Rivista di psichiatria最新文献

{"title":"[Capacity and right to therapeutic self-determination in law no. 219/2017. The case of persons with psychiatric and cognitive disorder.]","authors":"Edda Mariaelisa Turla,&nbsp;Corinna Porteri","doi":"10.1708/4056.40385","DOIUrl":"https://doi.org/10.1708/4056.40385","url":null,"abstract":"<p><p>Law no. 219/2017 represents Italy's most comprehensive regulatory framework aimed at enabling the exercise of the right to therapeutic self-determination and ensuring its best expression even for people without legal or natural capacity, through the tools of informed consent, shared care planning and advance care directives. Nevertheless, some criticalities affect the wording of the law, characterised by a promiscuous and heterogeneous use of the terms referring to capacity and by their interpretability. These criticalities may compromise the benefits of the law provisions at the implementation level, with particular reference to persons who may have a condition of limited capacity due to a psychiatric or cognitive disorder. We analysed the concept of capacity in the law and its critical aspects, both on a hermeneutical and applicative level. The analysis shows the difficulty of reconciling the rigidity of the legal categories of capacity with the changing and multifaceted nature of the clinical conditions. We underlined that possible correctives can come from both the healthcare contexts and legal practitioners and must be aimed at achieving maximum approximation between the formal plan of the law and the real contexts of care.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 3","pages":"134-142"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9630737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on the clinical efficacy of painting therapy of patients with anxiety disorders.","authors":"Jichong Hou,&nbsp;Ruifang Zhang,&nbsp;Jinmei An,&nbsp;Heqing Zhang","doi":"10.1708/4056.40384","DOIUrl":"https://doi.org/10.1708/4056.40384","url":null,"abstract":"<p><strong>Aims: </strong>This study analyzed the application value of drug combined painting therapy for patients with anxiety disorder by observing the changes in patients' mental and social functions.</p><p><strong>Methods: </strong>400 cases with anxiety disorder were recruited, and randomly divided into the experimental group and the control group with 200 cases in each group. Patients in the control group received drug therapy alone, while experimental group was combined with painting treatment on the basis of control group. The Nurses Observation Scale for Inpatient Evaluation (NOSIE) was used for the evaluation of mental and social functioning. Clinical efficacy was evaluated according to the degree of reduction in the Hamilton Depression Scale (HAMD) score.</p><p><strong>Results: </strong>After 8 weeks of treatment, the experimental group had a lower HAMD score than those in the control group. After 8 weeks of treatment, mental and social functions in both groups improved significantly. And the social competence, social interest and personal cleanliness of the experimental group were better than those of the control group, and the degree of irritability, retardation and depression were lower than those of the control group. In comparison with the control group, the experimental group had a higher cure rate and remarkable response rate.</p><p><strong>Conclusions: </strong>Painting therapy combined with drug therapy can relieve anxiety symptoms of patients with anxiety disorder, improve their mental and social functions, and improve clinical efficacy.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 3","pages":"129-133"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9664755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Validation of the Italian version of the DISCUS (DISC-Ultra Short), a brief standardized scale for assessing experienced discrimination among people with mental disorders.]","authors":"Antonio Lasalvia, Nicoletta Ingrosso, Andrea Fiorillo, Gaia Sampogna, Mariangela Lanfredi, Roberta Rossi, Sara Evans-Lacko, Ioannis Bakolis, Nicolas Rüsch, Chiara Bonetto","doi":"10.1708/4056.40382","DOIUrl":"10.1708/4056.40382","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the psychometric properties of the DISCUS (DISC-Ultra Short), a measure which assesses experienced discrimination among persons with mental disorders.</p><p><strong>Methods: </strong>Data collected in the three Italian sites (Brescia, Napoli, and Verona) participating at the international project INDIGO-DISCUS. Each Italian site recruited a sample of 50 individuals. Participants were evaluated with the DISCUS. This study evaluated: (a) reliability (internal consistency), (b) validity (convergent and divergent), (c) precision, and (d) acceptability. Participants were also asked to complete three additional measures: Stigma Consciousness, Brief Stigma Coping/Stigma Stress, and Internalized Stigma of Mental Illness (ISMI-10).</p><p><strong>Results: </strong>Overall, 149 people participated; 55% were males, with mean age of 48 (±12.4) years and on average participants had 12 (±3.4) years of education; only 23% were employed. Internal consistency was found to be good (Cronbach α=0.79). Convergent validity was confirmed (all correlations between DISCUS score and the other measures' scores were greater than 0.30). There was evidence of divergent validity, as the overall DISCUS score was not associated with the variable \"sex\". Precision showed a high correlation coefficient between the various items and the overall DISCUS score, with only one exception (discrimination when looking for housing), which showed a particularly high frequency of \"not applicable\" responses. Acceptability [measured with Maximum Endorsement Frequencies (MEF) and Aggregate adjacent Endorsement Frequencies (AEF)] was found to be fair (MEF violated in 2 items; AEF partially violated in 5 item).</p><p><strong>Conclusions: </strong>The Italian version of the DISCUS is a reliable, valid, precise, and acceptable measure of experienced discrimination to be used in large scale studies in the evaluation of anti-stigma initiatives in Italy.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 3","pages":"110-122"},"PeriodicalIF":0.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9630738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotic-like experiences associated with ICD-11 PTSD and cPTSD in a cohort of Italian late adolescents.","authors":"Rodolfo Rossi,&nbsp;Valentina Socci,&nbsp;Giulia D'Aurizio,&nbsp;Francesca Pacitti,&nbsp;Tommaso B Jannini,&nbsp;Isabella Federico,&nbsp;Flaminia Reda,&nbsp;Ramona Di Stefano,&nbsp;Alessandro Rossi,&nbsp;Giorgio Di Lorenzo","doi":"10.1708/4056.40383","DOIUrl":"https://doi.org/10.1708/4056.40383","url":null,"abstract":"<p><strong>Introduction: </strong>Post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD) are two sibling stress-related disorders. Evidence suggests a worse clinical picture associated with cPTSD in terms of comorbidities and outcomes. However, little is known about the association between cPTSD and psychotic-like experiences (PLEs). In this study, we aim to explore differences in PLEs in a sample of 1010 late adolescents with PTSD and cPTSD symptoms.</p><p><strong>Methods: </strong>A sample of 1010 late-adolescents and young adults attending the last year of high school was selected. PLEs were assessed using the 16-items Prodromal Questionnaire (PQ-16), PTSD and cPTSD were assessed using the International Trauma Questionnaire (ITQ).</p><p><strong>Results: </strong>999 (501 males, 50.15% and 498 females, 49.85%) subjects had complete data on the selected variables. Of these, 91 (9.11%) and 40 (4.00%) screened positive for PTSD and cPTSD, respectively. Mean number of PLEs endorsed in subjects with PTSD, cPTSD and control groups were 7.02 (sd=2.99), 8.17 (sd=3.70) and 4.49 (sd=2.93), respectively. Mean PQ-16 distress score was 5.08 (sd=4.6) in subjects not endorsing PTSD/cPTSD, 10.11 (sd=6.17) in PTSD and 14.51 (sd=9.1) in cPTSD subjects. A linear regression analysis revealed a significant association between PTSD/cPTSD and PLEs scores (respectively, b=4.91 [3.73, 6.10] and b=10.05 [8.40, 11.70]). Such associations were reduced after adjustment for depression, anxiety and dissociation.</p><p><strong>Discussion and conclusions: </strong>Our results find higher rates of PLEs in late adolescents screening positive for cPTSD and PTSD compared to negative subjects. Furthermore, cPTSD could be more specifically associated with distressing PLEs. These findings add to the vast literature of a worse psychopathological picture associated with cPTSD compared to PTSD, emphasizing the need for a separation between PTSD and cPTSD in terms of diagnosis and possibly treatment.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 3","pages":"123-128"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9630739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent schizophrenia: state of the art and proposals to improve transition management in Italy.","authors":"Antonello Bellomo, Gabriele Masi, Antonio Vita, Alessandro Zuddas","doi":"10.1708/4056.40381","DOIUrl":"10.1708/4056.40381","url":null,"abstract":"<p><p>In mental health care, transition refers to the pathway of a young person from a child and adolescent mental health service (CAMHS) to an adult mental health service (AMHS). In Italy, the age of transition from adolescents to adults' mental health services is at the age of 18. Difficulties in transitioning have shown to favor patients' and families' disengagement and discontinuity of care with pharmacological treatment dropouts. On the other hand, a smooth and effective transition may improve the management of the disease and increase the chances of improvement of young schizophrenic patients. This project of roundtables, including child neuropsychiatrists (CNPs) and adult psychiatrists (Psy) throughout Italy, was aimed at exploring the problems of transition in clinical practice and collecting the proposals to improve transition management. The need to fill some cultural and organizational aspects strongly emerged to improve the transition process of adolescents with schizophrenia to adults' mental health services. On the one hand, specific training programs for both Psy and CNPs on the transition process are hoped for. On the other hand, both Psy and CNPs have expressed a need for shared official protocols, direct handover between the services including a period of shared management, and building of territorial multidisciplinary teams. All these aspects imply having a national mental health policy dedicated to taking charge of young people with mental health disorders, and accompanying them across the border between children and adults' mental health services. Improving transitional care can facilitate not only recovery but also prevention of mental illness for young people. Allocation of resources should aim at matching the epidemiological burden and reducing the heterogeneity between Italian regions.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 3","pages":"101-109"},"PeriodicalIF":0.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9630740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Covid-19 emergency and telemedicine: multifamily psychoeducational intervention in a forensic setting.]","authors":"Marco Lombardi,&nbsp;Roberta Ortenzi,&nbsp;Jessica Sanna,&nbsp;Martina Pecorari,&nbsp;Maria Chiara Scenti,&nbsp;Cristina Iannini,&nbsp;Brunella Lagrotteria,&nbsp;Cristina Mancini,&nbsp;Giovanna Paoletti,&nbsp;Giuseppe Nicolò","doi":"10.1708/4022.39975","DOIUrl":"https://doi.org/10.1708/4022.39975","url":null,"abstract":"<p><strong>Aim: </strong>The aim is to describe remote multifamily psychoeducational intervention led by REMS \"Castore\" team (an Italian health care facility for offenders who suffer from mental disorders and socially dangerous) in ASL Roma 5, a local health authority, during covid-19 emergency.</p><p><strong>Methods: </strong>The applied theoretical models have been the integrated psychoeducational intervention by I. Falloon and the multifamily psychoeducational intervention based on problem solving by F. Veltro. The multifamily psychoeducational intervention was attempted by inpatients' relatives from June to August 2020 with 8 weekly meetings of 90' each led by two psychiatric rehabilitation therapists and healthcare experts. Six families were involved in the study and its members were assessed by questionnaire on family problems, Brief-COPE and general health questionnaire tests. Users were assessed by Level of Expressed Emotion Scale test for their expressed emotion.</p><p><strong>Results: </strong>Data analysis highlighted the general low level of subjective and objective burden for family members in association with a high perception of that support provided by REMS. Furthermore, the study has shown those coping approaches oriented to the research of practical solutions, acceptance of events and assertive communication.</p><p><strong>Discussion: </strong>The low subjective and objective burden may be attributed to implicit security conditions in REMS and the absence of tasks mainly carried out by experts. Those coping styles oriented to more practical than emotional approaches suggest an emotional hyper control or stigma perception leading to isolation and loneliness.</p><p><strong>Conclusions: </strong>The multifamily psychoeducational intervention has allowed a trustworthy relationship with REMS. Considering that the families involved in the study have never benefited by other psychoeducational interventions before, their early involvement appears to be a potential tool for preventing and managing crisis as well as minimizing recidivism.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 2","pages":"59-69"},"PeriodicalIF":2.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9329141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mediation role of impulsivity between childhood trauma and dissociative symptomatology in bipolar disorder.","authors":"Renato De Filippis,&nbsp;Elvira Anna Carbone,&nbsp;Martina D'Angelo,&nbsp;Marco Tullio Liuzza,&nbsp;Pasquale De Fazio,&nbsp;Luca Steardo","doi":"10.1708/4022.39978","DOIUrl":"https://doi.org/10.1708/4022.39978","url":null,"abstract":"In bipolar disorder (BD) patients, trauma has been associated with emotional dysregulation, potentially leading to an increase in impulsivity and dissociative symptomatology. We aimed to investigate the relationship between childhood trauma, impulsivity, and dissociative symptomatology in BD with a special focus on the role of impulsivity as a mediator between childhood trauma and dissociative symptomatology. METHODS We administered the Childhood Trauma Questionnaire (CTQ), Barratt Impulsivity Scale (BIS-11), Dissociative Experience Scale (DES-II), and Alda scale. Spearman correlation analysis assessed the independent variables associated with CTQ and DES-II. We performed a mediation analysis using the bootstrapping technique to verify the hypothesis that impulsivity represented an intervening variable between childhood trauma and dissociation. RESULTS CTQ and DES-II scores in 100 BD patients were both significantly associated with the number of lifetime affective episodes, a clinical course of mania-depression-euthymia, suicidal ideation, a history of antidepressant-induced manic switch, poor response to mood stabilizers, mixed features, psychotic symptoms, aggressive behavior, and BIS-11 (p<0.01). At the regression analysis, CTQ was associated with DES-II (p<0.001), while DES-II was associated with the CTQ (p<0.001) and BIS-11 (p< 0.001), as well as with aggression (p=0.002). The mediation analysis showed that impulsivity significantly mediated the effect of childhood trauma on dissociative symptomatology (z=25.71; 0.930-1.084). CONCLUSIONS Impulsivity might play a key role in onset and prognosis of BD patients. Our findings may help in increasing the knowledge about the possible association between impulsivity, childhood traumatic experiences and dissociative symptomatology. BD patients with dissociative symptoms might benefit from a tailored treatment which could include a training based on emotional and behavioral regulation.","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 2","pages":"84-92"},"PeriodicalIF":2.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9323861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How obsessive doubts about the past differ from ordinary ones.","authors":"Gherardo Mannino","doi":"10.1708/4022.39979","DOIUrl":"https://doi.org/10.1708/4022.39979","url":null,"abstract":"<p><p>Obsessive-compulsive disorder (OCD) still presents several enigmatic aspects, especially when viewed only from a third-person perspective. Instead, things become more comprehensible if we try to reconstruct the patient's first-person point of view. In this paper, an analysis of obsessive doubts about the past, illustrated by clinical examples, allows us to show that obsessive doubts, unlike ordinary ones, do not arise from insufficient knowledge of what happened. Instead, they seem to arise from the fact that OCD patients perceive all the mental images in which a feared event occurs as a sort of window open to a possible world. So that the authentic drama of an OCD subject is that he/she will face every time an array of possible worlds without knowing which of them is the real one. Furthermore, a comparison is made between the hypothesis presented in this paper and one of the best-known models in the literature: the hypothesis of 'inferential confusion'. Finally, some implications for psychotherapy of OCD are discussed.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 2","pages":"93-100"},"PeriodicalIF":2.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9329137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of bullying on healthcare workers: an umbrella review of systematic reviews and meta-analyses.","authors":"Corrado Colaprico, Simone Addari, Giuseppe La Torre","doi":"10.1708/4022.39973","DOIUrl":"10.1708/4022.39973","url":null,"abstract":"<p><strong>Objective: </strong>This umbrella review will provide a broad overview of the prevalence of vertical and horizontal bullying, the departments and the workers most affected by these attacks.</p><p><strong>Methods: </strong>We included systematic reviews and meta-analyses examining the effects of bullying on healthcare workers. Data extraction and analysis was performed on all included studies. The research strategy was undertaken in May 2021 and included three electronic databases (PubMed, Scopus and Web of Science): a total of 435 articles were retrieved from the Abstract and, once duplicates and irrelevant articles were removed, a total of 19 useful articles were reviewed. A comprehensive search was done to retrieve articles based on a PRISMA compliant protocol registered in PROSPERO: CRD 42021268082.</p><p><strong>Results and discussion: </strong>The general prevalence goes from 2 to 100%; for the individual healthcare workers, the highest prevalence is among nurses, 9-100%, followed by doctors 11.50-78.10%. Due to the heterogeneity of the studies, the other healthcare workers such as midwives, radiology technicians, administrative, employees were grouped and their prevalence goes from 3.30 to 100%. The results show that female nurses are significantly more likely to be abused than their male colleagues (women 3.60-100%; men 2.00-64.40%). The workplace in many studies was relevant for bullying: in particular, the most affected departments were emergency departments (2-100%) followed by intensive care units (17-84.80%).</p><p><strong>Conclusions: </strong>Bullying is extremely present among health workers and must be adequately countered. It will be necessary to carry out further studies to deepen the knowledge on this matter.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 2","pages":"41-49"},"PeriodicalIF":1.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9331678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The permanence of the setting modifications adopted during the covid-19 pandemic in the clinical practice of Italian psychoanalysts.","authors":"Daniela Cantone,&nbsp;Stefania Cella,&nbsp;Annarosa Cipriano,&nbsp;Carmela Guerriera","doi":"10.1708/4022.39976","DOIUrl":"https://doi.org/10.1708/4022.39976","url":null,"abstract":"<p><p>The research aims to verify if the remote modality, introduced widely by Italian psychoanalysts at the lockdown, remains in clinical practice today, with specific reasons and characteristics. The authors hypothesize that the use of such modality, beyond health limitations, is a point of no return compared to the classical setting. Based on this hypothesis, an ad hoc online questionnaire was proposed; the subjects were also called upon to express an opinion on taleanalysis. Two hundred sixty-seven subjects responded. The results confirm a wide use of remote analysis even in the current situation; they also seem to indicate recognition by psychoanalysts of the emergence of new psychic phenomena in this type of setting, for example, childhood traumas that in the face-to-face analysis were unknown or inelaborate, usable in the treatment process.</p>","PeriodicalId":21506,"journal":{"name":"Rivista di psichiatria","volume":"58 2","pages":"70-75"},"PeriodicalIF":2.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9329139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}