Biomedical subjects

G Masi

Publications and source records attributed to G Masi.

At least 55 records · Page 3Linked to original sources

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↗

PubMed1997

Paroxetine in depressed adolescents with intellectual disability: an open label study.

The aim of this study was to evaluate the efficacy and side-effects of paroxetine treatment in adolescents with mild intellectual disability and major depressive disorder (MDD). Seven adolescents (14.7-18.4 years of age) were treated with paroxetine (dosage 20-40 mg day-1). Clinical changes were assessed at the beginning of the pharmacological treatment and after 9 weeks utilizing the DSM-IV diagnostic criteria and the Montgomery-Asberg Depression rating Scale (MADRS). Four out of the seven subjects did not fulfil the DSM-IV diagnostic criteria after the 9-week treatment. The mean decrease in the total score on the MADRS was significant (41%). Some items of the MADRS showed significant improvement: inner tension (66%); lassitude (55%); apparent sadness (53%); inability to feel (44%); and reported sadness (43%). Three subjects showed sedation, two subjects gastrointestinal complaints and one subject insomnia; all these symptoms were transitory and not severe. No behavioural activation was evident. This preliminary, uncontrolled study of a few cases suggests that adolescents with intellectual disability and MDD may respond to paroxetine, and that adverse side-effects are mild.

Adolescent↗

PubMed1997

Atypical neuroleptics in the treatment of early onset schizophrenia.

The most complex problems in the use of neuroleptics for schizophrenia are the frequency of nonresponders, the severity of extrapyramidal side effects and tardive dyskinesia, especially in chronic treatment, the persistence of treatment-refractory symptoms, such as negative symptoms. All these problems are more frequent and severe in children and adolescents with early-onset schizophrenia. The classic neuroleptics act on the postsynaptic dopaminergic receptors, especially the D2 receptors, situated in various areas of the Central Nervous System. More recently, the so-called dopaminergic hypothesis of schizophrenia has been criticized and other neurotransmitter systems have been involved, particularly serotonin. The more recently synthesized neuroleptics, with combined action on dopamine and serotonin receptors, have been called atypical neuroleptics; the atypical neuroleptics currently used in clinical practice are clozapine and risperidone. These anti-psychotic drugs are known to be clinically more effective, especially on negative symptoms, have a lower incidence of extrapyramidal side effects, produce significant improvements in some refractory patients. A large number of the studies concern adults; the studies on young populations are much fewer and less rigorous. The aim of this critical review is to describe clinical use of atypical neuroleptics clozapine and risperidone in children and adolescents with early-onset schizophrenia.

Adolescent↗

PubMed1997

Psychiatric illness in mental retardation: an update on pharmacotherapy.

According to the DSM-IV, all types of psychiatric disorders can be observed in mentally retarded subjects, with prevalence estimated to be three or four times higher than in the general population. Clinical features, longitudinal course and triggering factors are influenced by the characteristics of the intellectual disability. The aim of this paper is to discuss the specificity of the psychopharmacological therapy in mental retardation (sensitivity to specific psychotropic drugs, incidence of side effects, predictive criteria for evaluating risk factors, etc.) and to propose an update in the pharmacotherapy in the most important psychiatric disorders (mood disorders, psychotic disorders, behavioral disorders, anxiety disorders, attention deficit disorders with or without hyperactivity.

Antipsychotic Agents↗

PubMed1996

[Cognitive organization in the motor pathology].

The aim of this paper is to describe intellectual performances in children and adolescents with cerebral palsy and with Duchenne muscular dystrophy. Three different forms of cognitive analysis are proposed: a quantitative analysis with the Wechsler scales; a qualitative analysis of reasoning in different levels of development, in a piagetian framework; an analysis of learning processes and school performances.

Cerebral Palsy↗

PubMed1996

Psychotropic medication in adolescence: psychodynamic and clinical considerations.

This study discusses the psychodynamic implications of psychopharmacological treatment in adolescence. A series of clinical situations are presented to illustrate how psychotropic medication may modify the adolescent's relationship with the mental and bodily self, the second separation-individuation process within the family, and the therapeutic relationship between adolescent and psychiatrist. Methodological issues are discussed for fostering a positive treatment outcome. The study suggests that pharmacotherapy should follow a psychopathological evaluation of adolescents and their families.

Adolescent↗

PubMed1996

[Psychopathology of chronic diseases in children and adolescents. Congenital cardiopathies].

A most significant life event in the first years of life is a disease, especially if it is of early onset, severe, life threatening, with an uncertain prognosis, and with the necessity of frequent diagnostic and therapeutic interventions. Psychological implications are a significant parts of the illness, not a marginal component; they can affect prognosis and outcome. The authors describe the different psychological implications of an experience of chronic disease in children and adolescents and their families (parents and siblings). Congenital disease (for example congenital heart failure) has a peculiar significance: since it is diagnosed early, it influences mother-infant interactions from the beginning, in a crucial moment of the infant's psychological development; diagnostic and therapeutical interventions are early and frequent; congenital defects determine the strongest guilt feelings in the parents. Some specific psychological aspects can be described: the weakening of the Bodily self, the inhibition of thinking, the theories the child and the family formulates on the disease, the death feelings. Emotional features in children and adolescents with congenital cardiopathy are described: inhibition of emotions, marked anxiety, depressive reaction, with loneliness, low self-esteem and inadequacy, emotional lability, with oscillation between omnipotence and inadequacy; impulsiveness; weakness of self identity; especially in bodily Self. Some psychopathological aspects in children and adolescents with heart transplant and their families are also described. Intellectual level of patients with congenital heart disease is in the normal range, although significantly lower than normal controls. There is a positive correlation between worsening of intellectual functioning and clinical severity of the heart disease; this clinical severity is related both to restrictions in normal daily life activities, and blood oxygen saturation. It is hard to tease apart the role of early physical limitations versus the role of chronic hypoxia, in affecting intellectual development. Some methodological considerations are described, relating to the role of the physician, the psychological support to the children and adolescents and their families, the problem of the shared-cares between main centres and local hospitals, where primary health-care team operates.

Adolescent↗

PubMed1994

[Cognitive functioning in adolescent depression].

In childhood and adolescent depression, the interaction between cognitive and emotional disorders is particularly evident: intellectual dysfunctioning often accompanies and integrates the clinical symptomatology. The studies on cognitive functioning have focused their attention on basic cognitive abilities; relatively fewer studies have analyzed other dimensions, such as logical reasoning. Furthermore, most studies have compared depressed patients to normal controls; this methodology tends to obscure the specific effect depression may have on cognitive functioning. The aim of our study is to analyze whether specific patterns of cognitive organization underlie adolescent depressive disorders. Cognitive functioning was assessed both with psychometric tests (WISC-R) and Piagetian logical reasoning tasks (Longeot Logical Thought Scale). The performance of depressed adolescents was compared to that of neurotic patients without depressive symptomatology. To evaluate the course of cognitive organization in relation to depressive symptomatology, some of our patients were studied in follow-up. Thirty-eight adolescents admitted to our Institute participated in the study. The experimental group consisted of 24 depressed adolescents; sixteen subjects were classified as neurotic depressives, eight were diagnosed as depressive personality disorder. The control group consisted of 14 subjects diagnosed as neurotic without depression. At the WISC-R the performance of depressed and controls adolescents were compared in: Full Scale IQ, Verbal and Performance IQ, Verbal-Performance discrepancy; single subtest scores; Bannatyne's four categories. Statistical analyses did not yield any significant differences between groups for any of the WISC-R measures. At the Logical Thought Scale Full Scale scores of the experimental group were significantly lower than controls'.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

[Considerations of psychopathology in mental retardation].

There is a high incidence of psychiatric disorders in mentally retarded subjects: one third to two thirds of mentally retarded subjects exhibit psychiatric disorders, a proportion which is much higher than that found in subjects with normal intelligence. The issue is to clarify the nature of the relationship between cognitive and psychiatric disorders (generally analyzed in a dichotomous approach). A way to analyze the phenomenon is to consider a psychopathological approach, which can define the underlying mechanisms responsible for this incidence. The aim of this paper is to analyze the explicatory value of deficient cognitive development, as the main factor determining a specific personality organization. Direct and indirect effects of cognitive impairment on the development of personality disorders are described: the first, in terms of how cognitive deficit (i.e. severity, homogeneity in several cognitive domains, pattern of development) disorganizes personality; the second, in terms of impact that cognitive deficit could have on the child's relationship with the external world, especially with the mother. In order to illustrate these viewpoint, the paper discusses the role of cognitive functions in the development of personality. Specifically, the way the normal child processes his perceptual and motor experiences is analyzed, that is pursuit of new causal links in his knowledge seeking activity of mastering the world. The child's primitive relationship with the world is then aimed at learning, exploring and searching for new causal links. In the light of these considerations, what the child with Mental Retardation experiences is discussed. A series of psychopathological mechanisms in Mental Retardation are postulated. The organization of the Mentally Retarded child's internal world is described, as reflected in Rorschach protocols, which outline a chaotic and primitive internal world, but with a specificity of its own. Finally, the paper discusses the hampering effect that cognitive impairment has on the quality of the relationship with the caregiver. This effect can be seen in terms of the child's interactive capacity and, at the same time, in terms of the emotional impact on the caregiver that derives from interacting with a mentally retarded child. From the above considerations a global approach to the psychopathology of cognitive and affective aspects of Mental Retardation seems warranted. Both aspects acquire a specific significance when seen in light of a specific personality organization. Defining the characteristic of this specific organization seems to be the key to a more comprehensive approach to psychiatric disorders of Mental Retardation.

Cognition Disorders↗