Límits i intimitat: reflexions sobre una experiència de treball en grup i de grup per al manteniment de la ment de l’analista

Els autors presenten la seva experiència grupal en un taller realitzat amb el mètode del psicodrama analític. Ells mateixo ssón els participants i protagonistes d’unes trobades periòdiques que els ofereixen la possibilitat de crear un espai i un temps on compartir emocions, experimentar el naixement d’un self grupal i on s’activen processos transformatius. Jugar amb els personatges que es representen esdevé una experiència terapèutica. Ens expliquen la tècnica del seu treball i ens en mostren unes vinyetes clíniques. D’acord amb els autors, aquesta experiència permet exercir el “manteniment de l afunció analítica de la ment de l’analista”, l’instrument principal de la nostra feina. A més, ha representat un factord’apropament íntim personal i professional molt poderós entre els participants

First-episode psychosis and migration in Italy (PEP-Ita migration): a study in the Italian mental health services

BACKGROUND: It has been frequently reported a higher incidence of psychotic disorders in immigrants than in native populations. There is, however, a lack of knowledge about risk factors which may explain this phenomenon. A better understanding of the causes of psychosis among first-generation migrants is highly needed, particularly in Italy, a country with a recent massive migration. METHODS/DESIGN: The "Italian study on first-episode psychosis and migration (PEP-Ita)" is a prospective observational study over a two-year period (1 January 2012-31 December 2013) which will be carried out in 11 Italian mental health centres. All participating centres will collect data about all new cases of migrants with first-episode psychosis. The general purpose ("core") of the PEP-Ita study is to explore the socio-demographic and clinical characteristics, and the pathways to care of a population of first-episode psychosis migrants in Italy. Secondary aims of the study will be: 1) to understand risk and protective factors for the development of psychotic disorders in migrants; 2) to evaluate the correlations between psychopathology of psychotic disorders in migrants and socio-demographic characteristics, migration history, life experiences; 3) to evaluate the clinical and social outcomes of first-episode psychoses in migrants. DISCUSSION: The results of the PEP-Ita study will allow a better understanding of risk factors for psychosis in first-generation migrants in Italy. Moreover, our results will contribute to the development of prevention programmes for psychosis and to the improvement of early intervention treatments for the migrant population in Italy

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

Quaderni de gli argonauti n. 29

Il volume osserva la senilità da vertici differenti occupandosi di cura e in particolare della possibilità di lavorare psicoterapicamente con pazienti anziani, di femminilità, di cinema, di psicoanalisi, di cambiamentoi anche nelle fasi più avanzate della vita. Vengono offerte al lettore riflessioni sulla rappresentazione psichica del proprio e dell'altrui invecchiamento e sugli stereotipi sociali dell'invecchiare: una certa negligenza sociale e cultuale nei confronti dei problemi della senescenza, a differenza di quanto accade in altre culture, può corrispondere a un attengiamento difensivo dell'uomo occidentale nei confronti dei limiti dell'esistere

Sogni premonitori

Il desiderio di conoscere il futuro fa parte delle più profonde aspirazioni dell'uomo anche se questo non è che un nuovo sogno in cui rilanciare la nostra presenza ottativa e la nostra bramosia: un'altra nostra realtà che si oppone alla certezza del nulla e della morte. E' tra queste due certezze che il sogno può essere riproposto come dimensione conoscitiva come rilancio di una fantasia che medica le ferite dell'uomo nella sua realtà sociale

L'amore nelle culture

Sintetico excursus sui problemi posti dall'esperienza amorosa e sessuale in culture diverse dalla nostra dal punto di vista della psicoanalisi

Nuove prospettive sulla clinica dei migranti

L'articolo riguarda l'accoglienza e la presa in carico di migranti richiedenti asilo nell'ambulatorio etnopsichiatrico attivo presso il Laboratorio di Psichiatria Cultura e Ambiente del Dipartimento di Scienze del Sistema Nervoso e del Comportamento dell'Università degli Studi di Pavia. Nel lavoro viene discusso il processo attraverso il quale si cerca di reintrodurre una forma di umanità là dove il soggetto, che ha subito esperienze traumatiche estreme, è abitato da una disumanità che sembra inemendabile. Questo processo diventa possibile in una dimensione relazionale che tolleri un'intensa espressione della sofferenza subita da queste persone, senza farsi travolgere, per attivare una possibilità di comprensione delle loro terribili vicissitudini esistenziali

Il trauma psichico: studio di un caso clinico

Viene esposto un caso clinico complesso dove s'intrecciano aspetti problematici della pratica psicoanalitica. Una paziente sulla quarantina si accosta progressivamente all'analisi dopo un passaggio attraverso l'istituzione pubblica. La paziente viene prima trattata con una breve psicoterapia individuale, mentre si trova in uno stato di scompenso psichico acuto, in un quadro psicopatologico poliedrico sul quale avevano inciso esperienze traumatiche di qualità e intensità diverse e prosegue poi il trattamento con una terapia di gruppo dedicato a pazienti con disturbi del comportamento alimentare. In seguito la paziente chiede una terapia analitica in studio privato a tre sedute settimanali. L'analisi ha raggiuntol a sua fase conclusiva dopo sette anni