psychology | MY SPECIAL DOCTOR

Friends never: parents and children, the value of difference

26 February 20246 January 2024 by marisadarrigo

I borrow the title of a very old song by Antonello Venditti to summarize the danger of a tendencyillusion that currently characterizes the way many parents understand their role.

I speak of a trend because, and this is a trivial element in its incidence, more and more the parental relationship emphasizes its affective function, renouncing the exercise of the normative one; it pursues consent and complicity, rather than a growth resulting from the effort of awareness, management and overcoming conflicts.

A friend more than a parent

We are increasingly faced with parents who have as their goal, or as their worry when they fail to do so, to please their children. Where “making happy,” which is, moreover, legitimate and desirable in many situations, and which is limited to the “here and now,” seems to become the only element of guidance and discrimination for an increasingly evanescent parental function. All in a general climate that fuels the illusion of the possibility of blurring if not nullifying role and age differences.
An amicable relationship is basically characterized by an equal status: one is on the same plane and at the same level. Hypothetically, there are no differences, and this (again hypothetically) could ensure that there are no conflicts.

The parent-child relationship, on the other hand, is based from its origin on the difference: between a “big one” and a “small one,” between those who have knowledge and skills, take responsibility, and act on their examination of present and future reality, and those who need to be helped to orient themselves, to learn, to acquire the tools, to be contained and accompanied to contact a sometimes difficult reality.

Behind the desire and sometimes the proud claim of “be like two friends” hide many elements: the fear of assuming a normative function, the insecurity of one’s adult role, the desire to erase all conflict and the inability to govern it, but also the “emptiness” of all those parental functions a child needs and is somehow deprived of.
“Being like two friends” therefore is not one more opportunity but one less, it robs the “little one” of the opportunity to form, to clash and to look for his own friends!

Narrative Medicine: a new way of relating to the patient

26 February 20246 January 2024 by pcarrieri

We live in a society that is now considered by many to be “postmodern” and in which an exclusively technical approach to medical care is no longer considered sufficient. Twenty-first-century patients seek a different approach to their health problems than in the past, and in particular demand a deeper dialogue with their physicians (Shapiro, 2011; Greaves, 2004).

Medicine can no longer be limited to collecting a medical history (anamnesis), performing an objective examination, and implementing a diagnostic procedure with a final discussion of therapeutic intervention strategies (Johna et Dehal, 2013). Medicine especially needs physicians capable of establishing narrative connections and more intense contact with the person asking for help (Charon , 2001). Narrative medicine aims to deal with patients comprehensively and to recognize and interpret their stories of illness by integrating education, medicine and the humanities (Frank A, 1995). The goal is to strengthen the doctor-patient relationship by providing more humane and ethical care.

The narrative

With narrative medicine, we seek to understand the patient-physician relationship through the collection and analysis of narratives, told from the perspectives of the different stakeholders, patient, civil society, health care facilities, physicians and family members (Charon, 2012). This practice uses methods aimed at obtaining information about how a person experiences his or her illness, in an effort to consider the many facets of the care journey: narratives allow health professionals to gather information about the patient’s perceived needs on how to cope with problems related to his or her health.

Empathy

Although objectivity and medical care always retain their importance, a good deal of empathy is asked of the physician that will be rewarded by greater patient satisfaction and better clinical outcomes. What is empathy? It has been defined as a psychological process that enables an individual to have feelings that are more congruent with others as well as himself: it is basically the ability to understand and share others’ feelings. Empathy can be distinguished into cognitive, which is the ability to understand how another person feels, and affective, which is experiencing the same emotions that the other person feels (Hoffman, 2000; McDonald et al. 2015).

The negative aspects of the traditional approach

At present, the doctor-patient relationship is overwhelmingly based on scientific aspects, a position corroborated by the biomedical innovations that have occurred over time, from antibiotics to organ transplants, and which have made it possible to solve many health problems. Medical examinations tend to be always and only “scientific”: diagnosis is based on objective parameters, treatment centered on clinical protocols closely related to scientific research, and consequently the patient’s “well-being” will be linked only to the achievement of certain standard goals.

All this fails to consider that medical practice is above all a human endeavor and that each patient is his or her own case. The patient’s history, the so-called anamnesis, is reduced to repetitive, routine sentences, whereas the human case should be the focus of clinical practice. (Montgomery, 2006). Narrative medicine makes it possible to view individual subjects as persons rather than clinical cases, to understand the world in which they live, and to tailor drug treatment to their needs. Both the patient and all caregivers, including caregivers, will be taken into account.

The goal: to improve patient care by enhancing both medical science and human aspects. Only in this way can the person be assisted as a whole and in a more meaningful way (Franke RJ, 2016). Narrative medicine fosters empathy and trust between patients and patients and between patients and physicians by improving communication with effect a therapeutic on patients. It is used in individuals with cancer, AIDS, stroke, and generally chronic diseases, but also in seemingly more mundane conditions, such as chronic spontaneous urticaria (Cappuccio et al, 2017). Another area of application is palliative care, treatment given to people at the end of their lives.

BIBLIOGRAPHY

Friendship is a real medicine

26 February 20246 January 2024 by MinnieLuongo

Friendship helps our health. You are wrong to think this is a simplistic statement, an excessive consequence of the well-known saying “he who finds a friend finds a treasure.” Actually, we are talking about scientific data that emerged from a study, published in the influential Journal of Epidemiology and Community Health, which found that being able to rely on a network of friends positively influences our well-being much more than family ties do.

The research authors concluded that friendship is a key determinant of health, on par with healthy eating, physical activity and regular medical checkups. Being able to rely on a friend, in fact, is good for your mood, boosts self-esteem, and helps you cope better with stress. In short, it generates a state of emotional and mental well-being that cannot help but be reflected in the body. But the beneficial effects of a good friendship-intimacy, security and affection-are not only transmitted to the emotional sphere; they also come to positively affect health and well-being. Therefore, building and nurturing good friendship relationships from adolescence onward allows people to live better and longer and, in addition, would protect against disease and overweight.

What happens to our body

Going into specifics: those who have an established core of true friends, by contacting them, activate the pressure receptors that are in the skin, the so-called “Pacini corpuscles,” which immediately send signals to the vagus nerve. This is enough to begin to make us feel better as the nerve is connected to nerve fibers that reach several cranial nerves, which are critical in regulating the majority of the body’s key functions including, precisely, blood pressure.

Another important change occurs directly in the brain. In fact, an authentic friendship relationship stimulates the production of dopamine, the neurotransmitter known as the “pleasure hormone.” But all it takes is a friend’s hug to increase the production of oxytocin-commonly called the “love hormone”-which enables us to connect emotionally with others. Always a simple hug between friends, as the researchers found, leads to a significant reduction in the level of cortisol in the blood, that is, the stress hormone.

To sum up, it may well be said that true friendship has a portentous effect on the brain, helping us on the one hand to achieve a kind of relaxation and well-being, and on the other hand to cope better with stress and fears of various kinds. Especially since-again according to the study-those without friends are more prone to stress and, over time, are likely to complain of various ailments.

And what better time than summer to cultivate friendship? Only condition: dating people to whom we are truly attached and who reciprocate our feelings in equal measure. Therefore, those who find a friend not only find a treasure, but are also able, at least in some cases, to avoid taking medication for anxiety or depression.

A healthy diet against depression (preview)

25 February 20246 January 2024 by clemente.ferrara

A recent article published in the journal The Lancet, titled “Nutritional Psychiatric: where to next?” hypothesizes a direct relationship between nutrition and depression in the individual. In fact, according to some studies there is a direct relationship between a healthy diet and a person’s mental and physical well-being. In particular, it has been shown that a proper and balanced diet can significantly reduce the risk of experiencing depression problems.

On the contrary, it seemed glaringly obvious that the so-called
Junk Foods
(junk food) are harmful not only to the physical health of the body, but also have negative effects on the mental and psychological condition of the individual.

In the next articles we will deal more specifically with this issue, analyzing two aspects of this scenario: healthy eating against depression and the use of dietary supplements to combat the individual’s psychiatric disorders.

Eating well, a weapon against depression too?

25 February 20246 January 2024 by Redazione My Special Doctor

A comprehensive article published in The Lancet’s journal, EbioMedicine, analyzes current knowledge on the relationship between nutrition and some psychiatric disorders, particularly depression.

What are the key messages of the article?

From the article, it was found how important it is to follow the Mediterranean diet, because in addition to the already known positive effects on cardiovascular health and cognitiveness, it can help reduce the risk of onset of depressive disorders. On the other hand, the possible negative effects on mental health of so-called“junk foods,” i.e., foods high in simple sugars, i.e., fast-absorbing, are already known. In addition, depression, in reducing appetite, can promote a state of malnutrition, which, in turn, negatively affects mood. Other key messages for dietary supplements emerge from the article. At present, only a few molecules have shown clinically relevant results. These molecules are:

Omega-3 fatty acids
Adenosyl methionine
Methylfolate
Vitamin D

In any case, many of these dietary supplements are routinely prescribed by physicians as an adjunct to drug therapy for depression.

The importance of gut flora

There also emerges a focus on the gut microbiota, that is, the flora consisting of the millions of bacteria living in the human gut. In fact, according to some studies, the composition of the microbiota would also affect mental health. Unfortunately, the balance of gut microflora can be altered by antibiotic treatment, physical and mental stress, and consumption of unhealthy foods. In cases of alterations in the intestinal ecosystem, the use of “probiotics,” or live bacterial strains that can colonize the intestine and restore its balance, is now well established.

In conclusion, the relationship between diet, dietary supplements and depression is certainly a fascinating and promising topic. Research, however, still has many steps to go before specific interventions can be suggested. To date, we can say that to prevent or counteract mood disorders, it is essential to have a
proper diet
in the context of a healthy lifestyle characterized by the right amount of physical activity and respect for sleep hygiene.

In collaboration with Dr. Piercarlo Salari

Good night and its rituals

26 February 20246 January 2024 by marisadarrigo

It is known that children do not like to go to sleep. They are capable of suddenly collapsing half-heartedly, but if they are told it is time for bed they either tergiversate, make a thousand excuses, or, when they are particularly tired, seem to engage in a real battle against sleep (and also account for us!), with all deliveries on the tantrums, of whining, etc. But why all this? Is it just a matter of irritability, of bad manners, or does this difficulty have a deeper meaning that education should take into account?

Why don’t babies want to sleep?

Children live in the immediate, the younger they are the more the future ( and by future we also mean the morning after or the after afternoon nap) for them is something extremely vague and nebulous. Falling asleep is like leaving, like dying: losing everything, leaving objects and landmarks behind and sinking into a kind of “black hole” of unawareness. It is precisely this kind of perception that leads them to struggle against sleep experienced almost as a danger and not as a restorative embrace. The goal is not only that the child falls asleep but also that from this fundamental function that is repeated and will be repeated every day and several times a day the child can derive , alongside the good habit, a security of self, based on trust and constancy (of objects, affections, circumstances).

How to promote sleep

For as long as the world has been alive, specific ways have been developed to help children fall asleep: just think of lullabies, the act of rocking, the cradles named after that movement, the habit of telling or reading a story, to the favorite puppet (or blankie or rag), etc. Since time immemorial, to go to sleep, lights are dimmed, noises are dampened, that is, we try to create a situation as of “decompression” in which “exciting” sensory stimuli become more and more distant to make way for a reassuring, repetitive and fading rhythmicity.

All of these behaviors serve the function of promoting relaxation, containing the child, and accompanying the child on a potentially anxiety-inducing path of “abandonment.” It is important that this delicate moment, which among other things marks that essential rhythm of life given by the alternation of wakefulness and sleep, be “ritualized“, that is, have its own canvas (for each child and for each stage of growth, his own) that enshrines the meaning of the moment, its preparation, its unfolding; that contains and reassures the child, never making him feel at the mercy of unknown events; that provides him with awareness of what is happening to him and allows him, precisely by virtue of the space and time dedicated, to connect today’s “bedtime” with yesterday’s and with tomorrow’s awakening.

Endless can be the rituals of the Good Night, rituals made of play, of creativity, of rules, but all of them, like any self-respecting ritual, must be solemnized (that is, they must have their own consistency and constancy), shared among several people (the child and those accompanying him, even if simply reminding him that it is time to sleep), have meaning and purpose.

Avoid sleep caused only by exhaustion

Otherwise, when children are only able to fall asleep if they are “exhausted,” watching television on the sofa, in their parents’ bed or alone in their bedroom, they lose the ability to gain awareness of this function, that is, to enter the world of sleep confidently and voluntarily. Instead, they “fall” into it as if into a net without any preparation and basically without any accompaniment. Parents, who are supposed to provide the time, place and mode, instead seem in many cases to passively and laboriously point to their children’s “battery exhaustion,” becoming victims themselves of this confusing mechanism. The principle of all full all empty is substituted for the ability to regulate and pace energy.

So many sleep disorders in children and, especially, adolescents stem from precisely this initial failure to gain awareness, autonomy, and pleasure in regulating rhythms and needs.

Exercise and happiness: how movement improves our mood

25 February 20246 January 2024 by clemente.ferrara

It is known by everyone now that thephysical activity, if carried out correctly and with passion, brings countless benefits to our body, both from a physical point of view (improvement in movement, elasticity and tone of muscles and joints, as well as benefits to the cardiovascular system) and mental, such as reducing stress and anxieties arising from the problems of daily life. But sports, and physical activity in general, do much more. They are indeed the bearers of happiness!

The University of Cambridge study

Revealing this theory were experts at theUniversity of Cambridge in England following analysis of the results of a 17-month study of more than ten thousand individuals. The experiment was carried out through a cell phone app with a dual function. First, it aimed to measure an individual’s physical data during sports activity (beats, breathing, etc…), but in addition to this it also analyzed people’s mood by means of a questionnaire to be submitted to the subjects, in which they had to specify what they had done in the 15 minutes prior to the questionnaire.

It appeared early on that individuals who had engaged in physical activity in the quarter hour prior to the questionnaire recorded significantly higher levels of happiness, as opposed to those who had not engaged in any type of exercise. In addition, the subjects said that, in the long term, physical activity improved their overall satisfaction with their lives.

The secret of happiness, endorphins

But what happens to our bodies during a physical activity, and why do we feel a deep state of well-being and mental fulfillment ? The answer may lie in endorphins, released especially during physical activity and movement. These are chemicals produced by the brain in the anterior lobe of the pituitary gland, and they have many properties and positive effects on the body, including:

Give physical and mental well-being, accompanied by cheerfulness and euphoria
They increase our sense of satisfaction and make us more optimistic
Alleviate hunger
Promote sleep
They increase our pain threshold
They improve our ability to concentrate and learn

For this reason, physical activity is also associated with a substantial increase in happiness in individuals who practice it consistently. Physical activity means not only sports, but also movement in general, such as a simple walk or bike ride. These are all activities that help break down the stress, anxiety and tensions of everyday life, which are certainly present to a greater extent in individuals who are sedentary and reluctant to exercise. So get moving and be happy!

Chromotherapy: the importance of colors for a person’s mental and physical well-being

25 February 20246 January 2024 by clemente.ferrara

Colors have always been a part of all people’s lives. Some fascinate us, such as those that artists pour onto their canvases in the creation of their masterpieces, others frighten us, such as the color of blood that we cannot but relate back to physical pain, and still others manage to soothe us, such as the green of an immense expanse of lawn or the soft blue of the sky. But what else can we say about colors ?

In response to this question, chromotherapy, or the science that deals with the meaning of colors and how and to what extent they influence the activities of the human mind, was born. The areas in which color therapy works are many: food (the color of various foods), clothing, personal care (more and more often we hear about spas offering showers with color therapy) and even on home furnishings. In fact, color and color graduation play an important role in the lives of individuals, with strong repercussions on our mood. So let’s find out what the main colors of the light spectrum are and what effects they have on our bodies.

Red

Red has always been regarded as the color of fire, blood and sexual excitement. It is related to strength, vitality and passion. In fact, it has been shown that painting the walls of a home red can increase blood pressure and accelerate the heart rate. It is also used in color therapy to combat burns and rash disease, as well as for asthma, depression, and impotence.

Blue

Blue is the opposite color to red, and is contrasted with it because of its calming, soothing and refreshing effect (clear reference to water). For this reason, blue is used to combat phenomena such as stress, anxiety and insomnia. It is also believed, although this is obviously not scientifically proven, that blue is also useful against inflammation of various parts of the body, depending on its different shades.

Green

Green is obviously the symbol of nature, plants and trees. It thus represents the sense of harmony and balance of existence, but it has also always been associated with the feeling of hope. According to proponents of color therapy, green would have positive effects on the nervous system by calming migraines and nerve-related diseases, as well as spreading a general feeling of harmony and calm.

Yellow

According to chromotherapists, yellow would represent the intellectual part of the brain. Its benefits would include aiding concentration (useful for study and work), but it would also be able to instill joy, a sense of protection and happiness.

Clearly, it should be pointed out that in the color therapy approach, there is nothing scientifically proven to prove the actual beneficial contribution that colors would have on our health. However, it remains interesting and fascinating to learn about and observe this particular methodology aimed at patient care.

When we are stressed we have more difficulty perceiving danger

25 February 20246 January 2024 by clemente.ferrara

We are often mistakenly led to think that a high-stress situation gives us the ability to pay more attention to the dangers around us, increasing our state of alertness, or perhaps making our senses more overpowering and able to pick up on any detail. But the reality is not always this, in fact most of the time the opposite happens! In fact, stress would only diminish our perception of pitfalls and dangers.

The study

This thesis was pursued by a team of New York University scholars, led by researcher Candace Raio, and published in the journal Proceedings of the National Academy of Sciences. According to the study, in fact, stress decreases our abilities in perceiving danger and predicting new dangerous stimuli. It thus contributes to making our bodies less flexible to the new forms that a threat might take, making us very vulnerable and thus putting our own health at risk in certain situations (think, for example, when we are driving or handling dangerous objects). According to Candare Raio in fact, “When we are under stress, we pay less attention to changes in the environment, exposing ourselves to increased risk precisely because we ignore new sources of danger.”

The test

To reach this conclusion, New York University scholars subjected some volunteers to a conditioning test divided into two phases. In the first phase, all participants viewed a series of photos, some of which were accompanied by a small electric shock on the wrist. The photos with the discharge depicted images of danger, those without, on the other hand, depicted harmless situations. The following day half of the participants (the unlucky ones we would say) underwent a procedure to increase the stress levels in their bodies: they had to immerse their arm in ice water for a few minutes in order to increase the levels of certain stress hormones, such as cortisol and the alpha amylase.

At this point the test was repeated again, however, reversing the shocks, which this time were carried out with the “safe” images. According to the researchers’ measurements, participants under stress showed a slower physiological reaction in ‘detecting new dangers, almost as if they had not grasped at all that the dangerous stimuli had changed. In fact, stress inhibited their ability to learn, interfering with their ability to associate shock with danger.

This is very important research, as learning how to quickly intercept dangers, or even predict them, can be very important for our safety and survival. So is being resilient and adapting quickly to the transformations that danger can have from one moment to the next.

Cyberbullying: the serious consequences of this new form of violence

25 February 20246 January 2024 by clemente.ferrara

Cyberbullying is a phenomenon that has become more prevalent especially in recent years due to the spread of new communication technologies, especially social networks (a favorite place for the cyberbully). But what is it specifically about ? Well, the term cyberbullying is defined as the use of new communication technologies to intimidate, harass, offend, threaten and exclude people. Usually the victims of this new type of violence are mostly teenagers, that is, that segment of the population that lives in a very close relationship with the Internet and social networks. Such behavior, unfortunately, if not stopped in time can scar the lives of the unfortunate cyberbullied forever, with serious consequences in real life as well.

The results of the research

According to research completed by scholars from theUniversity of Birmingham, carried out on a sample of more than 150,ooo children and youth (under age 25) from more than 30 different countries, victims of cyberbullying are more likely (in some cases even twice as likely) to engage in behaviors self-defeating e suicidal than those who are not its victims. In addition, the research also showed another very peculiar data, which concerns cyberbullying perpetrators instead. In fact, even in their case, the possibility of developing suicidal behaviors and thoughts is noted. Thus, it can be seen that this is a new form of violence that is dangerous for all concerned, both perpetrators and victims.

The advice of scholars

The results of this study highlight a very important problem that should not be underestimated. For this reason, the authors of the research themselves, among whom we cite Professor Paul Montgomery of the University of Birmingham, sharply point out that in order to permanently eradicate the problem, or at least lessen its consequences, prevention programs must be instituted in schools to prevent such a problem from occurring. In particular, according to the scientists, these recommendations should be followed:

include the concept of cyberbullying in all those programs that deal with bullying in general and safe I nternet use
psychologists and mental health professionals in the institution should ask pupils on a regular basis if they have experienced cyberbullying
all victims of cyberbullying should follow a guided pathway to identify any mental disorders or self-injurious tendencies
promote school (and non-school) programs that teach proper use of technology

Only if these regulations are put in place will there be a greater chance of combating this phenomenon and nipping any cyberbullying attacks in the bud, lest it lead to a tragic end as we are all too often accustomed to hearing.

Obsessive compulsive disorder

24 February 20246 January 2024 by Redazione My Special Doctor

Obsessive compulsive disorder (OCD) is a psychiatric disorder characterized by recurrent thoughts, accompanied by completely irrational and unmotivated fears and worries, that lead the sufferer to continuously repeat, in an obsessive and uncontrolled manner, certain actions or processes in an attempt to appease anxiety and protect himself from nefarious events otherwise deemed inevitable, despite the fact that they are, in reality, highly unlikely.

Disorders and symptoms

Often, the activities performed by OCD sufferers are completely “normal” and harmless, but they become pathological because of the obsession with which they are repeated and the inability to do without them. Typical compulsive behaviors include: obsessive and repeated washing of hands, hair, or the entire body, in fear of contamination; the verification, repeated even dozens of times, of having closed the gas or windows before leaving the house; the arrangement of clothes, objects, books in a definite and unchangeable order.

Not infrequently, those suffering from obsessive compulsive disorder nag friends and family members (often the mother) with continuous and exasperating requests for reassurance that he is combed, that he has no blemishes or marks on his skin, that his teeth are clean, or that he is being helped to “better check” details that cause agitation and anxiety and that he fears he cannot sufficiently check for himself.

If

obsessive compulsive disorder
is not treated, over time, obsessive-compulsive behaviors multiply and worsen, leading to serious deterioration of quality of life and family relationships, social and work withdrawal, with disabling outcomes. In addition, medical problems related to the effects of obsessive behaviors (such as dermatitis or alopecia due to excessive washing) and suicidal thoughts may ensue. To prevent these unfavorable developments, it is crucial that the affected person’s family members seek medical advice from the earliest signs of illness, turning first to the family physician or directly to the psychiatrist.

Causes

The causes of obsessive compulsive disorder are not known, but the disease is believed to be driven by a complex interaction between predisposing genetic factors (yet to be determined) and exposure to stressful stimuli or events during childhood or later stages of life, as well as possible specific environmental factors (e.g., infections), but these remain to be specified and verified.

You are more likely to be affected by the disease if you also suffer from other psychiatric disorders (in particular, pertaining to the area of anxiety disorders and the depression), if one has predisposing personality traits (perfectionism, excessive tendency to apprehension and control, insecurity, etc.), and if other people in the family suffer from obsessive compulsive disorder (in particular, one or both parents). Neurologically, obsessive compulsive disorder is linked to a series of alterations in the functioning of brain circuits that regulate impulsivity, emotions, and stress response, to date, only partially characterized.

Diagnosis

The diagnosis of obsessive compulsive disorder is based on the finding of various types of behaviors and actions characterized by obsessive repetition, compulsion, and an inability to give up performing them without going through severe and disabling anxiety and distress. Sometimes, recognizing the disease is not easy because the manifestations may be partly overlapping with those of other psychiatric disorders such as anxiety, forms of depression with psychotic features, or schizophrenia. The diagnosis of obsessive compulsive disorder is, in many cases, delayed because the sufferer’s family members tend to become accustomed to the extravagant behaviors and underestimate the severity of the warning signs, even adopting, more or less consciously, a “protective” attitude or denial of the illness.

The diagnostic delay also depends on the fact that, often, the patient’s family members also exhibit personality traits similar to those typical of obsessive compulsive disorder, albeit at a subclinical level, and thus have less “sensitivity” in recognizing the disease. In the case of recent onset of obsessive-compulsive manifestations, especially in people without a family history of the disease, possible specific triggers should be investigated, such as the presence of organic diseases (e.g., thyroid disorders) or the taking of drugs (in particular, dopamine agonists, used to treat Parkinson’s disease) or substances of abuse (alcohol, psychostimulants, etc.).

How to treat

The therapeutic interventions needed to regress obsessive compulsive disorder should be identified according to the severity of the manifestations, the patient’s age, and the duration of the illness. If the disorder has arisen recently and/or is not particularly severe, the first proposed approach is psycho-behavioral and is aimed at achieving progressive “deconditioning” from obsessive-compulsive habits, starting with those that create milder discomfort and interfere less with daily activities. In essence, you try to “dishabituate” the patient to perform the established rituals and make them feel less and less necessary.

When the disorder is more invasive and/or has been present for a long time, it becomes necessary to add drug therapy to psychotherapeutic interventions in order to achieve appreciable clinical outcomes. The drugs of choice for the treatment of obsessive compulsive disorder are antidepressants, particularly those belonging to the serotonin-releasing system inhibitor (SSRI) and norepinephrine-releasing system inhibitor (SNRI) classes, which should be taken for several months, continuing for some time even after the symptoms have disappeared.

Depending on the characteristics of the disorder in the individual patient, in some cases, it may be necessary to combine antidepressants with drugs of a different type, such as antipsychotics. In selected patients inadequately controlled by psychotherapy and drug treatments, deep brain stimulation may be considered (Deep Brain Stimulation
, DBS), involving implantation of microelectrodes that are designed to stimulate specific brain circuits involved in impulse control.

Extinguishing phobia with integrated care

24 February 20246 January 2024 by Redazione My Special Doctor

Recent research published in PNAS, the journal of the American Academy of Sciences, shows that the combination of psychotherapy and cortisone in people suffering from specific phobia (in this case, the phobia of high places) is particularly effective in extinguishing fear. According to the latest statistics, about 30% of Americans and about 16-20% of Europeans experience an anxiety disorder at some point in their lives. The burden of individual and collective suffering and expense is truly considerable: tens of billions of dollars spent each year in the U.S. alone to cope with what is technically called “spectrum of anxiety” namely a wide variety of anxiety-based disorders, among which Panic Disorder and Post-Traumatic Stress Disorder excel. But so-called specific phobias are also widely spread and cover the fear of the square (agoraphobia), that of blood (hematophobia), water (hydrophobia), animals (zoophobia), contamination (misophobia), enclosed spaces (claustrophobia), high places (acrophobia) and so on.

Treatments

For years, attempts have been made to help these people by administering anti-anxiety drugs, but with very little results. Since the early 1980s, a cognitive behavioral psychotherapy has been successfully tested, which, in various ways, exposes the patient to the stimulus that creates the phobia by teaching him or her a path to extinguishing the phobic memory. A sequence of steps is usually established that gradually exposes the patient to phobic stimuli. The goal is to get the patient used to practicing, in a protected environment, those situations he usually avoids. The modes of exposure may be based on imagination–that is, the patient mentally reenacts phobic situations–or on direct, in vivo exposure, as they say.

For example, if a person suffers from acrophobia, first you have them go up an open elevator that takes them to the second floors, then to higher floors until they go up to the roof. Obviously, this procedure requires a big commitment, including time, from the therapist and the patient. Today it is possible to strap on a device equipped with glasses connected to a computer and take a virtual reality trip, taking, virtually, elevators, crossing bridges suspended over a ravine or looking out of a 44th floor window. And that’s what a research team, led by neuroscientists from Basel, did on 40 acrophobics. With a twist: one hour before the expository psychotherapy sessions, everyone received a pill, but one half of it contained 20 mg of hydrocortisone and the other half a placebo. The group, which unknowingly took cortisone, had significantly better results than the other group, although good.

Why cortisol

How can this be explained? We have known for more than eighty years, from Pavlov’s experiments on conditioning, that when the dog hears the sound of the bell without it being accompanied by the offer of food, at first it has a salivation reflex, and that is, it expects that, as happened in the conditioning phase, that sound will be accompanied by food, but if this does not happen, after a while it stops salivating, and that is, the conditioning has died out. But in reality, as Pavlov himself showed, there is not the erasure of conditional memory, but rather the flanking of it with a new memory.

Cortisol is the stress hormone that is essential to the process of memory formation. Without positive stress, without mental activation, memories are not formed. Stress is detrimental later, when it is necessary to recall the worked and filed memory. In the group of people with acrophobia, administration before psychotherapy of a cortisone, hydrocortisone, very close to natural cortisone, reinforced the formation of a new memory to replace the old phobic trace. It seems to be a good example where medicine and psychology come together to help people in need.

by Francesco Bottaccioli

Asthma is sensitive to the psyche

24 February 20246 January 2024 by Redazione My Special Doctor

There is a close relationship between adversity in childhood and asthma risk, according to extensive research conducted by a group of pediatricians at Brown University in Providence, the U.S. capital on the Atlantic coast. Using data from the National Survey of Children’s Health, a national study of children’s health that involved, by detailed telephone interview, parents and guardians of more than 90,000 young people between the ages of 0 and 17, researchers found An increasing correlation between the number of adversities recorded in childhood and the incidence of asthma. As the Figure, excerpted from work published online in the journal of the American College of Allergy, Asthma & Immunology, shows, going from one to four adversities, the prevalence of asthma increases in parallel to an increase of more than 70 percent compared to children who experienced a more serene childhood.

But what kind of hardships were recorded? First and foremost is the loss of a parent through death or separation; having had a parent in prison, having lived with a parent with serious mental health problems or who committed suicide, or devoted to drugs or alcohol. With only one adversity, the study reported a 28 percent increase in pediatric asthma, which becomes more than 50 percent with 3 adversities and rises to 73 percent with the accumulation of four adversities (for example: living with a parent who is separated, has mental health problems, addicted to alcohol, and has problems with the justice system). Asthma is one of the great plagues of the contemporary world: hundreds of millions (150 to 300 million) of children and adults suffer from it worldwide. In the United States alone, 7 million children (9.5 percent of the total) face a condition that is often very serious and requires emergency hospitalizations. According to various sources, summarized by the National Epidemiology Center of the Istituto Superiore di Sanità (www.epicentro.iss.it ) , in recent years, the increase of the disease in Europe has been very rapid: it has reportedly doubled within a decade.

There are an estimated 9 million people in Italy with respiratory allergies, a category in which asthma takes the lion’s share. The factors underlying this condition may be numerous, but the mechanisms always seem to be the same: airway inflammation sustained by an imbalance of the immune system with an excess of inflammatory cytokines such as IL-4, IL-5, IL-13. The immune cells involved are TH2 group lymphocytes, mastoid cells, and eosinophils: cells with high inflammatory power that cause the typical signs of the disease (airway obstruction, choking sensation, excess mucus). There are now many studies that have documented that stressful life events can increase the occurrence of asthma in both adults and children. In 2012, a group of epidemiologists from the University of Verona in Pediatric Allergy and Immunology documented that children born to mothers who experienced stressful events in pregnancy, such as bereavement, divorce, and job loss, have a statistically significant increase in asthma, as well as other allergic diseases such as eczema and rhinitis.

Subsequent work by Swedish researchers in Pediatrics showed a relationship between the level of cortisol in pregnancy and that of their children at birth and in infancy. As is well known, cortisol is the main stress hormone, which normally increases in pregnancy but can increase further due to a stressful condition. Excess maternal cortisol goes to set the child’s stress system high, which will then produce too much cortisol in the early years of life. The excess of stress hormones, which also include adrenaline and noradrenaline, goes to alter the activity of the immune system in an allergic (TH2) sense, as we mentioned above. This explanation, which has a variety of experimental evidence both on animals and in vitro, has recently found further support from the introduction of a new system for measuring cortisol: the hair test, which we account for in the next section.

Chronic stress in the hair

From the 1950s until a few years ago, cortisol levels were measured in plasma and urine. Then came the completely noninvasive possibility of measuring the hormone in saliva. Now a further method promises a revolution of considerable magnitude. In the hair, which forensic biomedical scientists already used to track drugs or other illicit substances, cortisol can also be tracked. In 2012 in Endocrinology, authored by Jerrold Meyer and Melinda Novak of the University of Massachusetts, the first review was published that documented that hair cortisol levels correlate with those in blood or saliva. So this is a reliable test. But there is more. In our hair, it is also possible to read the history of our stress load in recent months! In fact, as hair grows an average of 1 cm per month, for example in three centimeters of hair (starting from the scalp) we find the measure of cortisol for the past three months. Thus, we have, for the first time, the possibility of measuring, with a biological marker, the chronic stress a person suffers from. The other methods in fact, while very valid, measure instantaneous cortisol levels, which are certainly important, but do not give us a measure of the overall load.

The usefulness of this method is already amply demonstrated by the flourishing of the scientific literature in recent years. The hair cortisol test has been applied in pregnancy, in infants, and in people with various diseases, from cardiac to psychiatric. Hair is an extremely stable biological material: it lasts for months, years, without altering significantly. Even cortisol has been traced in the hair of 1,500-year-old Peruvian mummies. But why is the hair a reliable probe of circulating cortisol levels? Because from the blood, cortisol passes into the follicular cells that generate the hair and accumulates there. In short, a reliable and revolutionary tool with one limitation: it is not applicable to total baldness!

by Francesco Bottaccioli

Anxiety: causes, symptoms and treatment

24 February 20246 January 2024 by Redazione My Special Doctor

Anxiety or, more precisely, “generalized anxiety disorder” as stated in the “Statistical Diagnostic Manual of Mental Disorders, is a psychiatric disorder characterized by: intense and persistent worry and anxiety not justified by the seriousness of real situations, events or risks; the need to plan and keep track of every aspect of life; inability to handle uncertainty and the unexpected; difficulty making decisions and excessive fear of making wrong choices; excessive apprehension about the health of a loved one; inability to divert thoughts from the object of concern, to relax and “loosen up”; and problems with concentration.

Disorders and Symptoms

Alongside variable combinations in type and intensity of the distinctive psychoemotional symptoms that define it, generalized anxiety disorder involves a range of physical manifestations related to nervousness and intense and persistent stress such as, for example: unmotivated fatigue, sleep disturbances, muscle contractures and aches, bruxism, headaches, appetite changes and digestive disorders (nausea, diarrhea, irritable bowel syndrome, etc.), sweating, irritability, repetitive gestures and the need to move, tachycardia, palpitations, pain in the center of the chest, drops in blood pressure, tightness and tightness in the chest, difficulty breathing, a feeling of suffocation, increased urinary frequency, disturbances in the menstrual cycle and sexual desire.

The physician should be consulted whenever a significant psychophysical distress characterized by intense/recurring anxiety and worry, sleep disturbances, pain syndromes, and other physical symptoms not justified by organic disease significantly interfere with general well-being and prevent one from serenely carrying out usual activities for periods longer than a few weeks. The first reference should always be the family physician, who will be able to frame the disorder and rule out the presence of any organic pathology at the origin of the malaise experienced. Once it is determined to be generalized anxiety disorder, psychological or psychiatric consultation may be recommended.

Causes

Like most psychiatric conditions, generalized anxiety disorder has complex causes and not yet well defined, given by the combination of genetic predisposition, alteration in the functioning of specific brain circuits involved in the control of emotions and stress response, predisposing personality profile, and neuropsychological developmental patterns.
The onset of generalized anxiety disorder can be promoted by risk factors such as: being female; history of traumatic experiences or having witnessed dramatic events in childhood; presence of chronic diseases (especially cardiac, respiratory, digestive, and metabolic) or history of serious physical illness/trauma (cancer, accident outcomes, myocardial infarction, etc.); exposure to acute intense or modest, but repeated or long-lasting stress; poor adaptability to external stimuli and tendency to nervousness and worry; intake of substances that worsen the stress response (alcohol, drugs, medications, caffeine, nicotine, exciting phytotherapeutic extracts, etc.).

Diagnosis

The diagnosis of generalized anxiety disorder is, as a rule, fairly straightforward because the symptoms are well recognizable and the discomfort experienced causes the sufferer to seek medical attention fairly quickly to identify a solution that can alleviate the discomfort.

In adults, to issue a diagnosis of generalized anxiety disorder, in addition to characteristic psychoemotional symptoms, at least three anxiety-related physical symptoms must be present. Taken together, the manifestations must be of an intensity that is not justified by the events/circumstances nor by the presence of specific triggers (in particular, intake of drugs/substances or presence of other diseases) and such that they interfere with the sufferer’s usual activities and well-being, and persist for more than six months. For the diagnosis of anxiety disorder in children, in addition to persistent anxiety and worry, the finding of a single related physical symptom, even for periods of less than six months, is sufficient.

How to treat

Treatment of generalized anxiety disorder varies depending on the characteristics and intensity of the distress in the individual case, but is almost always based on the use of medications that can restore good psychoemotional balance and improve the response to external stimuli and stress and/or psychotherapeutic interventions.

The pivotal drugs in anxiety therapy are antidepressants (mainly, serotonin-releasing-system inhibitors – SSRIs and serotonin-norepinephrine-releasing-system inhibitors – SNRIs), the use of which can be paired in the first 2-3 weeks with tranquilizing drugs (in particular, benzodiazepines) that provide quick relief while waiting for the antidepressants to start taking effect.

The psychotherapy provided in the presence of generalized anxiety disorder is mainly psycho-behavioral and is aimed at enhancing the ability to cope with stress and react more consciously and calmly to daily difficulties, through a kind of gradual re-adaptation.
Along with medication and/or psychotherapy, it may be helpful to take advantage of relaxation techniques such as yoga, tai-chi, meditation, rebirthing, shiatsu or traditional massage, acupuncture, listening to classical music, etc. Equally important is to exercise regularly (preferably, in the midst of greenery), sleep at least 7-8 hours each night, avoid overloading oneself with commitments, and be in the company of quiet and pleasant people as much as possible, follow a healthy diet, avoid smoking and caffeine and alcohol intake, take herbal teas and infusions with relaxing properties (e.g., made from chamomile, valerian, linden, lemon balm, hawthorn, passion flower, mallow, etc.)

VIDEOGAME DEPENDENCE: as of today it is officially a disease

24 February 20246 January 2024 by clemente.ferrara

How many of you in the past have found yourself spending entire afternoons in front of a screen and holding a controller? Certainly more than you can imagine. Video games, since their first appearance, have always kept the young (and not so young) company during boring winter afternoons when it was too cold to go out or conversely during torrid summer days. Often, however, this simple pastime, game and many times passion, exceeds the recommended limits and risks becoming a full-blown obsession, like a new pathology from which one must be treated and detoxified.

This is a phenomenon that has grown tremendously over the past 10 years, facilitated in part by the continuing evolution of video game consoles that offer increasingly exciting and compelling content that is often really hard to resist. For these reasons, there are numerous cases of individuals (not exclusively of adolescent age) who have developed a real addiction to video games, just as happens with alcohol and drugs. These are individuals who need medical treatment and to embark on a detoxification program in order to free themselves (with the help of experts) from this obsession.

The WHO decision

From this premise, it is easy to deduce what motivations prompted the World Health Organization to make the decision to include video game addiction in the next revision of the International Classification of Diseases, the “official list” of diseases, due mid-year. This is important news, communicated by WHO itself through a post on its official website. According to the Organization, “Gaming disorder encapsulates a range of behaviors characterized by a lack of control over gaming, the precedence given to gaming over other daily activities and interests, and the escalation of the problem despite the occurrence of negative consequences.”

The announcement also states the conditions under which one can claim to have “gaming disorder“, namely, “To reach diagnosis, the behavioral problem must involve significant impairment of personal, family, social and occupational functions for at least 12 months.” With the official recognition of this condition, new treatments for its treatment will be implemented worldwide. But in addition to post-diagnosis treatment, a significant prevention and information campaign regarding this new (albeit old) disease will also be implemented, the main target audience of which will be adolescents, usually the group most affected by this disorder.

DEPRESSION: the end of the supremacy of drugs

24 February 20246 January 2024 by Redazione My Special Doctor

From the myth of happy pills to integrated care

“Like most people I thought antidepressants worked”-so begins the book by Irving Kirsch, professor of psychology at Harvard and Plymouth, now available in Italian from Tecniche Nuove Editions under the title “Antidepressant drugs: the collapse of a myth. From happy pills to integrated care“. Page after page, with the force of numbers, Kirsch clarifies how he came to the conclusion that antidepressant drugs, when compared with placebo, have a modest degree of efficacy, documentable only in severe forms of depression, which on the other hand are a small minority of the manifestations of the disease. The book since it was published in England has sparked an uproar that is still in full swing.

They took the field, on the one hand, Marcia Angell, former editor of the New England Journal of Medicine, who took her cue from the book to draw an unapologetic analysis of American psychiatry judged to be on the bandwagon of the pharmaceutical industry (in the last 20 years antidepressant consumption has increased by 400 percent!), and on the other hand Peter D. Kramer, the head of the taskforce in charge of drafting the fifth edition of the DSM, the Diagnostic Manual of International Psychiatry, who defended antidepressants. In the middle is Thomas Insel, director of the National Institute of Mental Health, who stated in Psychiatric Times that in fact the difference with placebo is found only in severe forms of depression, so it is true that many people do not respond to drug treatment. According to the meta-analysis that Kirsch presents in the book, the difference between medication and placebo ranges from 16 to 18 percent in favor of medication, with a reduction of just two points on the Hamilton scale, which is the instrument for measuring depressive symptomatology. In short, little stuff, among other things full of side effects, that does not justify pivoting the treatment of depression into drug treatment.

In the final chapter Kirsch summarizes existing alternative approaches: psychotherapy, meditation, physical activity, herbal medicine. In late July, an international research group of which Kirsch is a member, in Plos published a detailed Systematic Review of more than 100 controlled studies examining the effectiveness of psychopharmacology, psychotherapy and alternative therapies. The data confirm that there is no difference between medication and psychotherapy and that while there is a (modest) difference between them and placebo, there is no statistically significant difference with alternative therapies (physical activity and acupuncture). Some positive difference in effectiveness can be seen from the combination of medication and psychotherapy. In short, integration of care is the way to go. Kirsch will speak about this in Milan at the Depression Conference organized for Nov. 24 by the Italian Society of Psychoneuroendocrinoimmunology (www.sipnei.it ). In this framework, meditation also proves to be a useful tool.

A recent study of ours submitted for publication to a qualified international journal and presented in the second edition of Meditation Psyche and Brain, New Techniques-shows that a short 4-day course reduces depressive symptoms by almost three times. The study, carried out by an interdisciplinary team including Sipnei psychologists and researchers and faculty members from the Faculties of Medicine in Ancona and Pharmacy in Urbino, was conducted on 125 people participating in our courses: The strong reduction in anxious-depressive symptoms seen at the end of the course is coupled with an equally sharp reduction and regulation of the discharge of cortisol, the main stress hormone.

by Francesco Bottaccioli

What it means to dream: curiosity and dream interpretation

21 February 20246 January 2024 by clemente.ferrara

Whether it is a premonitory, revelatory dream or a nightmare, dream interpretation and the dream world have always fascinated people of all times, especially the most distinguished figures in the fields of sociology and psychology. But what exactly is a dream? Literally speaking, dreams are representations made up of thoughts, voices, images and sounds that come to life in our minds while we sleep. The protagonists of our dreams can be both people familiar to us but also strangers we have never seen before; moreover, a dream can be a mere representation of a memory we have already experienced, or show us something new, an event we have never experienced on our own skin.

This last aspect is the one that most fascinates dream scholars, among whom we cannot fail to mention Sigmund Freud (author of the book “The interpretation of dreams“) who thought of dreams as a means of expression of our subconscious, and thus can reveal intrinsic traits of our personality, subconscious and mind, which may remain hidden during waking periods. But what happens during a dream? What are the oddities that can occur and how should they be interpreted?

Dream Interpretation

According to Freud ‘s theories, on which modern psychoanalysis and most subsequent theories are based, dreams are to be interpreted as the manifestation of our hidden desires, removed from our consciousness, which finds them unacceptable, particularly infantile ones. Dreams also have both manifest content and latent, hidden content: the latter, which represents the true meaning of the dream is thus obscured by censorship and must be reconnected to the former through the psychoanalytic method. There are also other theories of dream interpretation such as that of Jung, who at first was close to Freud but later broke away from his theories, that dreams should be seen as reinterpretations of episodes or events in our daily lives. The interpretation of dreams is not easy without the help of an expert, as it is very subjective and depends on a person’s daily life and past experiences, but writing down dreams in the morning on a piece of paper and noting down the symbols (objects, people or animals) and emotions felt in the dream can help in this regard.

Curiosities about dreams

A first characteristic (and oddity) of dreaming, unknown to many, is the fact that while dreaming most people cannot read. But in addition to this it is also almost impossible to consult the time on the clock, the clock will in fact tell a different time every time you look at it. Dreams can often turn into nightmares in which we are burdened with feelings such as anxiety, terror and even physical pain. In fact, it has been shown that even simply inducing tingling in someone’s foot causes him to dream of foot discomfort. But the emotions experienced during dreams can also be very positive as joy e happiness, especially when we talk about lucid dreams, i.e., those dreams in which the subject is aware that he or she is dreaming and realizes his or her innermost desires, such as flying, time travel, or playing a superhero (especially for children and adolescents).

About 80 percent of dreams also are in color, although there are still a percentage of individuals who claim to dream in black and white. Finally, dreaming helps the memory to memorize what we read or study before falling asleep, to a significantly greater extent than those who fall asleep but do not dream.

When do you dream?

When we sleep we go through two distinct phases: the REM phase and the NREM phase. According to experts, the individual dreams more in the REM phase (the one closest to waking), during which many respondents report interacting in their dream with as many as 3-4 different characters (usually part of their real life). It may happen, however, that one also dreams in the NREM phase, although in this case the dream may accommodate multiple characters, sometimes unknown to the dreamer.

Psychosocial risk: burn-out as an occupational disease

10 February 20246 January 2024 by Alessia Giannino

In recent years in Italy there has been a profound cultural revolution that, has enabled the understanding of the main European guidelines on the subject of worker protection. The National Health Plan 2006-2008 recognized some diseases resulting from psychosocial risks related to work organization. All this is taken up in Article 28, where it is indicated that the subject of risk assessment must also include those related to work stress. This fits into the context of a person’s life as one of the mismanaged work issues where elements of organizational constrictiveness or dysfunction in work organization prevail.

Such surveys aim to delineate the psychosocial risk present in a given work environment. It is not easy to identify stress, nor to establish the validity of the tools and methodologies adopted for this purpose, but it is possible to establish strategies that proceed gradually until the individual is analyzed. In group 7 of mental and psychosomatic illnesses, the disorders identified as occupational diseases are chronic adjustment disorder and chronic post-traumatic stress disorder. anxiety and depression represent the main work-related stress mental disorders and give rise to highly variable clinical pictures of predominantly somatic expression, such as gastritis, irritable bowel syndrome, headache and other somatizations.

Source: I don’t have time for… How it wears out care: health workers under stress by Ferdinando Pellegrino

Psychological interventions for Covid-19 patients

6 January 2024 by Redazione My Special Doctor

Questions are beginning to be asked about the Psychological Interventions needed following the outbreak of COVID-19. In a recent Chinese study, published in China Lancet February 18, 2020 starting with just what the Chinese experience has been, it shows how in the face of the psychological needs of patients, family members and medical personnel, medical institutions and universities have opened online platforms to provide psychological support, but all in no particular order without an organization capable of planning, coordinating activities and connecting them. In particular, there was a lack of timeliness of diagnosis and follow-ups related to treatment and evaluation. Specifically, in reference to patients who have faced health emergency, all studies emphasize how stress disorders persist, to varying degrees, even after the event is over (after recovery or discharge from the hospital) and how they should therefore continue to be followed up.

It would therefore be necessary, in order to prepare specific intervention measures, to classify people in need of psychological intervention according to various factors including: the course of the illness, the severity of symptoms, and the place of treatment (being isolated at home has a psychological impact that is certainly different from being in an isolation ward in a hospital or intensive care unit).Another problem is the fact that psychiatrists, clinical psychologists and social workers are considered non-essential personnel in pandemic emergency management and are not part of the staff assigned to isolation wards.

Consequently, health workers working in infectious disease wards, already on the front lines and under great pressure, find themselves having to manage without specific training all the psychological interventions needed for patients. Similarly to people quarantined at home, health services staff are forced to provide mental health care alongside basic medical care, despite complicated procedures, very heavy workloads and lack of training in psychiatry or clinical psychology. It would therefore be essential, in order to deal with emotional distress and disorders caused by health emergencies such as epidemics, to provide for and operationalize the presence of a team of professionals composed of mental health personnel.