Biomedical subjects

G Masi

Publications and source records attributed to G Masi.

At least 19 recordsLinked to original sources

PubMed2000

Depressive comorbidity in children and adolescents with generalized anxiety disorder.

Aim of this study is to examine the effect of depressive comorbidity in 108 children and adolescents with Generalized Anxiety Disorder (GAD). Fifty-five patients with GAD and depression were compared with 53 patients with GAD without depression. Age, gender and socioeconomic status did not differentiate the groups. Patients with comorbid depression had significantly more anxiety symptoms than patients without depression. Clinical presentation of GAD and pattern of comorbidity was similar in the two groups. Subjects with comorbid depression showed a more severe functional impairment, assessed with C-GAS. Data are discussed in the light of conceptualizations about the relationship between anxiety and depression.

Adolescent↗

PubMed2000

Depression and school functioning in non-referred adolescents: a pilot study.

Self-image and self-perceived competencies have been considered to be related to depression in childhood and adolescence. Data from literature points to school functioning as one of the most important factors in self-esteem and self-worth during adolescence. Academic self image, defined as the way adolescents represent themselves as students, directly affects the global self-image; for this reason it has important psychopathological implications. The major aim of this preliminary report is to specifically analyze the relationship between academic self-image (assessed with a specific questionnaire), and self-reported depressive symptoms (assessed with the Children's Depression Inventory) in a school sample 150 adolescents. Our data indicate that the emotional beliefs about schooling and learning were significantly related to depressive symptomatology. Females scored higher in CDI and school anxiety. A real school failure did not affect the academic self image. These data seem to suggest that different components of the academic self-image can be differently associated with depressive feelings.

Adolescent↗

PubMed2000

Generalized anxiety disorder in adolescents and young adults with mild mental retardation.

This report examines clinical features of generalized anxiety disorder in adolescents and young adults with mild mental retardation (MR), compared with children and adolescents with normal IQ. Frequency of symptoms, comorbidity, agreement between reports of subjects and parents, correlation between IQ and severity of disorder, and comparison between frequency of symptoms in the experimental and control groups are described. Twenty-two subjects with MR (12 males and 10 females aged 11-25 years; mean age = 16.3), 30 children (19 males and 11 females aged 7-11.11; mean age = 10), and 30 adolescents (18 males and 12 females aged 12.1-18; mean age = 15.2) participated in the study. All the subjects were comprehensively diagnosed with diagnostic interviews (K-SADS or DICA-R). According to our data, generalized anxiety disorder can be diagnosed in adolescents with mild MR, with high agreement between self-reports and parent reports. Phenomenology of GAD in mildly developmentally delayed persons grossly paralleled that of normal IQ people, except for brooding, somatic complaints, and sleep disorders. Number and severity of symptoms did not correlate with Full Scale and Verbal IQs. High rates of comorbidity with depression were evident both in normal IQ and in developmentally delayed subjects.

Adolescent↗

PubMed2000

The Kleine-Levin syndrome as a neuropsychiatric disorder: a case report.

The Kleine-Levin syndrome (KLS) is characterized by periodic, sudden-onset episodes of hypersomnia, compulsive hyperphagia, and behavioral-emotional disorders (typically indiscriminate hypersexuality, irritability, impulsive behaviors), lasting from a few days to a few weeks, with almost complete remission in the intercritical periods. Depression, confusion, and thought disorders are frequently associated with the critical symptomatology, and they may suggest other psychiatric diagnoses (schizophrenia, mood disorder, conversion disorder) or a substance abuse. A diencephalic-hypothalamic dysfunction is suspected, even if this composite symptomatology cannot easily be linked to a simple mechanism. The aim of this article is to illustrate problems in differential diagnosis, using a case approach. History, course, and therapeutic intervention in a 21-year-old patient with KLS, associated with a clear psychiatric symptomatology and a critical affective pattern, is reported. Psychiatric correlates of KLS are discussed, including the relationship with affective disorders and the possible emotional impact of the attacks. Implications regarding a combined psychological and pharmacological treatment are also discussed.

Adult↗

PubMed1999

Suramin in combination with weekly epirubicin for patients with advanced hormone-refractory prostate carcinoma.

BACKGROUND: Suramin and epirubicin are both active agents in the treatment of patients with hormone-refractory advanced prostate carcinoma, with demonstrated antitumor synergism in vitro on human prostate carcinoma cells and different dose-limiting toxicities. The authors conducted this Phase II study to determine the feasibility, toxicity, and antitumor activity of suramin in combination with epirubicin. METHODS: Only patients with hormone-independent advanced prostate carcinoma who had progressive disease after the last therapeutic maneuver they had undergone, including antiandrogen withdrawal, entered the study. Suramin was administered initially as a 6-day continuous infusion for 10 consecutive weeks and then for 6 days every 28 days for a maximum of 6 months. Doses were determined by a computer-assisted dosing system that used Bayesian pharmacokinetics to maintain suramin plasma concentrations of 200-250 microg/mL. Cortisone acetate 25 mg, administered at 8 a.m. and 8 p.m. daily, was begun 4 weeks after the initiation of suramin therapy. Epirubicin 25 mg/m2 was given as a weekly intravenous bolus beginning on Day 1 and was continued for a maximum of 6 months. RESULTS: Twenty-six patients entered the study. Toxicities mainly included World Health Organization Grade 1-2 nausea, fatigue, anorexia, neutropenia, peripheral neuropathy, creatinine elevation, proteinuria, and prolonged prothrombin time, whereas Grade 3 toxicities were uncommon. Among 11 patients with measurable disease, 3 (27%) demonstrated an objective response. Among 24 patients evaluated for prostate specific antigen (PSA) response, 8 (33%; 95% confidence interval 16-55%) had a > or =50% decrease in PSA levels, which lasted a median of 32 (range, 8-52) weeks. Median progression free and overall survival were both 8 months. CONCLUSIONS: The combination of suramin and epirubicin used in the current study is feasible, is associated with moderate toxicities, and has antitumor activity in advanced hormone-refractory prostate carcinoma. However, the results obtained with this combination do not represent major improvements in the treatment of patients with this disease, compared with suramin or epirubicin alone or other available treatments.

Aged↗

PubMed1999

Protracted continuous infusion of 5-fluorouracil and low-dose leucovorin in patients with metastatic colorectal cancer resistant to 5-fluorouracil bolus-based chemotherapy: a phase II study.

Continuous-infusion (c.i.) 5-fluorouracil (5-FU) can overcome resistance to bolus 5-FU, and leucovorin (LV) enhances the cytotoxic effects of 5-FU, mainly when the duration of exposure to the latter is prolonged. The main objective of this study was therefore to determine the activity of a prolonged infusion schedule of 5-FU + LV in patients with metastatic colorectal cancer resistant to a 5-FU bolus-based chemotherapy. Only patients with metastatic measurable disease in progression during or within 2 months of the end of a 5-FU bolus +/- LV-based chemotherapy were eligible for the study. 5-FU and l-LV were given as a 14-day c.i. every 28 days, the 5-FU dose being 200 mg/m2 per day and the l-LV dose being 5 mg/m2 per day. A total of 59 patients entered the study, of which 48 were resistant to 5-FU + LV and 11, to 5-FU + levamisole. Treatment was well tolerated, and WHO grade 3-4 toxicities were uncommon (11% of patients developed stomatitis and 7%, diarrhea). According to an intent-to-treat analysis, 10 of 59 patients obtained an objective response (1 complete response, 9 partial responses), for an objective response rate of 16% (95% confidence interval 8-25%). The median progression-free survival and overall survival were 4 and 9 months, respectively. The protracted 5-FU + LV c.i. schedule used in the present study is a well-tolerated and moderately active regimen in metastatic colorectal cancer patients resistant to 5-FU bolus +/- LV. Only randomized studies can determine whether this palliative treatment has advantages in comparison with other second-line therapies such as 5-FU c.i. without LV, irinotecan, or oxaliplatin.

Adult↗

PubMed1999

Psychopathological aspects of cryptorchidism in children and adolescents.

In the male sexual and aggressive drives are mostly centered on the penis, whose real or fantasied features strongly affect the way children and adolescents build up their own personal and gender identity. In some clinical conditions a shift of genital centrality from penis to testicles is evident. The most frequent is abnormality in the descent of testicles, especially cryptorchidism, characterized by an arrested descent of one or two testicles that remain in the abdomen. The aim of this paper is to define mechanisms by which cryptorchidism increases psychological vulnerability. Time of diagnosis and treatment, restoration of genital integrity, personality stability and familial interactions are considered as elements affecting psychopathological outcome. Behavioral and psychological features in children and adolescents with cryptorchidism are reviewed. A case report of an adolescent with unilateral cryptorchidism is reported and discussed, as an example of pubertal distortion in bodily and gender identity.

Adolescent↗

PubMed1999

Dysthymic disorder in adolescents with intellectual disability.

The present report examines the clinical features of dysthymic disorder in a sample of adolescents with mild intellectual disability (ID). Frequency of symptoms, comorbidity, agreement between reports of subjects and parents, comparison between the frequency of depressive symptoms in subjects with ID and in two different groups of normal IQ dysthymic subjects (aged 7-11, 11 and 12-18 years) are described. The sample consisted of 12 subjects (age range = 12-25.6 years; mean age = 16.3 years) screened from unselected consecutively referred patients with mild ID. All the subjects were comprehensively diagnosed with a structured diagnostic interview, the Kiddie-Schedule for Affective Disorder and Schizophrenia (K-SADS), according to DSM-IV criteria. A symptomatic profile in the group with ID showed that intrapsychic and cognitive symptoms, such as depressed mood, irritability, pathological guilt and low self-image, were frequently reported in people with ID. Parents were less aware of depressed mood, but they reported high rates of low self-esteem; the agreement between the depressive reports of ID subjects and their parents was higher than in previous findings in normal IQ children. The symptomatic profile of subjects with ID was more comparable to that of prepubertal dysthymic children than that of dysthymic adolescents, but more significant are the analogies between dysthymic disorder in ID and normal IQ subjects. High rates of comorbidity with generalized anxiety disorder were evident in the group with ID. According to the present data, dysthymic disorder can be diagnosed in adolescents with mild ID. The K-SADS clinical interview seems to be a reliable instrument for the diagnosis and clinical definition of depressive symptomatology in this special population.

Adolescent↗

PubMed1999

Infusions of fluorouracil and leucovorin: effects of the timing and semi-intermittency of drug delivery.

Preclinical and clinical studies have demonstrated that the circadian modulation of 5-FU delivery may reduce toxicities and improve antitumor activity. However, the relative importance of the timing of 5-FU delivery has not been clinically addressed. The aims of this study were to determine the toxicities, the maximum tolerable doses and the activity of a regimen with 5-fluorouracil (5-FU) and leucovorin (LV) administered as a 14-day continuous infusion according to a flat or three different chronomodulated rhythms in patients with metastatic gastrointestinal carcinomas. A total of 113 patients entered the study and their characteristics were comparable among the four groups. Toxicities included mainly stomatitis and diarrhea, and a reduced toxicity was observed in all the three chronogroups that allowed the delivery of higher dose intensities. Response rates were not significantly different among the four groups. These results suggest that a reduction in 5-FU+LV toxicity and an increase in 5-FU dose intensity can be obtained by a nonsinusoidally circadian modulated infusion. However, the reduction in toxicity observed seems to be dependent mainly on the quasi-intermittency and not on the timing of 5-FU+LV delivery.

Adenocarcinoma↗

PubMed1999

Emotional and cognitive aspects in adolescence-onset school difficulties.

Learning disorders in adolescence can become a significant risk factor for psychopathology. The paper investigates emotional and cognitive patterns in adolescents with learning disorders. The first part of the study describes the impact of child-onset learning disorders on adolescence passage. In the second part four clinical conditions that can determine adolescence-onset learning disorders are outlined. These are adolescent turmoil, intellectual inhibition, delay in reasoning development and metacognitive dysfunctioning. Cognitive, emotional and behavioral features of these conditions are discussed, in terms of diagnostic and therapeutic implications.

Adolescent↗

PubMed1999

Adolescents with congenital heart disease: psychopathological implications.

The psychopathological risks of congenital heart disease in adolescence are described. The emotional development of adolescents with cardiopathy is discussed, including distortions in body image and separation-individuation issues. The consequences of cyanotic and acyanotic cardiopathies for intellectual functioning are noted, and the impact of congenital heart disease on interactions with parents and siblings is presented. Psychopathological implications of heart transplant are also reviewed.

Adolescent↗

PubMed1999

Panic disorder in children and adolescents.

Panic disorder (PD) is a well-known and frequently described psychiatric disorder in adults, that can cause clinically significant distress and impairment of social and occupational functioning. It is characterized by a discrete period of intense fear and discomfort, that develops abruptly and reaches a peak in 10 minutes or less, with other somatic and cognitive symptoms. PD in prepubertal children and early adolescents in rarely reported, but 18% of adult patients with PD indicate onset of PA before 10 years of age. Probably many of the prepubertal cases are being misdiagnosed, and/or they can have a different clinical expression from adults. The lack of identification of these affected subjects can have serious consequences on social and academic development. The aim of this paper is to review clinical literature describing PD in children and adolescents. Prevalence, specificity of clinical features, comorbidity, instruments for diagnosis are described. Directions in pharmacological, psychotherapeutic and educational management of PD in children and adolescents are suggested.

Adolescent↗

PubMed1998

Depressive disorder in children and adolescents.

Depression is a relatively common health issue in children and adolescents. Different pathogenetic factors are implied: genetic, biological, psychological and environmental. The core symptoms of depression are the same for children, adolescents and adults but the prominence of characteristic symptoms changes with age. The clinical picture of depression according to age level is described in different types of mood disorders (major depressive disorder, dysthymia, bipolar disorder) and in mental retardation. Over half of the youths with depression have comorbid conditions: anxiety disorders, other mood disorders, attention deficit/hyperactivity disorder, and conduct disorders. Different factors affect the natural course and risk of suicide. Assessment procedures of depression and comorbid conditions include a psychiatric evaluation of the depressed subject and his family, structured interviews and specific rating scales. A comprehensive treatment strategy, psychoeducational, psychotherapeutic and psychopharmacological, is proposed.

Adolescent↗

PubMed1998

School failure in early adolescence: the psychopathological risk.

School difficulties and learning disorders in adolescence can become significant risk factors for psychopathology. This study investigates emotional and cognitive patterns in adolescents with school difficulties. Four clinical conditions that can determine adolescence-onset learning disorders are outlined. These are adolescent turmoil, intellectual inhibition, delay in reasoning development, and metacognitive dysfunctioning. Cognitive, emotional and behavioral features of these conditions are discussed in terms of diagnostic and therapeutic implications.

Achievement↗

PubMed1998

Adolescents with borderline intellectual functioning: psychopathological risk.

This paper presents a qualitative analysis of cognitive and emotional functioning in intellectually borderline adolescents (IQ ranging from 71 to 84) and the consequences for personality and social development. Psychopathological risk, particularly in terms of mood disorders, conduct disorders, and intellectual deterioration, is analyzed, with the distinction made between "excited" and "inhibited" forms. Conceptualizations intellectually borderline adolescents have of their own mental functioning are described in light of the notion of cognitive self--the ability to understand and control internal and external reality. The implications for psychotherapy and rehabilitation are discussed.

Adolescent↗

PubMed1998

Psychiatric illness in mentally retarded adolescents: clinical features.

Attempts have been made to establish objective diagnostic criteria for psychiatric disorders in persons with mental retardation. This paper describes the clinical features of the most important psychiatric disorders in mentally retarded adolescents: mood disorders, psychotic disorders, severe behavioral disorders, personality disorders, anxiety disorders, and attention deficit disorder with hyperactivity. The impact of mental retardation on personality development is confirmed by the high psychopathological vulnerability of the mentally retarded. All types of mental disorders can be observed, with an incidence estimated to be at least three or four times higher than in the general population. Adolescence is a particularly important phase for the mentally retarded, since adolescent turmoil can increase the risk of psychopathology.

Adolescent↗

PubMed1998

Clozapine treatment in an adolescent with bipolar disorder.

A 15 year-old adolescent boy with a severe treatment refractory bipolar disorder type I, most recent episode manic, severe with psychotic features had previously required hospitalizations and treatment with lithium and/or carbamazepine and high doses of standard neuroleptics without any response. A treatment with a combined clozapine-lithium therapy was progressively started in a hospital setting (clozapine 300 mg/day; lithium 1350 mg/day). After 15 days a dramatic improvement in mood and psychotic symptoms was evident. After four weeks there was 50% improvement on the BPRS (from 74 to 37). The mean CGAS score changed from 25 to 72. At the CGI-Severity of Illness subscale, a 57% decrease was evident; at the CGI-Global Improvement subscale there was a 75% increase. The only significant side effects were sedation and fatigue, but they were not so severe as to induce a reduction of dosage. The boy was discharged from the hospital after three weeks and successfully returned to school with no modifications in treatment. After a nine-month treatment there was no reoccurrence of psychotic or manic symptoms. The implications of pharmacological therapy in treatment refractory manic episodes with psychotic features are discussed.

Adolescent↗

PubMed1997

Impulsive-reflective cognitive style, metacognition, and emotion in adolescence.

The study investigated the relationship between reflective or impulsive cognitive style, metacognitive functioning, and depression in young adolescents. Metacognitive functioning (metacognitive knowledge about reading and memory, monitoring of text comprehension) and self-reported depressive feelings were analyzed in a group of subjects who showed a Reflective or Impulsive cognitive style. The sample consisted of 56 junior high-school students (Grades 6, 7, and 8) selected from a larger original group of 61 subjects. We excluded from the original group those with an IQ below 75 on both the Verbal and Performance subscales on the short form of the WISC-R, those reported by teachers to have a severe learning disability, and those that did not complete the test battery due to long absences from school. The reflective-impulsive cognitive style was identified with the Matching Familiar Figures Test-20. Using the median of the distribution for both Latency (17 sec. per item) and Errors (9 errors) on this task, the sample was divided in four partially overlapping subgroups: 16 with Impulsive cognitive style (Latency below the median, Errors above the median), 13 with Reflective cognitive style (Latency above the median, Error below the median), 4 fast and accurate (both scores below the median), and 11 slow and inaccurate (both scores above the median). Twelve subjects with one or both scores coinciding with the critical value (median) were excluded. Analysis showed that subjects with Impulsive cognitive style had significantly lower scores than those with Reflective cognitive style in monitoring of comprehension of text. No differences were found on monitoring by eighth graders, irrespective of cognitive style. No differences between the two groups were found in metacognitive knowledge. Subjects with Impulsive cognitive style had significantly higher scores than subjects with Reflective cognitive style on a self-rating scale for childhood depression, the Children's Depression Inventory. The implications of these data are discussed.

Adolescent↗