1,720,992 research outputs found
La legalizzazione della cannabis. Tra irresponsabilità politica e deresponsabilizzazione degli psichiatri
Full text linkIn Italy a political parliamentary majority, recognized by all the press as "cross party", is going to approve the law that will legalize the use of cannabis. As diversified in different Countries, it is a phenomenon which affects substantially homogeneous many European nations, as well as several states of the USA and other Countries of the world. The authors, after listing the main harmful effects of cannabis, especially in young people, on cognitive functions and on the onset of several psychotic disorders, express the need for reflection by the mental health experts on a problem of extreme relevance and urgency care
Sull'imprevedibilità del suicidio
No full textIl suicidio è divenuto una delle principali ragioni di procedimenti di responsabilità professionale per gli psichiatri. Si è diffusa
la convinzione che il suicidio sia espressione sistematica di malattia mentale e che, come per molte malattie, sia prevenibile con mezzi idonei.
Non vi sono, invece, dati di ricerca che consentano di affermare l’identificazione di variabili certe o clinicamente valide per identificare il rischio di suicidio, anche in persone che hanno già compiuto un tentativo di suicidio. Purtroppo queste convinzioni hanno condotto e conducono a giudizi di responsabilità professionale per gli psichiatri che non sono fondati su dati scientifici ma su esigenze sociali legate ai sentimenti di frustrazione e impotenza che si sviluppano dopo un suicidio e alla spinta a risarcire in qualche modo la famiglia della vittima di suicidio. Il suicidio è un fenomeno troppo complesso per poter essere riportato a una causalità al di là di ogni ragionevole certezza come, invece, richiesto dal Diritto Penale, né può essere affrontato con una progressiva perdita di libertà da parte dei pazienti.Suicide has become one of the main reasons of professional liability proceedings for psychiatrists. It is a widespread belief that suicide is a systematic expression of mental illness and that, as for many diseases is preventable by appropriate means. There is a lack of research data that can enable the identification of clinically useful variables to identify suicide risk, even in people who have already made a suicide attempt. Unfortunately, these convictions have led and lead to judgments of professional responsibility for psychiatrists that are not based on scientific data, but on social needs related to feelings of frustration and helplessness that develop after a suicide and by the urge to compensate in some way the family of suicide victim. Suicide is too complex a phenomenon to be reported to a causality beyond any reasonable certainty as instead required by the criminal law, neither can be faced with a progressive patients loss of freedom of our patients
The Shanti De Corte case. Euthanasia for mental disorder between clinic and bioethics, between law and medico-legal implications
Full text linkIntroduction. In recent months, a great uproar has been aroused by the case of a 23-year -old Belgian woman who requested and obtained euthanasia because she was suffering from a mental disorder, in the absence of any somatic pathology. The news raises some questions and stimulates some reflections both on the general theme of euthanasia carried out for the simple presence of a mental disorder, and for the indefiniteness of the clinical information on the case in question, as well as on the ethical and medico-legal questions connected to such indefiniteness. Case presentation. The information on the case was derived essentially from the press and from websites, with no specific access to actual clinical documentation and without in-depth knowledge of case details. One wonders what the real clinical diagnosis of the patient was, only hypothetically identifiable in a Post-traumatic Stress Disorder associated with Major or Chronic De-pressive Disorder, probably on the basis of a possible Personality Disorder. One wonders if all the necessary therapeutic interventions had been implemented, in a clinical case that did not theoretically have the characteristics of incurability. One wonders why the death request was considered valid, in a subject perhaps suffering from a mental disorder of such severity as to alter the ability to express valid consent to medical treatment. One wonders why the death request was not considered as an indicator of the severity of the disease, rather than simply being considered as a free choice of a subject capable of self-determination. One wonders why the negative opinion of the patient's family members was not considered. Conclusions. Belgian legislation provides for euthanasia for patients suffering from mental disorders who, like those suffering from somatic disorders, experience a condition of constant, unbearable and incurable suffering. But the case in question raises numerous perplexities both on the clinical and ethical coherence of Belgian legislation and on the ways in which the rules of this legislation have been observed in this specific situation
Nerve growth factor, brain-derived neurotrophic factor, and the chronobiology of mood: a new insight into the "neurotrophic hypothesis"
Full text linkThe light information pathways and their relationship with the body rhythms have generated a new insight into the neurobiology and the neurobehavioral sciences, as well as into the clinical approaches to human diseases associated with disruption of circadian cycles. Light-based strategies and/or drugs acting on the circadian rhythms have widely been used in psychiatric patients characterized by mood-related disorders, but the timing and dosage use of the various treatments, although based on international guidelines, are mainly dependent on the psychiatric experiences. Further, many efforts have been made to identify biomarkers able to disclose the circadian-related aspect of diseases, and therefore serve as diagnostic, prognostic, and therapeutic tools in clinic to assess the different mood-related symptoms, including pain, fatigue, sleep disturbance, loss of interest or pleasure, appetite, psychomotor changes, and cognitive impairments. Among the endogenous factors suggested to be involved in mood regulation, the neurotrophins, nerve growth factor, and brain-derived neurotrophic factor show anatomical and functional link with the circadian system and mediate some of light-induced effects in brain. In addition, in humans, both nerve growth factor and brain-derived neurotrophic factor have showed a daily rhythm, which correlate with the morningness–eveningness dimensions, and are influenced by light, suggesting their potential role as biomarkers for chronotypes and/or chronotherapy. The evidences of the relationship between the diverse mood-related disorders, with a specific focus on depression, and neurotrophins are reviewed and discussed herein in terms of their circadian significance, and potential translation into clinical practice
The assisted suicide of Italians in Switzerland and the silence of psychiatry
Full text linkThe debate on different forms of request of death has taken on a broad dimension in public opinion over last years, often referring on profoundly differentiated and often opposing positions of principle. Beyond cultural, political or ideal positions, a further critical issue, often underestimated or quite not considered, concerns a person’s ability to express a valid consent to the request of death, according to the same criteria of validity of the informed consent to any medical act. This assumes particular importance in the case of assisted suicide. Assisted suicide represents a phenomenon in sharp growth in Western world. It is legal in many nations, and in Switzerland it is also allowed for foreign citizens, thus increasing the phenomenon of the so-called “tourism of suicide”. In addition to neoplastic and neurological diseases, depression has also been accepted as a disease that makes assisted suicide possible. This imposes profound clinical and ethical considerations, since depression is unanimously recognized as a treatable disease and since in its most serious forms, such as those in which suicidal ideation dominates, it can compromise the patient’s ability to express a valid consent to any medical act, including the assisted suicide. Furthermore, it is often overlooked that any serious and disabling somatic disease, source of intense and chronic suffering, carries the very high risk of the onset of unrecognized depressive conditions, able in turn to negatively influence the ability to express valid consent. Faced with this situation,
which has involved a large number of Italian citizens in recent years, the personal and official voice of psychiatry is absolutely lacking, contrasting its silence with the opinions of those who do not want to take into account its potentially fundamental considerations
'Delusional' consent in somatic treatment: the emblematic case of electroconvulsive therapy
No full textEven more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy (ECT). In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient's motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient's inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the 'error' committed for which the depressed patient blames himself and the social repression of the maniacal patient's affirmation of his inflated self-esteem
'Delusional' consent in somatic treatment. The emblematic case of electroconvulsive therapy
No full textEven more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy (ECT). In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient's motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient's inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the 'error' committed for which the depressed patient blames himself and the social repression of the maniacal patient's affirmation of his inflated self-esteem
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