Behavior in degenerative dementias: mood disorders, psychotic symptoms and predictive value of neuropsychological deficits.

We studied mood disorders (MD) and psychotic symptoms (PS) in patients with fronto -temporal dementia (FTD) and Alzheimer's disease (AD) by means of different diagnostic instruments. These were: a subjective scale (subsets of survey psychiatric assessment schedule: SPAS), an objective scale (subsets of neuropsychiatric inventory: NPI) and a projective task (Wartegg completion task: WCT). A general tendency of NPI to over estimate the presence of symptoms compared to SPAS was observed, but distribution and severity of symptoms were quite homogeneous in the two dementia-groups, independently of the diagnostic scales. At variance with the scales, the WCT showed a more severe impairment in FTD than in AD. The regression analysis selected neuropsychological models able to predict behavioral disorders only in FTD, in particular, a planning deficit predicted PS. These data confirm the hypothesis that a damage in the frontal areas constitutes the neurobiological basis of PS in degenerative brain diseases. Furthermore, they suggest that mostly in FTD, behavioral disorders, as well as cognitive deficits, should be considered a direct expression of neural damage.

Multiple drug intolerance: allergological and psychological findings.

In order to evaluate pseudoallergic reactions to drugs, we studied a particular group of patients intolerant towards many drugs, pharmacologically dissimilar and administered during different periods of time. These patients consider themselves as "allergic" to "all" drugs. Twenty female patients, all with a history of intolerance to at least three drugs, chemically and antigenically dissimilar and not belonging to the same category of drugs, were studied. These patients underwent an allergological testing (negative in all cases) and a psychodiagnostic test (Rorschach's test); the latter was also performed in 20 normal control subjects. The psychodiagnostic findings demonstrated the negative psychological constitution of the experimental group in which the presence of a smaller quantity of energy leads to a minor capability of expressing emotions and to a major expression of depressive feelings. These patients suppress emotions to a greater extent, probably because of an expressive inhibition, while in the control group there is a possibility of mental elaboration. This implies that during the early period of emotional development with their parents, attempts to express affection received negative and frustrating replies. Therefore in later development, the expression of affection was suppressed. This last dynamic consideration, together with the former energetic and structural findings, demonstrates the pathogenic complexity of multiple drug intolerance, including, together with dysmetabolic, hormonal (clear prevalence of female subjects), autonomic and dysreactive factors, an important psychosomatic component. The diagnosis therefore also includes a careful psychodiagnostic test.