RESUMO
BACKGROUND: Several studies suggested that anxiety can significantly affect the outcome of schizophrenia. Despite this evidence, non-pharmacological interventions targeting anxiety are still heterogenous. This study aims to test the efficacy of a novel training specifically designed to target anxiety in patients with schizophrenia. Innovatively, this training, beyond psychoeducation and problem solving, also targets Theory of Mind, as it provides coping strategies. METHOD: Twenty-seven outpatients with schizophrenia received a novel rehabilitative training targeting anxiety (Anxiety Management Group [AMG]) combined with a Computer-Assisted Cognitive Remediation (CACR), and twenty received CACR plus a control intervention (Control Newspaper discussion Group [CNG]). All patients were assessed at baseline and after treatment for quality of life, neurocognition and anxiety. RESULTS: After training, patients treated with AMG+CACR showed significantly greater improvements on anxiety. A significant increase in quality of life was observed only for AMG+CACR group. Moreover, the participants' appraisal showed a significant difference between treatment groups with higher ratings among patients who received the AMG+CACR. CONCLUSIONS: This study thus suggests feasibility and efficacy of the proposed intervention, that could be implemented in rehabilitative programs for patients with schizophrenia with potential benefits also on disease course and outcome.
Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Qualidade de Vida/psicologia , Esquizofrenia/terapia , Adulto , Ansiedade/etiologia , Ansiedade/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/complicações , Resultado do TratamentoRESUMO
BACKGROUND: Cognitive Remediation represents the best available tool to treat cognitive deficits in schizophrenia and evidence suggests an effect also on global functioning. However, the relationship between cognitive and functional improvement is not yet fully elucidated: do cognitive changes need to be of a definite size and/or encompass a certain number of domains in order to impact on daily functioning? This study aims to explore the role of cognitive improvement, evaluated both quantitatively and qualitatively through the use of Italian equivalent scores, on the daily functioning of patients. As secondary goal, the influence of demographic, clinical and neuropsychological variables on functional outcome was also systematically investigated. METHODS: One hundred subjects with a diagnosis of schizophrenia underwent 36 sessions of Cognitive Remediation and were evaluated at baseline and after the training with the Brief Assessment of Cognition in Schizophrenia and the Quality of Life Scale. RESULTS: A total of 70% of patients improved in at least one cognitive domain and over 50% obtained a normalized score. Among the clinical and neurocognitive factors examined, the only significant predictor of quality of life's improvement was the proportion of cognitive functions that reached an equivalent score of "normal". CONCLUSIONS: This study suggests that improvements in daily functioning depend on the achievement of a cognitive profile as much as possible "normal", harmonious and balanced, supporting the idea that a qualitative leap in cognition is needed in order to gain an advantage in real life activities.
Assuntos
Atividades Cotidianas/psicologia , Remediação Cognitiva/métodos , Ensino de Recuperação/métodos , Esquizofrenia/reabilitação , Logro , Adulto , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Esquizofrenia/diagnóstico , Psicologia do EsquizofrênicoRESUMO
BACKGROUND: Neurocognitive and social cognitive impairments represent important treatment targets in schizophrenia, as they are significant predictors of functional outcome. Different rehabilitative interventions have recently been developed, addressing both cognitive and psychosocial domains. Although promising, results are still heterogeneous and predictors of treatment outcome are not yet identified. In this study we evaluated the efficacy of two newly developed social cognitive interventions, respectively based on the use of videotaped material and comic strips, combined with domain-specific Cognitive Remediation Therapy (CRT). We also analysed possible predictors of training outcome, including basal neurocognitive performance, the degree of cognitive improvement after CRT and psychopathological variables. METHOD: Seventy-five patients with schizophrenia treated with CRT, were randomly assigned to: social cognitive training (SCT) group, Theory of Mind Intervention (ToMI) group, and active control group (ACG). RESULTS: ANOVAs showed that SCT and ToMI groups improved significantly in ToM measures, whereas the ACG did not. We reported no influences of neuropsychological measures and improvement after CRT on changes in ToM. Both paranoid and non-paranoid subjects improved significantly after ToMI and SCT, without differences between groups, despite the better performance in basal ToM found among paranoid patients. In the ACG only non-paranoid patients showed an improvement in non-verbal ToM. CONCLUSION: Results showed that both ToMI and SCT are effective in improving ToM in schizophrenia with no influence of neuropsychological domains. Our data also suggest that paranoid symptoms may discriminate between different types of ToM difficulties in schizophrenia.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Avaliação de Resultados em Cuidados de Saúde , Esquizofrenia/fisiopatologia , Esquizofrenia/reabilitação , Percepção Social , Teoria da Mente/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicologia do EsquizofrênicoRESUMO
BACKGROUND: A Metacognitive Training for Schizophrenia patients (MCT) was developed to target the cognitive biases that characterize the illness. Results suggest positive MCT effects encompassing several aspects of psychopathology and subjective well-being. There are still open questions concerning the effect on different cognitive biases and the interplay between them and both psychopathology and neurocognition. Specifically, the bias against disconfirmatory evidence (BADE) has never been tested in previous trials on MCT. In this study we evaluated the feasibility of MCT combined with a cognitive remediation therapy (CACR) in schizophrenia and its effect on BADE. Moreover, we investigated the relationships between BADE and both neuropsychology and psychopathology, taking into account mutual influences on the degree of improvement. METHODS: Fifty-seven schizophrenia outpatients were randomly assigned to CACR + control group or MCT+CACR and assessed at baseline and after treatment for psychopathology, neurocognition and BADE. RESULTS: After MCT+CACR patients showed significantly greater improvements on BADE. Although BADE baseline performances correlated with several cognitive domains, no association was found between BADE improvement and neurocognitive nor psychopathological measures. CONCLUSIONS: This study enlightened for the first time the efficacy of MCT+CACR on BADE in schizophrenia, suggesting the importance to develop a more specific intervention tailored on individual needs of patients.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Metacognição , Testes Neuropsicológicos/estatística & dados numéricos , Esquizofrenia/reabilitação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distorção da Percepção , Escalas de Graduação Psiquiátrica , Psicologia do EsquizofrênicoRESUMO
The authors report a case of cystadenocarcinoma of the biliary tract, an uncommon tumor of the liver. A 68 aged white Caucasian jaundiced male subwent intervention for a tumor of the 4th hepatic segment. Forty-two months after discharge he is still alive without any secondary lesion. On the 16th follow-up month a prostatic malignancy was diagnosed. Differential diagnosis with other cystic lesion is an exacting and difficult target. Usual techniques such as US, CT, NMR infrequently get a correct diagnosis. Often only in surgical room a real diagnosis is achieved. In the aim to avoid tumor relapse the best surgical procedure is a large hepatic resection.
Assuntos
Cistadenocarcinoma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Idoso , Cistadenocarcinoma/patologia , Cistadenocarcinoma/cirurgia , Diagnóstico Diferencial , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Segunda Neoplasia Primária/patologia , Neoplasias da Próstata/patologia , Fatores de TempoRESUMO
The authors report a case of primary adenocarcinoma arising in the jejunal limb of a Roux-en-Y esophago-jejunostomy in a 76-years-old Caucasian woman. She was affected by esophageal achalasia and in another surgical department underwent gastric resection for adenocarcinoma 6 months before admission. A total gastrectomy performed was due to severity of achalasia symptoms conditioning a high degree of malnutrition. Two years after discharge the patient underwent surgery for total dysphagia, epigastric pain and inexorable weight loss. Histological response was adenocarcinoma of the long arm of Roux-en-y loop. Primary malignancies of the jejunum and ileum are extremely rare and many pathogenetic hypotheses were done but none of them received clinical or experimental demonstration. Symptoms are not specific and diagnosis is difficult and late, x-rays and endoscopy leading to it, US, CT and MNR are useful for differential diagnosis and staging. Prognosis is severe. Surgical therapy is large resection, if possible, but often it is only palliative.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Jejuno/diagnóstico , Segunda Neoplasia Primária/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Anastomose em-Y de Roux , Diagnóstico Diferencial , Esofagostomia , Evolução Fatal , Feminino , Humanos , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Jejunostomia , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
Isolated traumatic laceration of the azygos vein is a rare condition that is mainly associated with violent deceleration traumas. Diagnosis is crucially based on radiologic evidence of massive right pleural bleeding and hemorrhagic shock. Surgical exploration needs to be early and concomitant with resuscitation, prognosis largely depending on timely intervention. Median sternotomy provides the most advantageous access because it can be quickly performed and allows for surgical exploration.
Assuntos
Veia Ázigos/lesões , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Adolescente , Feminino , Seguimentos , Hemostasia Cirúrgica , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Radiografia Torácica , Ressuscitação , Ruptura , Esterno/cirurgia , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Toracotomia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
The authors present a case of malignant adrenal phaeochromocytoma incidentally discovered 14 years after a similar finding in the controlateral adrenal gland. The rarity of incidentally discovered malignant adrenal phaeochromocytoma (second report in the literature) and the importance of isotope scan with MIGB for the investigation of asymptomatic and nonfunctioning phaeochromocytomas are outlined.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Segunda Neoplasia Primária/diagnóstico por imagem , Feocromocitoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Feocromocitoma/patologia , Feocromocitoma/cirurgia , Cintilografia , Tomografia Computadorizada por Raios XRESUMO
Isolated intrahepatic lithiasis is a very rare condition in western countries; the reported case has to be added to the 29 cases described to date in the literature. The pathogenesis of this disease is unknown; physical and chemical bile alterations favouring lithogenesis is the most reliable hypothesis. In this case the Roux-en-Y hepaticojejunostomy with cutaneous stoma allowed us to perform periodic cleaning of intrahepatic bile ducts until complete elimination of all stones.
Assuntos
Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colelitíase/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiografia , Colelitíase/cirurgia , Feminino , Humanos , Jejunostomia , Pessoa de Meia-IdadeRESUMO
Isolated intrahepatic lithiasis is a very rare condition in western countries; the reported case has to be added to the 29 cases described to date in the literature. The pathogenesis of this disease is unknown; physical and chemical bile alterations favouring lithogenesis is the most reliable hypothesis. In this case the Roux-en-Y hepaticojejunostomy with cutaneous stoma allowed us to perform periodic cleaning of intrahepatic bile ducts until complete elimination of all stones.
Assuntos
Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Cálculos/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/cirurgia , Cálculos/cirurgia , Colangiografia , Coledocostomia , Diagnóstico Diferencial , Feminino , Cálculos Biliares/diagnóstico por imagem , Humanos , Cuidados Intraoperatórios , Hepatopatias/cirurgia , Pessoa de Meia-IdadeRESUMO
Twenty-four-hour home esophageal pH monitoring is proposed in order to study gastroesophageal reflux (GER) so that prolonged use of costly hospital equipment and staff can be curtailed and the diagnostic accuracy of the examination improved. Eighty-six patients affected by GER symptoms and 20 healthy volunteers underwent 24-hr home esophageal pH monitoring, x-rays, and endoscopy of the upper gastrointestinal tract to investigate reliability of outpatient recording. Fifteen more patients consecutively underwent out- and inpatient recording to detect possible differences between these methods in the two daily periods. Outpatient monitoring was well tolerated in 94.7% of the patients; 14.3% of them markedly reduced their routine activities. The range of normality of outpatient recording does not differ from that of inpatients. In the 15 patients who consecutively underwent out- and inpatient monitoring, no significant differences were reported. The sensitivity of 24-hr home esophageal pH recording is 0.85, the specificity 1, the accuracy for negative prediction 0.68, and the accuracy for positive prediction 1. The reliability of 24-hr home esophageal pH monitoring is comparable to inpatient recording. It allows hospital cost reduction and is also better tolerated by patients but has not greatly improved the diagnostic accuracy of the gastroesophageal reflux pH monitoring.
Assuntos
Refluxo Gastroesofágico/diagnóstico , Concentração de Íons de Hidrogênio , Monitorização Fisiológica/métodos , Adulto , Idoso , Esôfago/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
The choice of therapy--whether medical or surgical--for patients with gastroesophageal reflux (GER) is often a subject of debate. After a period in which surgery was almost the exclusive mode of treatment in patients with severe complications resulting from GER or in patients who did not respond to medical therapy, long-term follow-up showed that in 20 cases of GER in which only medical treatment was given, a progressive shortening of the esophagus--frequently in the absence of esophagitis--had developed. To investigate the pathophysiology of acquired short esophagus, we studied 34 patients--20 from the initial group and 14 who already had this condition. Clinical assessment consisted of interview, radiologic examination of the upper digestive tract, endoscopic and histologic examinations, and 24-hour home esophagogastric pH monitoring. We noted that acid GER causes shortening in the presence of severe mucosal lesions, while "nonacid" GER--a combination of gastric, pancreatic, and hepatic secretions--causes shortening of the esophagus even without evident mucosal lesions. Symptom evaluation, acid GER pH recording, and endoscopy are not sufficient for determination of the current choice of therapy. It is also important to quantify GER that results from the mixing of gastric and biliopancreatic secretions with use of the esophagogastric pH recording. This should reduce the possibility of silent shortening of the esophagus.
Assuntos
Refluxo Gastroesofágico/fisiopatologia , Adulto , Idoso , Endoscopia , Junção Esofagogástrica/fisiopatologia , Feminino , Refluxo Gastroesofágico/diagnóstico por imagem , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/cirurgia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
The authors analyze their experience in the management of 64 cases of Crohn's disease, located in the colon in 47 cases. The clinical and therapeutical aspects are discussed with particular attention to the surgical problems for which even today there is no general consensus of opinion especially when the colon is involved.
Assuntos
Colo/cirurgia , Doença de Crohn/cirurgia , Adulto , Colectomia , Colite/cirurgia , Feminino , Humanos , Ileostomia , Masculino , Reto/cirurgia , RecidivaAssuntos
Doença de Crohn/cirurgia , Adulto , Colite/cirurgia , Feminino , Humanos , Masculino , Métodos , Recidiva , ReoperaçãoRESUMO
Gastric lymphomas are still diseases for which no clear picture is available, owing to their anatomical, pathological, clinical, radiological, and endoscopic polymorphism. Reference is made to 28 cases observed over about 20 years in a discussion of the clinical diagnosis and treatment of these neoplasias. The results are compared with those obtained in cases of gastric carcinoma, which has a markedly poorer prognosis.