No abstract

Patients with comorbid MDD and BPD present differential characteristics that indicate a more serious and impairing condition with a stronger familial link with mood disorders than is shown by depression patients with other Axis II codiagnoses.

IntroductionThe term ‘revolving door (RD) phenomenon” was coined to define recurrent hospitalizations of chronically ill patients after closure of psychiatric hospitals and implementation of community treatments.ObjectivesContinued readmissions require a large portion of Mental Health Departments’ resources.AimsTo analyze the RD phenomenon in an acute psychiatric ward during a 5-year period.MethodsWe retrospectively selected all patients with 3 or more hospitalizations per year from 01/01/ 2009 to 31/12/2013 in SPDC-Modena Centro. From their medical records we collected selected variables, potential predictors of RD phenomenon. Data were statistically analyzed.ResultsIn the 5-year period, a sample of 105 patients (47 females, 58 males) with an average age of 40.25 years (± 13.47 SD), 5.68 % of all inpatients (n = 1850), realized 778 hospitalizations, 23.94 % of all admissions (n=3250). The most frequent reason for admission was ‘worsening of psychiatric symptomatology” (55.27%). The most frequent diagnoses at discharge were ‘Schizophrenia” (41.26%) and ‘Personality Disorders” (25.32%). Most of RD patients (87%) were Italian, only 15 % were employed and 50 % lived with family. The mean duration of RD hospitalizations (12.23 days ± 18.37 SD) was statistically significantly different from all others in the 5-year period (10.39 days ± 11.09 SD, p=0.0008, t test) as was the frequency of compulsory admissions (RD hospitalizations 18% vs. 26% all others, chi2, p<0.001).ConclusionsOur RD patients represented a small percent of all inpatients but required many and long hospitalizations, probably due to severe and disabling illness.

The results confirms the findings of our previous study: post partum is the only risk factor for the onset of OCD in female population, compared to healthy control. Furthermore, this research points-out the importance and the specificity of this association showing that post partum is not a risk factor in all psychiatric disorders.

Introduction: Borderline Personality Disorder (BPD) shares many symptoms with Bipolar Disorder (BD) and Attention-Deficit/Hyperactivity Disorder (ADHD), like aggressiveness, mood instability and impulsivity, which are often treated in off label modality with mood stabilizer drugs.We point out the diagnostic, therapeutic and rehabilitative difficulties of BPD treatment through the analysis of two extreme and parallel cases. Materials and methods: Two females, born in extra-EU Countries in 1986 and in 1988, emigrated in Italy in childhood, presented overlapping traumatic early life events and ADHD during scholar age. Later, both the patients presented such growing relational problems and disruptive behaviours to be expelled from family and school. So they began a long psychiatric history, characterized by frequent hospitalizations, due to violent behaviour against themselves and other people, many unsuccessful rehabilitative programs, due to poor compliance, and various pharmacological switches, due to drug scarce effectiveness.Both the patients were followed by the same staff for 8 years, with an integrated psychotherapeutic, rehabilitative and pharmacological program, which consisted of a perseverant and meantime flexibly setting, a support of educational community operators and an off label prescription of two mood stabilizers combined to an atypical antipsychotic drug.ResultsAt the moment, the patients showed reduced dangerous behaviours, but need a perseverant effort by many operators in order to promote their emancipation from institutional dependence. Conclusions: The complexity of these cases, characterized by the persistence of a childhood disease, developed into a stables unstable mood chronic pathology till the late adolescence, suggests us a likely pathogenic relationship among BPD, BD and ADHD.