The effectiveness of a new approach using movies in the training of medical students

INTRODUCTION: The use of movies in medical (particularly psychiatric) education has been often limited to portraits of mental illness and psychiatrists. The Psychiatric Institute of the Universit\ue0 del Piemonte Orientale has a longstanding tradition of working with/on movies according to a method developed by Eugenio Torre, using dynamic images as educational incitements. Our aim is to describe the preliminary results on the impact of this intervention in medical students. METHODS: The cinemeducation project lasted 6 months, and included 12 meetings. Forty randomly selected participants were assessed with: Attitudes Towards Psychiatry Scale (ATP-30), Social Distance Scale (SDS), Interpersonal Reactivity Index (IRI), and Toronto Alexithymia Scale (TAS), both at baseline and after 6 months, when the workshop was concluded. RESULTS: A significant increase was found in the ATP-30 score, and a reduction of the SDS and IRI-Personal Distress scale scores. CONCLUSIONS: Informal feedback from participants was strongly positive. Preliminary results from the assessment of participants are encouraging. Students' attitudes towards psychiatry and ability to tolerate anxiety when experiencing others' distress improved, while stigma decreased. The evocative power of movie dynamic images, developed in the group and integrated with the help of the group leader, can enrich students' knowledge, both from a cognitive and emotional standpoint

Dual Diagnosis Patients First Admitted to a Psychiatric Ward for Acute Psychiatric Patients: 2-Year Period 2003–2004 versus 2013–2014

Dual diagnosis (DD) is the coexistence of severe mental illness (SMI) and substance use disorder (SUD). The increase of DD observed in recent years has important implications for mental health services organization. The aim of this study is to assess the prevalence and features of DD over a decade, comparing the periods 2003–2004 and 2013–2014. We performed a retrospective study retrieving sociodemographic and clinical data from the medical records of patients at their first admission to the Psychiatric Ward of University Hospital “Maggiore della Carità” in Novara, Italy. Patients with SMI and comorbid SUD (SMI-SUD) and patients with SMI without comorbidity (SMI) were compared in the two periods, 2003–2004 versus 2013–2014. SMI-SUD patients in both 2-year periods were more likely to be male, younger, unemployed, living with parents (or alone, for the 2013–2014 period) rather than with a family of their own, and single (or divorced, in 2003–2004). The 2003–2004 patients were more frequently diagnosed with a personality disorder, whereas the 2013–2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods as well: in both periods, male gender was associated with an increased risk of DD, whereas age >61 years was associated with decreased risk. Only in the first period (2003–2004) was having a university degree associated with a decreased risk of DD, whereas the diagnosis of a personality disorder was associated with an increased risk of DD; on the contrary, in the second period (2013–2014), living in a protective environment was associated with a decreased risk of DD. The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors that may be the target of prevention and treatment approaches

Schizophrenia spectrum disorders: Focus on social cognition and empathy

Background Schizophrenic patients show deficits in social cognition, functioning and in interpreting facial expressions. These disabilities contribute to global impairment in social and relational skills. Data started being collected in the context of the Italian Network of Research on Psychosis headed by Prof. Maj and Prof. Galderisi (Galderisi S et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 2014:275\u201387. Mucci A et al. The Specific Level of Functioning Scale: Construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community. Schizophr Res 2014;159(1):144-50); collection in our centre went on also after the conclusion of the national project. Aims To identify the correlations among social inference, facial emotion identification and clinical history and therapies in schizophrenic patients. Material and methods We recruited patients with Schizophrenia referring to our Psychiatry Ward, AOU Maggiore della Carit\ue0, Novara, Italy. Socio-demographic characteristics were gathered; assessment of patients included The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test (FEIT), the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). Results Data collection is still ongoing. In a previous study we pointed out that schizophrenic patients showed social skills deficits and difficulties in identifying facial emotions. These features underlie poor and limited social relationships proper to schizophrenia. Our preliminary results revealed thatidentification of facial emotions is influenced by psychopathological symptoms especially by avolition, blunted affect and alogia. Implication will be discussed

Editorial Group: a Long-term Rehabilitation Approach Developed at SC Psichiatria, Maggiore Della Carita Hospital in Novara

Introduction Our Psychiatry Ward offers several group activities to both inpatients and outpatients. Among these, the Editorial Group involves only outpatients (who had been previously admitted to the Psychiatry Ward as inpatients) in fair psychopathological compensation, carefully selected for this long-term rehabilitation approach. Aims To describe the Editorial Group activity. Methods The Editorial Group meets once a week at the Psychiatry Ward. It involves patients, nurses and a group leader who is a Psychiatrist. The psychiatrists' and nurses' role is to facilitate the group process and the exploration of the topics discussed. Members are encouraged to discuss their opinions about tales, movies and books; to share poems, paintings, photographs. The aim of this process is to eventually develop a Ward magazine which is published quarterly. Results Members' commitment is extended beyond the weekly meeting hour of the group; indeed, we have observed that patients in their free time spontaneously decide to spend time collecting material to share and drawing up the articles, which are assigned according to patients' aptitudes and preferences. A continued commitment to share daily life experiences and to express creativity, helps patients get involved in the Group, and eventually leads to something concrete and valuable to share with others, also beyond the Group. Both the leader and the other equipe members help patients listening to each others' opinions, ideas and personal experiences. Conclusions The Editorial Group helps patients improving emotional and relational skills, and stimulates cognitive resources. Moreover, it enhances creativity, promotes collaboration and stimulates curiosity

Clinical characteristics associated with suicide attempts in clinical settings: A comparison of suicidal and non-suicidal depressed inpatients

INTRODUCTION: Both psychiatrists and psychiatric nurses are involved in the psychiatric management of suicidal inpatients. One-to-one observation by qualified nurses and the accommodation of the patient in a room close to the infirmary are usually recommended. Suicidal risk should be reassessed periodically to check response to treatment. AIM: To compare the severity of depressive symptoms in depressed inpatients admitted after an attempted suicide and those admitted for any other reason and to assess the severity of suicide attempts and the management of suicidal risk in clinical settings. MATERIALS AND METHODS: We divided the sample into two subgroups: patients with a diagnosis of depression admitted because of a recent suicide attempt and depressed patients with no recent history of attempted suicide. Socio-demographic and clinical data were gathered; assessments included the Montgomery-Asberg Depression Rating Scale and the Nurses’ Global Assessment of Suicide Risk (NGASR). RESULTS: Forty-six patients were recruited over a 1-year period: 20 were admitted to the hospital following a suicide attempt; the other 26 had not attempted suicide and were admitted for other depression-related reasons. Multivariate analysis revealed a correlation between use of antidepressants and recent attempted suicide. Attempting suicide was not related to the severity of depressive symptoms. In the recent suicide attempt subgroup, NGASR suicide risk levels were lower at discharge than at admission. Patients with a recent history of attempted suicide had a higher number of suicide attempts in their clinical history than patients with no recent history of attempted suicide. CONCLUSION: There were no correlations between psychiatric diagnosis, severity of depressive symptoms, and recent suicide attempt. Antidepressant therapy protected against suicide attempts. History of suicide attempts was one of the best predictors of recent attempted suicide. A more thorough understanding of the complex phenomenon of suicide and the reasons for suicidal behavior is needed

Feeling Through the Body: Alexithymia and Eating Disorders

INTRODUCTION Alexithymia is characterized by difficulties identifying and communicating feelings, and problems differentiating between feelings and bodily sensations; its concrete cognitive style focused on the external environment is typical of psychosomatic patients. Patients with eating disorders (EDs) have high levels of alexithymia, particularly difficulties identifying and describing their feelings. OBJECTIVE The aims of our study are (1) to assess the alexythimia, emotional empathy, facial emotion identification skills and social inference abilities in a sample of ED patients; (2) to compare these variables between ED patients and healthy controls (HC); and (3) to correlate levels of alexithymia with the severity of the ED as measured by the Eating Disorder Inventory-3 (EDI-3) EDRC score in the ED group. METHODS ED (N=42) and HC (N=42) were tested with the Toronto Alexithymia Scale (TAS-20), Eating Disorder Inventory (EDI-3), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT) and Interpersonal Reactivity Index (IRI). RESULTS Data collection is being completed and the results’ analysis is ongoing. We expect the ED sample to show greater alexythimia and a poorer performance at FEIT and TASIT than HCs. We expect to find a linear correlation between the TAS-20 and EDRC score. CONCLUSION A better understanding of the role of alexithymia in ED etiology and maintenance might allow the development of targeted treatment approaches to help patients improve their skills in identifying and expressing emotions

Who is a survivor of suicide loss? A systematic review

Introduction Death by suicide stuns with soul-crushing surprise, leaving family and friends not only grieving the unexpected death, but confused and lost by this haunting loss. The underlying structure of grief for survivors of suicide loss appears complicated. Aims The purpose of this study consists in reviewing literature data about survivors of suicide, especially exploring the few informations emerged by researches on the role of psychiatrist as “survivor”. Methods A PubMed search was conducted using combinations of the following keywords: survivors suicide or bereavement suicide or suicide psychiatrists and randomized. The search was conducted through September 10, 2015, and no conference proceedings were included. Results Bereavement following suicide is complicated by the psychological impact of the act on those close to the victim. It is further complicated by the societal perception that the act of suicide is a failure by the victim and the family to deal with some emotional issue and ultimately society affixes blame for the loss on the survivors. This individual or societal stigma introduces a unique stress on the bereavement process that in some cases requires clinical intervention. Conclusions Suicide bereavement seems to be different from natural loss. Clinicians may react to a patient's suicide both on a personal and professional level, with emotions such as loss of self-esteem or blame. This grief somehow nullifies the core of a helping relationship and may imply a more conservative management of future patients or even avoiding to accept suicidal patients for treatment. Support interventions have been proposed