La formazione dello psicoterapeuta in ambito pubblico

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Qualità della vita, psicofarmaci e psicoterapia.

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La psicosi della normalità

The Author points out some consderaUons cùxiut a cìinical case he mot just twice in a public depaitmen t. His attention is paid fo the demand and the need ol its coherent re/ormujcrtion.- to the cn'tìdsm to a distoited use oì the concepì of didactic analysis; to the right relationship to the principle ot reaiity as an indispensabile presupposition tor the analyUcal worfc fo the refusai as a care instrumen

L’ozio e la noia: casi clinici

"The Devil finds work for idle hands": this is the high negative idiom that describes for a long idleness and that hides the doing nothing idea, that in this article we try to discredit; in fact idleness can be considered a moment of great creativity that, even better, opposes to nothing's idea. We can suppose that the "nothing's idea" characterizes not the idleness but the boredom. Or better, a particular type of boredom, invincible and that deprives everything of all meanings and in this way we can define as mental illness

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

Nuove possibilità di valutazioni psichiatriche con sistemi web-based: uno studio pilota

Introduction. Telepsychiatry has raised to a role of growing importance, promoting experiments to provide rural areas clinical services and consultations, and to determine its reliability and feasibility to different clinical situations. In this study we describe a pilot experiment of psychiatric assessment of subacute patients via teleconferencing systems. Methods. 8 patients have been evaluated via web-based telecommunication systems. A general psychopathological assessment has been performed by a psychiatrist connected in videoconference to patients, using the Expanded version of BPRS (Brief Psychiatric Rating Scale). A second and original instrument, a toolbox called PERPS (Panama EmeRgency Psychiatric Scale), has been used to summarize urgency, severity, treatment strategy and need for involuntary commitment. Evaluations have been compared with those made by "control" psychiatrists and ICCs (Intraclass Correlation Coefficients) between couples of measures have been calculated. A second couple of evaluations has been performed by a normal face-to-face examination and used as a general comparison between ICCs. Results. For some BPRS factors and for all PERPS items, almost no differences have been found between ICCs from online and teleconferencing examinations. A slight difference has been found for thought disturbance and mood disturbance, and this could be hypothesized as a light bias of the instrument. Conclusions. Our study suggests that it may be possible and easy to perform psychiatric evaluations of mixed subacute patients by a web-based teleconferencing system

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

Psychic euosmia among obsessive-compulsive personality disorder patients : a case control study

BACKGROUND: Psychic euosmia (PE) has been described as a supposed psychological predisposition for which pleasant smells elicit an immediate sense of pleasure, order and calmness in obsessive-compulsive personality disorder (OCPD). In this study we tried to verify the interpretation that PE is the counterpart of disgust that has been associated to contamination and moral purity. Disgust and morality are significantly associated in people with obsessive-compulsive personality traits. We expected that OCPD patients would experience higher levels of PE. AIM: To investigate the PE frequency in OCPD patients and healthy controls (HC) and to evaluate the relationship between PE and disgust. METHODS: A single-center, case-control study was conducted in an outpatient service for obsessive-compulsive and related disorders. The sample consisted of 129 subjects: 45 OCPD patients and 84 HC. In both groups we submitted the Disgust Scale Revised (DS-R) and the self-report Structured Clinical Interview for DSM-5 Screening Personality Questionnaire to which we added an additional yes or no question to investigate the presence of PE. In order to verify differences between groups, t-test was employed for continuous variables and t-test for categorical variable; odds ratio was employed to analyze group differences in the PE survey. Correlation was explored with Pearson r correlations. RESULTS: No differences were observed between groups in gender composition or education. A slight significant difference was found in mean age (t = 1.988; P = 0.049). The present study revealed significantly higher proportions of PE among OCPD patients when compared to HC (OR: 5.3, 2.28-12.46). Patients with OCPD were more likely to report PE (n = 36; 80%) whereas a much lower proportion endorsed PE in the HC group (n = 36; 42.9%). Interestingly, no differences were observed between groups in mean score for the Disgust Scale. There was also no difference between the two groups in any of the Disgust Scale Revised subscales. Moreover, no significant correlations were observed in the OCPD group between PE and Disgust Scale Revised subscales. CONCLUSION: Results suggested that PE might be part of the clinical spectrum of OCPD, and it does not reflect the counterpart of disgust. This could also indicate that this phenomenon is a manifestation of orderliness or incompleteness. Further studies will need to be undertaken to better understand PE and its significance in OCPD

Studio longitudinale sul benessere e le attitudini degli Studenti di Medicina e Chirurgia. Primi risultati della fase 1: Le caratteristiche degli studenti selezionati

We present the first results of a longitudinal study for the recognition and assessment of non-cognitive aspects of the candidates access to medicine course, and throughout the course. This study considered 8 CLMs equally distributed throughout the country and 980 students enrolled in the first year, in the academic year 2013-2014. Preliminary results obtained from the analysis of the questionnaire used in the research show that students expect a profession characterized by the aid for patients and socially useful, while they do not expect a low pay as well as a work activity risky for health. Students are motivated to the academic course mainly by the desire to care for others, while variously opportunistic aspects are much less relevant. Students show high capacity of self-regulation, a high level of empathy in its both aspects of propensity to engagement with others in their difficult moments, as well as of tendency to spontaneously take the perspective of others, while they are able to maintain a goal directed behavior even in the presence of suffering others. These students are basically satisfied, they show a confident and positive attitude towards life and a substantial psychological health. However, it is possible to identify a sub-group of students showing signals of psychological fragility who must be carefully monitored: their profiles will be analyzed in more detail, through in-depth interviews scheduled for the third/fourth year as part of faculties counselling services

Accesso ai corsi di laurea in medicina: messa a punto di un questionario conoscitivo relativo a equilibrio personale e relazionale, attitudini, motivazioni e valori in contesti educativi (EMAV-E)

La grande domanda di accesso ai corsi di medicina richiede di individuare nei candidati le caratteristiche che ne possano fare un “buon medico”. A tal fine abbiamo sviluppato un questionario (EMAV-E) conoscitivo su alcune caratteristiche dei candidati, come base di partenza per l’incontro con l’esperto selezionatore. Le macro-aree indagate dal questionario sono state: equilibrio personale e relazionale (equilibrio e autoregolazione), attitudini accademiche e professionali (intelligenza emotiva, metacognizione, motivazioni), valori personali e professionali, e desiderabilità sociale dell’individuo, usata come controllo. Le macro aree erano divise in 20 aree di interesse entro le quali sono stati individuati 238 item ritenuti rappresentativi. Per la validazione del questionario, sono stati reclutati 653 studenti iscritti al primo anno di corsi di laurea di area medica. Dal questionario iniziale sono state ricavate tre versioni brevi di 80 items. Per saggiarne l’effettiva confrontabilità sono state risomministrate a 160 studenti diversi dal campione iniziale. I tre questionari avendo parametri statistici paragonabili, possono essere considerati forme parallele dello stesso questionario. La procedura ha consentito di sviluppare uno strumento per l’individuazione di punti di forza e di debolezza, secondo le macro aree prese in considerazione, degli studenti che ambiscono a intraprendere la formazione universitaria presso i corsi di laurea in medicina o delle professioni sanitarie