Psychoanalysis and art: artistic representations in patients' dreams.

The authors explore the psychic passages that were opened up within a patient, Ada, thanks to her contact with two works of art, Signorelli's frescoes in Orvieto and Picasso's painting La Nageuse--their themes, formal structures, and the conventions governing their creation. A work of art can be considered as a kind of window that allows one to look upon the imaginary world created by the artist. One can peer out of this window from the other side, permitting a look at the viewer (the patient), who is caught in a web of associations that are yet to be explored.

Type D personality impairs quality of life, coping and short-term psychological outcome in patients attending an outpatient intensive program of cardiac rehabilitation.

BACKGROUND: Type D personality represents a risk factor for adverse outcome and impaired Quality of Life (QoL) in CHD patients. Only few studies investigated Type D patients following cardiac rehabilitation (CR). No study investigated Type D personality in Italian patients attending a CR program of 4 weeks. The aims of the study were a) to verify the presence of Type D personality among patients attending an Italian CR program; b) to investigate psychological health status, QoL and coping style of CR patients and c) to test the influence of Type D personality on CR patients outcome. METHODS: Data from 59 patients attending an outpatient intensive program of 4 weeks of CR were collected at admission, and 1 month after discharge, using a set of self-report questionnaires. Variables were measured using CBA-H, DS-14, Q-LES-Q and Brief COPE Scale. RESULTS: The percentage of Type D personality found in the study sample was 39%. At admission Type D patients showed a significant lower level of psychological health status and QoL satisfaction compared to non Type D patients (p<0.05). After CR a significant percentage of Type D patients, despite an overall improvement, continued to show a clinically relevant psychological impairment in terms of anxiety (p=0.003), depressive mood (p=0.001), impairment in psychophysical well-being (p=0.002), perceived psychophysical stress (p=0.002), interpersonal difficulties (p<0.001), and social anxiety (p=0.045). Type D personality was also found to be associated with a significant greater use of maladaptive coping strategies (p<0.05). CONCLUSIONS: Type D personality played a significant clinically relevant role on psychological health outcome in CR. Type D personality patients reported a significant higher level of psychological impairment, in terms of anxiety, depressive mood, impairment in psychophysical wellbeing, perceived psychophysical stress, interpersonal difficulties, social anxiety, and a significant lower QoL, prior and after CR. Type D personality seemed also to be associated with maladaptive coping strategies. Importance of assessment for Type D personality is warranted in CR setting, as additional interventions seem required to enhance the outcome of these patients defined in letterature at high-risk.

Recurrent renal colic in young people: abdominal Munchausen syndrome--a diagnosis not to forget.

The Munchausen's syndrome (MHS) is a rare psychiatric disorder classified among the self-manipulated diseases. Incidence of Munchausen syndrome peaks in young-to-middle-aged adults, but it has been reported in patients of all ages (ie, childhood through advanced age). Diagnosing Munchausen syndrome is very difficult, but early diagnosis could to a considerable extent prevent the iatrogenic risks. Indeed, the management of Müchhausen syndrome is aggravated by the low compliance in these patients. We report an unusual case of MHS in urological practice, in order to demonstrate that the MHS is an underestimated and laborious to diagnose syndrome. A 25-year-old single female affected by recurrent episodes of renal colic was admitted to our institution, reporting right acute flank pain and at least two previous periods of hospitalization due to bilateral acute flank pain with no evidence of urinary calculi or either morphological or functional alterations. Neither the urodynamic study nor abdominal CT scan nor pelvic NMR revealed any morphological or functional alterations. In order to exclude a multiple sclerosis, an encephalic NMR and neurological evaluation were also performed. At this stage, suspicion was raised regarding the possible factitious nature of her problem and a psychiatric consultation was made. On the basis of psychiatric consultation and the symptoms resolution with simple intravenous saline solution infusions, the diagnosis of factitious illness (Munchausen syndrome) was confirmed. In the present case report, we stress the fact that the MHS is an underestimated medical problem and the necessity to evaluate the possible role of psychiatric disorders in the absence of pathological findings.

Delusion, narrative, and affects.

Delusions and narrations have very different communicative characteristics. Delusion, when reported, places itself outside of a shared communication, of an interactive field; it is presented as an absolute, non-modifiable, saturated truth, that can only be believed or refuted. A clinical vignette is an example on the possibility that psychoanalytic treatments might be sometime able to at least partly transform a delusion into an account narrated in an interactive situation. The possibility of treatment of a delusion by means of psychotherapy, which deals both with the delusion as a symptom and with the structures underlying it, by creating a relationship whose development can leave the person free to shed his or her delusion, should caution us against too hastily declaring that symptom inaccessible and thus considering it-as not infrequently happens -a sort of "marker" denoting a pathology which, from a psychological perspective, cannot be treated.