten times that of gray. Hence the phosphatidopeptides appeared to have a similar distribution to the classical neurokeratin. Besides the TRPR and phosphatidopeptides, FOLCH and LEES (1951) identified other trypsin and pepsin-resistant lipoproteins, the proteolipids in the chloroform : methanol extract of central white matter. The proteolipids from bovine brain

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 effects and ramifications of anger, and the resultant precarious cohesion of the self, are explored in the borderline syndrome; they are especially illuminated by the application of Kernberg’s pain-anger-hate-vengefulness cycle concept. Meanings of solitude, in its forms of aloneness and loneliness, are explored in their pertinence. Aloneness – the constant needy search for, but condemnation to never finding, objects to fill an inner sense of emptiness – is especially germane. Suggestions for assisting subjects with borderline personality disorder to overcome aloneness and the lack of historical progression are made.

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. In this paper, 12 cases of patients with paranoid schizophrenia who developed social phobia during clozapine treatment are reported, and their response to fluoxetine augmentation is assessed. Premorbid personality disorders were also investigated; patients were assessed using the Structured Clinical Interview for DSM-III-R-Patient Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (DSM-III-R=Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). In addition, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Liebowitz Social Anxiety Scale (LSAS), the Frankfurt Beschwerde Fragebogen (Frankfurt Questionnaire of Complaints), and the Brief Psychiatric Rating Scale were used to rate clinical symptomatology. All patients were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. In 8 (66.6%) of the 12 cases, symptoms responded (>/=35% LSAS score reduction) to an adjunctive regimen of fluoxetine. Furthermore, in 7 (58.3%) of the 12 cases, an anxious personality disorder (avoidant=33.3%; dependent=25%) was identified, but no significant differences in the prevalence of comorbid personality disorders emerged in comparison with a group of 16 patients with paranoid schizophrenia treated with clozapine who did not show symptoms of social phobia. The clinical relevance of the assessment and treatment of anxiety disorders is discussed in light of a clinical therapeutic approach that overcomes the implicit hierarchy of classification. Considering that the onset of anxiety-spectrum disorders (such as social phobia) can occur during the remission of psychotic symptoms in clozapine-treated patients with schizophrenia, a comprehensive approach to pharmacological therapy for patients with schizophrenia (or, at least for those treated with clozapine) should be adopted.

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 results of our study provide no evidence of linkage between alleles at D2 dopamine receptor loci and schizophrenia or bipolar disorders. The markers TH gene and MAO-A gene give slightly positive or negative results suggesting the utility of further analysis on more informative families.

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. Their personal histories and their clinical pictures were very similar. It is our hypothesis that up to the moment of facing the impact of becoming fathers themselves, these subjects had managed to avoid the oedipal conflict. As a consequence of this avoidance, they failed to identify with the father figure and to incorporate the paternal function into their symbolic universe. Once they accepted the concrete reality of fatherhood, these men underwent an acute psychotic crisis having inadequately interiorized paternal role models for themselves. We believe that this sort of psychopathological behavior becomes clinically manifest only when triggered by impending fatherhood.

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.

Trauma and Personality

The typical human proclivity of attributing one’s own afflictions to external events is currently very widespread and is often a way of building a defensive barrier. This tendency has always been connected with the genesis of permanent traits which characterize individuals and form their personality. An example is the relationship between humoral theories and astral influences. This relationship becomes even more explicit when considering behaviors currently identified as “personality disorders”: lunatic, martial, jovial are personality traits that can be related to our present distinctions.

La nascita nella mente della madre

L’articolo esplora la maternita interiore, cioe quella ‘atmosfera materna’ che si instaura durante la gravidanza e determina nuovi eventi mentali e trasformazioni nei processi di organizzazione del se. Gli autori ricordano le concettualizzazioni della «preoccupazione materna primaria» (Winni- cott) come stato regressivo che costituisce il preludio alla comprensione empatica del neonato, della «trasparenza psichica» (Bydlowski) come costruzione di un grembo psichico che accogliera il bambino della «costellazione materna» (Stern) come nuova organizzazione mentale che accompagna ogni maternita dell’«attaccamento prenatale» come costrutto psicologico capace di interferire con la relazione primaria e lo sviluppo del bambino. Il concetto di maternita interiore costituisce una sorta di mappa utile a definire il mondo della relazione madre-bambino in tutte le sue diverse articolazioni. Vengono individuate come disfunzionalita nella formazione della maternita interiore condizioni cliniche estreme, come ad esempio il diniego di gravidanza, spesso strettamente collegato con l’infanticidio. La descrizione di un caso clinico esemplifica come un funzionamento mentale fondato rigidamente sul diniego abbia determinato in una giovane donna la totale inconsapevolezza della gravidanza e la mancata costruzione della maternita interiore e di qualsiasi traccia di attaccamento prenatale verso il bambino.