coordinatore F. Bogetto Poiché la maggior parte dei soggetti che ha riportato complicanze perinatali non sviluppa disturbi alimentari o altri disturbi psichiatrici, è molto probabile che una interazione con altri fattori di vulnerabilità (fattori ge- netici o ambientali post-natali) sia necessaria perché si sviluppi una patologia.
Allo scopo di aumentare le conoscenze sul ruolo delle complicanze perinatali, questo studio si pro-
pone di esplorare: 1) la relazione tra complicanze ostetriche e le caratteristiche temperamentali; 2) la relazione tra complicanze ostetriche e il funziona- mento cognitivo; 3) il ruolo degli eventi stressanti in gravidanza nell’aumentare il rischio di complicanze ostetriche e nell’influenzare le caratteristiche tem- peramentali e neuropsicologiche delle pazienti con anoressia nervosa.
options. Yet outcomes from these approaches have been inconsistent.
This paper presents a model of how delusions and poor coping skills sustain lack of awareness of illness in a world in which mental illness is stigmatized and seen as synonymous with dangerousness and incompetence. Specifically it is suggested that impact of accepting an illness such as schizophrenia is mediated by the mean- ings associated with that illness. If persons are able to cope well and to see themselves as active agents in the world they may be able to reject stigma and ac- cept illness. If they have difficulties coping, however, and do not see themselves as an active agent and able to reject stigma they may reject instead that they have schizophrenia. In such cases delusions may come to function as both explanations for anomalous internal experiences (e.g. being persecuted explaines why I am angry) and poor self-esteem (e.g. being persecuted ex- plaines why I am alone) and be especially resistant to psycho-education.
Implications for treatment are discussed.
La dimensione insight nel disturbo ossessivo- compulsivo: aspetti clinici e terapeutici
F. Catapano
Dipartimento di Psichiatria, Università di Napoli - SUN La capacità del paziente di riconoscere come assurdi o irragionevoli i pensieri ossessivi o i comportamenti compulsivi è stata considerata una caratteristica essen- ziale del disturbo ossessivo-compulsivo (DOC), discri- minante nei confronti delle manifestazioni psicotiche. Più recentemente, numerosi studi hanno evidenziato che: 1) l’insight nei pazienti ossessivi è distribuito lungo un “continuum” che va dalla piena consapevolezza del- l’assurdità della sintomatologia alla completa adesione ai contenuti ossessivi e compulsivi; 2) la percentuale di pazienti con ridotto insight non è affatto trascurabile, es- sendo compresa tra il 15 e il 36%; 3) la ridotta capacità di critica è associata ad un’età di esordio del disturbo più precoce, ad una maggiore gravità della sintomato- logia ossessivo-compulsiva, alla presenza di ossessioni e compulsioni di accumulo, ad una più frequente co- morbidità con la depressione maggiore e con il distur- bo schizotipico di personalità; 4) i pazienti con ridotto insight rispondono meno favorevolmente alla terapia farmacologica e cognitivo-comportamentale. Nel com- plesso, i risultati di questi studi, anche se tuttora limitati ed eterogenei, sembrano confermare l’utilità della valu- tazione della capacità di critica nei pazienti ossessivi, probabilmente anche al fine della predizione della rispo- sta agli interventi terapeutici, e la validità del sottotipo diagnostico del DOC “con ridotto insight”, proposto nel DSM-IV. Partendo da un riesame critico della letteratura disponibile e dai risultati delle ricerche condotte in que- sto ambito dal nostro gruppo, nella relazione saranno analizzati i numerosi aspetti teorici e clinico-terapeutici
ancora controversi, ed in particolare: 1) la questione dei rapporti e delle possibili transizioni tra ossessioni, idee prevalenti e deliri; 2) l’impatto della comorbidità di asse I e II sulla compromissione della capacità di critica nei confronti della sintomatologia ossessivo-compulsiva; 3) i problemi della valutazione dell’insight nel paziente ossessivo e dell’adeguatezza degli strumenti standardiz- zati attualmente disponibili; 4) il significato prognostico a lungo termine della compromissione dell’insight; 5) l’identificazione di eventuali correlati biologici della ri- dotta capacità di critica; 6) l’individuazione di strategie terapeutiche più adeguate per il trattamento di questi pazienti.
Is there a role for antipsychotics in OCd?
J. Zohar
Department of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
There are actually four types of situations where inter- vention with antipsychotics might be considered for the treatment of Obsessive compulsive disorder. Obsessive compulsive patients with poor insight (what was previ- ously called ‘psychotic obsession’), schizophrenic pa- tients with OCD, obsessive compulsive patients with tic disorder, and obsessive compulsive patients who did not respond to intervention with an adequate treatment of antiobsessive medication.
The data supporting the role of antipsychotic medica- tion in obsessive compulsives with poor insight are not convincing. However, at times the treatment dilemma (antipsychotic or antiobsessive) actually derives from diagnostic ambiguity; many of the very severe ego-syn- tonic obsessive compulsive patients may be erroneously diagnosed as schizophrenic, while they are actually severe OCD that should be treated with antiobsessive medication and not antipsychotic.
The prevalence of OCD amongst schizophrenic patients ranges from 10-25% and has a negative effect on the prognosis for those substantial proportion of schizo- phrenic patients. Preliminary data implies that for this subset of patient (the schizo-obsessive patients) a com- bination of antipsychotic and antiobsessive medication might be useful.
It is crucial to screen for tic disorder in patients with, OCD as this subset of patients responds (both in terms of obsession and tics) to a combination of typical antipsy- chotic and antiobsessive medication.
Data in regard to augmentation of OCD patients who did not respond to treatment with SSRI suggest that risperidone might have a specific therapeutic poten- tial in this subset of patients. The role of antipsychot- ics with 5HT1D properties like ziprasidone need to be studied.
Cognitive decline in the general population: occurrence, risk factors and progression to dementia
L. Fratiglioni, B. Caracciolo
ARC, Karolinska Institutet, Stockholm, Sweden
Cognitive impairment is a highly incident condition in the non-demented elderly population. As observed for dementia, the incidence rates increase with increasing age, and the effect is stronger when selective dropout is taken into account. In the Kungsholmen Project, we investigated the role of potential risk factors in the devel- opment of Cognitive impairment, no dementia (CIND). Information on risk factors was collected at baseline and clustered according to four research hypotheses (frailty, vascular, neuropsychiatric, and social hypothesis), each representing a possible pathophysiological mechanism of CIND. After multiple adjustments, including adjust- ment for the development of AD at the 6-year follow-up, risk factors for CIND were hip fracture, polypharmacy, and psychoses. These results confirm that not only the AD-type neurodegenerative process, but also neuropsy- chiatry and frailty-related factors may induce cognitive impairment in non demented elderly persons. Recently, we further explored at which extent depressive symptoms are related to the development of cognitive impairment by comparing the associations of depressive symptoms with impairment in a single cognitive domain, such am- nestic mild cognitive impairment (aMCI), with a more global cognitive impairment such as CIND, and finally with clinically diagnosed dementia. People with previ- ous low mood (3 years earlier) had a 6-fold increased risk of developing aMCI, a 90% increased risk of de- veloping CIND, and a 60% increased risk of dementia, after adjustment for socioeconomic characteristics. The RR of aMCI and CIND did not change substantially after adjustment for other covariates, such as ApoE-ε4, vascu- lar disease, polypharmacy, psychotropic drug use, and low mood at time of outcome diagnosis, while the RRs of dementia decreased substantially. In all models, the RR of aMCI in relation to previous low mood was more than double the RR of CIND and dementia. In conclu- sions, low mood appears strongly associated to incipi- ent cognitive deterioration, especially of amnestic type, suggesting a possible common pathogenetic mechanism (e.g., volume losses in the medial-temporal lobe).
recent advances in the treatment of depression in old age
C. Katona
Department of Mental Health Sciences, University College London
In this presentation I will review the current evidence base on the efficacy of acute antidepressant treatment for depression in older people. Two of the three most recent large placebo controlled studies have failed to show significant separation between the agent under investigation and placebo; reasons for this will be dis- cussed. The evidence for brief psychotherapies will also be reviewed; whereas the evidence base for problem solving treatment is relatively robust, interpersonal psy- chotherapy may be less effective in older depressed pa- tients than previously thought.
The relapse and recurrence rates for depression in older people are relatively high; most but not all recent trials suggest a substantial benefit from continued antidepres- sant treatment.
There has recently been increasing interest in more pragmatic approaches to the management of depres- sion, particularly using case management rather than single treatment modalities. There is substantial but not conclusive evidence supporting this approach. Finally, the limited but promising evidence concerning the ef- ficacy of interventions aimed at preventing depression in high risk older patients is reviewed.
Structure and function of the anterior cingulate cortex and human emotion in late-life
S. Paradiso, J. Vaidya*
Associate Professor Psychiatry and Neuroscience, * Associate
Research Scientist Psychiatry, University of Iowa
Psychiatric disorders in late-life may have presenta- tions differing from young adulthood. The study of aging neuroanatomy allows understanding the bases for the cognitive and affective background on which late-life psychopathology insists. Neuroanatomical age-related changes may represent the etiological underpinnings of late-life psychiatric disorder but also play a pathoplas- tic role. The anterior cingulate cortex is a structure of pivotal interest because of its reduced functioning and structural changes in later life, and because it has been associated with emotional awareness in youth.
SAbATO 14 FEbbrAIO 2009 – OrE 11.10-13.10
Sala tiziano