Quality of Life and Biopsychosocial Paradigm: A Narrative Review of the Concept and Specific Insights

The quality of life concept was born in the 1970s within the social sciences and soon it arrived in the field of medicine and health, where this notion has been considered as a criterion to evaluate health interventions. The World Health Organization defines quality of life as the subjective perception individuals have of their life position, in their cultural context and value system, in relation to their objectives, expectations, standards, and worries. It is a very complex and articulated conception, and as a matter of fact in this chapter, we will analyze an overview about this topic, to examine it in depth, and clarify this concept; synthetically, we can note that the quality of life is specified by the perception of one’s physical, psychological, and emotional health, by the degree of personal independence, by social relations, and by the type of interaction with one’s context. We can note that this construct is broader than that of health, it is not a synonym of it, and it is also important to point out that the definition of the World Health Organization about this topic connects elements resulting from an enormous amount of studies. In this sense, being healthy is considered one of the numerous quality of life dimensions, and health-facilitating behaviors are judged as predictors of the quality of life itself. Moreover, the definition of quality of life always includes a reference to the individual’s physical state, but it is not considered only on the basis of a person’s bodily functions, detectable with standardized parameters, since it is described in relation to the perceived satisfaction degree regarding this functionality level. This kind of definition shifts the emphasis from the objectively definable functionality to the subjectivity dimension; the detection of both these two aspects can constitute a reliable quality of life measure. Furthermore, we can note that the most common method for measuring quality of life is the administration of questionnaires and, in addition, that there are two questionnaire types: generic and specific for pathology. Finally, this chapter highlights the importance of the biopsychosocial paradigm in relation to the quality of life concept

The Real Self and the Ideal Self

Every human psychic aspect, even the development of the Self, cannot be considered separately from the financial and cultural context in which it is inserted: ad a Matteo of fact the realization of individual freedom is correlated to broader economic and social changes, which influence the individual on self-realization. In the chapter, various theories about this topic and about the ideal self are explored, and it concludes by considering that self expression helps people to satisfy their real emotions and their real self, it also highlights the fact that self-realization and self-expression are among the highest needs on the human needs scale, and they affect human health

The Impact of Covid-19 Pandemic on Community Psychiatric Services in Northern Italy

The Covid-19 pandemic, started brutally in February 2020 in Northern Italy (first European area hit by virus), has induced the most drastic and prolonged containment measures by a European government. The most affected areas of the Italian territory were Lombardy and Veneto. A severe and global lock-down was ordered for more than two months, with the closure of essential medical services among others. All health resources have been diverted to address the health crisis caused by the pandemic. During the lock-down, however, the only community medicine services that remained open were mental health services: psychiatry, the area of addictions, child neuropsychiatry. The community facilities have always provided services favoring, on the one hand, the maintenance of care and rehabilitation paths for patients in care, and on the other, allowing anyone who needs to have access to treatment. The operators were also involved at the forefront in the management of covid + patients and in the support paths for the management of the operators’ stress. In this chapter, we want to describe the working conditions and the organizational responses of our services, referring to a large catchment area of the region most affected by covid-19

Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum~disorders

Background Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. Methods Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. Results Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. Conclusions Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery

Clinical Perspectives on Using Remote Measurement Technology in Assessing Epilepsy, Multiple Sclerosis, and Depression: Delphi Study

Background: Multiple sclerosis (MS), epilepsy, and depression are chronic central nervous system conditions in which remote measurement technology (RMT) may offer benefits compared with usual assessment. We previously worked with clinicians, patients, and researchers to develop 13 use cases for RMT: 5 in epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis), 3 in MS (detecting silent progression, detecting depression in MS, and donating data to a biobank), and 5 in depression (detecting trends, reviewing treatment, self-management, comorbid monitoring, and carer alert). Objective: In this study, we aimed to evaluate the use cases and related implementation issues with an expert panel of clinicians external to our project consortium. Methods: We used a Delphi exercise to validate the use cases and suggest a prioritization among them and to ascertain the importance of a variety of implementation issues related to RMT. The expert panel included clinicians from across Europe who were external to the project consortium. The study had 2 survey rounds (n=23 and n=17) and a follow-up interview round (n=9). Data were analyzed for consensus between participants and for stability between survey rounds. The interviews explored the reasons for answers given in the survey. Results: The findings showed high stability between rounds on questions related to specific use cases but lower stability on questions relating to wider issues around the implementation of RMT. Overall, questions on wider issues also had less consensus. All 5 use cases for epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis) were considered beneficial, with consensus among participants above the a priori threshold for most questions, although use case 3 (risk scoring) was considered less likely to facilitate or catalyze care. There was very little consensus on the benefits of the use cases in MS, although this may have resulted from a higher dropout rate of MS clinicians (50%). Participants agreed that there would be benefits for all 5 of the depression use cases, although fewer questions on use case 4 (triage support) reached consensus agreement than for depression use cases 1 (detecting trends), 2 (reviewing treatment), 3 (self-management), and 5 (carer alert). The qualitative analysis revealed further insights into each use case and generated 8 themes on practical issues related to implementation. Conclusions: Overall, these findings inform the prioritization of use cases for RMT that could be developed in future work, which may include clinical trials, cost-effectiveness studies, and the commercial development of RMT products and services. Priorities for further development include the use of RMT to provide more accurate records of symptoms and treatment response than is currently possible and to provide data that could help inform patient triage and generate timely alerts for patients and carers

Psychopathy - New Updates on an Old Phenomenon

This book collects the contribution of a selected number of clinical psychiatrists interested in the clinical evaluation of specific issues on psychopathy. The nine chapters of the book address some relevant issues related to nosography, early recognition and treatment, bio-psycho-social models (in particular cognitive-behavioral and ethological ones), and social and familial consequences of psychopathic personality

Psychotic Disorders - An Update

In this book, with the involvement not only of clinical psychiatrists but also of neurobiologists, specific issues of psychotic disorders (mainly schizophrenia and mood disorders) are reviewed. The focus of attention ranges from therapeutics to the new frontiers of epigenetics. A special focus is on the individual reactions to psychosis (ranging from psychological ones to treatments and neurobiological basis). Because of the rapid development of neurosciences, which are showing common underling factors to different phenotypical expressions of mental illness, we are facing an enormous growth of biological data, which is not always easy to interpret. The risk is to forget that we are relating to other individuals, with their stories, and, most of all, with their environmental resources and interactions. The contributions to this book will range from individual experience (a personal history of illness) through some aspects of individual management of illness (insight), from correct use of available psychosocial resources to the environment-gene relationships (epigenetics)

New Developments in Anxiety Disorders

This book collects the contribution of a selected number of clinical psychiatrists, interested in the clinical application of some aspects of neurobiology of anxiety. The seven chapters of the book address some issues related to the latest acquisitions of neurobiology, in particular those aspects that are related to responses to treatment - both psychological and pharmacological. Some chapters are also dedicated to the comorbidities, a rule rather than an exception when it comes to anxiety. Each author summarized the clinical importance of his work, underlining the clinical pitfalls of this new book on anxiety