Scielo RSS <![CDATA[The European Journal of Psychiatry]]> vol. 23 num. 3 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<B>Somatization and psychological awareness of ethnic minority clients in Western-European mental health care</B>: <B>A pilot study</B>]]> <![CDATA[<B>Clonal pluralization, as an interpretative delusion after a hallucinatory form of autoscopy</B>]]> Background and Objectives: Delusional misidentification syndromes are widely present in several major psychiatric and neurological disorders. After reviewing the recent terminology and psychopathology of the double phenomenon in the literature, the authors present a case of a patient with dementia, vascular type, where clonal pluralization of the Self appeared as a secondary, interpretative delusion after a hallucinatory type of autoscopic experience. Methods: Review of the literature and a case report. Results: In the presented case the linear evolution and the interpretative aspect of the arising misidentification phenomena are predominant. The differential diagnosis and the distinctive characteristics of the presented case from other potential delusional misidentification syndromes are also discussed. Brain lesions and neuropsychological impairments seem necessary, but the full development of these syndromes depends upon the individual,s responses to his or her defects as much as the defects themselves. Conclusions: Overviewing the broad spectrum of concepts on delusional misidentification syndromes, the authors emphasize the importance of those approaches which enhance the disappearance of the classical organic-functional dichotomy on the double phenomenon and which try to clarify the neurocognitive background of delusional misidentifications. <![CDATA[<B>Binding of levomepromazine and cyamemazine to human recombinant dopamine receptor subtypes</B>]]> Background and Objectives: Clozapine (CLOZ) and levomepromazine (LMP) improve treatment-resistant schizophrenia. The superior efficacy of CLOZ compared with other antipsychotic agents has been attributed to an effect on D1-like and D4 receptors. We examined the binding of LMP, CLOZ and cyamemazine (CMZ), a neuroleptic analog of LMP, to human recombinant dopamine (rDA) receptor subtypes. Methods: Binding studies were performed on frozen membrane suspensions of human rDA receptor subtypes expressed in Sf9 cells. Results: (i) LMP has a high affinity (Ki, nM) for rD2 receptor subtypes (rD2L 8.6; rD2S 4.3; rD3 8.3; rD4.2 7.9); (ii) LMP and CLOZ have comparable affinities for the rD1 receptor (54.3 vs 34.6); (iii) CMZ has high affinities for rD2-like and rD1-like receptors (rD2L 4.6; rD2S 3.3; rD3 6.2; rD4.2 8.5; rD1 3.9; rD5 10.7); (iv) CMZ is 9 times more potent than CLOZ at the rD1 receptor and 5 times more potent than CLOZ at the rD4.2 receptor; (v) CMZ has high affinities for rD1 and rD5 receptor subtypes compared with LMP and CLOZ. Conclusions: If D1 and D4 receptors are important sites for the unique action of CLOZ, the present study points to a need for clinical trials comparing CMZ with CLOZ in schizophrenia and in particular, treatment-resistant schizophrenia, especially given the risk for agranulocytosis with CLOZ. <![CDATA[<B>First admissions for psychoses in Eastern Piedmont-Italy</B>]]> Background and Objectives: 1) To identify the sociodemographic, anamnestic characteristics and presentation symptoms of patients, at the time of first hospitalization, associated with a discharge diagnosis of schizophrenic versus non-schizophrenic psychoses; 2) to define risk factors, at the time of the first admission, for a rehospitalization, regardless of reasons for readmission; 3) to assess the diagnostic stability between first and second hospitalization. Methods: This study includes 245 patients first admitted to the University Psychiatric Clinic of Novara in a period of seven years, discharged with a diagnosis of psychosis as reported in the Discharge Register (ICD-9-CM codes 290-299). Data were collected by consulting medical records and registers of community-based services of the South Novara Mental Health Department. A logistic regression model was used to determine the characteristics associated with a discharge diagnosis of schizophrenia. The relationship between the risk of rehospitalization and patients characteristics was studied using Cox,s regression analysis. Results: Risk factors for a discharge diagnosis of schizophrenia were age, compulsory admission, positive symptoms, and previous non-psychotic psychiatric episodes. Risk factors for rehospitalization were a diagnosis of schizophrenia, an age of less than 40 years, the absence of a stable affective relationship, and living with the family of origin. The 92% of the patients diagnosed as schizophrenic on the first hospitalization had the same diagnosis on readmission. Conclusions: Schizophrenia differs from other psychoses in terms of the greater prevalence of both some symptomatological characteristics and an history of previous non psychotic episodes. Some sociodemographic and clinical characteristics at the time of the first hospitalization can provide indications useful in preventing rehospitalization. <![CDATA[<B>Light-therapy applications for DSM-IV-TR disease entities</B>]]> Background and Objectives: Recent decades have seen significant advances in the knowledge of pathogenesis of mood disorders, as well as of other conditions directly or indirectly related to such diseases. Such progress has led to the emergence of new treatments, such as bright light therapy, based on the discovery of the therapeutic effects of exposure to bright light with the so-called seasonal affective disorder (SAD), a DSM seasonal pattern specifier linked to major depression and bipolar disorder recurrent describing the course of illness during seasons. The goal of the present work is to review the potential clinical applications of phototherapy, including SAD, obsessive-compulsive disorder, bulimia, premenstrual syndrome, non seasonal major depression, sleep disorders, jet-lag, dementia, normal populations and in primary care. Methods: A systematic review of the literature about this matter since the early Rosenthal,s group observations has been carried out. Results: A considerable number of studies has been published about this therapeutic approach, pointing that not only depression but also other pathologies that may follow a seasonal pattern could benefit from phototherapy integrated with more standard treatments, as well as other disorders directly or indirectly related to mood, and even another conditions without a seasonal pattern. Conclusions: The data about the different uses of this treatment neither confirm nor dismiss its efficacy, stating that the therapy should still be regarded as experimental. Future studies should continue investigating to draw reliable conclusions about the usefulness of bright light therapy on mood disorders and other conditions to provide an alternative to standard treatments almost exclusively based on psychoactive drugs. <![CDATA[<B>Nightmare in schizophrenic and depressed patients</B>]]> Background and Objectives: Nightmare is a common sleep disorder. While a sleep disorder such as insomnia can readily be associated with psychiatric disorders, the same cannot be said of nightmare. The objective of this study was to determine the prevalence rate of nightmare in a sample of psychiatric patients, and to compare this rate with the rate obtained in age- and sex- matched healthy control subjects in order to determine if there is a significant difference in the rates of nightmare in the different groups. Methods: Ninety - four randomly selected psychiatric patients made up of 54 schizophrenic patients and 40 depressed patients were recruited into the study. One hundred and twenty - three age- and sex- matched randomly selected control subjects were also recruited into the study. A questionnaire determining the one year prevalence of nightmare was administered to all the subjects. Each of them was required to indicate whether he or she had experienced nightmare in the previous one year and if so to indicate the number of episodes experienced during the said period. Results: The results showed prevalent rates of nightmare of 4.9%, 16.7% and 17.5% respectively for the healthy control subjects, schizophrenic patients and depressed patients. There was an overall prevalence rate of 17% among the psychiatric patients (schizophrenic patients and depressed patients) as against 4.9% in the healthy control subjects. Among those who experienced nightmare, the mean values for the number of episodes within the previous one year were, respectively 18 (sd = 6.6) for healthy control subjects (n = 6), 42.7 (sd = 6.3) for schizophrenic patients (n = 9) and 44.6 (sd = 5.9) for depressed patients (n = 7). Conclusions: The findings in this study provide support for a significant association between nightmare and schizophrenia as well as nightmare and depressive illness. In effect, there is a significant association between nightmare and psychopathology. <![CDATA[<B>Motor speed predicts stability of cognitive deficits in both schizophrenic and bipolar I patients at one-year follow-up</B>]]> Background: We examined whether motor speed assessed by the finger tapping test predicts generalized and specific stable deficits because of a common pathogenic process in bipolar and schizophrenic patients. Methods: One hundred and two patients underwent a battery of neuropsychological tests. Patients with a score of less than one standard deviation from their siblings', sample in two assessments with an interval of one year were defined as suffering from stable deficits because of a common pathogenic process. In addition to univariate analyses, factor analyses, ordinal logistic regression, and multiple linear regressions were used. A general score was also calculated. Results: No differences were found between schizophrenic and bipolar patients in the deficits of verbal fluency, shift reasoning ability and executive attention. Schizophrenic patients had greater persistent cognitive deficit because of a common pathogenic factor in the verbal memory dimension than bipolar patients. Motor speed predicted the specific deficits of verbal fluency, shift reasoning, executive attention and the general deficit of both bipolar I and schizophrenic patients. Bipolar patients suffered a lesser specific deficit in the verbal memory dimension than schizophrenic patients did, this domain not being predicted by motor speed. Motor speed predicted the generalized deficit and the specific dimensions in which schizophrenic and bipolar patients showed no differences. Conclusions: These results suggest the presence of general and specific stable cognitive deficits because of a common pathogenic factor related to psychomotor slowness. Motor speed seems to be suitable endophenocognitype for schizophrenia and bipolar disorder.