[Early attachement relationships and epigenetic customization]. / La regolazione epigenetica della relazione primaria.

Recently, new findings in epigenetic science switched the focus from the observation of physiological intragenomic dynamics to the idea of an environmental co-construction of phenotypic expression. In psichodynamic field, objectual relations and attachement theoreticians emphasized the interpersonal dimension of individual development, focusing the attention on the relational matrix of self organization. The construction of stable affective-behavioral traits throughout different parenting styles has actually found a coincidence in ethological studies, which have explored the epigenetic processes underlying the relationship between caregiving and HPA stress responsiveness. An adequate parenting style seems to support affective regulation throughout psychobiological hidden moderators, which would tend to rebalance the physiological systems homeostasis; an unconfident attachment style would promote, on the other hand, the allostatic load rise. Sites of longlife epigenetic susceptibility have also been identified in humans; although associated with risk of maladaptive developing in adverse environmental conditions, they seem to confer protection under favorable conditions. This persisting possibility of reorganization of stable traits throughout lifetime, which seems to be activated by a relevant environmental input, grant to significant relationships, and to therapeutical one as well, an implicit reconditioning potential which could result into the configuration of new stable affective-behavioral styles.

[Perinatal depression and affective bonds: experience in close relationship during pregnancy]. / Depressione perinatale e relazioni affettive: l'experience in close relationship in gravidanza.

AIM: This study aims to investigate the influence of the "romantic attachment" style, stressful life events, social factors on the risk of developing a depression during pregnancy and on the severity of depressive symptoms. METHODS: The study started with a screening on a sample of 453 women, during their third trimester of pregnancy, to which has been administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Experience in Close Relationship (ECR). Based on the results at EPDS, a clinical group of pre-natal depression (D=89) was selected and compared with a control group (C=89), in regards to psychopathological and social variables, exposure to stressful life events and attachment patterns. Analysis of correlation were performed to evaluate the influence of these factors on depressive symptoms severity. RESULTS: In D group, 52.8% of subjects reported previous psychiatric disorders and 49.4% a familiarity; 29.2% of these women complains of conflicts with their family of origin and 32.6% with partner. The ECR showed a prevalence of "fearful-avoidant" attachment style in clinical group (29.2% vs 1.1%, p=0.000); besides, ECR dimensions ("Avoidance", "Anxiety"), correlate with the severity of depressive symptoms. CONCLUSIONS: Positive family history for psychiatric disorders and an insecure romantic attachment might influence the development and the severity of perinatal depression.

Perinatal Depression and Patterns of Attachment: A Critical Risk Factor?

Background. This study aims to verify if the presence and severity of perinatal depression are related to any particular pattern of attachment. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, who were administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Experience in Close Relationship (ECR). A clinical group of subjects with perinatal depression (PND, 89 subjects) was selected and compared with a control group (C), regarding psychopathological variables and attachment patterns. Results. The ECR showed a prevalence of "Fearful-Avoidant" attachment style in PND group (29.2% versus 1.1%, p < 0.001); additionally, the EPDS average score increases with the increasing of ECR dimensions (Avoidance and Anxiety). Conclusion. The severity of depression increases proportionally to attachment disorganization; therefore, we consider attachment as both an important risk factor as well as a focus for early psychotherapeutic intervention.

[Maternal attachment patterns and personality in post partum depression]. / Modelli di attaccamento e personalità nella depressione post partum.

AIMS: This study investigates the prevalence of post partum depression (PPD) in a sample of Roman women, and the role of socio-demographic variables, personality structure and maternal attachment patterns, in order to identify primary and secondary prevention strategies. METHODS: Data were collected in two phases. During the third trimester of pregnancy, a sample of 453 women completed a socio-demographic data sheet and the Edinburgh Postnatal Depression Scale (EPDS). Among the patients scoring 12 or more at EPDS, 15 entered the second phase of the study and completed SCID-II and Adult Attachment Interview. PPD diagnosis was confirmed by the SCID-I. The study group was compared with a control group. RESULTS: Among the 453 women who were evaluated, 92 (20.3%) scored ≥12 at EPDS, 39 has been enrolled and 15 entered the study. Presence of depressive symptoms was associated with: complications in pregnancy, previous psychiatric disorders, family and marital conflicts. 66.6% of depressed mothers showed more than one diagnosis on Axis II (particularly avoidant/dependent + borderline or histrionic + dependent). The AAI showed a prevalence of insecure (33.3%) and unresolved/disorganized (46.6%) attachment pattern in the clinical group. DISCUSSION AND CONCLUSIONS: Our results suggest that psychological factors such as personality structure and attachment patterns are not only involved in post natal affective disorders, but have a key role in the onset and development of PPD.

[Anxiety: personality and relationship. Some considerations]. / Ansia: personalità e legame. Alcune riflessioni.

Anxiety is a well defined symptom in psychiatric field, but also a concept that refers to the theoretical and epi-stemological visions of the theories on the psychical functioning. The present work shows, in the first part, a brief description of the evolution of the anxiety concept, highlighting the several meanings of this word; particularly, is wanted to show off how in the modern psychodynamic points of view anxiety is tightly linked to the role of the "relationship" in the "personality forming". The second part shows a synthetic historical picture of the main psychoanalytic theories on this topic.

[Psychiatric care in Italy]. / L'assistenza psichiatrica in Italia.

Law 180 of 1978 started a deep change in psychiatric assistance in Italy, promoting new approaches to mental disease and leading toward new patterns of intervention: from the mental hospital-based model to a territory-based one. Going back over legislative and structural evolution of psychiatric assistance in our Country, we want to highlight how this new approach is still far, for some aspects, from attaining full efficiency. The last contribution to its improvement has been given by National Sanitary Plan 2006-2008, in which several critical points of our assistance system, and the objectives to reach in order to improve it, are pointed out.

[Narcolepsy]. / Narcolessia.

Narcolepsy is a neurologic sleep disorder characterized by excessive daytime sleepiness and by intrusions into wakefulness of physiological aspects of rapid eye movement (REM) sleep such as cataplexy, sleep paralysis and hypnagogic hallucinations. Although epidemiologic studies show that it is nearly as widespread as Parkinson's disease or multiple sclerosis, narcolepsy is often not much known and confused with other neurologic disorders and psychiatric pathologies. The hard psychosocial impact on patient's life can be mitigated by an early diagnosis and by a targeted pharmacological treatment alleviating the most debilitating symptoms. Through a deep assessment of international literature we traced an updated picture of narcoleptic disorder in order to provide a useful tool of neurobiological, clinical, and therapeutic knowledge. Particular attention has been turned to the new discoveries on the possible role of the neuropeptide orexin in the genesis of narcolepsy, which open new pharmacological and research frontiers in this field.