Defense style and psychopathology in oncological patients: a preliminary report.

INTRODUCTION: Previous studies shows that 30-40% of oncological and hematological patients report symptoms of distress compatible with a psychiatric disorder. The use of various and mostly unconscious defense mechanisms is implemented to cope with increased suffering after a cancer diagnosis. In this preliminary report, we explored the presence of defense mechanisms and their associations with psychopathological dimensions in a sample of late-stage cancer patients without history of psychiatric disorders. METHODS: We recruited 50 patients (28 females, 18-64 years old) with cancer diagnosis without prior history of any substance use disorder or psychiatric disorders. All participants were given the following self-report questionnaires: the Symptom Checklist 90 (SCL-90) and the 40-item version of the Defense Style Questionnaire (DSQ-40). RESULTS: In our study we demonstrated significant psychiatric distress in a third of our patients (defined as SCL-90 ≥2 points). A Pearson correlation analysis on all patients shows that psychotic defense styles were correlated with hostility, obsessive-compulsive, anxiety, somatization, interpersonal sensitivity, and psychoticism, while neurotic defense styles correlated with somatization. DISCUSSION AND CONCLUSION: Our results are in line with previous findings showing that one third of cancer patients suffers from a psychiatric disorder. Moreover, we found that somatization correlates with both psychotic and neurotic defense mechanism styles. This demonstrates the importance of assessing oncological patients coping mechanisms to achieve best possible treatment.

Traumatic experiences and type 2 diabetes mellitus.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a complex and demanding chronic condition resulting from the body's inability to adequately produce and or effectively utilize insulin. A wide variety of lifestyle factors are of great importance to the development of T2DM, such as sedentary lifestyle, obesity, physical inactivity, smoking and alcohol consumption. An emerging body of literature suggests that stress and traumatic experiences have a role in the aetiology of T2DM. METHODS: We recruited a sample of 52 patients with a diagnosis of T2DM and a control group of 48 subjects. Using the Traumatic Experience Checklist (TEC), the Childhood Experience of Care and Abuse Questionnaire (CECA-Q), and the Connor-Davidson Resilience Scale (CD-RISC 25), we investigated the presence of history of traumatic experiences and of childhood experience of neglect and abuse. RESULTS: We found that patients with a diagnosis of T2DM have a higher number of traumatic experiences in their personal history, when compared to the control group. DISCUSSION: Traumatic experiences or sustained stress exposure may contribute to the onset of T2DM. Neuro-inflammatory and psychoanalytic factors will be discussed to explain such association. CONCLUSION: We conclude that factors that determine high levels of resiliency can have a protective effect against the development of T2DM while stress and the consequent inflammation can contribute to the development of depression and T2DM. These biological features are analyzed in the psychoanalytical context of theories from Freud, Mahler, and Kohut.

Diagnostic and therapeutic challenges in neuroleptic malignant syndrome: a severe medical case.

Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic medical emergency usually associated with the use of dopamine antagonists, commonly typical antipsychotic drugs. However, it has been observed that it can occur with atypical antipsychotics as well. NMS is characterized by altered consciousness, fever, rigidity, autonomic instability and high creatine phosphokinase (CPK) blood levels. Here, we report a case of a 44-year-old female patient with history of a treatment-resistant bipolar disorder. She was admitted to our psychiatric ward for severe psychomotor agitation and treated with a therapy based on typical and atypical antipsychotics. During the course of the hospitalization she developed NMS. In this case, the diagnosis was delayed due to the slow and insidious symptom presentation, therefore requiring a differential diagnosis. Autoimmune NMDA receptor encephalitis, catatonic syndrome and malignant catatonia have been excluded. The patient met all the DSM-5 criteria for NMS: exposure to dopamine-blocking agent, severe muscle rigidity, fever, diaphoresis, dysphagia, altered level of consciousness, mutism, tremors, tachycardia, high or labile blood pressure, leukocytosis, high creatine phosphokinase. Since robust evidence-based protocols are lacking, here we discuss the relevance of this case in order to highlight the hurdles of a prompt diagnosis, clinical management of associated complications and treatment possibilities for such emergency.