Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer.

This is the report of an 80-year-old patient with diffuse brownish hyperpigmentation and velvety thickening of the skin with onset 1 year before. Warty lesions on his limbs were present as well as papillomatous and verrucous lesions on his lips, mouth and eyelid conjunctivae with hyperkeratosis of the nipples. Biopsies, performed at different sites, showed histological pictures consistent with a diagnosis of acanthosis nigricans (AN) with florid cutaneous and mucosal papillomatosis. This type of AN is frequently associated with internal malignancy. In our patient serum levels of tissue polypeptide antigen, carcinoembryonic antigen, cytokeratin fragment and squamous cell carcinoma antigen were high and chest computed tomography scan indicated a large tumour infiltrating the right lung and extending to the mediastinum. Cytological examination of bronchial drainage revealed the presence of neoplastic cells, non-small cell type carcinoma. The most frequent cancer associated with malignant AN is gastric adenocarcinoma. Lung tumour has rarely been reported with AN. Malignant AN is sometimes associated with other cutaneous and mucosal warty lesions, as in our patient. These various skin and mucosal lesions are the expression of a systemic epithelial disorder and may help clinicians to suspect a malignant form of AN.

Schizophrenia: a study comparing a family therapy group following a paradoxical model plus psychodrugs and a group treated by the conventional clinical approach.

A 'short family therapy' in schizophrenia, according to a specific systemic model (the 'Elementary Pragmatic Model' or EPM) with a strong paradoxical structure is presented. A total of 38 schizophrenic patients, randomly allocated, were treated according to the EPM model combined with psychotropic drugs (19 cases, each of whom underwent 10 weekly sessions of family therapy) or a traditional clinical-pharmacological approach (19 cases). With regard to all measures (number of drop-outs, symptoms according to the Brief Psychiatric Rating Scale, social activity according to the Strauss-Carpenter Outcome Scale and an interactive test) the EPM group showed better results. It is suggested that the systemic approach could be used not only as an effective therapy model in schizophrenia but also as an intervention in addition to or integrated into an ongoing psychoeducational family therapy.

The elementary pragmatic model: from theory to therapeutic practice.

A theoretical family therapy model which classifies possible outcomes of dyadic interactions into sixteen basic types is presented. The theoretical rules which are also presented predict how determined changes occur from the interactions. The model is already the object of an utilization by the author and his group of therapists in family therapy. The work modalities and results obtained in clinical field are briefly explained.

A technique to simulate human interaction: relational styles leading to a schizophrenic communication pattern and back to normal.

This article describes an attempt to use a theoretical model of human interaction called the elementary pragmatic model to determine which communication style leads from a normal subject's interactive pattern to a schizophrenic's and, conversely, from schizophrenia to normality. Results of this experimentation reveal a clear correspondence with the data published in the literature on communication deviances and family therapy. The computer simulation indicates preferential ways of therapeutic intervention.

Research on the effects of psychodrugs on human interaction. A theoretical/experimental approach.

An original method of testing which can measure interactional patterns is presented. This method is based on a relational model, which describes the relational behaviour as a sequence of elementary interactions, in which a "single bit of information" is exchanged. The model and the testing method are applied to monitoring treatment of patients with psychodrugs.