Quattro parole fondamentali per la vita della mente

The article proposes a broad reflection around four words which are crucial for psychiatric and psychological research: conscious memory, non-conscious memory, separation and transformation and the way these concepts differ from and relate to each other. Among the themes developed is the passage from sleep-wakefulness and wakefulness-sleep, the distinction between the disappearance fantasy and the annulment drive and the recreation of the preverbal dimension of the first year of life

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

La dimensione paranoicale nella sua distribuzione transnosografica

Introduction. Research at international level is increasingly highlighting the frequency with which a psychopathological paranoid dimension is present both in the general population and in the psychiatric population. In this paper we have aimed to explor the presence of a paranoid dimension, in a sample of patients. Materials and methods. Our research sample consists of 87 patients, visiting for the first time the unit of our Service. With each patient we used the SCL-90R multidimensional scale. After the test we conducted an anamnestic research and diagnostic evaluation based on the criteria of the DSM-IV-TR. The data obtained was analysed using the SPSS software that was used to carry out a descriptive statistical analysis of the entire sample for each individual socio-demographic variable. We then evaluated the percentage of the sample which manifested a pathological paranoid dimension according the SCL-90R, and finally we measured eventual statistically significant correlations regarding the distribution of this dimension within the various categorial diagnoses and any association regarding the socio-demographic variables of the sample. Results. Out of the total sample (N=87) 13 patients who did not complete the SCL-90R test were excluded. 41 of the remaining 74 (55.4%), manifested values above the cuff-off in the "paranoid dimension" of the SCL-90R were excluded. Regarding the socio-demographic characteristics of this subgroup, a greater frequency of the feminine sex can be noted (60%). So far as civil status is concerned, single patients are more frequently affected than married patients, and the paranoid dimension is accentuated. However such dimension appeared more latent respect to others on the simptomatologic plan and therefore more difficult to characterize. Conclusions. The results obtained from the analysis of our sample seems to confirm the high frequency of the paranoid dimension and their transnosographicity. Also this dimension has turned out to be more latent than others on the plan of the manifest symptomatology and it needs in depth diagnostic investi

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

Time is of the essence in eating disorders

A randomised trial in 1987 which compared family and individual relapse prevention following inpatient treatment for anorexia nervosa demonstrated the impact of the duration of untreated illness on both the overall outcome and the response to family treatment 1,2. After three years anorexia nervosa becomes resistant to psychotherapy.3 Prolonged starvation has profound effects on both body and brain and cognitive, emotional and social functioning is disrupted. This sets up a web of maintaining factors that accumulate over time 4. Early intervention taking into account other clinical factors such as age and severity is critical for the management of eating disorders5

Le origini del motodo medico

La psicoterapia è atto medico finalizzato alla cura e alla guarigione della malattia mentale: questa idea forte, che si impone nel dibattito culturale anche per le ripetute sollecitazioni della giurisprudenza, ha ispirato il lavoro e la ricerca degli autori di questo libro. La parola psicoterapia, nata alla fine dell’Ottocento, nella sua composizione ha chiaramente il senso di ‘medicina della mente’, ovvero si riferisce all’intenzionalità di affrontare, per curare, la malattia psichica. Le dure critiche di quanti non hanno voluto accettare il pensiero di una originaria sanità mentale che, come tale, poteva cadere nella malattia, hanno con ciò stravolto il significato della parola stessa, diventata per molti sinonimo di assistenza, ‘prendersi cura’ che presuppone l’immutabilità e quindi l’incurabilità della condizione altrui. Questo volume, frutto dello sforzo comune di chi da lungo tempo è impegnato nella psicoterapia di gruppo, propone una realtà nuova che si basa sulla teoria e sulla prassi di Massimo Fagioli, il quale da cinquant’anni ha portato il metodo medico alla mente senza coscienza, legando così la psichiatria alla psicoterapia, e ha fatto dell’interpretazione dei sogni il cardine della cura per la guarigione

La schizofrenia non è una malattia neurologica

The author briefly presents M. Fagioli's 1962 article, Chronic epileptic psychosis and pseudoschizophrenic syndrome, republished in this issue, highlighting the distance that separates its rigorously psychopathological formulation and its idea of a possible cure for mental illness from "neo-kraepelinian" developments of psychiatry of the last few decades that have given rise to the DSM