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

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

"My Life during the Lockdown": Emotional Experiences of European Adolescents during the COVID-19 Crisis

This study investigates, using an online self-report questionnaire, adolescents' emotional reactions during the lockdown in a sample of 2105 secondary school students (aged 14-19) in Italy, Romania, and Croatia. We used a self-reported online questionnaire (answers on a 5-point scale or binary), composed of 73 questions investigating the opinions, feelings, and emotions of teenagers, along with sociodemographic information and measures of the exposure to lockdown. The survey was conducted online through a web platform in Italy (between 27 April and 15 June 2020), Romania, and Croatia (3 June and 2 July 2020). Students aged >14 years, living in a small flat, and not spending time outside were more likely to report anger, sadness, boredom/emptiness, and anxiety. Boys were significantly less likely than girls to report all measured emotional reactions. Those who lost someone from COVID-19 were more than twice as likely to experience anger compared to those who did not. Our findings may help identifying adolescents more likely to report negative emotional reactions during the COVID-19 pandemic and inform public health strategies for improving mental health among adolescents during/after the COVID-19 crisis

[Diagnostic interpretation of depressive symptoms from a psychodynamic point of view].

The principal aim of this study is: (i) to assess the rate of depressive disorders in a sample of patient in a psychotherapy service of the Department of Psychiatric Sciences and Psychological Medicine at the Sapienza University, Roma; (ii) to focus the psychopathological features of depressive patient through the SCL-90R scale; (iii) to evaluate the correlation between SCL-90R score and categorical diagnosis. The sample of this study includes 178 patients, who came to our service for a psychotherapy. The anamnestic and clinical information were collected for each patient. Each patient is submitted to the multidimensional scale SCL-90R in the curse of the first interview. A descriptive analysis of all the data collected was made and the principal links between SCL-90 R score and categorical diagnosis were detected. About 46% of the patients were depressive disorders following the DSM-IVTR diagnostic criteria. About 70% of depressive patients have psychoticism pathological scores, 60% have paranoic pathological scores, 70% anxiety pathological scores and 60% interpersonal sensibility pathological scores. The depressive dimension was pathological in about 77% of anxious patient and in 87% of patient with personality disorders. The DSM.IVTR categorical psychiatric diagnosis might underestimate important psychopathological dimensions which are underline through a dimensional scale as the SCL-90R and through a psychodynamic diagnostic instrument

Valutazione del rischio di drop-out in un ambulatorio di psicoterapia psicodinamica. Studio clinico su un campione d 160 pazienti.

The principal aims of this study are: to assess the drop-out rate from a university psychotherapy service; to indentify the period at major risk for drop-outs; to delineate a profile of the drop-out patient through the research of a significant correlation between drop-out and social and clinical variables, in order to prevent this adverse event. The sample of this study includes 160 patients, which came to our service for a psychotherapy. The anamnestic and clinical information was collected for each patient. The outcome is classified as drop-out, discharged, and remainers. Each patient is submitted to the multidimensional scale SCL- 90R during the first interview. A descriptive analysis of all the data collected was made and the principal links between clinical and socio demographic variables and drop-out, and between SCL-90 R score and dropout were detected. About 42% of the patients were drop-outs, among which 86% by the third session, and only 3% after 6 months of psychotherapy. The variables associated with drop-out are: the young age, the fact of being single, of being unemployed, of being referred by the general practitioner, the absence of previous psychiatric contact, and pathological score in the psychotic scale of SCL-90R. In conclusion: the drop-out percentage is high in psychotherapy; the higher rates of drop-out are in the first three sessions; subjects at high risk are young, at the first contact with psychiatric services, therefore are patients in an outset phase, with better feedback at the treatment. It is very important to recognize these subjects to prevent the drop-out

Dalla crisi del paradigma neokraepeliniano verso una nuova nosografia psichiatrica. Il DSM-5.

With this article we intend to outline the story of American psychiatry starting at the end of the 19th century until the present time, describing the cultural, political and economic context which culminated in the development and diffusion of biological psychiatry and its nosography. The diffusion of psychoanalysis and of A. Meyer’s psychological psychiatry, beginning at the end of the Second World War until the end of the Sixties, determined such as an enlargement of psychiatric diagnosis which no longer allowed one to distinguish a sane individual from an ill individual. This “dimensional” model caused a slow process of de-medicalization of psychiatry which removed consent and legitimacy from the discipline. The answer was the publication in 1980 of DSM III, the work of a small number of psychiatrists known as the “Neo-Kraepelinians”. The new nosography based on a categorial diagnostic system, emphasized what is directly observable and therefore measurable, and not what is clinically significant. Whit DSM III and the successive versions the interest of the psychiatrists moved from the clinical to the epidemiological research. In the attempt to take psychiatry back to one of the medical sciences DSM III has in reality continued the process of undermining started whit Meyer and psychoanalysis. And now with the forthcoming publication of DSM V, psychiatry will be confused ever more with neurosciences

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revision of published data and discussion about impairment and quality of life for people at risk of developing psychosi

Interpersonal sensitivity and functioning impairment in the at risk syndrome for psychosis

A personality trait that often elicits poor and uneasy interpersonal relationships is interpersonal sensitivity. The aim of the present study was to explore the relationship between interpersonal sensitivity and psychosocial functioning in individuals at ultra-high risk for psychosis as compared to help-seeking individuals who screened negative for an ultra-high risk of psychosis. A total sample of 147 adolescents and young adult who were help seeking for emerging mental health problems participated in the study. The sample was divided into two groups: 39 individuals who met criteria for an ultra-high-risk mental state (UHR), and 108 (NS). The whole sample completed the Interpersonal Sensitivity Measure (IPSM) and the Global Functioning: Social and Role Scale (GF:SS; GF:RS). Mediation analysis was used to explore whether attenuated negative symptoms mediated the relationship between interpersonal sensitivity and social functioning. Individuals with UHR state showed higher IPSM scores and lower GF:SS and GF:RS scores than NS participants. A statistically negative significant correlation between two IPSM subscales (Interpersonal Awareness and Timidity) and GF:SS was found in both groups. Our results also suggest that the relationship between the aforementioned aspects of interpersonal sensitivity and social functioning was not mediated by negative prodromal symptoms. This study suggests that some aspects of interpersonal sensitivity were associated with low level of social functioning. Assessing and treating interpersonal sensitivity may be a promising therapeutic target to improve social functioning in young help-seeking individuals.Background: A personality trait that often elicits poor and uneasy interpersonal relationships is interpersonal sensitivity. The aim of the present study was to explore the relationship between interpersonal sensitivity and psychosocial functioning in the Attenuated Psychosis Syndrome (APS). Method: A total sample of 147 adolescents and young adult who were help-seeking for emerging mental health problems participated to the study. The sample was divided into two groups: 39 APS who scored 18 or over on the Prodromal Questionnaire (PQ) and met criteria for the Structured Interview for Prodromal Symptoms (SIPS), and 108 Negative Screening (NS) who scored 17 or less on PQ. The whole sample completed the Interpersonal Sensitivity Measure (IPSM), the Global Functioning: Social and Role Scale (GF:SS; GF:RS) and the Global Assessment of Functioning scale (GAF). Results: Individuals with APS showed higher IPSM scores and lower GF:SS, GF:RS and GAF scores than NS participants. A statistically significant correlation between interpersonal sensitivity and psychosocial functioning impairment was found among both groups. Conclusion: This study suggests interpersonal sensitivity was strongly associated with social functioning impairment. Considering that psychosocial functioning impairment was found to be associated with considerably decreased subjective quality of life within people with APS, detecting and treating subjective psychopathological aspects (i.e. interpersonal sensitivity) associated with it seems to be an important therapeutic target for APS

Disorder, not just state of risk:Meta-analysis of functioning and quality of life in people at high risk of psychosis

Background The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an ‘at risk’ state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment. Aims To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes. Method Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654). Results People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did. Conclusions Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders