Dermatoscopía del poroma ecrino: a propósito de un caso clínico / Dermoscopy of eccrine poroma: a case report

El poroma ecrino es un tumor benigno anexial raro. Clínicamente se presenta como un nódulo solitario rosado, asintomático, topografiado comúnmente en palmas y plantas. El diagnóstico clínico diferencial más importante se plantea con el melanoma amelanótico. La dermatoscopía ayuda en algunos casos a distinguir entre ellos. Se describe el caso de una paciente de 50 años que se presenta con un nódulo palmar derecho que a la dermatoscopia presenta estructuras vasculares solitarias, glomerulares, con áreas blanco rosadas sin estructuras y pequeñas erosiones. El diagnóstico histopatológico fue de poroma ecrino.

Eccrine poroma is a rare benign adnexal tumor. It usually, presents as an asymptomatic, solitary, pink nodule in palms and soles. Its main differencial diagnosis is amelanotic melanoma. Dermoscopy can improve the differentiation between them. We describe the case of a 50 year-old woman who presented with a nodule in the her right palm which at dermoscopy showed solitary vascular structures, glomerular vessels, pink white structureless areas and little erosions. The histopathologic diagnosis was eccrine poroma.

Queratosis liquenoide benigna / Benign lichenoid keratosis

La queratosis liquenoide benigna es una dermatosis relativamente frecuente, con presentación clínica en determinados ocasiones, que puede llegar o lo confusión con el melanoma. Se plantea que puede ser una lesión benigna en regresión. La dermatoscopia es de gran utilidad para lo orientación diagnóstica. El diagnóstico es histopatológico, por lo cual en los casos confusos lo realización de una biopsia está indicada. Se realizo uno revisión de lo literatura sobre la clínica, histopatología y dermatoscopia de lo queratosis liquenoide benigna.

Benign lichenoid keratosis is a relatively common dermatosis which clinical presentation in some cases causes confusion with melanoma. It is suggested that it may be a regressing benign lesion. Dermascopy is very useful for diagnostic orientation. The histopathological diagnosis, thus confusing where the biopsy is indicated. A review of the literature on benign lichenoid keratosis clinical, histopathology and dermascopy pattems is exposed.

Family burden and social network in schizophrenia vs. physical diseases: preliminary results from an Italian national study.

OBJECTIVE: To compare burden and social network in families of patients with schizophrenia or physical diseases. METHOD: A total of 709 relatives of patients with schizophrenia and 646 relatives of patients with physical diseases were recruited in 169 specialized units located in 30 randomly selected Italian geographical areas. RESULTS: In both groups, the consequences of caregiving most frequently reported as present were constraints in social activities, negative effects on family life and a feeling of loss. Objective burden was similar in the two groups, while subjective burden was higher in schizophrenia. Social support was lower among relatives of patients with schizophrenia than among those of the other group. CONCLUSION: These results highlight the need to provide families of those with long-term diseases with supportive interventions, aiming to: i) manage relatives' psychological reactions to patient's illness; ii) provide information on patient's disease; iii) reinforce relatives' social network, especially in the case of schizophrenia.

The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy.

OBJECTIVE: (a) To explore burden related to caregiving and support received from professionals and social network in relatives of patients with schizophrenia in Northern, Central and Southern Italy; and (b) to test whether a higher level of family burden is associated with a lower level of professional and social network support. METHOD: Seven hundred and nine patients with schizophrenia and their key-relatives were consecutively recruited in 30 Italian mental health departments. Data were collected on: (a) patients' clinical status and levels of disability; (b) relatives' burden, social and professional support; (c) interventions received by patients and their families. RESULTS: Family burden was found lower in Northern Italy. However, after controlling for psychosocial interventions, differences in family burden among the three geographical areas disappeared. Family burden was associated with patients' levels of disability and manic/hostility symptoms, and with professional and social network support received by the family. CONCLUSION: Professional and social network support represent crucial resources to reduce family burden in schizophrenia.

Testosterone dose-response relationships in healthy young men.

Testosterone increases muscle mass and strength and regulates other physiological processes, but we do not know whether testosterone effects are dose dependent and whether dose requirements for maintaining various androgen-dependent processes are similar. To determine the effects of graded doses of testosterone on body composition, muscle size, strength, power, sexual and cognitive functions, prostate-specific antigen (PSA), plasma lipids, hemoglobin, and insulin-like growth factor I (IGF-I) levels, 61 eugonadal men, 18-35 yr, were randomized to one of five groups to receive monthly injections of a long-acting gonadotropin-releasing hormone (GnRH) agonist, to suppress endogenous testosterone secretion, and weekly injections of 25, 50, 125, 300, or 600 mg of testosterone enanthate for 20 wk. Energy and protein intakes were standardized. The administration of the GnRH agonist plus graded doses of testosterone resulted in mean nadir testosterone concentrations of 253, 306, 542, 1,345, and 2,370 ng/dl at the 25-, 50-, 125-, 300-, and 600-mg doses, respectively. Fat-free mass increased dose dependently in men receiving 125, 300, or 600 mg of testosterone weekly (change +3.4, 5.2, and 7.9 kg, respectively). The changes in fat-free mass were highly dependent on testosterone dose (P = 0.0001) and correlated with log testosterone concentrations (r = 0.73, P = 0.0001). Changes in leg press strength, leg power, thigh and quadriceps muscle volumes, hemoglobin, and IGF-I were positively correlated with testosterone concentrations, whereas changes in fat mass and plasma high-density lipoprotein (HDL) cholesterol were negatively correlated. Sexual function, visual-spatial cognition and mood, and PSA levels did not change significantly at any dose. We conclude that changes in circulating testosterone concentrations, induced by GnRH agonist and testosterone administration, are associated with testosterone dose- and concentration-dependent changes in fat-free mass, muscle size, strength and power, fat mass, hemoglobin, HDL cholesterol, and IGF-I levels, in conformity with a single linear dose-response relationship. However, different androgen-dependent processes have different testosterone dose-response relationships.

A multicenter Italian study of patients' relatives' beliefs about schizophrenia.

This study explored patients' relatives' beliefs about schizophrenia in Italy, a country with a long history of community-based psychiatry. The study was conducted among 709 key relatives of patients with schizophrenia who were recruited in 30 mental health departments. Relatives seemed to believe that mental hospitals are not appropriate places in which to treat their loved ones, even though most of them felt that they were alone in coping with the burden of their ill relative's disease. Most of the relatives agreed that people who have schizophrenia should be allowed to vote, but they appeared to have a stricter attitude toward affective rights, such as the patient's right to get married and have children, and tended to perceive their loved ones as being subject to social discrimination. The findings of this study may be useful for developing psychoeducational intervention and sensitization campaigns for the general population.

[The condition of families of patients with schizophrenia in Italy: burden, social network and professional support]. / La situazione delle famiglie dei pazienti con schizofrenia in Italia: carico familiare, risposte dei SSM, sostegno sociale.

OBJECTIVE: This study aimed to describe: a) the interventions received by patients with schizophrenia attending Italian mental health services (MHS); b) the relatives' burden and social network and the professional support received by the families. DESIGN: The study has been carried out in 30 MHS, randomly selected and stratified by geographic areas and population density. 25 patients with a DSM-IV diagnosis of schizophrenia and 25 relatives were recruited in each MHS. Family burden was evaluated in relation to: a) geographic area; b) interventions received by the patients; c) social and professional support received by the families. MAIN OUTCOME MEASURES: a) patients: Brief Psychiatric Rating Scale (BPRS) and Disability Assessment Interview (AD); b) key-relatives: Family Problems Questionnaire (QPF) and Social Network Questionnaire (QRS); c) interventions received by the patients and their families: Scheda di Rilevazione degli Interventi--Pattern of Care Schedule (SRI). RESULTS: Data on 709 patients and their key-relatives were collected. In the two months preceding the data collection, 35% of patients attended rehabilitative programmes; 80% of the families were in regular contact with the MHS and 8% received family psychoeducational interventions. Family burden was higher in Southern than in Central and Northern Italy. This difference disappeared when rehabilitative interventions and family support were provided. CONCLUSIONS: This study highlights that the situation of the families of patients with schizophrenia is more burdensome in Southern Italy and is greatly influenced by the type of interventions provided by the MHS.

Psychological consequences of the 1998 landslide in Sarno, Italy: a community study.

OBJECTIVE: This community study assessed the prevalence of post-traumatic stress disorder (PTSD) and the psychosocial consequences of the landslide which occurred in Sarno, Southern Italy, in May 1998. METHOD: A random sample (n=272) of the population living in the highest risk area of Sarno, and a control group recruited in a small town situated near the disaster area, but not affected by the event, were assessed 1 year after the disaster by standardized instruments. RESULTS: Of the subjects recruited in Sarno, 27.6% met DSM-IV criteria for PTSD; 59% subjects recruited in Sarno and 35% of the control group were identified as "probable cases" by the GHQ-30 (P<0.0001). Subjects recruited in Sarno had significantly higher scores on the four GHQ-30 subscales identified by factor analysis. CONCLUSION: This study emphasizes the negative impact of a natural catastrophic event on mental health, and the need for preventive interventions.

[Causes and psychosocial consequences of schizophrenia: the opinions of patient's relatives]. / Cause e conseguenze psicosociali della schizofrenia: le opinioni dei familiari dei pazienti. Gruppo di Lavoro.

OBJECTIVE: Description of the opinions on schizophrenia and its psychosocial consequences in a sample of relatives of patients with schizophrenia, recruited in 30 Italian Mental Health Centres (MHC), stratified by geographic areas and population density. DESIGN: Cross-sectional study on key-relatives of clinically stable patients with a DSM-IV diagnosis of schizophrenia. Evaluation of relatives' opinions on schizophrenia and its psychosocial consequences, in relation to: a) patient's clinical and family's socio-demographic variables; b) geographic areas and population density. SETTING: 30 Italian MHC randomised and stratified by geographic areas (Northern, Central, Southern Italy) and population density (> 100,000 inhabitants; between 100,000 and 25,000 inhabitants; < 25,000 inhabitants). Main outcome measures--Patient's clinical status and social functioning: Brief Psychiatric Rating Scale (BPRS) and Disability Assessment interview (AD). Interventions provided to patient and his/her family: Scheda di Rilevazione degli Interventi--Pattern of Care Schedule (SRI). Relatives' opinions on schizophrenia and its psychosocial consequences: Questionnaire on the Opinions of the Family (QOF). RESULTS: Data on 709 patients and their key-relatives were collected. Relatives' pessimistic opinions on social competence of patients with schizophrenia were found to be associated with: high levels of patient's disability, hostility and negative symptoms, relatives' knowledge of patient's diagnosis of schizophrenia, residence in a medium or low population density area, low levels of relative's education. Relatives' pessimistic opinions on social restrictions imposed by schizophrenia were found to be associated with high levels of disability and high number of hospital admissions in the patient and older age in the relative. CONCLUSIONS: The results of this study emphasise the need to: a) provide families with educational interventions covering not only clinical aspects of schizophrenia, but also those concerning disability and psychosocial consequences of the disorder; b) plan educational campaigns on mental illnesses which take into account the socio-cultural characteristics of the target populations.

Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study.

BACKGROUND: To date, only few data are available on how family burden in schizophrenia changes over time. In addition, no study has explored how such factors as coping styles and social support influence burden over time. This paper presents the 1-year follow-up data from the BIOMED I study on family burden and coping strategies in schizophrenia. METHODS: A sample of 159 relatives of patients with schizophrenia living in five European countries was followed up prospectively for 1 year with regard to burden and coping strategies, using validated questionnaires. RESULTS: In the sample as a whole, the burden was stable. A reduction of family burden over time was found among relatives who adopted less emotion-focused coping strategies and received more practical support from their social network. In addition, family burden decreased in relation to the improvement of patient's social functioning. CONCLUSIONS: When relatives of patients with schizophrenia are able to improve their coping strategies, it is possible for burden to be reduced even after several years. This points to the necessity to provide families of chronic psychotic patients with psychoeducational interventions emphasising the adoption of an effective coping style.

Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning.

OBJECTIVE: Development of a scale to assess patients' social functioning, the Personal and Social Performance scale (PSP). METHOD: PSP has been developed through focus groups and reliability studies on the basis of the social functioning component of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS). The last reliability study was carried out by 39 workers with different professional roles on a sample of 61 psychiatric patients admitted to the rehabilitation unit. Each patient was rated independently on the scale by the two workers who knew them best. RESULTS: The PSP is a 100-point single-item rating scale, subdivided into 10 equal intervals. The ratings are based mainly on the assessment of patient's functioning in four main areas: 1) socially useful activities; 2) personal and social relationships; 3) self-care; and 4) disturbing and aggressive behaviours. Operational criteria to rate the levels of disabilities have been defined for the above-mentioned areas. Excellent inter-rater reliability was also obtained in less educated workers. CONCLUSION: Compared to SOFAS, PSP has better face validity and psychometric properties. It was found to be an acceptable, quick and valid measure of patients' personal and social functioning.

A new questionnaire assessing the opinions of the relatives of patients with schizophrenia on the causes and social consequences of the disorder: reliability and validity.

This paper describes the development and the validation of a questionnaire assessing the opinions of the relatives of patients with schizophrenia on the causes and the social consequences of the disorder. The final version of the questionnaire includes 28 items, grouped in four sub-scales (social restrictions, social distance, utility of treatments, biopsychosocial causes of schizophrenia), whose intra-rater reliability ranges from 0.36 to 0.84. Cronbach's alpha coefficient, which tests the content validity of the sub-scales, ranges from 0.56 to 0.66. Factor analysis identifies two factors (opinions on social consequences and the utility of treatments, and the beliefs on the causes of schizophrenia), which account for the 73% of the total variance. This questionnaire may be particularly useful to assess relatives'beliefs about schizophrenia and to target psychosocial interventions in the families of patients with schizophrenia.

Family burden and coping strategies in schizophrenia: are key relatives really different to other relatives?

Subjective and objective burden, psychiatric symptoms and coping strategies in a sample of 90 key relatives and other relatives of patients with schizophrenia, living in two European countries, were explored by means of well-validated questionnaires. The levels of burden on key relatives did not differ significantly from those on other relatives. Moreover, the risk of developing psychiatric symptoms was similar in the two subject groups at both centres. Significant correlations were found between key relatives and other relatives concerning the adoption of emotion-focused coping strategies. These data contrast with the current belief that family burden in schizophrenia is mainly a burden of key relatives, and they emphasize the need to provide supportive interventions for as many relatives as possible.

Burden on the families of patients with schizophrenia: results of the BIOMED I study.

The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma.

Social and clinical factors influencing the choice of coping strategies in relatives of patients with schizophrenia: results of the BIOMED I study.

The impact of social and clinical factors on the choice of coping strategies of a sample of 236 relatives of patients with schizophrenia, living in five European countries, was explored using well-validated questionnaires. The adoption of problem-focused coping strategies was more frequent among young relatives and among relatives of younger patients, and was associated with higher levels of practical and emotional social support and of professional help. In contrast, emotion-focused strategies were more frequently adopted by relatives who had been living longer with the patient and who had poorer social support. It is suggested that supportive and educational interventions should be provided as early as possible to relatives of patients with schizophrenia, which, in addition to having a practical focus, should also have a social focus, aiming at extending the family's social network.

Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic.

OBJECTIVE: In this prospective study, information was collected on all bipolar I patients who started lithium prophylaxis at a lithium clinic during more than 15 years. METHOD: Patients were evaluated bimonthly with standardized instruments for as long as they took lithium. Treatment surveillance conformed to internationally accepted guidelines. Five years after starting prophylaxis, each patient was contacted for a follow-up interview. RESULTS: Of the 402 enrolled patients, 27.9% were no longer taking lithium at follow-up; 38.1% were taking lithium and had had at least one recurrence of the disorder; and 23.4% were taking lithium and had had no recurrence. Among patients still taking lithium whose plasma lithium levels had been below 0.5 mmol/liter on no more than 10% of checks, 88.0% had at least a 50% reduction in mean annual time spent in the hospital compared to a reference pretreatment period, and 43.0% had had no recurrence. Patients not taking lithium at follow-up had a poorer outcome than those taking lithium, but patients no longer taking any psychotropic drug did not differ from those taking lithium. Patients no longer taking lithium had had a higher frequency of psychotic features in the index episode than those still taking lithium. CONCLUSIONS: The impact of lithium prophylaxis on the course of bipolar disorder is severely limited by the high dropout rate. In bipolar patients taking lithium regularly for several years, a drastic reduction of time spent in the hospital is almost the rule; these patients represent a self-selected population in which at least one group at high risk of poor outcome is under-represented.

[Family burden in schizophrenia: effects of socio-environmental and clinical variables and family intervention]. / Carico familiare nella schizofrenia: effetto delle variabili cliniche e socio-ambientali e degli interventi familiari.

OBJECTIVE: Description of burden, attitudes and received professional support in a sample of relatives of patients with schizophrenia recruited in 8 Italian Mental Health Services (MHS), stratified by geographic areas and population density. DESIGN: Cross-sectional study on key-relatives of clinically stable patients with a DSM-IV diagnosis of schizophrenia. Evaluation of: a) relationships of family burden with patient's clinical characteristics, family's socio-demographic variables, relative's attitudes toward the patient, professional and social support received by the family; b) differences in the levels of burden, attitudes and support received by the family with respect to geographical area and population density. SETTING: 8 Italian MHS stratified by geographic areas (Northern, Central, Southern Italy) and population density (urban vs. rural areas). MAIN OUTCOME MEASURES: Patient's clinical status and social functioning: BPRS and ADC. Family burden, attitudes and support received by the family: FPQ. RESULTS: Data on 144 patients and their key-relatives were collected. Higher levels of burden were found among relatives referring to Southern MHS. The burden was found positively correlated with the levels of patients' BPRS positive and manic/hostility symptoms and disability, and with the number of daily hours spent by the relative in contact with the patient, and negatively correlated with the levels of professional support received by the family. CONCLUSIONS: The results of this study highlight the need to provide rehabilitative programmes for patients with schizophrenia as well as informative and psychoeducational interventions for their families.

A new questionnaire assessing coping strategies in relatives of patients with schizophrenia: development and factor analysis.

This paper describes the development and validation of a questionnaire assessing the coping strategies adopted by relatives of patients with schizophrenia. The final version of the questionnaire includes 27 items, grouped into seven subscales (information, positive communication, social interests, coercion, avoidance, resignation and patient's social involvement), the intra-rater reliability of which ranges from 0.46 to 0.76. Cronbach's alpha coefficient, which tests the content validity of the subscales, ranges from 0.68 to 0.83. Factor analysis identifies three factors (problem-oriented coping strategies, emotionally focused strategies, and maintenance of social interests in association with patient's avoidance), accounting for 70.9% of the total variance. This questionnaire may be particularly useful for targeting and monitoring psychoeducational interventions in the families of patients with schizophrenia.