The psychosocial rehabilitation of the offending psychiatric patients: Looking the good practices

Introduction

The Italian law 81/2014 has given a strong push to the design of therapeutic-rehabilitative paths for psychiatric patients who are offenders. This innovation requires a constant organizational effort on the part of mental health services to enforce the law. The rehabilitation team is represented by different professionals like psychiatrists, psychologists, nurses, psychiatric rehabilitation technicians, educators, social workers and others. They must be able to work in an integrated way among them and with private social sector.

Objectives

It is in our interest to reach an agreement between different professionals working in the rehabilitation-forensic field about good practices.

Methods

We have prepared a survey to identify good practices in the field of psychosocial rehabilitation of the offender psychiatric patient, involving different professionals who have expertise.

Results

This audit revealed, in everybody’s opinion, that these offending citizens have received a security measure capable of having greater control over their actions in a therapeutic-rehabilitative perspective but it is fundamental to educate them also to exercise their own safety for a social shared culture. Ensuring the safety of the offender during the therapeutic-rehabilitative path is as important as responding to a society’s need for social security.

Conclusions

Satisfying a society’s need for security, established by the Judge and the Law, all this cannot separated from the active exercise of security of the offending psychiatric patient towards himself, through psychoeducation. The safety towards others and towards oneself can constitute a good practice in the field of psychosocial rehabilitation.

Disclosure

No significant relationships.

Persistent secondary hyperparathyroidism after renal transplantation

BACKGROUND

The persistence of secondary hyperparathyroidism after renal transplantation is frequent and often complicated by overt hypercalcemia. Recent investigations have shown an effect of the different vitamin D receptor (VDR) genotypes on parathyroid hormone (PTH) secretion in both primary and secondary hyperparathyroidism. The aims of this study were (i) to assess whether persistent secondary hyperparathyroidism after renal transplantation is characterized by any change in calcium-controlled PTH secretion, and (ii) whether different VDR allelic distributions might play any role on this setting.

METHODS

Eighty-one cadaveric renal transplantation recipients, followed-up for at least 12 months, were checked for PTH, other primary metabolic and clinical variables, and VDR B/b alleles (BsmI). In 22 of these the following parameters were evaluated: (a) kinetics parameters of the Ca-PTH relation curve; (b) vertebral mineral density; (c) calcitriol serum levels; (d) PTH-related peptide serum levels; and (e) urinary hydroxyproline.

RESULTS

According to the stabilised PTH levels (reached by the third month), the patients were divided in two groups: group A (N = 40, PTH < 80 pg/ml) and group B (N = 41, PTH > 80 pg/ml). Group B differed from group A in that patients had higher PTH levels at the time of transplantation, were older in age, and spent more time on dialysis. Group B had increased maximal and minimal PTH levels, and higher set-point levels than Group A. The patients with the BB pattern of VDR genotype were characterized by the lowest PTH levels both at time of transplantation and after stabilization, and lower set point values than patients with Bb and bb patterns.

CONCLUSIONS

Our study suggests that (i) the severity of pre-existing secondary hyperparathyroidism is the main factor determining its persistence after renal transplantation, (ii) persistent secondary hyperparathyroidism is characterized by an autonomous pattern of PTH secretion, (iii) the VDR BB genotype seems to be related to lower PTH levels.

Calcium-dependent ADP-ribosylation of high-mobility-group I (HMGI) proteins

Micrococcal nuclease digestion of nuclei from mouse Lewis lung carcinoma cells releases a protein mixture into the supernatant that lacks histone H1 and contains a full complement of high-mobility-group I (HMGI) proteins (i.e. I, Y and I-C). This implies that all three HMGI proteins are localized at the nuclease-sensitive regions of active chromatin. It is also shown that if Ca2+ ions are present in the nuclear incubation buffer (with or without exogenous nuclease), all three HMGI proteins become ADP-ribosylated. We propose that this modification of HMGI family proteins is part of the general poly(ADP-ribosyl)ation that accompanies DNA damage in apoptosis and other processes.