Paolo Scudellari

Psychopathology of first-episode psychosis in HIV-positive persons in comparison to first-episode schizophrenia: A neglected issue

Abstract This study aims to detect different psychopathological dimensions in first-episode psychoses with different underlying causes. We evaluated 22 subjects with first-episode psychosis, who differed in biological variables (HIV-positive versus HIV-negative) and who were compared by using the Structured Clinical Interview for DSM-III-Reviewer, the 18-item Brief Psychiatric Rating Scale (BPRS), the 17-item Hamilton Depression Rating Scale, the 14-item Hamilton Anxiety Rating Scale and the Mini-Mental State Examination. HIV-positive subjects had higher mean scores on the global BPRS and on the paranoid Positive and Negative Syndrome Scale subscale compared with HIV-negative subjects. Conversely, higher prevalence of affective and anxious symptoms was found in the HIV-negative patients in comparison to HIV-positives. HIV-positives had significantly greater attention/concentration impairment than HIV-negative persons. In conclusion, taking into account psychopathological dimensions may help psychiatrists in clinical decision-making regarding the differential diagnosis of psychotic symptoms. The psychopathological pattern of first-episode psychosis in HIV-positive patients may represent an ‘elementary model’ of acute psychosis characterized by paranoid delusions in the absence of the usual affective symptoms.

A systematic review of metabolic side effects related to the use of antipsychotic drugs in dementia

BACKGROUNDnIn clinical practice, Second Generation Antipsychotics (SGAs) are often used as first-line treatment for the Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults due to their fewer neurological adverse events and similar effectiveness compared with First Generation Antipsychotics (FGAs). SGAs, however, are associated with more severe metabolic side effects (weight gain, hyperglycemia, diabetes risk, and hyperlipidemia) than FGAs are. In general, older patients, especially those affected by dementia, are at increased risk for malnutrition, and tend to have lower basal metabolism and reduced liver and kidney function. However, little is known about the metabolic side effects of antipsychotic drugs in this population.nnnMETHODSnA comprehensive review of the literature published between January 1996 and December 2012 investigating the metabolic side effects related to FGAs and SGAs use in old patients affected by dementia.nnnRESULTSnAntipsychotic drugs currently used to treat BPSD in subjects with mild to moderate dementia are associated with weight gain. Currently, there are insufficient data to support a causal relationship between the use of FGAs and SGAs and changes in glucose homeostasis or lipid metabolism in older persons affected by severe dementia (MMSE <14).nnnCONCLUSIONnA possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals.

Anger and Narcissism: Between the Void of Being and the Hunger for Having

The borderline syndrome, a typical marginal structure, is certainly a specific, autonomous pathology, with its own distinctive characteristics: among them, acting out, cyclical repetition of events without historical progression and anaclitic depression. Kohut’s concept of ‘narcissistic hunger’ is particularly pertinent to the borderline condition: the borderline patient hungers to have that which is missing in his being. Through the application of the related notions of ‘tragic man’, ‘self objects’, ‘grandiose self’, and ‘damaged self’, the authors further develop their theory that the borderline syndrome has much in common with paranoid personalities.

Sex-specific issues in eating disorders: a clinical and psychopathological investigation

AbstractObjectiveTo highlight the characteristics of eating disorders (ED) in males, with particular attention to sex-related clinical features and psychiatric co-morbidities.MethodOut of 280 persons, referred to our outpatients ED clinic between January 2011 and June 2014, 267 with complete information were included in this retrospective observational study.ResultsThe men/women ratio was one to five (male 16.5% vs female 83.5%) with an increasing proportion of male patients over the years. The most frequent ED in males was binge eating disorder, whereas in females anorexia nervosa and bulimia nervosa prevailed. Excessive exercising and fasting were the most common compensation behaviours in males; while self-induced vomiting and laxative–diuretic abuse were more typical in females. Among women, the most represented psychiatric co-morbidities were mood and somatoform disorders, whereas among men, anxiety and psychosis spectrum disorders were the most frequent ones. Borderline and histrionic personality disorders were prevalent in female ED, while narcissistic and antisocial personality disorders prevailed in males.DiscussionED in men is a growing phenomenon. Male ED, compared to female ED, show differences in clinical presentation, symptoms and co-morbidities. Despite the use of clinical and psychometric evaluating tools targeting female patients, sex differences do exist and additional studies are required to investigate male specific issues in ED.n Level of Evidence Level V, cross-sectional descriptive study.

Il trattamento antidepressivo: effetti sul peso corporeo

SommarioLa depressione maggiore è attualmente la patologia psichiatrica a maggior incidenza nel mondo. La ricerca sui farmaci antidepressivi è in continuo sviluppo, al fine di migliorarne l’efficacia e ridurre al minimo gli effetti collaterali. Uno degli effetti collaterali più comuni con le classi di antidepressivi maggiormente usate attualmente è rappresentato dall’incremento ponderale. Nella pratica clinica è quindi fondamentale monitorare le variazioni di peso associate al trattamento antidepressivo e la diversa potenzialità di ciascun farmaco di provocarlo.

Late-Life Mental Health Disorders. Data from a Population-Based Study

Although highly prevalent, so far mental disorder in late life has deserved little research interest, especially at the population level. Our study provides a reliable picture of the distribution of mental health disorders in a sample of 462 Italian older people aged 75+, women are 53.2%, from a population-based study, the Faenza Project. In our sample, one mental disorder is diagnosable in one out of 3 elderly. The most prevalent diagnosis was General Anxiety Disorder (20.7%) and Dementia (19.0%), with female significantly more affected than male. Also Cognitive Impairment No Dementia was highly prevalent with 13.9% of the sample showing these symptoms. The most frequent overlap was between GAD and Major Depressive Episode. The risk of suicide is very high among older, in our sample 7.3% had suicidal thoughts. In spite of that approximately 70% of older adults with mood and anxiety disorders did not use services. There is a need to improve awareness about mental disorders in late- life, both in the community and among health care professionals to find innovative strategies to promote a successful aging with the integration of geriatric psychiatry and primary care.