RESUMO
BACKGROUND: Borderline Personality Disorder (BPD) is a severe and disabling psychiatric syndrome, frequently associated with self-injurious behaviours (SIB). In recent years, functional magnetic resonance imaging (fMRI) investigations have tried to identify alterations associated with SIB amongst BPD patients, in order to better delineate possible neurobiological underpinnings of these manifestations. In this mini-review, we aimed at summarizing fMRI studies exploring patterns of neural activation associated with SIB in BPD patients. METHODS: Literature searches on PubMed, Psych-Info and Embase databases were performed for all fMRI studies including adult patients with BPD and SIB undergoing different tasks, including painful or thermic stimulation, affective stimulation through the presentation of picturesor the recollection of personal memories as well as tasks that evaluate sustained attention and impulsivity, and reward processing. Thirteen relevant papers were considered eligible for the present review. RESULTS: Patients with BPD and SIB, compared to HC, showed prefrontal, nucleus accumbens overactivation and amygdala deactivation during pain stimulation. During negative affective stimulation, BPD patients showed a hyperactivation of the amygdala and a hypoactivation of the orbitofrontal cortex (OFC), which was also found to be enhanced during a gambling task and during a recalling of aversive memories. In contrast, during cognitive tasks with negative affective interference, BPD patients showed hypoactivation of OFC, anterior cingulated cortex, and basal ganglia. LIMITATIONS: The limited number of studies and the heterogeneity regarding the fMRI tasks employed allowed only suggestive conclusions. CONCLUSIONS: The reviewed fMRI studies highlighted that BPD patients with a history of SIB showed altered brain activity, compared to HC, in regions involved in inhibitory cognitive processes and affect regulation, which may in turn, explain the overwhelming emotional experiences eliciting SIB in these patients.
Assuntos
Transtorno da Personalidade Borderline , Comportamento Autodestrutivo , Adulto , Tonsila do Cerebelo , Transtorno da Personalidade Borderline/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Emoções , Humanos , Imageamento por Ressonância Magnética , Comportamento Autodestrutivo/diagnóstico por imagemRESUMO
INTRODUCTION: A large amount of studies demonstrated reduced serum Brain-Derived Neurotrophic Factor (BDNF) levels in stress-related and depressive disorders. However, it is still unclear if a similar deficit in BDNF concentrations might also characterize maternal perinatal depression. METHODS: We performed a bibliographic search on PUBMED of all the studies investigating the association between maternal BDNF levels and perinatal depression. The inclusion criteria were met by thirteen studies. RESULTS: Overall, the majority of the studies reported a significant reduction in serum BDNF levels among depressed mothers compared to healthy mothers either during pregnancy or in the postpartum period. Moreover, some studies also demonstrated that the BDNF reduction could be more evident in those depressed mothers with perinatal stressful life events and suicide risk. LIMITATIONS: BDNF were collected at different time points across the studies. Potential confounding factors, including the clinical characteristics of the samples employed by the original studies, might have influenced the results. CONCLUSIONS: So far, the evidences suggested the presence of decreased BDNF concentrations in perinatal depressive disorders. However, further studies are needed in order to confirm the role of BDNF in this disorder.
Assuntos
Fator Neurotrófico Derivado do Encéfalo/sangue , Depressão/sangue , Período Pós-Parto/sangue , Período Pós-Parto/psicologia , Adulto , Depressão Pós-Parto , Família , Feminino , Humanos , Transtornos do Humor , Parto , GravidezRESUMO
BACKGROUND: Cognitive deficits represent a core feature of Bipolar Disorder (BD), which seem to characterize this disorder regardless of the mood phase. However, the role of pharmacological treatment in determining cognitive alterations is still not clear. Indeed, although drugs improve cognition by targeting mood symptoms, they could also carry their own cognitive side effects. This is true especially for mood stabilizers as they are the most commonly prescribed drugs in patients affected by BD and they are usually administered also during euthymic phases. METHODS: In this context, the present review aimed at summarizing the results of the studies evaluating the impact of valproate on cognitive functions in patients suffering from BD, as primary or secondary results. The inclusion criteria were met by ten studies. Specifically, we included one double-blind quasi-randomized study and nine cross-sectional or naturalistic studies, which a) used healthy subjects as control group (Nâ¯=â¯1), b) compared valproate treated patients with healthy individuals and other treatments (Nâ¯=â¯5), and c) compared valproate treated patients just with other treatments, with a specific focus on lithium (Nâ¯=â¯3). RESULTS: Overall the results suggested a negative effect of valproate on cognitive functions in chronically-treated patients affected by BD. Notably, it has been found that the working memory was the most affected cognitive domain. LIMITATIONS: Few studies directly explored the effect of valproate on cognition in BD. CONCLUSIONS: These findings seem to suggest that valproate might have a negative effect on cognitive functions, especially on working memory domain. However, the results should be taken cautiously since the limited number of available studies published so far. In conclusion, these evidences seem to point out that the possible cognitive side effects of pharmacological treatments should be carefully taken into account, especially in chronic patients.
Assuntos
Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/etiologia , Ácido Valproico/efeitos adversos , Adulto , Afeto , Antimaníacos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/tratamento farmacológicoRESUMO
BACKGROUND: Mania is a state of elated or irritable mood characterizing Bipolar Disorder type I (BD-I). Among the pharmacological treatments for the management of mania, mood stabilizers are regularly employed, with valproate being one of the most used because of its effectiveness. However, while the oral formulation is approved for acute mania, it is unclear whether the intravenous (IV) formulation could be a valid and safe alternative. METHODS: We performed a bibliographic research on PUBMED of all studies investigating the use of IV valproate as a treatment of acute mania in BD-I. A total of 13 studies met our inclusion criteria. RESULTS: Overall, the results suggest that IV valproate as a loading therapy is an efficacious, safe and well tolerated treatment for manic episodes, and it is comparable to the oral loading regimen. Interestingly, only a few patients experienced significant side effects due to the administration of the IV valproate. LIMITATIONS: Few open label clinical trials have explored the effect of IV valproate in manic patients. Moreover, the original studies employed different clinical assessments and included manic patients taking other drugs, which made it impossible to determine whether the resolution of symptoms was due to valproate therapy alone. Additionally, serum valproate levels were not assessed by all studies. CONCLUSIONS: IV valproate may represent a valid option for the management of acute mania, with comparable effects in terms of efficacy and safety to the oral valproate. However, larger and more homogeneous studies are warranted in order to collect more precise information on the beneficial effect of IV valproate.
Assuntos
Antimaníacos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Ácido Valproico/uso terapêutico , Adulto , Euforia , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Borderline personality disorder (BPD) affects 1-5% of the population and is characterized by a complex symptomatology and selective functional impairments. Although brain imaging studies have contributed to better characterizing the pathophysiological mechanisms underlying BPD, the white matter (WM) deficits associated with this disorder are still unclear. Therefore, the present review aims at providing an overview of the findings emerged from the available diffusion tensor imaging (DTI) studies on BPD. METHODS: From a bibliographic research in PubMed until May 2019, we collected 12 studies that fulfilled our inclusion criteria, including a total sample of 291 BPD subjects and 293 healthy controls. RESULTS: Overall, the DTI studies reviewed showed impairments in selective WM tracts that are part of the prefronto-limbic system, including frontal WM (short and long tracts), anterior cingulate cortex, corpus callosum, corona radiata, hippocampal fornix and thalamic radiation, in BPD patients compared to healthy controls. LIMITATIONS: Few DTI studies with heterogeneous findings. CONCLUSIONS: Overall these results reported that BPD is characterized by selective structural connectivity alterations in prefronto-limbic structures, further supporting the neurobiological model of BPD that suggests the presence of an abnormal modulation of frontal regions over limbic structures. Finally, the results also highlighted that the disrupted WM integrity in selective brain regions may also explain key-aspects of BPD symptomatology, including emotional dysregulation, ambivalence, contradictory behaviors and cognitive dysfunctions.
Assuntos
Transtorno da Personalidade Borderline , Substância Branca , Transtorno da Personalidade Borderline/diagnóstico por imagem , Corpo Caloso/diagnóstico por imagem , Imagem de Tensor de Difusão , Humanos , Sistema Límbico/diagnóstico por imagem , Substância Branca/diagnóstico por imagemRESUMO
BACKGROUND: Excessive bleeding may complicate congenital cardiac defects. To explain the pathogenesis of this abnormality, we evaluated selected parameters of primary hemostasis in patients with aortic valve stenosis before and after corrective surgery. METHODS AND RESULTS: We examined shear-induced platelet aggregation with the filter aggregometer test and von Willebrand factor (vWF) structure by evaluating the multimeric distribution and extent of subunit proteolysis. The platelet count was reduced before corrective surgery, and shear-induced platelet aggregation was impaired. Moreover, vWF multimers of higher molecular mass were decreased, and proteolytic subunit fragments were increased. After correction of the cardiac defect, all of these parameters returned to normal. CONCLUSIONS: Alterations of vWF and platelet function may contribute to the bleeding diathesis in patients with aortic valve stenosis. Improvement after corrective surgery suggests that the passage of blood through a stenosed aortic valve may result in shear forces that induce vWF interaction with platelets in the circulation and, in turn, trigger platelet clearance, vWF degradation, and the impairment of primary hemostasis.
Assuntos
Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/metabolismo , Agregação Plaquetária , Fator de von Willebrand/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/cirurgia , Feminino , Hemostasia , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Estresse MecânicoRESUMO
We have evaluated platelet function in different subtypes of von Willebrand disease (vWD) by pushing blood through the capillary-sized channels of a glass filter. Patients, including those with type IIB vWD, showed lower than normal platelet retention and increased cumulative number of blood drops passing through the filter as a function of time. In contrast, shear-induced platelet aggregation, measured in the cone-and-plate viscometer, was paradoxically increased in type IIB patients. Treatment with 1-desamino-8-D-arginine vasopressin (DDAVP) tended to normalize the filter test in patients with type I-platelet normal and type I-platelet low vWD, but infusion of a factor VIII/von Willebrand factor (vWF) concentrate lacking the largest vWF multimers was without effect in type 3 patients. Experiments with specific monoclonal antibodies demonstrated that the A1 and A3 domains of vWF, as well as the glycoproteins Ib alpha and IIb-IIIa on platelets, are required for platelet retention in the filter. Thus, the test may reflect vWF function with regard to both platelet adhesion and aggregation under high shear stress, and provide relevant information on mechanisms involved in primary hemostasis.
Assuntos
Plaquetas/patologia , Doenças de von Willebrand/sangue , Adolescente , Adulto , Feminino , Filtração , Humanos , Masculino , Pessoa de Meia-Idade , Adesividade Plaquetária , Agregação Plaquetária , Valor Preditivo dos TestesRESUMO
The organisation of our Counselling Service for the relatives of patients undergoing bone marrow transplant is structured in various phases. During the first phase, contact is established with the relatives. The therapist introduces himself to the relatives when the patient is hospitalized and enters the sterile ward. The second phase consists in an illustration of the objectives and purpose of the Service. During this phase, two weekly interviews lasting approximately one hour are proposed, plus assessment tests (CFI, Camberwell Family Interview--and MMPI--Minnesota Multiphasic Personality Inventory). A third phase, which is often contextual to the presentation of the Service, consists in the recognition of the needs and suffering of the given relative. Here, the therapist acts as a receptacle for the anxieties and fear of death brought to him by the subject, thus empathetically accepting these states of mind and legitimizing them. Moreover, our model of intervention envisages the formation of support groups for the relatives of patients suffering from blood cancers. A further phase concerns the exchange of information between the two therapists helping, respectively, the relative and the patient, and also with medical and nursing staff. To further the same aims, for a number of years now, our Service has been organising intervention groups for nursing staff working at CTMO. The final phase is counselling, which takes place twice a week. There are two fundamental areas of intervention that must be taken into account for families of subjects suffering from blood cancers: providing information and offering support. From our experience, it emerges that the relatives need to obtain information on organic aspects of the illness and the transplant.
Assuntos
Transplante de Medula Óssea , Aconselhamento , Terapia Familiar/organização & administração , Neoplasias/terapia , Ansiedade , Atitude Frente a Morte , Humanos , Entrevistas como Assunto , Itália , MMPI , Inventário de Personalidade , Relações Profissional-FamíliaRESUMO
We investigate the effects of highly active antiretroviral therapy (HAART) on humoral immune responses during a 24-month follow up of 15 HIV patients with acute primary HIV infection. The patients were divided into three groups on the basis of the therapeutic protocol they were following at the time of entry: a) five naive patients (untreated or treated with only ZDV or AZT); b) five patients following a triple combination of ZDV+ lamivudine (3TC)+ saquinovir (SQV); and c) five patients on a four-drug combination of ZDV+3TC+SQV+ ritonavir (RTV). The results show that the early introduction of HAART greatly reduces plasma viremia levels and restores the number of CD4 cells. A significant correlation was found between anti HIV neutralising activity and the four-drug, but not the three-drug combination. The reduction in infectivity was directed against viruses of different clades and associated with immunoglobulin fractions. Moreover, the neutralising antibodies in the HAART-treated patients appeared after two weeks of treatment and remained stable throughout the 24 months of follow up. The early appearance of neutralising antibodies represent an important component of immune responses during primary HIV infection, may contribute towards immune reconstitution in patients on HAART, and give further information that may be useful in developing new strategies designed to eradicate the disease.
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Anticorpos Anti-HIV/biossíntese , HIV-1/imunologia , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/virologia , Adulto , Contagem de Linfócito CD4 , Quimioterapia Combinada , Anticorpos Anti-HIV/imunologia , Humanos , Pessoa de Meia-Idade , Viremia/tratamento farmacológico , Viremia/imunologia , Viremia/virologiaRESUMO
BACKGROUND: From a theoretical standpoint, primary HIV infection (PHI) represents a great chance to modify the natural history of the disease. In this study we purposed a four drugs regimen with zidovudine, lamivudine, ritonavir and saquinavir to treat aggressively the infection and achieve a complete immune reconstitution. METHODS: This is an Italian multicentric open label study. Adult patients with PHI were eligible for the study if they met at least one clinical criterion and one laboratory criterion of the following. Clinical criteria: Signs and symptoms of acute retroviral syndrome within the past 70 days, exposure to HIV-1 within the last 3 months, a preceding negative antibody test within the past 6 months. Laboratory criteria: Detectable p24 antigen with neutralization in serum; detectable HIV-RNA in plasma; indeterminate Western blot test with negative or low positive value HIV antibody in ELISA test. RESULTS: Since April 1997 to April 1999 40 patients with PHI have been enrolled; 80% of this cohort referred symptoms related to acute antiretroviral syndrome. Treatment has been withdrawn in 17 patients (12 for intolerance, 3 for toxicity and 2 for failure). At baseline the mean CD4+ T cells count and CD4/CD8 ratio were 537 (range 55-1287) and 0.58 (range 0.1-1.03) and the mean plasma HIV-RNA level was 5.9 log copies/ml (range 3-7.15). Plasmatic HIV-1 RNA levels of all patients dropped below 200 copies/ml in 68% of patients at week 12, 81% at week 24, 93% after 12 months and 100% after 18 months. Immunological parameters have been improved and have achieved normal range since 6th month. CONCLUSIONS: A rapid virologic suppression and immunological reconstitution are associated with PHI therapy. However early treatment should be weighted against the potential disadvantages such as immediate adverse events (intolerance and drug toxicity) and long term manifestation (metabolic disorders).
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/administração & dosagem , HIV-1 , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/virologia , Adulto , Contagem de Linfócito CD4 , Relação CD4-CD8/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Humanos , Lamivudina/administração & dosagem , Masculino , Estudos Prospectivos , Ritonavir/administração & dosagem , Saquinavir/administração & dosagem , Zidovudina/administração & dosagemRESUMO
The 20-item Toronto Alexithymia Scale (TAS-20) has been shown in previous research to measure a general dimension of alexithymia with three intercorrelated factors. This study evaluated the reliability and factorial validity of an Italian translation of the TAS-20 in a group of normal adults (N = 206) and in a mixed group of medical and psychiatric outpatients (N = 642). Using confirmatory factor analyses, the previously established three-factor model of the TAS-20 was found to be replicable in both groups. In addition, the Italian TAS-20 demonstrated adequate estimates of internal reliability and test-retest reliability. Although evaluation of the convergent, discriminant, and concurrent validity of the TAS-20 is required in Italian populations, the present results support the use of the Italian translation of the scale for clinical and research purposes.
Assuntos
Sintomas Afetivos/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Adulto , Idoso , Distribuição de Qui-Quadrado , Análise Fatorial , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Reprodutibilidade dos Testes , Estudos de Amostragem , TraduçãoRESUMO
Socio-therapy of schizophrenia cannot fail to consider such an important element as assistance to relatives. This report will review the main treatment methods used today and presents an intervention model which acts on the family of the schizophrenic at different levels. While the schizophrenic patient receives an individual treatment (pharmacological and psychotherapeutic), his/her relatives undergo a two-step group intervention. The first phase concerns an information group. This paper gives an early assessment as to the efficacy of the information groups for relatives. Particularly, it focuses on the actual ability of the group in conveying information to relatives. Such transfer of information is measured by means of a structured interview (Knowledge Interview). Results demonstrate that after an information group family members had a significant statistical increase of their information level (p less than 0.001). Some areas recorded a considerable increase in the knowledge levels, as far as the legitimacy of the illness and the management of symptoms are concerned.
Assuntos
Terapia Familiar/métodos , Educação de Pacientes como Assunto/métodos , Psicoterapia de Grupo/métodos , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Adulto , Terapia Combinada , Emoções , Família , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Papel do Doente , Meio SocialRESUMO
Expressed Emotion (EE) is a method of assessing the emotional make-up of a family, widely used in English-speaking countries, with particular reference to schizophrenia. This research programme arose out of a trial application of EE to a group of Italian families. Data are given here relative to a sample of 19 families with a schizophrenic member (according to DSM III criteria). The results confirm the hypothesised correlation between family EE and recidivist symptomatology of schizophrenic subjects: "high family EE" is associated with the most serious and habitual schizophrenic cases. The necessary adaptations which had to be made in order to apply EE assessment methods to Italian families are also discussed.
Assuntos
Emoções , Família , Esquizofrenia , Adolescente , Adulto , Humanos , Itália , Pessoa de Meia-Idade , Vigilância da População , Recidiva , Esquizofrenia/classificação , Esquizofrenia/epidemiologia , Psicologia do EsquizofrênicoRESUMO
OBJECTIVE: To evaluate potential differences in insight among bipolar manic, mixed and bipolar depressed inpatients and assess the role of clinical and demographic characteristics as possible predictors. METHOD: One hundred and twenty consecutive inpatients divided into three diagnostic groups were studied on admission (T0), at discharge (T1) and at 18weeks after hospitalization (T2). The young mania rating scale (YMRS), the Hamilton rating scale for depression (HAMD) and the scale to assess unawareness of mental disorder (SUMD) were used. RESULTS: Patients with mixed mania showed highest scores on the SUMD than patients with mania or bipolar depression. It was found a significant relationship between improvements in mania and in the insight. The level of insight at baseline was the only predictor of awareness in social consequences, moreover clinical and demographic characteristics were predictors of insight into mental illness. For what concerns insight about therapy benefits it was influenced by level of mania at baseline. CONCLUSION: The three general dimensions of insight revealed significant differences among the three groups. Regression models suggest that insight is a multidimensional concept in which some aspects are state-related, associated with psychopathology, whereas others are trait-like qualities, not directly associated with symptoms and predicted only by level at baseline.
Assuntos
Conscientização/fisiologia , Transtorno Bipolar/fisiopatologia , Adulto , Transtorno Bipolar/classificação , Transtorno Bipolar/diagnóstico , Feminino , Humanos , Pacientes Internados , Itália , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Análise de Regressão , Índice de Gravidade de Doença , Fatores de TempoRESUMO
This cross-sectional survey aimed to evaluate the prevalence of burnout and estimated psychiatric disorders among haemato-oncology healthcare professionals in Italy. The aspects of work that respondents perceive as stressful and satisfying have also been examined. The assessments were made using the Maslach Burnout Inventory (MBI), General Health Questionnaire and a study-specific questionnaire. Logistic regression models were applied to show associations between different sources of work-related stress and burnout. Three hundred and eighty-seven out of 440 (87.95%) returned their questionnaires. The scores on MBI subscales indicate a high level of emotional exhaustion in 32.2% of the physicians and 31.9% of the nurses; a high level of Depersonalisation in 29.8 and 23.6%, respectively; and a low level of personal accomplishment in 12.4 and 15.3% respectively. The estimated prevalence of psychiatric disorders was 36.4% in physicians and 28.8% in nurses. Statistical analysis confirmed age, sex, personal dissatisfaction, physical tiredness and working with demanding patients to be associated with burnout. In conclusion, haemato-oncology healthcare professionals report a level of burnout and estimated psychiatric morbidity comparable to other oncological areas. Knowledge of the mechanisms of burnout and preventing and dealing with them is therefore a fundamental requirement for the improvement of quality in health services and job satisfaction.
Assuntos
Esgotamento Profissional/epidemiologia , Coleta de Dados , Pessoal de Saúde , Hematologia , Oncologia , Fatores Etários , Humanos , Itália , Satisfação no Emprego , Transtornos Mentais/epidemiologia , Saúde Mental , Enfermeiras e Enfermeiros , Médicos , Qualidade de Vida , Fatores SexuaisRESUMO
The Expressed Emotion (EE) index is today one of the most important tools to evaluate the effect of family environment on the course of schizophrenia. The A. critically examine many experimental researches, performed on the EE index during the past 15 years, reporting the results of the first Italian replication study. The psychoeducational family interventions (originated by the EE research) are then considered, with particular attention to the treatment conceived by the team of the Association for the Research on Schizophrenia (A.R.S.). In the final section of the paper, the A. propose an extension of the EE research to families with chronic organic pathologies, reporting some preliminary results.
Assuntos
Emoções , Saúde da Família , Terapia Familiar/métodos , Família , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Seguimentos , HumanosRESUMO
Expressed Emotion (EE) is a form of assessment of the family environment: it is highly reliable and has proved to be predictive for symptomatologic relapse with schizophrenic subjects. Rating is obtained by offering to relatives living with the schizophrenic patient a structured interview, the Camberwell Family Interview (CFI). In the present study we will undertake a linguistic analysis (with quantitative and semantic evaluation) of 16 CFI, in order to detect communication parameters likely to be correlated with basic EE categories (high and low EE). The results obtained demonstrate that high EE relatives show a more immediate response style and a greater amount of speech. Moreover, these subjects tend to neglect their task during the interview, starting in most cases a self-referred communication.
Assuntos
Emoções , Terapia Familiar/métodos , Família , Entrevista Psicológica , Testes de Personalidade , Comportamento Verbal , Adaptação Psicológica , Humanos , Psicometria , Semântica , Papel do DoenteRESUMO
Over a four year period, the Schizophrenia Research Association (A.R.S. - Associazione Ricerche sulla Schizofrenia) has drawn up a multi-dimensional plan of action for the families of schizophrenic subjects. The basic points of this plan revolve around advice to the family and group therapy for family members, split into "informative" and "relationship orientation" sessions. Conducting an assessment of Expressed Emotion on family members admitted to these groups, it was observed that their emotional make-up is very different from that of family members of schizophrenics selected on the basis of casual criteria. Therefore, we are proposing a strategy which takes into account the emotional make-up of the family member in dictating therapists' action in terms of each family member.
Assuntos
Emoções , Família/psicologia , Relações Interpessoais , Psicologia do Esquizofrênico , Terapia Familiar , Humanos , Comportamento SocialRESUMO
BACKGROUND: Increased levels of circulating von Willebrand factor (vWF) have been found in patients with inflammatory bowel disease (IBD); this increase may reflect either endothelial damage or systemic inflammation. Our aim was to evaluate serum vWF levels in patients with IBD and their correlation with clinical and biochemical disease activity. METHODS: We evaluated serum vWF levels in 32 patients with ulcerative colitis (UC) (10 active with increased acute-phase reactants (APR), 6 active with normal APR, 16 in remission), 27 with Crohn disease (CD) (10 active, 12 quiescent, and 5 quiescent with increased APR), and 31 healthy controls. RESULTS: Mean levels of vWF were 100.1 (standard deviation (s), 51.4) in IBD and 89.9 (s, 36.9) in controls (P = 0.33). Only five (8.47%) patients (three with active UC, one with active CD, and one with inactive CD but increased APR) showed circulating vWF levels higher than the upper limit of normal (150), compared with 1 (3.2%) of controls (P = 0.32). Among CD patients vWF levels were 80.0+/-25.4 in patients with quiescent disease and normal APR, 123.3+/-63.4 in patients with active disease (P = 0.04 versus inactive with normal APR), and 135.8+/-90.0 in patients with quiescent disease and increased APR (P = 0.059 versus inactive with normal APR). Among UC patients vWF levels were 82.7+/-35.6 in patients with quiescent disease and normal APR and 125.1+/-54.2 in those with active disease and increased APR (P = 0.002). Overall, mean vWF levels were significantly higher in patients with increased APR than in patients with normal APR (P = 0.0005) and controls (P = 0.009). CONCLUSIONS: Our data show slight but significant increases in serum vWF levels in patients with IBD, which are correlated with signs of systemic inflammation.
Assuntos
Colite Ulcerativa/sangue , Doença de Crohn/sangue , Fator de von Willebrand/metabolismo , Proteínas de Fase Aguda/análise , Estudos de Casos e Controles , Colite Ulcerativa/imunologia , Doença de Crohn/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Inflamação/sangue , Fator de von Willebrand/análiseRESUMO
Family interaction is a basic factor in determining the quality of life of patients undergoing heart surgery. The present study investigates the emotional attitudes in the relatives of 10 heart-operated patients. The results indicate that a high amount of relatives' emotional overinvolvement and warmth tends toward a correlation with lower anxiety and depression scores, and with a better 12-month outcome of the illness.