IMPROVING HEALTH CARE ACCESSIBILITY FOR PEOPLE WITH COMPLEX DISABILITIES

For many people with disabilities in health care even the simplest actions such as performing an examination or a test can be extremely difficult, just as a hospitalization or an access to the emergency room can be complex experiences. The issue of acce ss to health services is felt to be particularly critical and unresolved by users, families and operators, who still report significa nt difficulties. The solutions to the problems of accessibility to care cannot be sought only at the clinical and professional lev el, but must rely on organizational and managerial innovations. The Seraphic Institute has promoted a project to ensure a better respon se to the health needs of people with complex disabilities to adapt the health care offer to the needs of people with disabilities , activating a proximity service aimed at reducing the inconvenience and costs related to the fragmentation of services and to im prove and extend access to care of people with complex disabilities through the activation of a regional reference pole and a network of specialized multicenter and multidisciplinary assistance (Hub & Spoke model

MIXED STATES: A “NEW” NOSOGRAPHIC ENTITY

Objective: Mixed states represent a controversial topic in the current psychiatry. The definitions and the diagnostic criteria have changed over the past years. The new DSM-5 classification will have a substantial impact in several fields: epidemiology, diagnosis, treatment, research, education, and regulations. Methods: We reviewed the latest literature by using the key words “mixed states” and “agitated depression” on the PubMed. Results: Although there is a great expectation about the validity of the new DSM-5 mixed states diagnosis, little is known about its application on large population study but the formulation of less restrictive and more specific criteria for the diagnosis of mixed states represent a starting point for future researches, mainly in consideration of the fact that previous classifications consider the MS a superposition of manic and depressive symptoms, underestimating the clinical complexity and the wider phenomenologic variability of these conditions. Conclusions: Clinical trials need to address treatment effects according to the presence or absence of mixed features in consideration of the fact that replacing in the bipolar spectrum patients that traditionally are considered to be affected by unipolar depression, represent a topical research hypothesis and has a practical remarkable importance in the appropriate therapeutic choice

RESILIENCE AND DEPRESSIVE DISORDERS

Introduction: There is considerable variability in the response of individuals to adverse environmental conditions, while some develop psychiatric illnesses like depression, others seem very capable of dealing with it. It is in this observation that the concepts of vulnerability and resilience are rooted. Methods: We conducted a review of the literature by inserting in PubMed the keywords resilience, vulnerability and depressive disorders. Discussion and conclusions: Freud formerly used the so-called crystal-principle to describe the concept of vulnerability: according to this, the different psychopathologies would arise depending on the different psychological weaknesses, just like a crystal thrown to the ground shatters along its lines of cleavage intrinsic to it, albeit invisible. The term resilience has been borrowed from physics where it is used to describe the ability of a material to withstand impact without cracking. In psychology, the term resilience refers to a complex and dynamic multidimensional construct, which derives from the interaction of neurobiological, social and personal factors and indicates the ability to adaptively cope with stress and adversity, preserving a normal physical and psychological functioning. Resilience has proven to be a protective factor against the development of psychiatric disorders such as depression. Making a conceptual leap, the concepts of vulnerability and resilience can be related to the psychodynamic classification of depression postulated by Gaetano Benedetti, who distinguished four kinds of depression: the first due to the failure of the ego, the second to the perversion of the superego, the third to the inhibition of the Id and the fourth to the collapse of the ego ideal. It is possible to improve the resilience of depressed subjects through pharmacological and psychotherapeutic interventions

RESILIENCE AND DEPRESSIVE DISORDERS

Introduction: There is considerable variability in the response of individuals to adverse environmental conditions, while some develop psychiatric illnesses like depression, others seem very capable of dealing with it. It is in this observation that the concepts of vulnerability and resilience are rooted. Methods: We conducted a review of the literature by inserting in PubMed the keywords resilience, vulnerability and depressive disorders. Discussion and conclusions: Freud formerly used the so-called crystal-principle to describe the concept of vulnerability: according to this, the different psychopathologies would arise depending on the different psychological weaknesses, just like a crystal thrown to the ground shatters along its lines of cleavage intrinsic to it, albeit invisible. The term resilience has been borrowed from physics where it is used to describe the ability of a material to withstand impact without cracking. In psychology, the term resilience refers to a complex and dynamic multidimensional construct, which derives from the interaction of neurobiological, social and personal factors and indicates the ability to adaptively cope with stress and adversity, preserving a normal physical and psychological functioning. Resilience has proven to be a protective factor against the development of psychiatric disorders such as depression. Making a conceptual leap, the concepts of vulnerability and resilience can be related to the psychodynamic classification of depression postulated by Gaetano Benedetti, who distinguished four kinds of depression: the first due to the failure of the ego, the second to the perversion of the superego, the third to the inhibition of the Id and the fourth to the collapse of the ego ideal. It is possible to improve the resilience of depressed subjects through pharmacological and psychotherapeutic interventions

BEYOND THE DISEASE: "...AM I MY BROTHER\u27S KEEPER?"

Today, the concepts of health and illness require a global vision of man; the suffering of the person places the entire environment in great difficulty: health professionals, family, society. It is important not to simplify the response to a purely health-focused view of the disorder, because fragile people possess a deep need to feel welcomed, listened to, understood and accepted. Service provision that is respectful of the dignity of the person is an important challenge both for those who are responsible for providing services to individuals and their families as well as for the entire community. Therefore in providing care the human qualities of the health professional and not only his technical skills come into play: blending together science and humanitarian ethos. The provision of care therefore "forces" us to broaden our horizons and requires us to face the challenge of responsibility towards the Other, the human condition of being-for. However, ethical capacity cannot be born solely out of sharing standards or adhering to regulations and respecting prohibitions: it stems from high and unconditional moral values and meanings. The ME-YOU relationship represents the primary ethical factor of the human being: my responsibility towards the Other is unconditional. In the book of Genesis when the Lord asks Cain: "... where is Abel, your brother?" He responds with another question: "Am I my brother\u27s keeper?" In this biblical passage Cain kills Abel: the rejection of brotherhood and the care of the other only leads to the death of the Other. "Where is your brother?" This question is crucial in today’s day and age and must be taken seriously: it is the decisive question that forces us to decide how to place ourselves in relationship with the other and with the world: do we choose proximity or distance, connection or indifference