Mr G, a 48-year-old Italian man, manager of a small firm, married and father of two children, was diagnosed with sarcoidosis 24 years ago. The diagnosis, based on radiological and histological findings, was made at Ospedale Maggiore in Bologna. Tuberculosis, cryptococcosis, histoplasmosis, and other infective diseases were excluded by the laboratory analysis. The disease concerned his skin and his lungs, with the characteristic noncaseous granulomas. The main symptoms were an erythema nodosum to the legs and dyspnoea. The disease did not affect the central nervous system or other organs.
The patient was treated with corticosteroids, with different dosages according to the clinical condition. The physician noticed a state of depression and thus requested an evaluation from a clinical psychologist.
During the clinical interview the patient showed an alexithymic communication style, with limited speech, a pessimistic approach to the future, and social withdrawal. He worried about appearing idle at work, and spending little time with his family, with whom he felt isolated and not respected. He criticized himself and felt mortified when going against his own limits in his professional activity. He felt helpless that he had failed to meet his own expectations and that he was unable to cope with his pressing problems. This evidenced a state of demoralization, particularly frequent in medically ill patients.
Moreover, he suffered from dyspnea, and, every 3-4 months, the sarcoidosis nodule on his right leg worsened, as it had been doing for the last ten years. The sarcoidosis manifested itself six months after the patient started working and got married. These events coincided with the onset of the oncological disease of his father, who died three years later. At the time of his father's death, the patient had just started an entrepreneurial activity. The patient was therefore left without the important psychological support of his father. During this period the wife's depressive disorder, which had already appeared five years before, returned, with the onset of the oncological pathology of her mother, who died the year after the death of the patient's father.
A minor depressive disorder was diagnosed, according to DSM-IV-TR, based on the following aspects: depressed mood, feelings of low self-esteem, and difficulties in making decisions. From the anamnesis these research criteria were met during the last decade.
To the medical therapy, consisting of 5 mg/die of Prednisone, a supportive-expressive weekly psychotherapy session was associated, according to the technique introduced by Trombini for psychosomatic patients with alexithymic traits. At the beginning and at the end of the psychotherapy, and for the long-term outcome evaluations, the patient's psychological distress (anxiety, depression, somatization, and hostility) was investigated using the Italian version of the Symptom Questionnaire (SQ) by Kellner. The SQ is a widely used instrument in psychosomatic assessments and in the test-retest control of psychotherapies.
The psychotherapy lasted three years.