Mental disorders and request for psychiatric intervention in an Italian local jail.

The issue of the prevalence of psychiatric illnesses in Italian prison samples has not received the same attention paid at an international level. The aims of the present study were to evaluate the prevalence of psychiatric disorders diagnosed according to DSM-III-R criteria among an Italian prisoner population, and to examine prisoners' requests for psychiatric intervention in relationship to the presence or absence of different psychiatric disorders. One hundred forty-two Italian male subjects from the Casa Circondariale of Messina, Italy, were evaluated using the Structured Clinical Interview for DSM-III-R Non-Patient Version - SCID I and SCID II. A very high rate of disorders was found among inmates: 85.2% (n=121) of the sample were affected by a psychiatric disorder. Of the total sample, 51.4% (n=73) had requested psychiatric treatment during detention. The detection, diagnosis and treatment of the mentally ill prisoners is a primary goal for a better organization of services and prison settings; screening procedures for evaluating the presence of psychiatric disorders, with the aim to promote differential strategies for the care and rehabilitation of inmates, are needed.

Temperament and character dimensions in opiate addicts: comparing subjects who completed inpatient treatment in therapeutic communities vs. incompleters.

The aim of this study was to compare temperamental profiles of patients who completed inpatient treatment of drug dependence with those who failed to complete the program. One hundred forty four opiate addicts, all resident in therapeutic communities and screened to exclude Axis I disorders, were assessed using the Temperament and Character Inventory (TCI). After one year, the TCI scores were compared between those who were still resident and those who had dropped out. Significant differences between groups were found in Reward Dependence, Persistence, Cooperativeness, Self-Transcendence. Temperament and character features may have an influence on motivation and on the adherence to treatment and community rules, as they modulate the maintenance of ongoing behaviors and the sensitivity to social rewards. The findings suggest that personality assessment with TCI in opiate addicts may be helpful in screening procedures to increase the efficiency of treatment and rehabilitative strategies.

The effect of lamotrigine augmentation of clozapine in a sample of treatment-resistant schizophrenic patients: a double-blind, placebo-controlled study.

Based on the evidence that lamotrigine added to clozapine in refractory schizophrenic patients has reported promising results, the present 24-week double-blind, randomized, placebo-controlled trial had the aim to explore the efficacy of lamotrigine add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of treatment-resistant schizophrenic patients receiving clozapine. After clinical and neurocognitive assessments patients were randomly allocated to receive, in a double-blind design, either up to 200 mg/day of lamotrigine or a placebo. A final sample of fifty-one patients completed the study. The results obtained indicate that lamotrigine added to stable clozapine treatment showed a beneficial effect on the negative, positive and general psychopathological symptomatology in a sample of treatment-resistant schizophrenic patients. Regarding cognitive functions, improvement was observed in some explored areas, such as attentional resistance to interference, verbal fluency and executive functioning. The findings provide evidence that lamotrigine augmentation of clozapine treatment is well tolerated and may be proposed as an effective therapeutic strategy to improve outcome in treatment-resistant schizophrenia.

Defense mechanisms in hemodialysis-dependent patients.

Defense mechanisms are automatic psychological processes that protect the individual against anxiety and from the awareness of internal or external dangers or stressors. The influence of defense mechanisms in patients on chronic hemodialysis treatment was studied. There were 53 uremic subjects (37 males and 16 females), aged between 22 and 88 years (mean age 60.11, SD 15.03), on chronic dialysis and 50 healthy subjects as controls have been enrolled in the study. According to the duration of dialysis, uremic patients were divided in two subgroups: 21 patients with less than 5 years and 19 patients with more than 10 years of dialytic treatment. Assessment was conducted using the Defense Mechanisms Inventory DMI. The inventory identifies five defensive styles: turning against the object (TAO), projection (PRO), principalization (PRN), turning against the self (TAS) and reversal (REV). Results showed DMI scores within the normal range both for uremics and controls with significant differences in TAO (t = -3.053, p = 0.003) and REV (t = 5.067, p < 0.0001) between groups. No significant differences in the use of defensive styles related to the duration of dialytic treatment were observed. Besides other psychological features, the assessment of defense mechanisms in patients with chronic and invalidating diseases may contribute to ameliorate the knowledge of the adjustment processes and of the psychological well-being of the patients.

Anger and ego-defence mechanisms in non-psychiatric patients with irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome is commonly accepted as a disorder closely influenced by affective factors, which can either trigger the symptoms or contribute to their persistence, independently from their aetiology. It has been previously documented that irritable bowel syndrome patients respond to a variety of emotional states (anger, fear and anxiety) with an increase in colonic motility. AIMS: The aim of this study was to evaluate the experience and the expression of anger and the prevalent ego-defence mechanisms in a group of non-psychiatric patients with irritable bowel syndrome. SUBJECTS: Fifty-two patients with irritable bowel syndrome (18 males, 34 females) and 100 healthy volunteers from the community (44 males, 56 females) matched for age, level of education and social-status were enrolled. METHODS: Assessment was conducted using the State-Trait Anger Expression Inventory and the Defence Mechanism Inventory. RESULTS: No important differences between the two examined groups were found using the State-Trait Anger Expression Inventory and Defence Mechanism Inventory. CONCLUSIONS: It can be hypothesised that stable personality features and habits, such as anger disposition and defence mechanisms, play only a marginal role in irritable bowel syndrome, while psychological and psychosocial influences may act as predisposing or precipitating factors which contribute to the pathogenesis or expression of irritable bowel symptoms.

Panic-agoraphobic spectrum in obese binge eaters.

OBJECTIVE: This study investigated the frequency of the panic-agoraphobic spectrum symptoms in a sample of obese subjects affected by Binge Eating Disorder (BED) vs controls. METHOD: Fifty obese with BED were matched by age, sex and marital status to twenty-five normal weight controls. The Structured Clinical Interview For Panic-Agoraphobic Spectrum--SCI-PAS was administered to all participants. RESULTS: Obese subjects with BED presented significantly higher frequencies of typical and atypical panic symptoms (82% vs 8%, p<0.0001), agoraphobia (58% vs 12%, p=0.002) and reassurance orientation (56% vs 8%, p=0.001) than controls. DISCUSSION: BED frequently co-occurs with other major psychiatric disorders, traditionally assessed using categorical methods of classification of mental disorders. The spectrum of the subthreshold, atypical and partial symptoms of full-blown mental disorders, often neglected by categorical approach, may also affect subjective well-being and functioning as full-blown disorders. The identification of the subthreshold symptomatology may have relevant implications for the response to treatment and the outcome of the eating disorder.

The effect of clozapine on aggressive behaviour in patients with chronic schizophrenia.

We studied the effect of 12 months' treatment with clozapine (150-400 mg/day) in 16 chronic schizophrenic patients with aggressive behaviour. The number of aggressive episodes, the time spent in seclusion and physical restraint, and the number of pharmacological interventions used as chemical restraint during the 12 months of clozapine treatment were calculated and compared to those for the previous 12-month period (during which treatment was with conventional antipsychotics). During clozapine therapy there was a statistically significant decrease (P<0.001) in all the parameters of aggressive behaviour which we investigated, as compared with the pre-clozapine period. The reduction in aggressive behaviour was more prominent within the first 6 months of clozapine administration. Clozapine treatment was also associated with a global improvement in psychosis, as measured by the Brief Psychiatric Rating Scale. Despite the limitations in sample size and study design, our results confirm that clozapine appears more effective than classical antipsychotics in reducing aggressive behaviour in chronic schizophrenic patients.

Prevalence of acute dystonic reactions associated with neuroleptic treatment with and without anticholinergic prophylaxis.

The occurrence of acute dystonic reactions was intensively monitored in a population of 646 patients, 379 males and 267 females, aged 18-87 years, consecutively admitted to different psychiatric units and treated with neuroleptics alone or in combination with anticholinergic drugs. Thirty-four patients experienced acute dystonic reactions yielding a total incidence of 5.3%. There was a tendency towards a higher frequency of dystonia in males than in females, and in young patients than in older ones. Patients without anticholinergic medication had a higher frequency of the reaction than those receiving anticholinergic drugs (8.5% vs. 2.8%; p < 0.02). Neuroleptic-induced dystonia was more common in patients treated with butyrophenones than in those receiving phenothiazines or substituted benzamides.

Debrisoquine oxidation phenotype and neuroleptic-induced dystonic reactions.

To evaluate the role of defective drug oxidation as a predisposing factor for neuroleptic-induced dystonic reactions, 26 patients who developed the reaction and 53 with no history of dystonia were phenotyped by the debrisoquine hydroxylation test. The percentage of poor debrisoquine metabolizers was similar in patients with dystonic reactions (11.5%) and in the control group (9.4%). These results suggest that there is no association between the individual's drug oxidative status and the occurrence of neuroleptic-induced dystonia.

Neuroleptic malignant syndrome: description of two cases with prolonged clinical course.

Two cases of neuroleptic malignant syndrome presenting an unusual clinical course are reported. The first patient was untreated for the syndrome and recovered completely only after four months, while the other one was given dopaminergic and myorelaxing drugs only 10 days after the onset of the symptoms and died about six months later with an unmodified clinical picture. In both cases the treatment seemed to influence the clinical course, a delay or lack of drug intake worsening the prognosis.

Voiding disorders in patients with cerebrovascular disease.

Eighty patients affected by ischemic cerebrovascular disease (ICVD) in stable conditions were studied: brain CT scan was performed in all patients to evaluate site/extension of brain injury, while urodynamic tests were employed in those patients who showed urinary bladder symptomatology (n = 30). Twenty-six complained of urgency and urge incontinence, only 4 patients showed urinary retention. Micturition abnormalities seem to occur mostly in patients with multiple infarcts and cerebral atrophy and particularly among those with bilateral lesions.

Vascular compression from goiter as an unusual cause of cerebrovascular accident.

The unusual case of a patient with goiter and left faciobrachiocrural paresis due to right temporoparietal infarction is reported. Cerebral angioscintigram and arteriography showed a brachiocephalic and right subclavian stenosis secondary to compression by an extended thyroid nodule.

Functional hyperthermia due to central dopaminergic impairment.

The clinical cases described are characterized by rigidity, mutism and hyperthermia, with cutaneous pallor and diaphoresis. This symptomatology marks the "malignant neuroleptic syndrome" and can be found, at times, in parkinsonians on "drug holiday". The cases described, which comprehend patients with both disorders, lead us to a single pathogenetic hypothesis: a central dopaminergic impairment. Hyperthermia, secondary to functional hypothalamic deficiency, is maintained by defective heat dispersion due to the lack of cutaneous vasodilation.

"Enuresis risoria": evaluation and management.

"Enuresis risoria" or "giggle incontinence" is a particular condition characterized by a sudden, involuntary, uncontrollable and complete emptying of the bladder during giggling or hearty laughter. We had under observation a 15-year-old girl affected by this condition. The tests she underwent did not reveal anatomic or functional alterations. We were able to control her symptoms with Imipramine. We can thus assume that laughter reacts as a trigger that activates micturition reflex through the intermediation of the limbic system.

Computerized tomography in amyotrophic choreo-acanthocytosis.

CT has been performed in five patients affected by amyotrophic choreo-acanthocytosis (ACA) and bicaudate diameter, bicaudate index and frontal horn/bicaudate ratio (FH/CC) have been evaluated. Findings have been confirmatory of caudate nuclei atrophy as shown by previous ACA autopsy reports, but did not differ from Huntington's chorea CT picture. There was no correlation between CT measurements and age, illness duration or degree of hyperkinesia in contradistinction to that reported for Huntington's chorea.

Parkinson-like side effects during prolonged treatment with flunarizine.

Forty-two elderly patients affected by a generic cerebrovascular disease developed a parkinsonian syndrome after prolonged treatment with flunarizine. Following flunarizine withdrawal the extrapyramidal symptomatology remitted slowly and progressively for 12 weeks, leading to the belief that the observed parkinsonian syndrome is directly linked to the chronic use of this compound. Similar side effects are not described in young populations, however. A periodic flunarizine discontinuation in chronically treated subjects aged 65 or more is suggested.