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[Clinical features of mental disorders among gynecologic patients with hormonal dysfunction and hormone-dependent pathology].

Using clinical procedures supplemented with a method of multiple personality investigation, the author found nonpsychotic psychic disturbances in 56.6% of 297 gynecological patients with a hormonal dysfunction of central or peripheral (inflammatory) genesis and with hormone-dependent pathology (uterine myoma, endometriosis, cystoma and cysts of the ovaries); another 22.4% of these women showed marked accentuation of personality features. The most typical psychopathological symptomatology was represented by affective disturbance (predominantly depressive, seen significantly more frequently in patients with hormonal dysfunction of central genesis rather than in hormone-dependent pathology), the syndrome of senestopathic hypochondria and psychopathlike conditions with a tendency to form super worship ideas, paranoid reactions (occurring significantly more often in patients with hormone-dependent pathology as compared with hormonal dysfunctions of central genesis). A conclusion is drawn about pathogenetic relationships existing between alterations in the psychic state and characteristics of the reviewed gynecological hormonal and hormone-dependent pathology.

Antisocial Personality Disorder↗

[Predictors of tobacco addiction in young adults].

To identify smoking dependence predictors, 150 active smokers were interviewed. To assess tobacco dependence Fagerström's test was used. The potential associations between smoking dependence and some variables related to life style were investigated. In a case-control study design an induction period > or = 2 months was assumed. After estimating crude odds ratios, a logistic regression model was fitted. The dependent variable was dependence to tobacco smoking. In the multivariate analysis independent predictors, in addition to age, were: a) an earlier hour for starting smoking (OR: 6.08; 95% CI: 2.29-16.2), b) thinking that smoking avoids getting fat (OR: 4.36; 95% CI: 1.50-12.7) and c) not knowing any person with smoking-related pathology (OR: 3.75; 95% CI: 1.36-10.3). Exercise appeared to protect against smoking addiction (OR: 0.36; 95% CI: 0.13-0.98). The knowledge of these factors could help to avoid the development of smoking addiction.

Adolescent↗

[Chronic prescription of drugs for geriatric patients at an urban health center].

OBJECTIVE: To find the chronic prescription of medication in older people, associated variables and its quality. DESIGN: Observation, descriptive-crossover study. SETTING: Urban health district. PATIENTS: Sample stratified in age and sex groups of 385 people of 65 and over registered at the health centre and not in institutions. MEASUREMENTS AND MAIN RESULTS: Social and demographic data, self-perception of health and functional capacity were obtained through interview; and pathology and medication records, from the clinical records and authorized medication cards. 349 people, average age 73 (SD +/- 6.5), were interviewed. There were 210 women and 139 men. 12% perceived their health as bad/very bad. Barthel's index and the Lawton scale were disturbed in 13.8% and 30.4%, respectively. 93% suffered some chronic pathology (average 2.7). 81.4% habitually took medication (average 3.1). The most commonly consumed drugs belonged to the cardiovascular (32%), nervous system (21%) and digestive apparatus and metabolism (17%) groups. For the first group, the main drugs were ACEIs and diuretics; for the second, analgesics and neuroleptics; for the third, antacid and antiulcer drugs. 86% had high intrinsic value, the most prescribed drugs of those with low intrinsic value belonged to the antivaricose, cerebral and peripheral vasotherapy, and urological drugs groups. Multiple medications was related significantly to having more than two chronic pathologies (OR = 7.89, 95% CI 4.40-14.15) and self-perception of worse health (OR = 2.51, 95% CI 1.13-5.59). CONCLUSION: The elderly persons with a greater number of pathologies and perception of worse health took more medication. We thought that our quality of prescription was acceptable, although we should review the indications for neuroleptics and reduce prescription for medication of low therapeutic value.

Age Factors↗

Demographic and clinical comparison of obsessional followers and offenders with mental disorders.

OBJECTIVE: The purpose of this study was to compare certain demographic and clinical variables in a group of obsessional followers and in a group of offenders with mental disorders. METHOD: A static group design comprised of a nonrandom group of convenience and a randomly selected comparison group was used. Twenty obsessional followers in custody and 30 offenders with mental disorders in custody were evaluated by psychiatrists and psychologists for court-ordered reasons during their criminal proceedings. Both groups were evaluated during the same period, in the same court diagnostic clinic, and for the same psycholegal reasons. The group of obsessional followers was measured on demographic, clinical, and victim variables. Inferential comparisons that used nonparametric statistics were done between groups on selected demographic and clinical variables. RESULTS: The obsessional followers were significantly older, more intelligent, and better educated than the offenders. There were no significant differences in DSM-III-R axis I diagnoses. Axis II diagnoses showed significant differences, with the obsessional followers more likely to have a personality disorder other than antisocial personality disorder and less likely to have antisocial personality disorder. CONCLUSIONS: The likelihood of obsessional followers having a nonantisocial axis II personality disorder (related to attachment pathology) distinguishes them from offenders with mental disorders in general. They are also likely to be older, smarter, and better educated, consistent with their resourcefulness and manipulativeness. Idiographic aspects of the obsessional followers further illuminate their psychological defenses and object relations.

Adolescent↗

[Cowper's canals and glands. Pathological manifestations and radiologic aspects].

From 11 personal case studies, the authors conduct a general review of the problems raised by Cowper's glands. Cowper's glands, accessory sexual glands, are made up of main glands situated behind and on either side of the bulbar urethra right at the level of the urolgenital diaphragm and of accessory glands situated in the thickness of the bulbar spongy body. The main glands are drained by long canals (several centimeters in length) which empty into the bulbar urethra by paramedian orifices. The fusion of these canals into one single canal at the urethral opening, although rare, could lead to obstruction. These canals can be the site of cystic dilatation ranging from a few millimeters to as much as 6 cm in diameter. These cysts are rarely due to terminal canal obstruction as the result of chronic inflammatory urethritis. Most often they are congenital. The cysts which develop at the level of the accessory glands are usually obstructive while those which develop at the level of the main glands rather have a perineal expansion. The indicative signs of this particular pathology are not specific (pyuria, hematuria, enureis, known urethral stenosis, dysuria with pollakuria, perineal pain with post voiding urethral dripping). Voiding urethrography investigation (the best) shows: --either cystic dilatation seen as a lacuna on the ventral aspect of the urethra, --or opacification of the dilated cavities of the exretory canals which have been spontaneously broken or opened by endoscopic manoeuvres. The opacification of these cavities leads often to the erroneous interpretation of "diverticula" of "incomplete duplication of the urethra" and yet their essential characteristic is twofold: they are oriented in an anterior-posterior direction with respect to the urethra and lead back and away from it; they have a canal type of morphology for at least part of their course.

Adolescent↗

[Organic risk factors and developmental psychopathology in a group of 100 hospitalized adolescents].

In the Psychiatric Clinic for Children and Adolescents, a group of 100 hospitalized adolescents were assessed with respect to organic risk factors and developmental psychology, using original questionnaires drawn up by the clinic. Pathology during infancy, early childhood and the results of psychological tests assessing changes in the C.N.S. differentiated 4 diagnostic subgroups: psychoses, neuroses, anorexia and conduct and personality disorders. Organic risk factor indicators were most frequent in the subgroup of conduct and personality disorders. Some indicators of developmental pathology such as speech impediments, eating disorders and conduct disorders, correlated highly with psychiatric diagnosis during adolescence.

Adolescent↗

Self-mutilation and the borderline personality.

As part of a larger study of pathological self-injury, 14 self-mutilators and 14 psychiatric controls matched for age, sex, and inpatient/outpatient status were administered the Diagnostic Interview for Borderlines. Consistent with Gunderson's theory of borderline personality disorder, the self-mutilators scored significantly higher on impulse-action patterns, affects, psychoticism, and interpersonal relations as well as on the total borderline index. A review of clinical records likewise revealed that self-mutilators were more likely than controls to have been diagnosed as borderline and to have received a greater number of different diagnoses during their treatment career. The results have implications for developmental theory, diagnosis, and treatment and provide support for the construct validity and clinical utility of the borderline syndrome and the Diagnostic Interview for Borderlines.

Adult↗

Clinical experience in gynecological cancer management. c). Cervical cancer: report from the Gynecologic Institutes of Padua University (1963-1989).

The retrospective analysis of 1876 cases of invasive cervical cancer allows some considerations and conclusions on the clinical management of this neoplasia. Always led by the Gynaecologist, in the aims of prophylaxis and early diagnosis, personalized screening are necessary, with regard to risk factors. Surgical Pathological Staging (SPS) is mandatory for adequate treatment and prognosis. By personalizing surgical radicality and avoiding the application, in all cases, of the routine and standard extended operations of the past, it may be possible to reduce the complication rate with 5 year survival rate unchanged. In early stages personalized radical operations with systemic pelvic lymphadenectomy allow the best results (94% 5 year survival rate). Integrated therapies must be planned only in lymph nodal positive or in vascular space invasion cases. In advanced cases, surgery must be personalized in enlarged operations and integrated with adjuvant treatments on the basis of surgical pathological findings. In very advanced stages, integrated therapies, even without surgery, are justified, due to the poor prognosis of these cases.

Combined Modality Therapy↗

Violence in mental disorders and community sample: an evolutionary model related with dominance in social relationships.

The major risk determinants of violence are to be young and male, to have low socioeconomic status and suffering substance abuse. This is true whether it occurs in the context of a concurrent mental illness or not; i.e., mental disorders are neither necessary, nor sufficient causes for violence. Intense motivation is a facilitating factor for violence in clinical and non clinical samples. This explains why 'normal' people, are implicated in planned violence at higher rates than mentally ill (e.g. in criminal acts against property). However mentally ill patients are more easily implicated in impulsive violence or in violence without obvious cause due to veiled motivation fuelled by unidentified symptoms. Subjective or real awareness of competitive disadvantage increases motivation for violence (e.g. paranoid, narcissistic symptoms, etc.). Many psychiatric disorders as antisocial disorder, borderline, schizophrenia, have most of the factors that facilitate the appearance of violence. Antisocial disorder is a good model to study determinants of violence in normal samples as it is present in young males that do not have any psychotic symptom, have stable symptomatology, self control under scrutiny, and their motivations are similar to normal samples. Our evolutionary model suggests that there is a non random association of genetic factors (genes, pseudogenes, promoting areas, etc.), that is, a genetic cluster (cluster DO), whose phylogenetic function is to motivate to be the dominant in social relationships. To be the dominant is a major psychological feature present in many social groups of animals, included primates. DO cluster have sense from an evolutionary viewpoint: when expressed in no pathological way it increases inclusive fitness (transmission of the genes of a person genotype whether by oneself or by relatives reproduction). Features of cluster DO in humans are expressed differently according to sex, age, moral education, level of intelligence, etc. Cluster DO has higher phenotypical expression in males and young people. Primary antisocial personality disorder and other related disorders (cluster B personality disorders, disocial, defiant disorder, etc.), are a pathological manifestation of this cluster DO. Some other genetic clusters that causes the genetic liability to some disorders (e.g. attention deficit disorder) are non random associated with cluster DO, thus explaining clinical comorbidity. According to our model, motivation for dominance usually prevails over motivation for material benefit or antinormative behaviour, this explains some incongruent behaviour in antisocial patients not elucidated by other models. Along with the primary expressed feature of dominance of cluster DO there are other secondary features that have been identified by psychobiological studies: novelty seeking, intolerance for frustration, impulsiveness, fearless, aggressiveness, higher threshold for activation of the sympathetic system, lack of empathy, egoism, non acceptance of rules, defiant and rebellious behaviour, manipulation in social interactions, selfishness and deficits in altruism or in social co-operation.

Adult↗