Paolo Poli

BACKGROUND AND HYPOTHESIS: This umbrella review aims to comprehensively synthesize the evidence of association between peripheral, electrophysiological, neuroimaging, neuropathological, and other biomarkers and diagnosis of psychotic disorders. STUDY DESIGN: We selected systematic reviews and meta-analyses of observational studies on diagnostic biomarkers for psychotic disorders, published until February 1, 2018. Data extraction was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Evidence of association between biomarkers and psychotic disorders was classified as convincing, highly suggestive, suggestive, weak, or non-significant, using a standardized classification. Quality analyses used the Assessment of Multiple Systematic Reviews (AMSTAR) tool. STUDY RESULTS: The umbrella review included 110 meta-analyses or systematic reviews corresponding to 3892 individual studies, 1478 biomarkers, and 392 210 participants. No factor showed a convincing level of evidence. Highly suggestive evidence was observed for transglutaminase autoantibodies levels (odds ratio OR = 7.32; 95% CI: 3.36, 15.94), mismatch negativity in auditory event-related potentials (standardized mean difference SMD = 0.73; 95% CI: 0.5, 0.96), P300 component latency (SMD = -0.6; 95% CI: -0.83, -0.38), ventricle-brain ratio (SMD = 0.61; 95% CI: 0.5, 0.71), and minor physical anomalies (SMD = 0.99; 95% CI: 0.64, 1.34). Suggestive evidence was observed for folate, malondialdehyde, brain-derived neurotrophic factor, homocysteine, P50 sensory gating (P50 S2/S1 ratio), frontal N-acetyl-aspartate, and high-frequency heart rate variability. Among the remaining biomarkers, weak evidence was found for 626 and a non-significant association for 833 factors. CONCLUSIONS: While several biomarkers present highly suggestive or suggestive evidence of association with psychotic disorders, methodological biases, and underpowered studies call for future higher-quality research.

Our focus in this chapter is to address some of the philosophical issues that arise in the scientific and clinical study of the prodromal phase of psychosis. We discuss issues from both metaphysics and philosophy of science as we all as those related to phenomenological approaches and clinical ethics. A clear challenge arises in considering how models of a continuum of psychosis and of schizophrenia as a neurodevelopmental disorder can be reconciled with a scientific understanding of the prodrome as a discrete constellation of signs and symptoms. Clinical and research work on the prodromal stage of psychosis also highlights ethical concerns. Demarcating a mental disorder and applying therapeutic interventions, based solely on risk estimation, should not be carried out lightly.

Il libro ricostruisce la vita e il pensiero di Jean Guitton (1901-1999), il grande amico di Paolo VI, a quasi ventʼanni dalla sua morte. La vicenda umana di questo scrittore e filosofo cristiano ha attraversato quasi integralmente il XX secolo quale testimone diretto di eventi epocali: i primi tentativi ecumenici, le due guerre mondiali, le radicalizzazioni ideologiche del secondo dopoguerra, lʼera atomica e il Concilio Vaticano II. Il primo capitolo del volume è dedicato alla ricostruzione della vita di Guitton e alle sue prime sintesi accademiche; ed esso fanno seguito altri due capitoli che trattano della sua antropologia (il tempo, il pudore, l'amore umano) e della sua cristologia filosofica (le condizioni di possibilità della rivelazione, la filosofia della risurrezione, la sua innovativa mariologia). Ne viene il ritratto di un pensiero di impronta umanista, ben radicato nella tradizione francese e che forse, come già lamentava Yves Congar nel 1963, non ha avuto, fino ad oggi, quellʼattenzione e quellʼaccoglienza che sembra meritare.