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Esposito CM, Barkin JL, Ceresa A, Buoli M. Does the comorbidity of borderline personality disorder affect the response to treatment in bipolar patients? Int Clin Psychopharmacol 2024; 39:51-58. [PMID: 37551606 DOI: 10.1097/yic.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Bipolar disorder (BD) is a highly prevalent condition whose response to pharmacological treatment is associated with a number of factors including psychiatric comorbidity. Borderline personality disorder (BPD) shares clinical symptoms and biological vulnerability with BD and the two conditions are frequently comorbid, thus representing a clinical challenge. The purpose of the present review is to summarize the data related to treatment response in bipolar patients with comorbid BPD. According to systematic review process, a literature search was performed on the PubMed, Embase, PsycInfo, Isi Web of Knowledge, Medscape, and Cochrane Library databases. Peer-reviewed articles until December 2022 were eligible for inclusion. Comorbidity with BPD seems to be associated with a more difficult clinical stabilization in bipolar patients, often requiring poly-therapy or a longer duration of hospitalization. However, three studies, assessing the effectiveness of mood stabilizers in bipolar patients, did not demonstrate a prominent influence of BPD comorbidity in achieving clinical response. The most frequently administered pharmacological treatments in the selected studies include mood stabilizers and atypical antipsychotics. The presence of comorbid BPD in bipolar patients may hamper treatment effectiveness. Future studies, comparing different treatments and with larger samples, are needed to confirm the results critically summarized in the present review.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, Georgia, USA
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Dusi N, Esposito CM, Delvecchio G, Prunas C, Brambilla P. Case report and systematic review of cerebellar vermis alterations in psychosis. Int Clin Psychopharmacol 2024:00004850-990000000-00123. [PMID: 38266159 DOI: 10.1097/yic.0000000000000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Cerebellar alterations, including both volumetric changes in the cerebellar vermis and dysfunctions of the corticocerebellar connections, have been documented in psychotic disorders. Starting from the clinical observation of a bipolar patient with cerebellar hypoplasia, the purpose of this review is to summarize the data in the literature about the association between hypoplasia of the cerebellar vermis and psychotic disorders [schizophrenia (SCZ) and bipolar disorder (BD)]. METHODS A bibliographic search on PubMed has been conducted, and 18 articles were finally included in the review: five used patients with BD, 12 patients with SCZ and one subject at psychotic risk. RESULTS For SCZ patients and subjects at psychotic risk, the results of most of the reviewed studies seem to suggest a gray matter volume reduction coupled with an increase in white matter volumes in the cerebellar vermis, compared to healthy controls. Instead, the results of the studies on BD patients are more heterogeneous with evidence showing a reduction, no difference or even an increase in cerebellar vermis volume compared to healthy controls. CONCLUSIONS From the results of the reviewed studies, a possible correlation emerged between cerebellar vermis hypoplasia and psychotic disorders, especially SCZ, ultimately supporting the hypothesis of psychotic disorders as neurodevelopmental disorders.
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Affiliation(s)
- Nicola Dusi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan
| | | | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan
| | - Cecilia Prunas
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan
- Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy
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Esposito CM, Stanghellini G. Affective Permeability: On Hysteria and Atmospheres. Psychopathology 2023; 57:63-69. [PMID: 38109874 PMCID: PMC10836918 DOI: 10.1159/000535188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/08/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Phenomenological literature has recently given much attention to the concept of atmosphere, which is the pre-individual affective tonality of the intersubjective space. The importance of atmospheres in psychopathology has been described for various disorders, but little is known about the interaction with hysteria. The aim of the present paper was to describe the psychopathology of hysteria from the angle of the phenomenon of atmosphere, focussing on the hysterical person's peculiar "affective permeability". SUMMARY Hysterical people have difficulty defining themselves autonomously. As compensation, they adopt models transposed from the external environment such as social gender stereotypes or are influenced by the gaze and desire of others. They also possess a special sensitivity in perceiving the affectivity present in a given social situation, by which they are easily impressed and influenced. Their sensibility to environmental affectivity may allow them to take centre stage, assuming the postures and behaviours that others desire and that they sense by "sniffing" the atmosphere in which the encounter is immersed. Thus, a paradox may take place: sensibility is not mere passivity in hysteria but may become a tool for "riding" the emotional atmosphere and manipulating it. KEY MESSAGES Affective permeability to environmental atmospheres and manipulation of the environment are the two sides of the same coin. This overlap of passive impressionability and active manoeuvring is necessary to be grasped in the clinical encounter with hysterical persons not to be submerged by their theatricality, that is, by the hyper-intensive expressivity of their feelings and behaviours.
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Affiliation(s)
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
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Esposito CM, Ceresa A, Auxilia AM, Zanelli Quarantini F, Caldiroli A, Capuzzi E, Clerici M, Buoli M. Which Clinical and Demographic Factors are Related to Incarceration in Male Patients With Antisocial Personality Disorder? Int J Offender Ther Comp Criminol 2023; 67:1630-1641. [PMID: 36495101 DOI: 10.1177/0306624x221139073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Antisocial Personality Disorder (APD) is a condition largely represented in detention centers where can reach a prevalence of 60% in male prisoners. The objective of this study is to identify the clinical and demographic factors that differentiate subjects with APD and hosted in penitentiary with respect to those are treated in outpatient psychiatric clinics. We recruited 65 male patients affected by APD, whose 26 were followed up in community mental health services and 39 were serving their sentence in a detention center located in Monza. Socio-demographic and clinical data were obtained through a review of the clinical charts, and interviews with patients or their relatives (if available). We performed descriptive analyses on the total sample, then we compared the two groups identified by the type of setting (outpatient clinic vs. penitentiary) by independent sample t tests (quantitative variables) or χ2 tests (qualitative ones). For qualitative variables odds ratios (ORs) were also calculated. Outpatients with APD (with respect to those hosted in the detention center) resulted: to be older (p = .02), to be less likely married (p = .01), to have more pre-onset psychiatric comorbidity (p = .05), to have more pre-onset substance poly-misuse (p = .01), to have more previous psychiatric hospitalizations (p < .01), and to be less likely to have received lifetime psychotherapy (p < .01). Globally, the results of this study show how the presence of psychiatric comorbidity or substance abuse (with the probable access to psychiatric services) before the onset of APD prevents imprisonment. This aspect is even more surprising when we consider that the two groups of patients show no differences in the frequency of crimes. Future research will have to confirm if early mental health care can really limit the access to penitentiary of subjects affected by APD.
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Affiliation(s)
| | - Alessandro Ceresa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | - Massimo Clerici
- University of Milano Bicocca, Monza, Italy
- Azienda Socio Sanitaria Territoriale Monza, Italy
| | - Massimiliano Buoli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Italy
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Esposito CM, Auxilia AM, Ceresa A, Zanvit FG, Zanelli Quarantini F, Capuzzi E, Caldiroli A, Clerici M, Buoli M. Which factors are associated with duration of untreated illness in borderline personality disorder? Early Interv Psychiatry 2023; 17:1216-1221. [PMID: 37046384 DOI: 10.1111/eip.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/02/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
AIM Borderline personality disorder (BPD) is a prevalent condition associated with high rates of hospitalizations. The purpose of this manuscript was to detect the factors associated with duration of untreated illness (DUI) in BPD. METHODS Through chart review, we identified 152 patients followed up by community psychiatry services in Milan and Monza, Italy. The association between DUI and socioeconomic and clinical variables was examined using Pearson correlation and analyses of variances. The statistically significant variables from univariate analyses were then inserted in regression models. RESULTS A longer DUI was associated with several variables (substance misuse after the onset of BPD, older age, earlier age at onset, longer duration of illness), but these results were not maintained in the regression analyses. CONCLUSIONS In conclusion, DUI does not seem to be significantly associated with specific clinical aspects of BPD, or significantly modify the course and outcome of the disorder. Studies with larger samples have to confirm these preliminary findings.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Auxilia
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesco Zanelli Quarantini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Buoli M, Legnani F, Nosari G, Pan A, Ciappolino V, Esposito CM, Ceresa A, Di Paolo M, Surace T, Auxilia AM, Capellazzi M, Tagliabue I, Cirella L, Zanelli Quarantini F, Dakanalis A, Clerici M, Capuzzi E, Caldiroli A. Which clinical factors and biochemical parameters are associated with late-life major depression? Int J Psychiatry Clin Pract 2023; 27:359-366. [PMID: 37755139 DOI: 10.1080/13651501.2023.2260426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Late-life major depression (MD) is a frequent and high-cost psychiatric disorder. Our purpose was to detect clinical and biological factors possibly associated with this condition to better prevent and treat it. METHODS We recruited 343 patients, consecutively admitted for a Major Depressive Episode to the inpatient clinic of Policlinico of Milan and ASST Monza, Italy. A large set of clinical and biochemical variables was collected from clinical charts. Univariate analyses were performed both dividing the sample into two groups (age < or ≥65) and considering age as a continuous quantitative variable. Regression analyses were then performed considering as independent variables only those statistically significant at univariate analyses. RESULTS Patients aged ≥ 65 resulted in having longer duration of illness, shorter duration of last antidepressant therapy, higher number of antidepressants assumed in the past, higher frequency of treatment-resistant depression, higher frequency of overweight/obesity and diabetes. As for biochemical parameters, patients ≥ 65 showed lower total plasmatic proteins and albumin, higher uric acid and creatinine. CONCLUSIONS These preliminary results suggest less effectiveness of antidepressants, more susceptibility to metabolic disorders and poor nutritional status in patients with late-life depression; such aspects may consequently be taken into consideration for a proper therapeutic approach. KEY POINTSDepression in late life seems to be associated with poorer response to antidepressants;Clinicians should prefer compounds with minimal pharmacokinetic interactions and less risk of side effects including metabolic ones;The poor nutritional status and the higher risk of metabolic disorders in older patients points out the importance of proper diet and healthy lifestyle in this group of subjects;Further studies are needed to confirm the results of this research.
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Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesca Legnani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Guido Nosari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Pan
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Di Paolo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Teresa Surace
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Anna Maria Auxilia
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Martina Capellazzi
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Ilaria Tagliabue
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Luisa Cirella
- Healthcare Professionals Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Zanelli Quarantini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
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Fusar-Poli P, Estradé A, Stanghellini G, Esposito CM, Rosfort R, Mancini M, Norman P, Cullen J, Adesina M, Jimenez GB, da Cunha Lewin C, Drah EA, Julien M, Lamba M, Mutura EM, Prawira B, Sugianto A, Teressa J, White LA, Damiani S, Vasconcelos C, Bonoldi I, Politi P, Vieta E, Radden J, Fuchs T, Ratcliffe M, Maj M. The lived experience of depression: a bottom-up review co-written by experts by experience and academics. World Psychiatry 2023; 22:352-365. [PMID: 37713566 PMCID: PMC10503922 DOI: 10.1002/wps.21111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley, London, UK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
| | - Cecilia Maria Esposito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - René Rosfort
- S. Kierkegaard Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Milena Mancini
- Department of Psychological Sciences, Health and Territory, University of Chieti and Pescara "G. d'Annunzio", Chieti, Italy
| | - Peter Norman
- Recovery College, South London and Maudsley NHS Foundation Trust, London, UK
- Mosaic Clubhouse Brixton, London, UK
| | | | - Miracle Adesina
- Global Mental Health Peer Network, Ibadan, Nigeria
- Slum and Rural Health Initiative, Ibadan, Nigeria
| | - Gema Benavides Jimenez
- Global Mental Health Peer Network, Madrid, Spain
- Utrecht University, Utrecht, The Netherlands
- Instituto Superior de Estudios Psicológicos, Madrid, Spain
| | - Caroline da Cunha Lewin
- Global Mental Health Peer Network, London, UK
- Patient and Public Involvement Team, NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | | | - Marc Julien
- Global Mental Health Peer Network, Douala, Cameroon
| | | | - Edwin M Mutura
- Global Mental Health Peer Network, Nairobi, Kenya
- Mentally Unsilenced, Nairobi, Kenya
- Psychiatric Disability Organization of Kenya, Nakuru, Kenya
| | - Benny Prawira
- Global Mental Health Peer Network, Jakarta, Indonesia
- Into The Light Indonesia, Jakarta, Indonesia
| | - Agus Sugianto
- Global Mental Health Peer Network, Jakarta, Indonesia
- Indonesian Community Care for Schizophrenia, Jakarta, Indonesia
- University of Manchester, Manchester, UK
| | - Jaleta Teressa
- Global Mental Health Peer Network, Nekemte, Ethiopia
- Nekemte Specialized Hospital, Nekemte, Ethiopia
| | - Lawrence A White
- Global Mental Health Peer Network, Yellowknife, Canada
- Centre for Learning & Teaching Innovation, Aurora College, Yellowknife, Canada
- Advanced Graduate Student, Unicaf University, Lusaka, Zambia
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Candida Vasconcelos
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jennifer Radden
- Philosophy Department, University of Massachusetts, Boston, MA, USA
| | - Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Goretti S, Esposito CM, Di Petta G. Phenomenology of psychiatric emergencies. Front Psychol 2023; 14:1212054. [PMID: 37767218 PMCID: PMC10520776 DOI: 10.3389/fpsyg.2023.1212054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Psychiatric urgency is defined as a situation of serious mental suffering and behavioral alteration, which promptly requires adequate treatment; we talk about emergency when the condition can be life-threating. Even if until now neglected by phenomenological psychopathology, the emergency issue faces a clinical management challenge in which the phenomenological method becomes fundamental. The purpose of this manuscript is then to explore the phenomenological perspective of psychiatric emergencies. The manuscript is organized into four sections: the first deals with the encounter in clinical phenomenology, the second with the life-word of the crisis, the third with the atmosphere of emergency; finally, a final section on the importance of the phenomenological method for the clinician. The encounter in clinical phenomenology The centrality of the encounter in clinical phenomenology cannot be stressed enough. It is not just the encounter between doctor and patient, but also and above all the encounter between two men, between two subjects. And it is in the affective space between them, in the intersubjectivity and intercorporeality of their encounter, that the transformative power of understanding emerges and reverberates from both sides. The approach to the other must be respectful, along the lines of the ethics of approximation, it must recognize the other as other and not overwrite it with one's own prejudices. Otherwise, if clinicians are not sufficiently trained in the encounter, the risk is to get stuck in the anguish of the instant, to be absorbed by it, to become its tools. It is precisely the atmosphere of the emergency room that is full of expectations, haste, anxiety, which actually hinders the possibility of encountering. Instead, this possibility must be recovered, because the encounter is the founding aspect of every clinical interview, of every diagnostic suspicion, of every therapeutic resolution. The life-word of the crisis Seizing the encounter in its immediacy and in its totality, through the atmosphere that characterizes it, means for the clinician to position himself not outside the crisis, in an observational position in front of the patient, but to position himself next to him, to immerse himself in his life-world. Only then will the explosiveness of his symptoms appear to us not only as a symptomatic cascade to be contained and extinguished, but as the expression of a life-world in crisis. To use Ey's terminology, the madness of an instant must be placed within the madness of a lifetime. The patho-gnostic structures of the psychiatrist must tune into the structures of the life-world of the crisis, with the perspective of giving meaning, of helping the subject to re-inscribe the crisis within his history, and to overcome it. The atmosphere of emergency The experience of emergency is in fact detached from daily life of our being-in-the-world, both from the clinician's side and from that of the patient, who loses himself in this pathically charged and tense atmosphere and needs someone to walk alongside him to find the reins of his world. The context of the emergency room puts the clinician in the position of applying Strauss's sympathetic perception of the world, made up of atmospheres, sensations, profiles, and not of eidetic knowledge. The concept of atmosphere, inaugurated by Tellenbach and taken up in recent years by several authors, appears fundamental in understanding the amalgam of emotional tension, haste and immersiveness that characterizes the emergency room environment. An atmosphere that can become oppressive, if not thematized, and that can lead the clinician to defend himself in the haste and superficiality of the intervention. The phenomenological method Psychiatric crisis is always a situation in which we are thrown, perhaps to the highest degree, and the unfolding of references between the self and the world and between the self and the others becomes an essential skill. Even in the absence of an adequate setting, in the intersection between several pressures, the phenomenological method retains its panoramic gaze intact. We define it panoramic because it does not aim only at the observation and description of the present phenomena, which are generally characterized by violence, anguish, chaos. It is through the suspension of the epochè that the clinician can distance himself from the oppressive atmosphere of the crisis and grasp the coordinates of the patient's life-world. Only with this attitude does an authentic encounter become possible even in the difficult situation of emergency, paving the way for the challenge of care.
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Affiliation(s)
- Stefano Goretti
- Department of Psychiatry, Torrecárdenas University Hospital, Almeria, Spain
| | | | - Gilberto Di Petta
- SPDC, Mental Health Department, Santa Maria delle Grazie Hospital, Naples, Italy
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Esposito CM, Barkin JL, Ceresa A, Nosari G, Di Paolo M, Legnani F, Cirella L, Surace T, Tagliabue I, Capuzzi E, Caldiroli A, Dakanalis A, Politi P, Clerici M, Buoli M. Are There Any Differences in Clinical and Biochemical Variables between Bipolar Patients with or without Lifetime Psychotic Symptoms? J Clin Med 2023; 12:5902. [PMID: 37762843 PMCID: PMC10531939 DOI: 10.3390/jcm12185902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Psychotic symptoms occur in more than half of patients affected by Bipolar Disorder (BD) and are associated with an unfavorable course of the disorder. The objective of this study is to identify the differences in the clinical and biochemical parameters between bipolar patients with or without psychotic symptoms. METHODS A total of 665 inpatients were recruited. Demographic, clinical, and biochemical data related to the first day of hospitalization were obtained via a screening of the clinical charts and intranet hospital applications. The two groups identified via the lifetime presence of psychotic symptoms were compared using t tests for quantitative variables and χ2 tests for qualitative ones; binary logistic regression models were subsequently performed. RESULTS Patients with psychotic BD (compared to non-psychotic ones) showed a longer duration of hospitalization (p < 0.001), higher Young Mania Rating Scale scores (p < 0.001), lower Global Assessment of Functioning scores (p = 0.002), a less frequent history of lifetime suicide attempts (p = 0.019), less achievement of remission during the current hospitalization (p = 0.028), and a higher Neutrophile to Lymphocyte Ratio (NLR) (p = 0.006), but lower total cholesterol (p = 0.018) and triglycerides (p = 0.013). CONCLUSIONS Patients with psychotic BD have a different clinical and biochemical profile compared to their counterparts, characterized by more clinical severity, fewer metabolic alterations, and a higher grade of inflammation. Further multi-center studies have to confirm the results of this present study.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Jennifer L. Barkin
- Department of Community Medicine, School of Medicine, Mercer University, Macon, GA 31207, USA;
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Guido Nosari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Martina Di Paolo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Francesca Legnani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Luisa Cirella
- Healthcare Professionals Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Teresa Surace
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Ilaria Tagliabue
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Monza, Italy;
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Monza, Italy;
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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Esposito CM, De Cagna F, Caldiroli A, Capuzzi E, Ceresa A, Di Paolo M, Auxilia AM, Capellazzi M, Tagliabue I, Cirella L, Clerici M, Brondino N, Barkin JL, Politi P, Buoli M. Gender differences in clinical and biochemical parameters among patients hospitalized for schizophrenia: towards precision medicine. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01644-4. [PMID: 37436457 DOI: 10.1007/s00406-023-01644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/25/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The scientific literature shows some gender differences in the clinical course of schizophrenia. The aim of this study is to identify gender differences in clinical and biochemical parameters in subjects affected by schizophrenia. This would allow for the implementation of individualized treatment strategies. METHODS We examined a large set of clinical and biochemical parameters. Data were obtained from clinical charts and blood analyses from a sample of 555 schizophrenia patients consecutively admitted for exacerbation of symptoms to the inpatient clinic of Fondazione IRCCS Policlinico (Milan) or ASST Monza in Italy from 2008 to 2021. Univariate analyses, binary logistic regression, and a final logistic regression model were performed with gender as dependent variable. RESULTS The final logistic regression models showed that male patients (compared to females) were more prone to lifetime substance use disorders (p = 0.010). However, they also had higher GAF (global functioning) mean scores (p < 0.001) at the time of hospitalization. Univariate analyses showed that male patients (with respect to females) had an earlier age at onset (p < 0.001), a more frequent family history of multiple psychiatric disorders (p = 0.045), were more often smokers (p < 0.001), had a more frequent comorbidity with at least one psychiatric disorder (p = 0.001), and less often suffered from hypothyroidism (p = 0.011). In addition, men had higher levels of albumin (p < 0.001) and bilirubin (t = 2.139, p = 0.033), but lower levels of total cholesterol (t = 3.755, p < 0.001). CONCLUSIONS Our analyses indicate a less severe clinical profile in female patients. This is evident especially in the early years of the disorder, as suggested by less comorbidity with psychiatric disorders or later age at onset; this is consistent with the related literature. In contrast, female patients seem to be more vulnerable to metabolic alterations as demonstrated by more frequent hypercholesterolemia and thyroid dysfunction. Further studies are needed to confirm these results in the framework of precision medicine.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | | | - Alice Caldiroli
- Psychiatric Department, Azienda Socio-Sanitaria Territoriale Monza, Monza, Italy
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio-Sanitaria Territoriale Monza, Monza, Italy
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Martina Di Paolo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Anna Maria Auxilia
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Martina Capellazzi
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Ilaria Tagliabue
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Luisa Cirella
- Healthcare Professionals Department, Foundation IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio-Sanitaria Territoriale Monza, Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- ASST Pavia, Pavia, Italy
| | | | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- ASST Pavia, Pavia, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Esposito CM, Stanghellini G. The Body in Question in the Existence of Hysteric Persons: A Phenomenological Perspective. Psychopathology 2023; 56:492-498. [PMID: 37121225 DOI: 10.1159/000530355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023]
Abstract
The concept of hysteria, although apparently surpassed by contemporary nosographic classifications, continues to be talked about. Following Charbonneau's attempt to de-feminize and de-sexualize hysteria, clinical phenomenology can offer a perspective which, freed from stigma and prejudices through the suspension of judgement, allows us to understand hysteria not as a diagnostic category but as an existential position. In this sense, hysteria would be based on a hypo-sufficiency of the embodied self, which is not perceived as solid and continuous and needs external confirmations of its adequacy. According to the optical-coenaesthetic disproportion hypothesis, the hypo-sufficiency of the embodied self originates from the difficulty of experiencing one's body from the first-person perspective and from the consequent use of the gaze of others as a prosthesis to achieve a sense of selfhood and identity. Hysteric persons develop a mode of access to their corporeality mediated by visual representations - hence the theatricalization, centrality, and seductiveness of hysteric persons' behaviour. We suggest to call "figural body" the visual apprehension of one's body which tries to compensate for the weakness of coenaesthetic apprehension of the lived body. Over time, the figural body ends up superimposing itself on the immediate experience of the lived body. Placing itself on a representative register, this image conveys not only individual ghosts but also cultural aspects, social prejudices, gender stereotypes. Thus, the attempt to experience one's own body with the mediation of the other's gaze becomes an involuntary and unaware throwing of oneself into the meshes of representation that are necessarily alienating for the person. Hysterical persons remain stuck in their inability to access an experience of their body that is not figurative, alienating themselves in representations which always come from outside.
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Affiliation(s)
| | - Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Diego Portales University, Santiago, Chile
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12
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Ceresa A, Esposito CM, Surace T, Legnani F, Cirella L, Cetti D, Di Paolo M, Nosari G, Zanelli Quarantini F, Serati M, Ciappolino V, Caldiroli A, Capuzzi E, Buoli M. Gender differences in clinical and biochemical parameters of patients consecutively hospitalized for unipolar depression. Psychiatry Res 2022; 310:114476. [PMID: 35240393 DOI: 10.1016/j.psychres.2022.114476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 10/19/2022]
Abstract
Major Depressive Disorder (MDD) is a medical illness twice as common in women than in men lifetime. Purpose of this study is to identify gender differences in clinical and biochemical parameters in subjects affected by MDD to implement individualized treatment strategies. We recruited 234 patients (112 males and 122 females) consecutively hospitalized for MDD in Milan (Italy). Data were obtained through a screening of the clinical charts and blood analyses. Univariate analyses, binary logistic regressions and a final logistic regression model were performed. The final logistic regression model showed that female patients (compared to males) had lower plasmatic levels of hemoglobin (p = 0.020) and uric acid (p = 0.002), higher levels of cholesterol (p < 0.001), had been treated with a lower number of antidepressants (p = 0.011), presented lower red blood cells (p < 0.001) and showed more frequently comorbidity with hypothyroidism (p = 0.036). Univariate analyses identified also that women had an earlier age at onset (p = 0.043), were less likely to have comorbidity with diabetes (p = 0.002) and were less frequently treated with a psychiatric polytherapy (p < 0.001). Finally, female patients had achieved more frequently remission in the last depressive episode (p = 0.001) and were more likely to have family history for psychiatric disorders (p < 0.001) than males. Female patients globally have a better response to treatments, but they seem to be more vulnerable to specific metabolic abnormalities as showed by more frequent hypercholesterolemia and lower plasma levels of uric acid. These results have to be confirmed by further studies.
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Affiliation(s)
- Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Teresa Surace
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Francesca Legnani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luisa Cirella
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy
| | - Denise Cetti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy
| | - Martina Di Paolo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Guido Nosari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy
| | - Francesco Zanelli Quarantini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy
| | - Marta Serati
- Department of Mental Health, ASST RHODENSE, Rho, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Buoli M, Capuzzi E, Caldiroli A, Ceresa A, Esposito CM, Posio C, Auxilia AM, Capellazzi M, Tagliabue I, Surace T, Legnani F, Cirella L, Di Paolo M, Nosari G, Zanelli Quarantini F, Clerici M, Colmegna F, Dakanalis A. Clinical and Biological Factors Are Associated with Treatment-Resistant Depression. Behav Sci (Basel) 2022; 12:bs12020034. [PMID: 35200285 PMCID: PMC8869369 DOI: 10.3390/bs12020034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/19/2022] [Accepted: 01/29/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Treatment-resistant depression (TRD) is a debilitating condition associated with unmet clinical needs. Few studies have explored clinical characteristics and serum biomarkers associated with TRD. Aims: We investigated whether there were differences in clinical and biochemical variables between patients affected by TRD than those without. Methods: We recruited 343 patients (165 males and 178 females) consecutively hospitalized for MDD to the inpatient clinics affiliated to the Fondazione IRCCS Policlinico, Milan, Italy (n = 234), and ASST Monza, Italy (n = 109). Data were obtained through a screening of the clinical charts and blood analyses conducted during the hospitalization. Results: TRD versus non-TRD patients resulted to be older (p = 0.001), to have a longer duration of illness (p < 0.001), to be more currently treated with a psychiatric poly-therapy (p < 0.001), to have currently more severe depressive symptoms as showed by the Hamilton Depression Rating Scale (HAM-D) scores (p = 0.016), to have lower bilirubin plasma levels (p < 0.001). In addition, more lifetime suicide attempts (p = 0.035), more antidepressant treatments before the current episode (p < 0.001), and a lower neutrophil to lymphocyte ratio at borderline statistically significant level (p = 0.060) were all associated with the TRD group. Conclusion: We identified candidate biomarkers associated with TRD such as bilirubin plasma levels and NLR, to be confirmed by further studies. Moreover, TRD seems to be associated with unfavorable clinical factors such as a predisposition to suicidal behaviors. Future research should replicate these results to provide robust data in support of the identification of new targets of treatment and implementation of prevention strategies for TRD.
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Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio-Sanitaria Territoriale Monza, 20900 Monza, Italy; (E.C.); (A.C.); (M.C.); (F.C.)
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio-Sanitaria Territoriale Monza, 20900 Monza, Italy; (E.C.); (A.C.); (M.C.); (F.C.)
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-55035983
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Cristina Posio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
| | - Anna Maria Auxilia
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (A.M.A.); (M.C.); (I.T.); (A.D.)
| | - Martina Capellazzi
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (A.M.A.); (M.C.); (I.T.); (A.D.)
| | - Ilaria Tagliabue
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (A.M.A.); (M.C.); (I.T.); (A.D.)
| | - Teresa Surace
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Psychiatric Department, Azienda Socio-Sanitaria Territoriale Monza, 20900 Monza, Italy; (E.C.); (A.C.); (M.C.); (F.C.)
| | - Francesca Legnani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Luisa Cirella
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
| | - Martina Di Paolo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Guido Nosari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
| | - Francesco Zanelli Quarantini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.); (C.M.E.); (C.P.); (T.S.); (F.L.); (L.C.); (M.D.P.); (G.N.); (F.Z.Q.)
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio-Sanitaria Territoriale Monza, 20900 Monza, Italy; (E.C.); (A.C.); (M.C.); (F.C.)
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (A.M.A.); (M.C.); (I.T.); (A.D.)
| | - Fabrizia Colmegna
- Psychiatric Department, Azienda Socio-Sanitaria Territoriale Monza, 20900 Monza, Italy; (E.C.); (A.C.); (M.C.); (F.C.)
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (A.M.A.); (M.C.); (I.T.); (A.D.)
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Esposito CM, Goretti S. Decomposition: Partition as an Escape from Decay - A Gestalt of the Obsessive Life-World. Psychopathology 2022; 55:317-324. [PMID: 35863321 DOI: 10.1159/000525369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
According to phenomenological literature, the life-world of the obsessive subject is characterized by its claustrophobic closure, the attempt to stop the flow of time, and the inability to accept the formlessness hidden behind the form. The obsessive obstinately tries to build defences against what he cannot tolerate of reality and this effort causes loss of spontaneity in the pre-reflective dimension of existence, resulting in the thought process being oversaturated and ending up by blocking action. Our proposal is to unpack the phenomenon of partition in the obsessive's world, analysing the similarities and differences with the schizophrenic life-world. In fact, although the mechanization and the predominance of a reflective dimension are similar in these psychopathological typologies, these phenomena are based on completely different foundations: the ontological question in the case of the schizophrenic subject, while the ontic question in the case of the obsessive subject. By decomposing reality, the obsessive tries to stem the dimension of the formless, which is hidden under the representative order of things which he cannot tolerate. Understanding the hyper-rationalizing tendency of obsessive thought offers important clinical implications by providing shareable insights into psychotherapeutic development.
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Affiliation(s)
| | - Stefano Goretti
- Department of Psychiatry, Torrecárdenas University Hospital, Almeria, Spain
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Mancini M, Esposito CM. Lived body and the Other's gaze: a phenomenological perspective on feeding and eating disorders. Eat Weight Disord 2021; 26:2523-2529. [PMID: 33544360 PMCID: PMC8602135 DOI: 10.1007/s40519-020-01103-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022] Open
Abstract
According to the phenomenological perspective, the lived body disorder is a core feature of feeding and eating disorders (FEDs). Persons with FEDs experience their own body first of all as an object looked by another person, rather than coenaesthetically or from a first-person perspective. In particular, the main features of this disorder are: alienation from the own body and from the own emotions, disgust for it, shame, and an exaggerated preoccupation for the way in which one appears to the others. Phenomenological research has recently highlighted that the gaze of the Other plays an important role. Because persons with FEDs cannot have an experience of their own body from within or coenesthetically, they need to apprehend their own body from outside through the gaze of the Other. This way of apprehending one's own body when it is looked by another person is called by Sartre the 'lived body-for-others'. Normally, the constitution of one's own body, and consequently of one's own Self and identity depends on the dialectic integration between the first-person apprehension of one's body (lived body) that it is based on coenaesthesia, and the third-person one, that it is based on the sense of sight (lived-body-for-others). When the dialectic is unbalanced toward the pole of the lived-body-for-others, experienced from without, the symptom occurs. Starting from these clinical observations, the so-called Optical-Coenaesthetic Disproportion model has been developed. In this paper, we describe this model, its philosophical and clinical foundations, and finally its clinical implication and its relationship with other disciplines, i.e., neurosciences. Level of evidence: V.
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Affiliation(s)
- Milena Mancini
- Department of Psychological, Humanistic and Territorial Sciences, University "G. D'Annunzio", Via Dei Vestini 31, 66013, Chieti, IT, Italy.
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Esposito CM, D'Agostino A, Dell Osso B, Fiorentini A, Prunas C, Callari A, Oldani L, Fontana E, Gargano G, Viscardi B, Giordano B, D'Angelo S, Wiedenmann F, Macellaro M, Giorgetti F, Turtulici N, Gambini O, Brambilla P. Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, italy. Psychiatry Res 2021; 298:113802. [PMID: 33592401 PMCID: PMC7874958 DOI: 10.1016/j.psychres.2021.113802] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023]
Abstract
The ongoing Corona Virus Disease 2019 (COVID-19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms. The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalized in the first four months since lockdown in Milan. We recruited sixty-two patients hospitalized between March 8 to July 8, 2020 versus those first hospitalized in the same period in 2019. The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes. Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse. Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019. These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.
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Affiliation(s)
- C M Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A D'Agostino
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - B Dell Osso
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - A Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Prunas
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Callari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Fontana
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gargano
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Viscardi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Giordano
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - S D'Angelo
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - F Wiedenmann
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - M Macellaro
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - F Giorgetti
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - Ne Turtulici
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - O Gambini
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Esposito CM, Buoli M, Ciappolino V, Agostoni C, Brambilla P. The Role of Cholesterol and Fatty Acids in the Etiology and Diagnosis of Autism Spectrum Disorders. Int J Mol Sci 2021; 22:ijms22073550. [PMID: 33805572 PMCID: PMC8036564 DOI: 10.3390/ijms22073550] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
Autism spectrum disorders (ASDs) are a group of neurodevelopmental disorders whose pathogenesis seems to be related to an imbalance of excitatory and inhibitory synapses, which leads to disrupted connectivity during brain development. Among the various biomarkers that have been evaluated in the last years, metabolic factors represent a bridge between genetic vulnerability and environmental aspects. In particular, cholesterol homeostasis and circulating fatty acids seem to be involved in the pathogenesis of ASDs, both through the contribute in the stabilization of cell membranes and the modulation of inflammatory factors. The purpose of the present review is to summarize the available data about the role of cholesterol and fatty acids, mainly long-chain ones, in the onset of ASDs. A bibliographic research on the main databases was performed and 36 studies were included in our review. Most of the studies document a correlation between ASDs and hypocholesterolemia, while the results concerning circulating fatty acids are less univocal. Even though further studies are necessary to confirm the available data, the metabolic biomarkers open to new treatment options such as the modulation of the lipid pattern through the diet.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (C.M.E.); (M.B.); (V.C.); (P.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (C.M.E.); (M.B.); (V.C.); (P.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (C.M.E.); (M.B.); (V.C.); (P.B.)
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (C.M.E.); (M.B.); (V.C.); (P.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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Iodice S, Ceresa A, Esposito CM, Mucci F, Conti DM, Pergoli L, Tarantini L, Vigna L, Bollati V, Buoli M, Serati M. The Independent Role of Body Mass Index (BMI) and Severity of Depressive Symptoms on Biological Changes of Women Affected by Overweight/Obesity. Int J Environ Res Public Health 2021; 18:ijerph18062923. [PMID: 33809270 PMCID: PMC8001334 DOI: 10.3390/ijerph18062923] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
Background: Both obesity and depression are medical conditions associated with severe disability and biological abnormalities. Our aim was to study associations between Body Mass Index (BMI), depression and biological changes in women affected by overweight or obesity. Methods: Depressive symptoms were evaluated by the Beck Depression Inventory II (BDI-II) questionnaire in 200 women affected by overweight/obesity (mean age of the sample 52.7 ± 12.9 years, BMI 33.8 ± 5.5 kg/m2). A blood sample was obtained for evaluation of biochemical (oxytocin and vitamin D), inflammatory and epigenetic (methylation of clock genes) parameters. Multivariable linear regression models were used to study the association between BMI or severity of depressive symptoms (BDI-II scores) with different biomarkers. Results: BMI was found to be associated with severity of depressive symptoms (p = 0.050). Severity of obesity resulted to be associated with lower plasma levels of oxytocin (p = 0.053), vitamin D deficiency (p = 0.006) and higher plasma levels of IFN-γ (p = 0.004), IL-6 (p = 0.013), IL-7 (p = 0.013), TNF-alpha (p = 0.036) and chemokine ligand 3 (CCL3) (p = 0.013, R2 = 0.03). Severity of depression was significantly associated with more methylation of clock genes CRY1 (p = 0.034, R2 = 0.16) and CRY2 (p = 0.019, R2 = 0.47). More severe depression together with higher levels of IL-8 strongly predicted lower methylation of CLOCK gene (p = 0.009); Conclusions: Different biological abnormalities have been found to be independently associated with BMI and severity of depressive symptoms in women affected by overweight/obesity. The complex interplay between overweight, depression and biological changes will have to be better clarified by future studies.
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Affiliation(s)
- Simona Iodice
- EPIGET LAB, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (S.I.); (L.P.); (L.T.); (V.B.)
| | - Alessandro Ceresa
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (C.M.E.); (F.M.); (M.B.)
- Correspondence: ; Tel.: +39-02-55035983
| | - Cecilia Maria Esposito
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (C.M.E.); (F.M.); (M.B.)
| | - Francesco Mucci
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (C.M.E.); (F.M.); (M.B.)
| | - Diana Misaela Conti
- Occupational Health Unit, Center of Obesity and Work EASO Collaborating Centers for Obesity Management, Fondazione Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.M.C.); (L.V.)
| | - Laura Pergoli
- EPIGET LAB, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (S.I.); (L.P.); (L.T.); (V.B.)
| | - Letizia Tarantini
- EPIGET LAB, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (S.I.); (L.P.); (L.T.); (V.B.)
| | - Luisella Vigna
- Occupational Health Unit, Center of Obesity and Work EASO Collaborating Centers for Obesity Management, Fondazione Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.M.C.); (L.V.)
| | - Valentina Bollati
- EPIGET LAB, Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy; (S.I.); (L.P.); (L.T.); (V.B.)
| | - Massimiliano Buoli
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (C.M.E.); (F.M.); (M.B.)
- Department of Neurosciences and Mental Health, Fondazione IRCSS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Marta Serati
- Department of Mental Health, ASST Rhodense, 20024 Rho, Italy;
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Esposito CM, Ceresa A, Buoli M. The Association Between Personality Traits and Dietary Choices: A Systematic Review. Adv Nutr 2021; 12:1149-1159. [PMID: 33427288 PMCID: PMC8321831 DOI: 10.1093/advances/nmaa166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/05/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Increasing evidence shows how diet may play a role in improving health including mental health. Of note, personality may influence the type of diet and consequently the prognosis of medical and psychiatric conditions. The purpose of the present systematic review is to summarize the available data regarding the influence of personality on dietary habits affecting health outcomes. A search in the main databases was conducted matching the terms "personality," "personality traits" with "food choices," "food preferences," "diet," and "dietary habits." A total of 1856 articles were screened, and 24 articles were finally included. Exclusion criteria consisted of studies on animals or children, studies about eating disorders, types of diet not clearly associated with health outcomes, and studies for marketing reasons. Several studies showed that personality traits can influence both dietary choices and the type of diet, including the preference for healthy or unhealthy food. Unfavorable personality traits such as neuroticism and alexithymia (the inability to identify and describe emotions) were associated with unhealthy diet habits such as low consumption of fruit and vegetables, and the increased consumption of sugar and saturated fats. Personality seems to play a role in food selection and in the propensity to change diet. The interpretation of these results should be weighted by the different cultural contexts in which the studies were conducted and the extreme heterogeneity of tools used to assess personality and food preferences. Future research should clarify how personality can affect diet in specific populations such as patients with severe psychiatric disorders.
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Affiliation(s)
| | - Alessandro Ceresa
- Department of Pathophisiology and Transplantation, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
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Esposito CM, Mandolini GM, Delvecchio G, Fiorentini A, Brambilla P. Psychomotor Agitation Non-responsive to Treatment: A Case Report of Phenibut Withdrawal Syndrome. Front Psychiatry 2021; 12:688147. [PMID: 34262493 PMCID: PMC8273510 DOI: 10.3389/fpsyt.2021.688147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Phenibut (4-amino-3-phenyl-butyric acid), acting as a GABA-B receptor agonist, has a beneficial effect on anxiety. Although its medical use is not approved in western countries, it can be easily obtained worldwide via the Internet, so it spread as a substance of abuse. In recent years, some case reports have, therefore, highlighted episodes of acute toxicity or withdrawal, but it is still a largely unknown phenomenon. Methods: In this case report, a 50-year-old woman was admitted to the emergency room with psychomotor agitation, psychotic symptoms, and insomnia, and was non-responsive to treatment. She was hospitalized at the psychiatry ward for 25 days and gave her consent for the publication of the present case report. Results: The suspicion of phenibut withdrawal allowed to establish the appropriate management, leading to the restitutio ad integrum of the psychopathological case. Conclusions: In the face of an incoercible psychomotor agitation case, the knowledge of the so-called novel psychoactive substances allows for more appropriate clinical management of intoxication and withdrawal syndromes. This is a scientifically significant report as it provides therapeutic and outcome data concerning a syndrome that is still quite unfamiliar.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Mario Mandolini
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessio Fiorentini
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Esposito CM, Fiorentini A, Callari A, Galeazzi GM, Brambilla P. Transition Between Sensitive Delusion of Reference and Mood Disorder: A Case Report. Front Psychiatry 2021; 12:712552. [PMID: 34552517 PMCID: PMC8450362 DOI: 10.3389/fpsyt.2021.712552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
The Sensitive Delusion of Reference is a clinical entity described by Ernst Kretschmer and never integrated into mainstream nosographic systems. It represents the possibility of developing psychosis starting from a personality characterized by sensitivity, scrupulousness, and fear of judgment of others. The presentation of the following clinical case highlights how the overlap between this clinical entity and mood disorders leads to characteristic psychopathology, which has not been sufficiently detailed. In particular, the delusions, which always starts from the idea of reference and the shame in the face of the judgment of others, takes on characteristics of guilt during the depressive phases and persecutory themes during the activation phases. This clinical observation, which obviously needs to be confirmed on a larger scale, encourages a renewed interest in the concept of Kretschmer's Sensitive Delusion of Reference and creates the possibility of intersecting multiple psychopathological levels, for a more complete perspective on the individual case.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Callari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento di Salute Mentale e Dipendenze Patologiche, USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Esposito CM, Enrico P, Sciortino D, Caletti E, Marchetti GB, Cesaretti C, Oldani L, Fiorentini A, Brambilla P. Case Report: The Association Between Chromosomal Anomalies and Cluster A Personality Disorders: The Case of Two Siblings With 16p11.2 Deletion and a Review of the Literature. Front Psychiatry 2021; 12:689359. [PMID: 34168584 PMCID: PMC8217436 DOI: 10.3389/fpsyt.2021.689359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Although several studies have shown the correlation between chromosomal rearrangements and the risk of developing psychotic disorders, such as schizophrenia, little attention has been given to identifying the genetic basis of pre-disposing personality so far. In this regard, a limited but significant number of studies seem to indicate an association between chromosomal anomalies and cluster A personality disorders (CAPD). Starting from the clinical description of two brothers affected by familial 16p11 deletion syndrome (OMIM #611913), both sharing cluster A and C personality traits, the aim of the present study is to critically review the literature regarding the correlation between chromosomal rearrangements and CAPD. A bibliographic search on PubMed has been conducted, and eight studies were finally included in our review. Most of the studies highlight the presence of schizotypal personality disorder in the 22q11.2 deletion syndrome, whose evolutionary course toward psychotic pictures is well-known. One study also identified a paranoid personality disorder in a patient with a deletion on chromosome 7q21.3. No studies have so far identified the presence of paranoid personality disorder in 16p11 deletion, as in the case of the two siblings we report, while its association with psychosis and autism is already known. Although further epidemiologic studies on broader populations are indicated, our observations might pave the way for the definition of new diagnostic subgroups of CAPD and psychotic disorders, in order to implement the clinical management of such complex conditions.
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Affiliation(s)
| | - Paolo Enrico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Domenico Sciortino
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elisabetta Caletti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Bruna Marchetti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cesaretti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Serati M, Esposito CM, Grassi S, Bollati V, Barkin JL, Buoli M. The Association between Plasma ERVWE1 Concentrations and Affective Symptoms during Pregnancy: Is This a Friendly Alien? Int J Environ Res Public Health 2020; 17:ijerph17249217. [PMID: 33317172 PMCID: PMC7763945 DOI: 10.3390/ijerph17249217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
Human endogenous retroviruses (HERVs) comprise 8% of the human genome, and HERV DNA was reported to be essential in human embryonic development. Specifically, HERV-W encodes a protein, syncytin-1, alternatively known as ERVWE1 (Human Endogenous Retrovirus W EnvC7-1 Envelope Protein), participating in human placental morphogenesis and having a role in immune system regulation. Syncytin-1 activity is increased in neuropsychiatric disorders, autoimmune diseases, and cancer. In our study, forty-four women in the third trimester of pregnancy were tested for ERVWE1 plasma levels. In concomitance with blood samples the following rating scales were administered to women: the Edinburgh Postnatal Depression Scale (EPDS), State Anxiety Inventory (STAI-S), Trait Anxiety Inventory (STAI-T), and Prenatal Attachment Inventory (PAI). We found that higher ERVWE1 protein plasma levels were significantly associated with higher PAI scores (p = 0.02), an earlier gestational age at the time of blood collection (p = 0.01), a longer duration of symptoms (p = 0.03), and fewer lifetime attempted suicides (p = 0.02). Our results seem to support the role of ERVWE1 in maintaining clinical psychiatric symptoms as a result of potential prolonged inflammation. At the same time, this protein may have a protective role in pregnant women by a reduction of suicidal behavior and a better mother-fetus relationship.
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Affiliation(s)
- Marta Serati
- Department of Mental Health, ASST RHODENSE, 20024 Rho, Italy;
| | - Cecilia Maria Esposito
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (C.M.E.); (S.G.)
| | - Silvia Grassi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (C.M.E.); (S.G.)
| | - Valentina Bollati
- EPIGET-Epidemiology, Epigenetics and Toxicology Lab-Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
| | - Jennifer Lynn Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA 31207, USA;
| | - Massimiliano Buoli
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (C.M.E.); (S.G.)
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-55035983; Fax: +39-02-55033140
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Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The Link Between Autonomic Nervous System and Rheumatoid Arthritis: From Bench to Bedside. Front Med (Lausanne) 2020; 7:589079. [PMID: 33365319 PMCID: PMC7750536 DOI: 10.3389/fmed.2020.589079] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Neuronal stimulation is an emerging field of research focused on the management and treatment of various diseases through the reestablishment of physiological homeostasis. Electrical vagus nerve stimulation has recently been proposed as a revolutionary therapeutic option for rheumatoid arthritis (RA) in combination with or even as a replacement for conventional and biological drugs. In the past few years, disruption of the autonomic system has been linked to RA onset and activity. Novel research on the link between the autonomic nervous system and the immune system (immune-autonomics) has paved the way for the development of innovative RA management strategies. Clinical evidence supports this approach. Cardiovascular involvement, in terms of reduced baroreflex sensitivity and heart rate variability-derived indices, and mood disorders, common comorbidities in patients with RA, have been linked to autonomic nervous system dysfunction, which in turn is influenced by increased levels of circulating pro-inflammatory cytokines. This narrative review provides an overview of the autonomic nervous system and RA connection, discussing most of the common cardiac and mental health-related RA comorbidities and their potential relationships to systemic and joint inflammation.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flavia Antonucci
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
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Esposito CM, Buoli M. The biological face of melancholia: Are there any reliable biomarkers for this depression subtype? J Affect Disord 2020; 266:802-809. [PMID: 32217262 DOI: 10.1016/j.jad.2020.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/24/2020] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Melancholic depression (MD) is a subtype of Major Depression associated with more clinical severity and poorer prognosis that non-melancholic depression (NMD). The differentiation between depression subtypes is still clinical, although the identification of specific biomarkers could be useful for diagnosis and the development of new treatments. Purpose of the present manuscript is to review the biomarkers that have been associated with MD. METHODS We performed a bibliographic research on the main databases (PubMed, Embase, PsycInfo, Isi Web of Knowledge, Medscape, The Cochrane Library), in order to find studies that proposed biological markers for melancholic depression. A total of 14 studies met our inclusion criteria. RESULTS Most of studies focused on immune dysregulation. Subjects with MD show biological abnormalities than healthy controls (HC). MD might be characterized by specific biological changes and it could be associated to more severe abnormalities with respect to NMD; however especially about this latter point the available data are preliminary. LIMITATIONS Most available data have not been replicated; the studies focused on different biomarkers. In addition, many articles report results on a limited sample size. CONCLUSIONS Melancholic depression is a subtype of major depression that seems to be associated with specific alterations of different biological systems. Future studies with larger sample can confirm the results and hypothesis presented in this review.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy.
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Esposito CM, Stanghellini G. The Pathogenic and Therapeutic Potential of the Gaze of the Other in the Clinic of "Eating Disorders". Psychopathology 2020; 53:291-297. [PMID: 32882702 DOI: 10.1159/000509625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
Building on the optical-coenaesthetic disproportion model of so-called eating disorders, this paper provides a framework for the psychotherapy of people affected by these conditions. This model characterizes "eating disorders" as disorders of embodiment and identity, where a sense of unfamiliarity with one's own flesh, experienced as shifting and incomprehensible, leads to an impairment in the constitution of the Self and thus of one's own identity. Since there is a deficit of the coenaesthetic experience of the embodied Self, greater importance is assumed by body perception conveyed from without. To these persons, their corporeality is principally given as a body-object "to be seen" from a third-person perspective, rather than as a body-subject "to be felt" from a first-person perspective. The Other's look serves as an optical prosthesis to cope with dis-coenaesthesia and as a device through which these persons can define themselves. They are unable to accept the hiatus between "being a body" and "having a body," constitutively present in every human being, forcibly trying to recouple it, and finally ending up objectifying themselves to succeed. The external foundation of the Self thus takes the form of a constriction one can never be completely free of. Psychotherapy should thus accompany persons affected by eating disorders in their encounter with the miscarried dialectic between feeling oneself from within and seeing oneself from without through the gaze of the Other, so keenly feared by people desperately in search of self-control. Tactfully, the clinician accompanies the patient in taking a stance towards her symptom as the outcome of this miscarried dialectics, which is one premise for overcoming it. The clinician's gaze becomes the herald of recognition, allowing the patient to feel accepted in terms of her individuality. Feeling themselves touched by a gaze that waives its alienating potential in order to signify acceptance reactivates the identity-forming dialectics. Their body is thus revealed as the receiver of gazes, but also rediscovers its own possibility for self-determination starting out from these gazes. This intersubjective resonance between the clinician's gaze and the patient reactivates the identity-making dialectics between body-subject and body-object, creating the relational premises for overcoming the symptom.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,
| | - Giovanni Stanghellini
- Department of Psychological, Health and Territorial Sciences, G. d'Annunzio University, Chieti, Italy.,Diego Portales University, Santiago, Chile
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Buoli M, Grassi S, Iodice S, Carnevali GS, Esposito CM, Tarantini L, Barkin JL, Bollati V. The role of clock genes in perinatal depression: the light in the darkness. Acta Psychiatr Scand 2019; 140:382-384. [PMID: 31400146 DOI: 10.1111/acps.13084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Grassi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Iodice
- EPIGET-Epidemiology, Epigenetics and Toxicology Lab-Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G S Carnevali
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C M Esposito
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Tarantini
- EPIGET-Epidemiology, Epigenetics and Toxicology Lab-Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - J L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - V Bollati
- EPIGET-Epidemiology, Epigenetics and Toxicology Lab-Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Buoli M, Esposito CM, Caldiroli A. Commentary on "Long-term validity of the At Risk Mental State (ARMS) for predicting psychotic and non-psychotic mental disorders". Eur Psychiatry 2018; 54:98-99. [PMID: 30149359 DOI: 10.1016/j.eurpsy.2018.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 02/09/2023] Open
Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Cecilia Maria Esposito
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Buoli M, Rovera C, Esposito CM, Grassi S, Cahn W, Altamura AC. THE USE OF LONG-ACTING ANTIPSYCHOTICS FOR THE MANAGEMENT OF AGGRESSIVENESS IN SCHIZOPHRENIA: A CLINICAL OVERVIEW. Clin Schizophr Relat Psychoses 2018:CSRP.BURO.061518. [PMID: 29944415 DOI: 10.3371/csrp.buro.061518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Aggressive behaviour represents a challenge in the treatment of patients with schizophrenia, being often associated with clinical predictors of severity of illness such as poor insight, psychotic re-exacerbation, concomitant substance misuse or comorbidity with personality disorders. As psychotic relapses and consequent risk of aggressive behaviour are often associated with a poor compliance, purpose of the present manuscript is to give an overview of the available data about the use of depot antipsychotics for the management of violence in patients with schizophrenia. A research in the main database sources has been conducted to identify relevant papers about the topic. Few studies (most of them retrospective and with small sample sizes) have investigated the effectiveness of depot antipsychotic for the treatment of aggressive behaviour in schizophrenia. Aripiprazole depot appears to be promising for the management of aggressive behaviour of subjects with schizophrenia, however data about its efficacy in the long-term are absent and lack of evidence prevents the recommendation of this compound for the treatment of aggressiveness in subjects affected by schizophrenia. In addition, there is not sufficient evidence to conclude that a specific depot antipsychotic may have a better efficacy on aggressive behaviour of patients affected by schizophrenia. Prospective comparative studies (e.g. with oral clozapine and aripiprazole depot) are needed to assess the real clinical advantage of the use of depot antipsychotic versus oral alternatives for the prevention of violent behaviour in schizophrenia.
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Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - Chiara Rovera
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Silvia Grassi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Wiepke Cahn
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, The Netherlands
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
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Buoli M, Esposito CM, Godio M, Caldiroli A, Serati M, Altamura AC. Have antipsychotics a different speed of action in the acute treatment of mania? A single-blind comparative study. J Psychopharmacol 2017; 31:1537-1543. [PMID: 28462607 DOI: 10.1177/0269881117705098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Available antipsychotics show different efficacy on manic symptoms of bipolar patients, but few studies have investigated the speed of action of the various compounds. For this reason, purpose of the present paper was to compare antipsychotic mono-therapies in terms of speed of action in a sample of manic bipolar patients. In total, 155 bipolar patients, treated with antipsychotic mono-therapy and followed-up in Inpatient Psychiatry Clinic of University of Milan, were included in this single-blind comparative study. Clinical response was defined as a reduction of Young Mania Rating Scale (YMRS) scores ⩾50%, while remission as a YMRS score <10. After 4 days patients who had been treated with asenapine, were more likely to have achieved a clinical response than those in treatment with haloperidol ( p = 0.001). After 7 days, a more frequent clinical response was achieved by patients treated with asenapine than those who had been treated with haloperidol ( p < 0.001) or olanzapine ( p = 0.047). Asenapine appears to be faster in determining treatment response in manic patients compared with haloperidol and less markedly with olanzapine.
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Affiliation(s)
- Massimiliano Buoli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cecilia Maria Esposito
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Godio
- 2 Cantonal Psychiatric Clinic, Mendrisio, Switzerland
| | - Alice Caldiroli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Serati
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Carlo Altamura
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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