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Spettro schizofrenico
No full textRiassunto
Nel definire la Schizofrenia e i disturbi ad essa correlati, il DSM 3, l’ICD 10 ed il DSM 4, in accordo con la tradizione Kraepeliana, postulano strette relazioni tra i sintomi clinici, il decorso longitudinale e l’esito. Questo riferimento paradigmatico è stato messo in discussione negli ultimi 20 anni, suscitando numerose richieste di modificare i criteri di definizione del disturbo: il gruppo di lavoro del DSM 5 ha revisionato i nuovi dati riguardanti diversi aspetti dei disturbi psicotici, per valutare l’opportunità di avviare una svolta critica nosografica. I risultati riflettono un approccio sostanzialmente conservativo: i cambiamenti introdotti nel DSM 5 forniscono un quadro generale in cui prevalgono, come priorità, il miglioramento dell’utilità clinica, la semplicità, l’affidabilità diagnostica. I biomarkers ed in generale i dati di laboratorio sono stati ignorati e l’obiettivo di costruire una “nuova nosologia” è stato procrastinato. Un’altra sfida riguardava l’opportunità di includere una “sindrome di rischio psicotico” all’interno della classificazione, come conseguenza del movimento di ricerca clinico che nell’ultimo decennio ha contribuito a definire la cosiddetta “Sindrome di Rischio Psicotico”. Sebbene, in contesti di ricerca, l’affidabilità di questa diagnosi sia ben consolidata, il gruppo di lavoro ha deciso di includere la “Sindrome Psicotica Attenuata” nella III sezione del manuale, come condizione che giustifica ulteriori studi e validazioni.Summary
In defining schizophrenia and related disorders, DSM 3, ICD 10 and subsequent DSM 4, in keeping with the Kraepelinian tradition, postulated close relationships between clinical symptoms, longitudinal course and outcome. This paradigmatic background has been put into discussion in the last 20 years, generating multiple requests to modify the criteria defining the disorder: the DSM 5 workgroup reviewed new data about different aspects of psychotic disorders in order to evaluate the opportunity of a critical nosological turning point. At the end of the process, results reflects a substantially conservative approach: changes in DSM 5 provide a framework having as priorities improvement of clinical utility, simplicity, diagnostic reliability. Laboratory biomarkers have been ignored, and the objective of “a new nosology” has been moved forward.
Another challenge was related to the appropriateness of including a “risk syndrome” in the classification, as a consequence of the emphasis –shifting, in the clinical research domain, to defining psychosis-risk syndrome and evaluating treatments that can prevent transition to psychosis in these groups. Although the reliability of this diagnosis is well established in research settings, the workgroup decided to recommend the inclusion of a “Attenuated Psychosis Syndrome” as a category in the appendix, as a condition warranting further study and validation
Acute psychosis in an adolescent with undiagnosed homocystinuria
No full textHomocystinuria due to cystathionine-β-synthase deficiency (CBS deficiency) usually presents with ectopia lentis, myopia, intellectual disability, skeletal anomalies resembling Marfan syndrome, and thromboembolic events. Whereas neurodevelopment impairments have been often described in untreated homocystinuria adult patients, acute psychosis has rarely been reported as a presenting symptom of the disease. Here, we describe a 17-year-old girl affected by CBS deficiency presenting acute onset of visual hallucinations, behavioral perseverance, psychomotor hyperactivity, and affective inappropriateness. Ectopia lentis, diagnosed several years before, didn't have been considered as possible sign of a metabolic disorder. Psychotic symptoms were unresponsive to the conventional antipsychotic drugs and relieved after pyridoxine and folic acid treatment
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Assessment of self-disturances in high risk adolescents and clinical controls: preliminary findings from a multicentre psychosis prevention programme.
No full textBackground: Two sets of high risk criteria are commonly used in the early detection of psychosis: the ultra-high risk (UHR) and the Cognitive Disturbances (COGDIS) criteria. Besides these, Parnas and colleagues have developed the Examination of Anomalous Self-Experience (EASE) for the assessment of Self-Disturbances (SD), which are considered a specific subjective phenotype of schizophrenia.
Methods: This is a multi-centre study. The sample consists to date of 79 non-psychotic adolescents aged 14–18. The following instruments were administered: (i) The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version; (ii) The Structured Interview for Prodromal Syndromes; (iii) The Schizophrenia Proneness Instrument – Child and Youth version; (iv) The EASE; (v) The Global Functioning Role and Social Scales. Data were analysed using non-parametric tests.
Results: 48 subjects were classified at High Risk (HR) for psychosis, according to UHR or COGDIS criteria; 31 subjects were classified as clinical controls (CC). Compared to CC, HR had higher total EASE scores (10.1 ± 4.8 vs. 5.6 ± 4.1, p = 0.001), as well as higher domain scores of ‘Cognition and Stream of Consciousness’ (4.3 ± 2.5 vs. 2.1 ± 2.0, p = 0.001), ‘Self-Awareness’ (4.1 ± 2.8 vs. 2.8 ± 2.3, p = 0.040) and ‘Presence and Existential Reorientation’ (0.6 ± 1.0 vs. 0.1 ± 0.4, p = 0.009). No correlations were found between SD and Global Functioning scores.
Discussion: SD seem to be confirmed as a specific subjective phenotype of schizophrenia-spectrum disorders. Thus, the EASE may be a valid early detection instrument
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