1,720,973 research outputs found
The phenomenology of depression
Full text linkThe phenomenological method, characterized by the suspension of judgment (epoché), has helped analyzing the subjective experience of patients affected by mental disorders. Psychiatry, dealing with the human being itself in its complexity and unicity, is placed between the biological positivistic attempt, for which the symptoms of mental illness are a mere consequence of brain dysfunctions and the phenomenological-existential approach, inclined to consider the symptoms as meaningful phenomena of the person’s subjective experience. Eugène Minkowski, Ludwig Binswanger, Arthur Tatossian, Kimura Bin, Henri Maldiney and Hubertus Tellenbach are fundamental authors in the phenomenological psychopathology of depression; they described the alterations of the lived time, space, body and others experienced by the depressed. Starting from the main theoretical contributions of the authors, we will focus on the psychopathology and discuss the key themes of clinical depression: guilt, poverty and hypochondriasis. Finally we will focus on the typus melancholicus construct
The impact of early-life stress in the development and course of bipolar disorder: Mechanisms and implications
Full text linkTraumatic events experienced throughout the different stages of childhood and adolescence are frequent circumstances with a detrimental impact on the physical and psychological health of the individual. A growing body of evidence shows the trauma-related effects on the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system, the serotonin system, the immune system, on brain development, structure, and connectivity. Interestingly, a relation was found between early life stress and Bipolar Disorder: the patients who were exposed to childhood trauma showed a worsened course of the disorder with poor clinical and psychopathological factors. According to the kindling hypothesis, early environmental stressors interact with the genetic susceptibility through epigenetic mechanisms, making the subject more vulnerable to milder stressors, and lowering the threshold for the occurrence of subsequent mood episodes. Understanding these processes is crucial to the discovery of new targets of treatment to reduce or, possibly, revert the effect of early life stress on bipolar disorder
Personality Disorders
Full text linkThe present chapter aims at providing an overview of the current state of the art as to the conceptualization, diagnosis, epidemiology, etiological correlates, and treatment of personality disorders (PDs). The two DSM-5 models for PDs (i.e., the traditional categorical model listed in DSM-5 Section II and the Alternative Model of PD proposed in DSM-5 Section III) are reviewed and the scientific rationale for moving from a categorical model to an empirically based dimensional model of PDs are presented. Key aspects and basic principles of PD treatment are summarized. Finally, the chapter offers three clinical vignettes to help the reader familiarizing with the clinical presentation of PDs
Letter to the Editor: Interpersonal Violent Behavior in Bipolar Disorder: A Preliminary Study on Gender Differences
No full textIntroduction
Full text linkPsychiatry is the branch of medicine appointed to the diagnosis, treatment, and prevention of mental disorders. Throughout ages, the concept of mental illness had changed many times, and today, the biopsychosocial model tries to explain mental disorders as the result of the complex interaction between biological correlates, psychological factors, and the socio-cultural background. The psychiatric interview is the fundamental element for the evaluation of the subject with mental illness. It allows to have access to the patient’s psychic state, enabling to collect the information that will guide the professional in formulating a diagnosis and through the choice of therapy
Clinical and personality profile of depressed suicide attempters: A preliminary study at the open-door policy Mood Disorder Unit of San Raffaele Hospital
No full textSuicidal behavior is a complex phenomenon with high rates among psychiatric inpatients. Mood disorders and
personality dysfunctions represent relevant risk factors for suicides attempts and suicidal ideation. Our study
aims to investigate the role of the co-occurrence of clinical variables (duration of depressive state, previous
suicide attempts), socio-demographic variables (gender, employment and civil status) and narcissistic personality
features in the suicide risk of admitted psychiatric patients affected by a mood disorder. The sample was
composed of 93 patients consecutively admitted in an open ward psychiatric Unit. Forty-eight participants had a
positive history of previous suicide attempts: the suicide attempters (SA) were mostly female, unemployed and
married. The SA group were observed to have suffered from a depressive episode with a longer duration;
moreover in the SA group, the presence of active suicidal ideation was significantly related to a higher number of
previous suicide attempts. In the whole sample, suicidal ideation was significantly related to narcissistic vulnerability
personality features. Using a multidimensional approach, the present study allows a preliminary
profiling of patients at risk for suicidal behavior during hospitalization
Eating Disorders
Full text linkAnorexia and bulimia are diseases known since ancient times, but in recent years their frequency has been continuously increasing in most industrialized countries. The etiology of these disorders can be traced back to the interaction between genetic predisposition, childhood experiences, and cultural pressures. As regards the course, a certain tendency to chronicity can be observed, and in extreme cases, they can cause death. According to the diagnostic classification of the DSM-5, eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder (which, compared to DSM-IV, becomes a diagnostic category in its own right), and other specified feeding and eating disorders (OSFED). Both anorexia and bulimia cause potentially serious medical complications. To maximize the chances of good outcomes a multidisciplinary intervention is necessary with staff including professionally heterogeneous figures: a psychiatrist, a psychologist, and a nutritionist. Therapeutic success for these patients is limited. Eating disorders require, among psychiatric disorders, the greatest possible collaboration between different professional figures with different specializations
Sleep architecture modifications after double chronotherapy: A case series of bipolar depressed inpatients.
No full textThe aim of this study is to objectively evaluate sleep architecture changes of depressed bipolar subjects treated
with chronoterapeutics. Eleven depressed bipolar inpatients received 3 cycles of Total Sleep Deprivation, followed
by daily light therapy sessions for one week. Polysomnography was performed before and after the
treatment. Depressive symptoms significantly reduced, and sleep architecture changed with significant differences
in N2% and N3% and REM density. Change in N3% was also positively correlated to depressive symptoms
reduction. Although, previous studies reported sleep architecture changes after chronoterapeutics in unipolar
depression, this is the first study to demonstrate changes also in bipolar depressed subjects
Psychiatric Emergencies
Full text linkPsychiatric emergencies are conditions of acute disturbance of thought, behaviour, affect or psychomotor activity, demanding urgent interventions. They mostly include attempted suicide, severe depression, psychosis, substance abuse, violence or other rapid changes in behaviour. The initial assessment should include a thorough history collection and a general physical examination with a lab screening, to rule out any underlying medical cause, as well as providing a secure environment for both the patient and healthcare workers
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