Therapeutic strategies for behavioral and psychological symptoms (BPSD) in demented patients.

In the context of the diseases characterized by cognitive impairment, the appearance of behavioral modifications is frequently observed, in particular agitation and/or aggression. In dementia, cognitive symptoms are often associated with psychiatric symptoms, such as personality, mood, behavioral and "psychotic" disorders, at present defined as behavioral and psychological symptoms of dementia (BPSD), representing the main cause of hospitalization for these patients. Among the different pharmacological classes, justified by the complex genesis of BPSD, the choice of a specific treatment is mainly related with the safety of different molecules, among which atypical antipsychotics are the first choice class.

Increased bile acid excretion and reduction of serum cholesterol after crenotherapy with salt-rich mineral water.

The effect of a spring mineral water from Montecatini (Italy) on bile acid excretion, and lipid and apolipoprotein serum levels was evaluated. The study was conducted in subjects with serum total cholesterol (TC) level > 240 mg/dL and LDL cholesterol (LDL-C) > 170 mg/dL, over a 9-week period, with 3 weeks of dietary stabilization, 3 weeks of active treatment, and 3 weeks of tap-water treatment as a control period. Serum lipids and apolipoproteins, total and fractionated bile acid excretion, gallbladder motility, and safety parameters were evaluated. Active treatment with mineral water significantly reduced serum TC by 7.5%, LDL-C by 12.5%, TC/HDL-cholesterol ratio by 6.3%, and apolipoprotein B by 6.3%; total fecal bile acid excretion was increased by 98.9%, and gallbladder volume was reduced by 40%. The reduction in serum and LDL-cholesterol levels observed during the active treatment period ran parallel to the increased excretion of bile acids in the stools. We suggest that salt-rich spring water treatment reduces serum and LDL-cholesterol levels in subjects with mild hypercholesterolemia through a mechanism of increased excretion of fecal bile acid sterols.

[Changes caused by mineral water on gastrointestinal motility in patients with chronic idiopathic dyspepsia]. / Modificazioni indotte da un'acqua minerale sulla motilità gastrointestinale di pazienti con dispepsia cronica idiopatica.

BACKGROUND: The antidyspeptic property of mineral waters has been based for ages on empirical data. In the present paper the effects of one of them (Tettuccio, Montecatini) on gastrointestinal motility of patients with dyspepsia has been evaluated. METHODS: The study was carried out on 24 patients with idiopathic dyspepsia and delayed gastric emptying at scintigraphy and 18 healthy subjects with normal gastric emptying. The gastric emptying of this mineral water was studied with a scintigraphic method in comparison with tap water, while its effects on gastroduodenal contractions were evaluated by of manometry. RESULTS: The gastric emptying of this mineral water was significantly faster than that of tap water, both in dyspeptic patients and in normals. Manometric examination showed that the administration of mineral water induced a brief decrease of phasic motor activity, followed by a progressive increase, which in some cases ended in an activity front of the Migrating Motor Complex. CONCLUSIONS: This mineral water has a stimulating effect on both gastric emptying and interdigestive cyclic motor activity of the gastroduodenal tract. Both these effects could be useful in the treatment of chronic idiopathic dyspepsia and impaired gut clearing.

Effect of a mineral water on gastric emptying of patients with idiopathic dyspepsia.

The antidyspeptic property of mineral waters has for many years been based on empirical data. In the present paper we evaluated the effects of one type of mineral water, Tettuccio water from Montecatini, on gastric emptying in patients with idiopathic dyspepsia. Fourteen subjects, eight patients with idiopathic dyspepsia and delayed gastric emptying at scintigraphy and six healthy subjects with normal gastric emptying were studied. The gastric emptying of mineral water was studied with a scintigraphic method and compared with that of tap water. In patients with idiopathic dyspepsia, gastric emptying of both waters was slower than in controls but the gastric emptying of mineral water was significantly faster than that of tap water, both in dyspeptic patients and in healthy subjects. In conclusion, this mineral water stimulates gastric emptying. Further studies are needed on the possible role of this water in the management of chronic idiopathic dyspepsia.

[Clinical-epidemiological study of the efficacy of thermal therapy in gastroenterologic diseases]. / Indagine clinico-epidemiologica sulla efficacia della terapia termale nella patologia gastroenterologica.

PURPOSE: To evaluate the therapeutic effects of drinking mineral water, its influence on gastrointestinal drug consumption as well as on working days missed in patients with dyspeptic syndrome or chronic constipation due to irritable bowel syndrome. MATERIALS AND METHODS: A questionnaire was sent to 1500 physicians and 965 forms were available concerning patients who had mineral water treatment at Montecatini. RESULTS: Mineral water therapy determined a striking short- and medium-term improvement on clinical symptoms. Furthermore, this treatment reduced gastrointestinal drug consumption per year, as well as the number of working days missed. CONCLUSIONS: This epidemiological study confirms the utility of drinking mineral water in the treatment of some gastrointestinal syndromes either in the short and in the medium run.

Thermal therapy of functional dyskinesias of the alimentary tract.

There are described the studies performed in Italy-especially at Montecatini-about activity of certain mineral waters, administered by mouth, in functional troubles of the digestive apparatus. The illnesses especially considered have been: idiopathic chronic constipation, irritable colon syndrome, biliary dyskinesias, correlated pathological conditions. The mineral waters analyzed had been: salso-sulphate-alkaline, bicarbonate, sulphate, bicarbonate-sulphate-alkaline, sulphate-bicarbonate waters and others. There are reported: research methods employed, the obtained results, the possible mechanisms of effect. The hydrological favourable influences about pathophysiology of digestive motor activity and in therapeutics of correlated diseases are demonstrated. The clinical results, and particularly their duration in time, are affermatif about therapeutic usefulness of thermal treatment by mouth. It's possible to suggest and to stress their better knowledge in Medicine and their increased employment in the treatment of functional dyskinesias of the alimentary tract.

[The influence of psychological factors on the patient's management of diabetes. Critical survey of psychodynamic models on personal management of diabetes]. / Influenza dei fattori psichici sull'autogestione del diabete. Rassegna critica dei contributi dei modelli psicodinamici sull'autogestione del diabete.

The authors have examined the currently accepted methods to face a chronic disease like diabetes. The person affected by this illness should learn to accept his/her limits and find a new identity. The aim of technical and scientific medicine is to teach the patient how to cope with the disease. However, in spite of the progress of the scientific research in this field, diabetes remains a poorly treated disease. A review of the literature shows that there is a deep interaction between diabetes and psychological states. Psychological disorders like depression and anxiety might be associated with the origin of diabetes and can affect its course. It seems that emotional factors have a more important role than education in diabetes care. The psychological aspect becomes even more important during adolescence, as the chronic illness can affect the normal development of the teen-ager who will deny it to protect himself. If the patient does not collaborate, his behaviour may be unconsciously aggressive and destructive. Some patients can use diabetes as a tool to act out aggressive feelings against themselves or the environment. Diabetes bad management becomes then the expression of their destructive narcissism which prevents them from finding a new identity. The collaboration of medical and psychological operators should help these patients to find a new identity which includes diabetes as an integrating part of their personality and enables them to cope with it under the guidance of the diabetes team.

[Iontophoresis of tenoxicam in the therapy of osteoarthrosis]. / Ionoforesi con tenoxicam nella terapia dell'osteoartrosi.

After a brief physiopathological research about iontophoresis applications, the authors examine this treatment by two drugs (Tenoxicam and acetylsalicylic acid) in a group of patients suffering from painful osteoarthritis. They came to the conclusion that the treatment is efficacious with both substances though realising a quicker analgesic result in the group treated with tenoxicam.