Health services utilization in patients with eating disorders: evidence from a cohort study in Emilia-Romagna

Purpose: To estimate the treated prevalence of eating disorders (ED) in Emilia-Romagna, Italy, and to compare health services utilization among age groups and geographical areas. Methods: The study cohort consists of patients aged 12\u201364 years with a primary or secondary ED diagnosis, treated in regional healthcare facilities in 2012. Patients were followed up for 1\ua0year from the first contact. Data were extracted from regional administrative databases. Results: The study cohort included 1550 cases, 36.8\ua0% with anorexia nervosa, 21.9\ua0% with bulimia nervosa and 41.3\ua0% with ED not otherwise specified. Adolescents\ua0(12\u201317 years) were 18.6\ua0%, young adults\ua0(18\u201330) 32.7\ua0% and older adults\ua0(31\u201364) 48.7\ua0%. The annual treated prevalence rate was 5.2/10,000 (13.3 for adolescents, 9.3 for young adults and 3.4 for older adults) and was highest among adolescent (24.6/10,000) and young adult females (17.1/10,000). Cases without a record for ED in the previous year were 46.8\ua0%. Older adults displayed higher comorbidity and used more services including hospital-based care. Outpatient care greatly exceeded inpatient care across age groups. Variations in care patterns across regional areas were found. Conclusions: Our results indicate that the care pathway for ED varies among age groups and geographical areas, but is consistent with the regional care model that favors the use of outpatient services. Future perspectives include evaluating the integration among mental health services, specialty outpatient units and primary care

Dimensional structure of first episode psychosis

Current diagnostic systems, DSM-5 and ICD-10, still adopt a categorical approach to classify psychotic disorders. The present study was aimed at investigating the structure of psychotic symptomatology in both affective and non-affective psychosis from a dimensional approach

Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants.

Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Background Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in \u2018real-world\u2019 services. Methods/Design The Psychosis early Intervention and Assessment of Needs and Outcome (PIANO) trial is part of a larger research program (Genetics, Endophenotypes and Treatment: Understanding early Psychosis - GET UP) which aims to compare, at 9\u2009months, the effectiveness of a multi-component psychosocial intervention versus treatment as usual (TAU) in a large epidemiologically based cohort of patients with FEP and their family members recruited from all public community mental health centers (CMHCs) located in two entire regions of Italy (Veneto and Emilia Romagna), and in the cities of Florence, Milan and Bolzano. The GET UP PIANO trial has a pragmatic cluster randomized controlled design. The randomized units (clusters) are the CMHCs, and the units of observation are the centers\u2019 patients and their family members. Patients in the experimental group will receive TAU plus: 1) cognitive behavioral therapy sessions, 2) psycho-educational sessions for family members, and 3) case management. Patient enrolment will take place over a 1-year period. Several psychopathological, psychological, functioning, and service use variables will be assessed at baseline and follow-up. The primary outcomes are: 1) change from baseline to follow-up in positive and negative symptoms\u2019 severity and subjective appraisal; 2) relapse occurrences between baseline and follow-up, that is, episodes resulting in admission and/or any case-note records of re-emergence of positive psychotic symptoms. The expected number of recruited patients is about 400, and that of relatives about 300. Owing to the implementation of the intervention at the CMHC level, the blinding of patients, clinicians, and raters is not possible, but every effort will be made to preserve the independency of the raters. We expect that this study will generate evidence on the best treatments for FEP, and will identify barriers that may hinder its feasibility in \u2018real-world\u2019 clinical settings, patient/family conditions that may render this intervention ineffective or inappropriate, and clinical, psychological, environmental, and service organization predictors of treatment effectiveness, compliance, and service satisfactio

Ontopoiesi, autopoiesi. sistemi biologici e giustizia

Si documenta il tentativo di numerosi studiosi di varia provenienza e cultura, di inventariare le risorse teoretico-metafisiche ancora disponibili nella nuova situazione di pensiero, da J. Habermas denominata “post-metafisica”. Inediti sentieri-di-senso ne sono emersi, certo ancora privi di quella esplicita capacità di complessiva articolazione dell’orizzonte ontologico, che solo una nuova sistematica metafisica potrà fornire, ma già reale auspicio del prossimo New Enlightenment, annunciato da Anna-Teresa Tymieniecka. Anche alla sua fenomenologia della vita attinge la presente ricerca, nell’intento di contribuire validamente alla ricostruzione di un orizzonte d’essere adeguato alle sfide dei nostri giorni

Vie della fenomenologia nella post-modernit\ue0. Confronto con la fenomenologia della vita di A.-T. Tymieniecka

Da quando Fran\ue7ois Lyotard ha rilevato l\u2019affermarsi post-moderno dell\u2019incredulit\ue0 nei confronti delle meta-narrazioni di legittimazione dei saperi moderni, sempre pi\uf9 pressante si \ue8 fatta l\u2019esigenza di inventariare le risorse teoretico-metafisiche ancora disponibili nella nuova situazione di pensiero, da J. Habermas denominata \u201cpost-metafisica\u201d. Di tale esigenza si sono fatti interpreti l\u2019International Society for Phenomenology and the Sciences of Life, affiliata al World Phenomenology Institute e presieduta da Francesco Totaro dell\u2019Universit\ue0 di Macerata, il Centro Italiano di Ricerche Fenomenologiche (CIRF) di Roma, guidato da Angela Ales Bello dell\u2019Universit\ue0 del Laterano e il Centro Studi e Ricerche \u201cEdith Stein\u201d (CSES) di Roma, diretto da Anna Maria Pezzella dell\u2019Universit\ue0 del Laterano, quando nel 2010 hanno diramato il call for papers per il Convegno Internazionale: \u201cSentieri fenomenologici nella Post-Modernit\ue0. Confronto con la fenomenologia della vita di Anna-Teresa Tymieniecka\u201d/Phenomenological Paths in Post-Modernity. A comparison with the Phenomenology of Life of Anna-Teresa Tymieniecka, che si sarebbe tenuto a Roma, presso l\u2019Auditorium della Pontificia Universit\ue0 \u201cAntonianum\u201d, dal 13 al 15 gennaio 2011. L\u2019iniziativa ricevette il patrocinio della Presidenza della Repubblica Italiana, dell\u2019Ambasciata della Repubblica Federale Tedesca in Italia, dell\u2019Universit\ue0 di Macerata e dell\u2019Universit\ue0 di Bari. Il Dipartimento di Filosofia e Scienze umane dell\u2019Universit\ue0 di Macerata, oggi Sezione del Dipartimento di Studi Umanistici, il World Phenomenology Institute, Banca Intesa e Banca delle Marche apportarono il loro fondamentale sostegno e contributo. Gli studiosi partecipanti furono invitati a cogliere e ad individuare inediti sentieri-di-senso nella \u201cliquida\u201d compagine culturale del nostro tempo, che trova le funzioni e le strutture di pensiero consolidate impotenti ad afferrarla e comprenderla. E poich\ue9 J. Habermas aveva pure evidenziato quanto la flessione fenomenologica della teoresi mantenesse tuttora la vitalit\ue0 per nuove germinazioni di senso, al contrario della filosofia analitica, dello strutturalismo e del neo-marxismo gi\ue0 da tempo giunti al loro \u201cpostismo\u201d, nel call for papers del convegno romano si richiese anche di privilegiare il confronto con le prospettive fenomenologiche pi\uf9 recenti e innovative, tra le quali spiccava la fenomenologia della vita di Anna-Teresa Tymieniecka. A tutta prima, l\u2019impresa sembrava non solo provocatoria ma addirittura disperata: come dalla dominante mentalit\ue0 tardo-novecentesca, neo-positivistica, decostruttivistica, nichilistica, sarebbe potuta scaturire qualche novit\ue0 relativamente al rinvenimento di un logos unitario, capace di ritessere una rete di senso per il complesso della viva esperienza umana e dell\u2019essere tutto? Invece proprio questo \ue8 accaduto e la Post-Modernit\ue0 \u2013 fin qui caratterizzata filosoficamente solo dalla caduta in disuso delle grandi narrazioni di senso e quindi dalla perdita, da parte dei fenomeni, della rete teoretica che fino a quel momento li \u201csalvava\u201d dalla dispersione, dalla frammentazione e dalla incomunicabilit\ue0 reciproca \u2013 si \ue8 rivelata essere l\u2019incubatrice di nuovi sentieri di senso, certo ancora privi di quella esplicita capacit\ue0 di complessiva articolazione dell\u2019orizzonte ontologico, che solo una nuova sistematica metafisica potr\ue0 fornire, ma gi\ue0 reale auspicio di un prossimo New Enlightenment. La stessa qualit\ue0 post-metafisica della teoresi post-moderna \ue8 cos\uec cambiata di segno, nella misura in cui, sulle dinamiche correnti, applicate a polverizzare l\u2019edificio ontologico-metafisico, divenuto ormai heideggerianamente mero ricettacolo della semplice presenza dell\u2019ente, e/o a gettarsi alle spalle la metafisica, quale stadio superato del sapere, soppiantato da quello scientifico-positivo, si \ue8 rilevato, piuttosto, l\u2019imporsi crescente dell\u2019intenzione di ripensare la metafisica sia per rinnovarne l\u2019impresa originaria di trovare un senso ai fenomeni sia anche per approfondire la questione metafisica del senso e far progredire la ricerca fenomenologica del senso del senso

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services