Epilepsy and argininosuccinic aciduria.

BACKGROUND: We have reviewed the occurrence of epilepsy in our patients with argininosuccinic aciduria (ASA) (OMIM 207900) and the possible relationship of late epilepsy to symptomatic seizures in the neonatal period, hyperammonaemia and treatments. METHODS: We retrospectively analysed 11 ASA patients (8 neonatal onset and 3 late onset), 6 of whom had developed epilepsy. RESULTS: Epilepsy in our sample was frequent (55 %). It developed after a seizure-free period from the onset of the metabolic disease and seizures were responsive to treatment in all cases. Arginine plasma levels were kept in the same range for the 2 groups of patients with and without epilepsy. CONCLUSIONS: Although epilepsy is reported to be common among patients with ASA, very few long-term follow-up studies are available. The pathophysiological mechanism of epileptogenesis remains unclear. Neither hyperammonaemia nor acute symptomatic seizures at birth seem to be predictive of late epilepsy. Excessive arginine dosages as a cause of epilepsy could be reasonably excluded since our 3 late onset patients developed epilepsy before the diagnosis of ASA, at a time when they were likely to be arginine deficient. Arginine deficiency may not be excluded as cause of epilepsy, but further studies are needed to define its role.

[The dependence of alcohol abuse and psychiatric comorbidity]. / Abuso-dipendenza da alcol e comorbilità psichiatrica.

Aim of this paper, based on data collected at the General Hospital Psychiatric Unit of Pavia (Italy), is to study comorbidity between alcohol abuse/dependence and other mental illness. Thirty-five out of 188 patients admitted during the study period received a (DSM-III-R) diagnosis of alcohol abuse/ dependence and an other psychiatric diagnosis. Data were collected through a questionnaire, from patients and relatives, about history of dependence, psychiatric history both in patients and relatives, about life style and drinking opinions. Psycho-diagnostic (Wechsler, Rorschach) informations were obtained for 29 patients. Results show the importance of a complex treatment for both psychiatric and alcoholic problems.

[Levels of the training of psychotherapists and results of analytic psychotherapy]. / Niveau de formation des psychothérapeutes et résultats de la psychothérapie analytique.

The purpose of this study was to investigate therapists experience as predictor of psychotherapy outcome. We studied consecutive patients (n = 76) assigned to psychoanalytic psychotherapy after being referred to the Geneva University Psychiatric Center for psychiatric treatment. Fifty-seven subjects were treated by trainees and nineteen had certified psychotherapists. Each treatment was carefully evaluated at intake, at the sixth session and at 1-year follow-up. Those patients treated by trainees appeared to be clearly improved (p < 0.01), but 49.1% of them did not completed the psychotherapy. In addition, increased therapist's training and experience (certified psychotherapist vs trainee) was associated with better global outcome, reduced early termination and more improvement after six psychotherapy sessions (p < 0.01). The present data indicate that increased therapist's experience is associated with more compliance and more improvement after the initial phase of the treatment in psychiatric subjects assigned to psychoanalytical psychotherapy.

[Possible relationship between childhood malaise and psychiatric disorders in adulthood. Preliminary study on an in-patient sample from the psychiatric unit of the general hospital in Pavia]. / Possibili rapporti tra disagio infantile e patologia psichiatrica adulta. Studio preliminare su un campione di utenti del SPDC di Pavia.

The authors report the preliminary data of a study which aims to identify the variables (socio-demographic, clinical and nosographic) which may be used to predict the evolution of psychiatric disorders. A retrospective follow-back study was carried out using the medical records and any other documentation available from medical and psychological centers in order to identify the evolutionary stages of disease and possible pre-disease antecedents. The sample group examined was selected from users attending the Diagnosis and Treatment Psychiatric Unit at Pavia Hospital who were found to have undergone infantile neuropsychiatric outpatient or hospital treatment during childhood. The preliminary phase of the study reports the results of the first 42 cases. The predictive value of the diagnosis made during childhood emerges from an analysis of the results and consequently emphasises the need to orient Infantile Neuropsychiatric structure not only towards diagnosis and care but also, towards a more strictly therapeutic action.

[Premenstrual syndrome: review of literature]. / La sindrome premestruale. Una rassegna della letteratura.

This is a comprehensive review of recent studies on premenstrual syndrome. The specific purpose of the present paper was to update major premenstrual syndrome related research/clinical issues in the following areas: nosographic validity, diagnostic reliability, clinical assessment, psychobiology, treatment progress. Increasing consensus has addressed the development of both performant assessment instruments and prospective clinical studies as well as careful psychobiologic investigation of the affective disorders/premenstrual syndrome crossroad as valuable directions for future studies. Such a research perspective is discussed in the light of the author's previous work in the field.

[Heart transplantation experience: Rorschach test five years after surgery]. / Sul vissuto del trapianto cardiaco. Analisi di protocolli rorschach a 5 anni dall'intervento.

This paper presents some reflections on the experience of heart transplantation on the basis of Rorschach tests, collected from fifteen patients who underwent cardiac transplantation five years before. We suggest the use of six criteria: responses to Card I; movement (M, MA, m) as a key determinant; importance of surfaces and middle line; responses to Cards IV and VI; responses to Card X; complexual response, if present. Performances show problems related to the integration of the acquired organ. This process is long and difficult but easier in those patients who succeeded in working-through the graft re-acquisition.