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Recent studies have identified DAAO as a probable susceptibility gene for schizophrenia and bipolar disorder. However, little is known about how this gene may affect brain function to increase vulnerability to these disorders.
The present investigation examined the impact of DAAO genotype on brain function in patients with schizophrenia, patients with bipolar I disorder and healthy volunteers.
We tested the hypotheses that the high-risk variant of DAAO would be associated with altered prefrontal function and functional connectivity in schizophrenic and bipolar patients.
We used functional magnetic resonance imaging to measure brain responses during a verbal fluency task in a total of 121 subjects comprising 40 patients with schizophrenia, 33 patients with bipolar I disorder and 48 healthy volunteers. We then used statistical parametric mapping (SPM) and psycho-physiological interaction (PPI) analyses to estimate the main effects of diagnostic group, the main effect of genotype and their interaction on brain activation and functional connectivity.
In schizophrenic patients relative to bipolar patients and controls, the high-risk variant of DAAO was associated with lower deactivation in the left precuneus and greater activation in the right calcarine and posterior cingulate gyrus during task performance. In addiction, these areas expressed altered functional connectivity with the rest of the brain in schizophrenic patients relative to bipolar patients and controls.
Our results suggest that genetic variation in DAAO has a significant impact on brain function and provide preliminary evidence for a disease-specific pattern of gene action in specific brain regions.
Most users of psychiatric services shows jointly clinical severity, disability and marginalization so complex that it can not be answered fully only within the same services.
Within the Mental Health Department of Lecce, in the Mental Health Center of Casarano it is started the Natural Social Network Project “One for all and all for one” aimed to provide a more adequate response to the needs of these patients.
It will be identified patients with most psychosocial problems according to frequency of hospitalizations, emergency visits and rating scales (Brief Psychiatric Rating Scale, Life Skills Profile and Short Form 36 Health Survey). Then it will be identified with the patient a “facilitator”, or a person outside the CSM and longer fit into the everyday life of the patient (eg, relatives, friends, etc..). After that, the various parties involved (doctor, nurse, facilitator and user) agree an individual program based on which we make a psychoeducational path. The process will be checked quarterly with the presence of all the parties involved and monitored monthly or on the basis of needs.
After one trial year it is expected a substantial improvement by the patient in the satisfaction of his needs and more generally in his rehabilitation.
Based on the assumptions of Group Analysis theorized by Burrow and Foulkes, in the Center for Mental Health of Casarano (Department of Mental Health of Lecce, Italy), it has been experienced the “Workshop of words, sounds and music”, with the aim to develop and empower the skills of the participants promoting the functional re-inclusion in the context of normal life.
The work group has provided weekly meetings and involved 12 schizophrenic patients followed by the Mental Health Center of Casarano. It was stimulated the writing of songs first by lyrics and then by melody starting from individual and group introspective thoughts.
Several songs have been created by the participants and it was released a CD in the recording studio.
It was possible to develop creative moments in which they could be expressed deep emotions that dwell in the individual lives of the protagonists stimulating at the same time socialization as an intrinsic part of the therapeutic process. This allowed the metaphorical language of the unconscious could be communicated to the conscious, resulting in a curative effect on psychosis. in this way, the pent-up energy from the disease has been usefully channeled in a group setting where each component has expressed a new access to mental regenerative sources.
Starting from the theoretical assumptions of Group Therapy, within the Department of Mental Health of Lecce, in the Center for Mental Health of Casarano it was experienced the “Project Hinterland: the way of the steps and thoughts”.
The “Project Hinterland: the way of the steps and thoughts”, through a group activity, was aimed to provide a undergoing reorganization of the gap between inner and outer world, characteristic of the mental disorder.
- Conductors: psychiatrist and psychologist
- Sample: 9 schizophrenic patients
- Duration: 12 months
Phases of the project:
1. Exposure of the project and identification of individual interests
2. Identification of journey and collection of information about it
3. Excursion on the sites identified
4. Sharing emotions and thoughts related with the experience of excursion
- Clinical Global Impression (CGI) at baseline and 12 months
- Short Form 36 Health Survey Questionnaire (SF-36): at baseline and at 12 months
Significant reduction in mean scores in all areas of the CGI and the SF-36.
Knowledge of the territory of belonging has reinforced the cultural and social identity of participants favoring the appropriation of their life contexts. The integration between cognitive space and motor activity has encouraged the perception of emotions related to it. The group activity has positively stimulated socialization longer valid and closer to the needs of the patient.
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