Modalità di gestione della terapia integrata in ambito psichiatrico. Uno studio 'cross-sectional' su un campione selezionato di psichiatri

Obiettivi. Frequente è l’associazione del trattamento farmacologico alla psicoterapia. Tuttavia, manca univocità rispetto ai criteri di gestione del paziente in terapia integrata. Pertanto, si è ritenuto utile sondare all’interno di un campione di psichiatri psicoterapeuti, quali fossero le metodologie più frequenti. Materiali e Metodi. A 120 psichiatri è stato somministrato un questionario di 10 items volto ad esplorare le modalità di gestione della terapia integrata applicata è stata eseguita un’analisi descrittiva dei dati. Le analisi statistiche sono state effettuate mediante SPSS 13.0® Risultati. Il 35,0% degli intervistati lavora come libero professionista, il 19,17% lavora in ambito pubblico. Due terzi del campione ritiene la terapia integrata una forma di trattamento efficace. In ambito pubblico il trattamento maggiormente applicato è quello di tipo integrato (43,48%), in ambito privato quello di tipo psicoterapeutico (78,57%). Il 75,0% prescrive personalmente la farmacoterapia, mentre il 25,0% delega ad un altro collega questo compito. Nell’85,0% dei casi i farmaci vengono prescritti nelle psicosi con sintomi produttivi, seguono poi i disturbi dell’umore con sintomi psicotici. La classe di farmaci maggiormente somministrata è quella degli antipsicotici, seguita dagli stabilizzatori dell’umore. Conclusioni. Le Terapie Integrate, sono funzionali quando l’intervento farmacologico è congruo con il modello psicoterapico. Gli psicofarmaci vanno utilizzati solo se strettamente necessari e l’utilizzazione va elaborata nel lavoro di psicoterapia. Se possibile, è preferibile un solo terapeuta di riferimento. Clin Ter 2009; 160(3):e39-e4

Biostratigraphic investigations assisted by virtual outcrop modeling: a case study from an Eocene shallow-water carbonate succession (Val Rosandra gorge, Trieste, NE Italy)

Virtual outcrop modeling has emerged as a tool for supporting geological field activities such as geological mapping and stratigraphic investigations. Here we show how this technique can be used to support the detailed stratigraphic logging and sampling with a case history from the Eocene carbonate platform succession exposed in the Val Rosandra gorge, in the vicinity of the city of Trieste, NE Italy. The biostratigraphic analysis highlighted the occurrence of Shallow Benthic zones (SBZ) 10 to 12 and the planktonic zones E7/E8. An upwards -deepening trend, from inner platform to a hemipelagic domain, is observed through the studied stratigraphic interval and is in accordance with the vertical evolution recorded in other Eocene successions of the Adriatic Carbonate Platform. Aerial drone imaging was used to produce a virtual outcrop model of the studied succession that provided a highresolution geometrical framework for field measurements, sample geotagging and observations. For instance, the virtual outcrop model assisted in determining the true thickness of beds, a task that can be subject to significant imprecisions when measurements are taken by hand. Ultimately, the integration of virtual outcrop modeling with classical sampling and measuring methods resulted in accurate stratimetry and in the precise spatial positioning of samples that were taken for biostratigraphy and facies characterization

Psicoterapia psicodinamica e formazione universitaria: problematiche e prospettive

This article proposes a reflection on the problem of psychiatric training taking into consideration the current situation present in Italy where, apart from public (university) schools of specialization, there are a number of private post-graduate schools which qualify one to practice the profession of psychotherapist. By keeping separate the more didactic-educational aspect from the training, there is an attempt to verify how much attention is devoted to the latter because within the university schools more and more students ask for a possibility to discuss clinical cases and understand the sense of a therapeutic relationship. Furthermore, it is necessary to verify, not only the didactical learning of students, but also their personal aptitudes during the four years of specialization. There seems to be an incongruity between the statutes that govern the single private specialization schools that regulate the supervision of clinical cases and in some cases prescribe an obligatory didactic analysis for the student, and what happens in a university context

Valutazione del rischio di dropout in una popolazione di pazienti affetti da disturbi dell'umore

Introduction. The aims of this study are (i) to assess the drop-out rate in an outpatient sample with mood disorder diagnosis in a psychotherapy unit; (ii) to focus clinical and sociodemographic variables related with drop-out; (iii) to delineate a psychopathological profile of the dropping-out patient through the SCL-90-R and OPD scores.Method. The sample of this study includes 90 depressive patients, which came to our service for a psychotherapy. The outcome is classified as drop-out and non drop-out. Each patient is submitted to the multidimensional scale SCL-90-R in the course of the first interview. At the end of the first visit each patient has been evaluated through the first and the fourth OPD axis. A descriptive analysis of all the data collected was made and the principal links between clinical and sociodemographic variables and dropout, between SCL-90-R score and drop-out, and between OPD scores and drop-out were detected. Results. About 42% of the patients were drop-out, of which 89% by the third session.The variables associated with drop-out are: pathological score in the paranoic and interpersonal sensibility scale of SCL-90-R, low compliance scores, low integration of defences, self perception, object's perception and link. Discussion. The drop-out rate in depressive patients turned out to be frequent. The patient's resources in terms of relationship, self-perception and object's perception are strongly related to the drop-out risk. These results are suggestive for the idea that the evaluation of drop-out risk in psychiatric patients must considerate the subjective aspects of the patient besides the clinical features

Uno studio sulle caratteristiche di un campione di pazienti internati presso l'Ospedale Psichiatrico Giudiziario di Castiglione delle Stiviere e dimessi nella regione Lazio.

Aim. The aim of this study was: i) To identify socio-demographic and clinical data in a sample of inmates in the Criminal Mental Hospital (CMH) at Castiglione delle Stiviere; ii) to assess the presence of characteristics which could foresee the commission of a crime of psychiatric interest; iii) to assess the frequency of crime repetition. Materials and Methods. This study was carried out on a sample of 38 patients. A descriptive analysis of the sample was carried out and the associations among several variables were analyzed. Results. The sample is characterized by a high frequency of schizophrenia diagnosis (73.0%), the presence of hospitalization before the commission of the crime (68.4%) and the absence of criminal precedents (71.1%). For men the age of the commission of the crime is equal to 33.72±10.6 years and for women to 45.18±11.4 years (p=0.011). The time between the onset and the commission of the crime is longer in patients who have received therapy (treatment) than in those ones with no treatment (p=0.012). About 12% of the sample committed new crimes. Conclusions. The results showed previous criminal acts are not predictive for the commission of new crimes of psychiatric interest. However many patients had previous contacts with community facilities before their first admission to hospital and the treatment extended the interval between the onset of the disease and the commission of the crime. The relapse rate after the discharge was very low if compared with samples coming from other services that offered more custodial rather than rehabilitative facilities

Che fine ha fatto la psichiatria? Crisi di interesse, voglia di formazione e nuove sfide.

The aim of this article is to describe the current crisis of psychiatry’s scientific credibility. A review of the literature points to a lack of identity characterizing this discipline and giving rise to many contrasting schools of thought. A fall in the request for specialist training and the high number of drop-outs during the professional training period testify to the fact that there is a crisis of credibility. This phenomenon is attributed to a lack of prestige afflicting psychiatry and to a poor consideration of the current diagnostic and therapeutic tools. Many authors suggest giving more importance to the human qualities of the psychiatrist and resuscitating psychopathology as a way of coping with this situation. The Authors believe that a reconsideration of psychodynamic psychotherapy is a key factor in solving this crisis provided that it proves its efficacy in order not to be excluded from scientific debate

Trent'anni di legge 180: dalla gestione della cronicità alla possibilità di cura.

The aim of this article is to describe the current situation of the Italian mental health system thirty years after the proclamation of law 180, to assess the quality, accessibility, adequacy, acceptability and continuity of the treatments offered, by presenting a series of data found within the most important epidemiological studies carried out at a national level. From what has emerged we are able to gather that structural, organizational and methodological factors insure that the system appears strongly conditioned by the necessity to manage pathologies which have already become chronic at the expense of the possibility of fostering, stimulating and supporting operations directed at preventing chronicity itself through diagnosis and early intervention. Practical changes and theoretical transformations are therefore not only necessary but urgent if we want to carry out a conceptual and practical revolution within the Italian mental health system; something which must still be achieved

Was ist aus der Psychiatrie geworden? Interessenskrise, fragen der ausbildung und neue herausforderungen.

The aim of this article is to describe the current crisis of psychiatry’s scientific credibility. A review of the literature points to a lack of identity characterizing this discipline and giving rise to many contrasting schools of thought. A fall in the request for specialist training and the high number of drop-outs during the professional training period testify to the fact that there is a crisis of credibility. This phenomenon is attributed to a lack of prestige afflicting psychiatry and to a poor consideration of the current diagnostic and therapeutic tools. Many authors suggest giving more importance to the human qualities of the psychiatrist and resuscitating psychopathology as a way of coping with this situation

Psicoterapia di gruppo: la prassi, la formazione, la ricerca.

The aim of this study is to conduct research into the activity carried out by 118 psychotherapists whose work is based on the theory and practice of Massimo Fagioli and constitute the editorial committee of this journal. In order to make this survey possible a questionnaire containing 28 questions was prepared and sent to them. 82 answers were obtained, constituting 69,5% of the group interviewed. We started off considering general characteristics, such as the number of therapists carrying out this profession and the number of patients in treatment. Then followed more specific information, such as the characteristics of the therapists, of the groups, patients and the factors implied in the process of curing mental illness. We tried to understand the working method adopted and how psychotherapy sessions are conducted from the answers. We tried to outline this practice in its more peculiar aspects, trying to identify the different methods compared to other theories and techniques. The results revealed that we are dealing with a group practice carried out by a consistent number of therapists with a fair amount of professional experience. The therapist have a considerable number of patients, estimated at 1568. Many differences emerge with what is reported in the literature starting from the criteria adopted for the admission and dismissal of patients. The data which emerge on the therapeutic factors are completely different from those recognized by other forms of group psychotherapy. The therapists interviewed believe that the principle therapeutic factors are the personal identity of the therapists, the interpretation of dreams and the interpretation of the therapeutic relation. These results imply that the human formation and professional training of the therapist is very important