Treatment of depression in HIV-infected patients.

BACKGROUND: Pharmacological treatment of depression in HIV-infected patients has been found to be effective. This study assessed the efficacy and feasibility of treatment with fluoxetine and the best method of administering the drug to patients with HIV infection. METHODS: Sixteen seropositive and 16 seronegative patients, equally matched for age and sex, who had Hamilton Rating Scale for Depression scores of at least 16 and who received at least 20 mg/d of fluoxetine for 8 weeks were studied. RESULTS: Depression was alleviated in both groups. However, improvement in the seropositive patients occurred later. INTERPRETATION: The results confirm the effectiveness of fluoxetine in treating depression in people with HIV infection. The lack of adverse effects makes this treatment particularly suitable, especially because seronegative people take longer to respond to treatment.

Family adaptation to institutionalised mentally retarded patients. A preliminary report on an Italian population.

Family interactive patterns were investigated in the relatives of 20 mentally retarded patients institutionalised in two centres in Northern Italy. Expressed emotion (EE) was used as evaluation instrument. The results show a surprisingly high rate (45%) of high EE, even in relatives of patients who did not live inside the family. High EE was positively correlated to the presence of behavioral disorders in the patients, as already shown for children with conduct disorders. Treatment implications are discussed; there is an opportunity for the implementation of a family psychoeducational approach, aimed both at managing the behavioural consequences of the disorder and at enhancing rehabilitation programmes.

Increased levels of CD8+ and CD4+ 45RA+ lymphocytes in schizophrenic patients.

Peripheral blood (PB) lymphocyte subpopulations, IgG, IgM, IgA and IgE serum immunoglobulins and C3 and C4 complement fractions were evaluated in 29 schizophrenic patients, 31 of their relatives and 20 healthy subjects. The patients fulfilled DSM-III criteria for schizophrenia, and were unmedicated for 3 months prior to the PB sample collection. When compared to healthy controls and their own relatives, the schizophrenic patients showed a lower level of CD4+ cells, while the CD4+ 45RA+ (naive) subset was significantly higher. Conversely, the number of CD4+ 45RA- (memory) lymphocytes was significantly lower in schizophrenic patients in comparison to their relatives and controls, while the CD8+ supressor/cytotoxic T-cell percentage was significantly higher. No significant differences were observed for the IgG, IgM, IgA, IgE and C3 and C4 complement fraction levels among the three groups. The present data confirm the presence of immunological abnormalities in schizophrenic patients and suggest a possible role of environmental factors in the triggering of an autoimmune pathogenic mechanism.

[Mental retardation and family environment: role of emotional factors]. / Ritardo mentale e ambiente familiare: ruolo dei fattori emotivi.

The authors present data from an experimental study conducted on 20 institutionalized mentally handicapped adult patients. Relevant family variables were investigated by means of the Expressed Emotion (EE) scales, then compared with similar variables obtained in a matched sample of 20 schizophrenic patients and their families. Results show, in relatives of mentally handicapped patients, a higher rate of Warmth than in relatives of schizophrenics (p = 0.009), while other EE scales appear to reach similar values in both groups. Within the mentally handicapped family group, a higher rate of Emotional Over-involvement (p = 0.046) is shown by relatives of patients treated with neuroleptic drugs. The presence of high Warmth and Emotional Over-involvement, together with low Criticism and Hostility, may be interpreted as adaptation by the families to an organic disease with very early onset, clearer ad less rejecting than schizophrenia.

Expressed emotion and schizophrenia in Italy. A study of an urban population.

Forty-two schizophrenic patients and their close relatives took part in an Italian replication study of expressed emotion (EE). The patients were selected from the psychiatric ward of a general hospital in Milan and were subsequently followed up for nine months. All patients attended a community service clinic as out-patients, and all but one were prescribed neuroleptics for the duration of the study. Relatives were assigned to the high-EE group if they scored 4 or 5 on the emotional overinvolvement (EOI) scale, or showed hostility, or made six or more critical comments. On this basis, 18 (42%) families were rated as low EE and 24 (57%) as high EE. At follow-up, the admission rate for the 9-month period was significantly higher for the high-EE group (P less than 0.05). Furthermore, significantly fewer patients were readmitted from families showing high warmth (P less than 0.05). The presence of high warmth appeared to be associated with a lower admission rate, even in high-EE families.

The reflexive loop of past, present, and future in systemic therapy and consultation.

Time is one of the most basic social constructions. There are several different "times" (individual, social, cultural). This article deals with the time variable in systemic therapy--a most important variable, but often underestimated by therapists--and seeks to illustrate, with clinical examples, the peculiar interplay of past, present, and future in the therapy session. The co-creation of the past and future in the therapeutic system is also considered, together with the different temporal horizons of the family therapist and the observation team. In our view, time is one of the key issues in successful therapy: consideration of time can open new perspectives in both therapy and research.

Emotional profiles of families with a heart-operated patient: a pilot study.

Family interaction is a basic factor in determining the quality of life of patients undergoing heart surgery. The present study investigates the emotional attitudes in the relatives of 10 heart-operated patients. The results indicate that a high amount of relatives' emotional overinvolvement and warmth tends toward a correlation with lower anxiety and depression scores, and with a better 12-month outcome of the illness.

[Family expressed emotion. From research to therapeutic intervention]. / Emotività espressa familiare. Dalla ricerca all'intervento terapeutico.

The Expressed Emotion (EE) index is today one of the most important tools to evaluate the effect of family environment on the course of schizophrenia. The A. critically examine many experimental researches, performed on the EE index during the past 15 years, reporting the results of the first Italian replication study. The psychoeducational family interventions (originated by the EE research) are then considered, with particular attention to the treatment conceived by the team of the Association for the Research on Schizophrenia (A.R.S.). In the final section of the paper, the A. propose an extension of the EE research to families with chronic organic pathologies, reporting some preliminary results.

[Schizophrenia and family-expressed emotions. Study of an Italian population]. / Schizophrénie et expression émotionnelle familiale. Etude d'une population italienne.

Expressed Emotion (EE) is a method of assessing the emotional make-up of a family, widely used in English-speaking countries, with particular reference to schizophrenia. This research programme arose out of a trial application of EE to a group of Italian families. Data are given here relative to a sample of 19 families with a schizophrenic member (according to DSM III criteria). The results confirm the hypothesised correlation between family EE and recidivist symptomatology of schizophrenic subjects: "high family EE" is associated with the most serious and habitual schizophrenic cases. The necessary adaptations which had to be made in order to apply EE assessment methods to Italian families are also discussed.

The efficacy of an information group intervention on relatives of schizophrenics.

Socio-therapy of schizophrenia cannot fail to consider such an important element as assistance to relatives. This report will review the main treatment methods used today and presents an intervention model which acts on the family of the schizophrenic at different levels. While the schizophrenic patient receives an individual treatment (pharmacological and psychotherapeutic), his/her relatives undergo a two-step group intervention. The first phase concerns an information group. This paper gives an early assessment as to the efficacy of the information groups for relatives. Particularly, it focuses on the actual ability of the group in conveying information to relatives. Such transfer of information is measured by means of a structured interview (Knowledge Interview). Results demonstrate that after an information group family members had a significant statistical increase of their information level (p less than 0.001). Some areas recorded a considerable increase in the knowledge levels, as far as the legitimacy of the illness and the management of symptoms are concerned.

Family assessment and linguistic interaction: analysis of the Camberwell Family Interview.

Expressed Emotion (EE) is a form of assessment of the family environment: it is highly reliable and has proved to be predictive for symptomatologic relapse with schizophrenic subjects. Rating is obtained by offering to relatives living with the schizophrenic patient a structured interview, the Camberwell Family Interview (CFI). In the present study we will undertake a linguistic analysis (with quantitative and semantic evaluation) of 16 CFI, in order to detect communication parameters likely to be correlated with basic EE categories (high and low EE). The results obtained demonstrate that high EE relatives show a more immediate response style and a greater amount of speech. Moreover, these subjects tend to neglect their task during the interview, starting in most cases a self-referred communication.

[Emotional expression: from research to psychosocial treatment]. / Expression émotionnelle: de la recherche aux traitements psycho-sociaux.

Over a four year period, the Schizophrenia Research Association (A.R.S. - Associazione Ricerche sulla Schizofrenia) has drawn up a multi-dimensional plan of action for the families of schizophrenic subjects. The basic points of this plan revolve around advice to the family and group therapy for family members, split into "informative" and "relationship orientation" sessions. Conducting an assessment of Expressed Emotion on family members admitted to these groups, it was observed that their emotional make-up is very different from that of family members of schizophrenics selected on the basis of casual criteria. Therefore, we are proposing a strategy which takes into account the emotional make-up of the family member in dictating therapists' action in terms of each family member.

[Care of the terminal cancer patient. General treatment and psychological management]. / Assistenza al paziente canceroso terminale. Trattamento generale e management psicologico.

The treatment of neoplastic patients in a terminal stage causes the surgeon who takes them in charge several problems, many of which are of a psychological nature. Such problems can be summarized as concerning the psychological attitude of the patient, the relationship between the patient and his family and the relationship between the patient and the hospital. These problems, together with others more specifically linked to the nature of the neoplastic disease, are not often easy to be solved by the single physician. Therefore, we propose to set up "Multidisciplinary groups for the study of untreatable neoplastic diseases", in order to assist the surgeon in the treatment of the last stages of the disease.

A study of neuropsychological alterations in multiple sclerosis.

The Luria-Nebraska Neuropsychological Battery was administered to 22 patients with ascertained multiple sclerosis. The result is tht in these patients a brain damage exists in 54.5% of cases, but without preferential localization of the damage. Furthermore, the damage is not significantly correlated to four clinical parameters of the illness: age of the patient, age of the onset of the illness, duration of the illness and disability level.