Depression in the early phase of MS: influence of functional disability, cognitive impairment and brain abnormalities.

This study investigated the relationship between depression, physical disability, cognitive deficit and brain abnormalities on magnetic resonance imaging (MRI) in patients with early MS. Eighteen relapsing-remitting MS patients were evaluated: depression was diagnosed according to DSM-III R and measured by the MMPI depression subscale, physical disability was assessed by using the Kurtzke Expanded Disability Status Scale (EDSS) and cognitive functions by means of an extensive neuropsychological test battery. A neuroradiologist blinded to clinical findings quantified cerebral lesion on MRI. Weighted brain area lesion score were developed according to number and size of cerebral lesions. On the basis of DSM-III criteria, six patients were classified as having major depression, seven patients had minor depression and five patients were without depressive symptoms. No significant differences were found among the three groups on both neuropsychological performances and weighted MRI lesion scores. However patients with major depression exhibit greater physical disability than the other MS subgroups. A significant correlation was found between MMPI depression subscale and physical disability. This study suggests that at least in the early phase of MS, depression appears more related to the physical disability than to the severity of pathological brain involvement.

Typology of interactive models in depression.

Despite the increasing diffusion of the illness there is poor systemic investigation in the area of depression. This study examines the typology of interactive models of the depressed patient in the couple relationship, with the family of origin, the children, the outside world and the therapist. The couple relationship usually becomes an helping relationship with the depressive patients that assumes the "care eliciting" while the partner develops the "care giving" attitude. Sequential disqualification and negative self fulfilling prophecy are as well typical of the depressive couple. An intrusive bind with families of origin is very often activated by depressive behavior, and a transgenerational competition for taking care of one relative's chronic inability may rise. Some guidelines for a specific therapeutic strategy for depressive families together with some case examples are given. The role of the therapist's own depressive feelings when working with this type of families is considered.

Relationship patterns in "folie à deux".

"Folie à deux" is characterized by the communication of delusional ideas from one subject to other ones who have been living closely with him for a long time, usually his relatives. Before illness shows, there is a leader-follower relationship between partners, who are lacking of external sources of pleasure and are socially or culturally isolated. The dominating partner usually is a paranoic subject who strongly needs his ideas to be accepted by other people, while the dominated partner is a dependent subject who shares the other one's ideas in order to get pleasure from him and who is not able to criticize these ideas because of the lack for external influences. The two partners project hostility into the external world because, if the dominated partner does not share the other one's ideas, hostility will be projected into him and he will become very anxious. Interpersonal mechanisms in "folie à deux" are similar to those which take place in brainwashing, hypnosis and psychotherapy.

Typologies of family reaction to pediatric malignancies.

The psychologic adaptation of children with malignancies is influenced by the strategies that both the relatives and the other members of the family employ as a reaction towards the disease and the therapeutic progress. Our experience in the Department of Hematology of the University "La Sapienza": by carefully observing the communication styles, the distribution of roles, and the modification of the family organization up to the eventual adaptation to the disease, we have been able to identify various reaction typologies of the family, and also to evaluate their frequency and their varying functionality with time. A thorough analysis of these modalities of reaction may allow prompt recognition of problems related with psychologic and social adaptation of both the pediatric patient and his family, and may allow the adoption of pertinent strategies of intervention, in order to guarantee a better compliance throughout the whole therapy.

Interactive patterns in the schizophrenic family during hospitalization.

Our research is based on the cases of 40 patients diagnosed as schizophrenics and the patterns of their family interaction at the moment of the hospitalization, in order to formulate an initial analysis of the reason of admission as the first phase in a therapeutic process. With this intent the authors have conducted a catamnestic research on the charts of patients who have been divided in three groups according to the presence or absence of the parents. The following variables have been therefore taken into consideration: the referrals, her/his behavior at the moment of hospitalization, expectations and difficulties in widening the field of observation within the family.

Interactive typology of the hypochondriacal patient.

Many authors agree on the idea that the affective and behavioural characteristic of a certain type of family encourages the use of the body as a primary means of communication with others. This way of communicating has usually been acquired during childhood and later, in the adult life, it appears again in the different social contests. Some authors like Alby, Levy, Baker, Parker, Lipscombe, Marcelli, Bianchi and others focus on this type of family interaction and the single characteristic of the personalities of each family member. These authors describe some relationship patterns used by hypochondriac patient such as: avoiding unpleasant situations, blaming others, adopt a sick-role as a way of controlling the relationship between existential events and somatic symptoms; relationship with physicians and the need to confirm her/himself.