ACUTE INTERMITTENT PORPHYRIA (A.I.P): A MULTIDISCIPLINARY APPROACH

Guida Cc1, Pileri M2, Garrubba M2, Potenza A3, Caravella M4, Stallone C1

 

Departments of 1Nephro-Urology, 2Clinical Pathology, and 3Dietology, "Casa Sollievo Sofferenza" Hospital, Scientific Research Institute, San Giovanni Rotondo (Foggia) and 4Mental Health Department, Local Health Service FG3, Foggia, Italy

 

 

In February 1998 a 38-year-old female patient was admitted to Nephrology Department complaining recurrent abdominal colic pain, hyper-chromatic urine with transient urinary retention and bilirubin 2+ at urinary test. The clinical course was characterized by progressive asthenia affecting lower limbs till paralysis and psychiatric symptoms as irritability and aggressive behaviour in the familiar context.

 

Objectives:

1) prophylactic measures

2) strict clinical and laboratory surveillance

 

  Feb
1998
Sep
1998
Mar
1999
Feb
2000
Nov
2001
Dec
2001
Mar
2002
Apr
2002
Jun
2002
Jul
2002
Sep
2002
Nov
2002
Mar
2003
A L A 30.9
0.1-4.5
16.4
0.1-4.5
  17.5
0.1-4.5
N
o
r
m
o
s
a
n
g

® 
6.98
0-6.0
N
o
r
m
o
s
a
n
g

®
10.54
0-6.0
  3.11
0-6.0
4.96
0-6.0
3.56
0-6.0
10.07
0-6.0
P B L 83.2
0-2.0
15.7
0-2.0
  54.9
0-2.0
2.10
0-2.0
2.50
0-2.0
  1.20
0-2.0
1.60
0-2.0
1.4
0-2.0
1.90
0-2.0
T. P. 1200
0-150
1151
0-150
339
0-150
1000
0-150
  73
50-200
75
50-200
124
50-200
105
50-200
96
50-200
76
50-200
 

                                                                  â—„    DECAPEPTYL 3.75 ®   â–º

 

3) diet

overweight patient (real BW 62 kg vs ideal BW 55 kg)

normocaloric  (30 Kcal/kg) and  hyperglycidic diet (Kcal 1700):

protein (gram 70: 16.6%) – glucose (gram 293: 64.7 %) - lipids (gram 35: 18.7%).

dietary supplements of malt dextrin (malt sugar) with the aim of integrate calories and glycide supplies.

4) menstrual cycle blockade

use of triptorelina (Decapeptyl 3.75 ®) for nine months (March - December 2002)

5) psychotherapy

since January 2002 the patient is following a program of Transactional Analysis Psychotherapy for the aggressive behaviour at home. Psychotherapy work enhanced the change of  patient’s feelings and her social interactions, and also the body manifestations versus the organic and molecular problems.

 

Results:

Clinical data in our patient show the psychobiologic unit of human being and confirm Damasio and Edelman’s theories where body, mind, brain and environment are considered dynamic and interactive systems. The therapeutic relationship, activating chemical and neural response of the brain, can cause a deep change in the way human tissues or organs are operating. Energy bioavailability and metabolisms can be affected. The relationship between caring team and patient is essential element of the therapeutic work and founds his ground on the emotional communication that represents a powerful mean of the change.