Classificazione, diagnosi ed ICD-10. I - Principi generali e considerazioni critiche

Scopo - Discutere i principali problemi teorico-pratici connessi alia classificazione in campo medico e psichiatrico, e presentare la struttura generale della decima revisione della Classificazione Internazionale delle Malattie (ICD-10), entrata ufficialmente in vigore dal gennaio del 1993. Risultati - Sono dapprima discussi i fondamenti epistemologici della classificazione, le varie strategic classificatorie adottate in campo medico e psichiatrico ed i principali modelli classificatori esistenti. Sono quindi analizzati i problemi relativi alia attendibilità ed alia validità delle diagnosi psichiatriche, e vengono descritte le strategic che possono essere impiegate per migliorarle. Infine sono discussi i principi che hanno informato ia stesura dell' ICD-10 ed i field trials effettuati al fine di preparare il testo finale delle direttive diagnostiche. Conclusioni - La classificazione in psichiatria rappresenta un passaggio obbligato e necessario per rendere possibile la sistematizzazione delle nuove conoscenze e la comunicazione tra operatori, ricercatori ed utenti. La decima revisione dell' ICD rappresenta lo sforzo più ampio sinora compiuto in campo psichiatrico al fine di predisporre un sistema classificatorio rigoroso che, nel contempo, sintetizzi approcci e culture psichiatriche differenziat

Classificazione, diagnosi ed ICD-10. II - Le sindromi schizofreniche

Scopo: Presentare un breve profilo storico relativo ai numerosi tentativi di classificazione dei disturbi schizofrenici succedutisi dal secolo scorso ad oggi e descrivere le principali caratteristiche della classificazione ICD-10 della schizofrenia e dei disturbi ad essa correlati, le principali novità introdotte in essa rispetto all'ICD-9 ed infine le principali similarità e differenze ravvisabili tra la classificazione della WHO ed il DSM-III-R. Risultati - Il concetto di schizofrenia si é venuto definendo attraverso i contributi di autori di rilievo storico, quali Kraepelin, Bleuler e Schneider. Nella definizione dei criteri diagnostici per la schizofrenia, I'ICD-10 ha ripreso i principali criteri schneideriani relativamente ai sintomi patognomonici per questo disturbo, mentre ha ridimensionato, rispetto al DSM-III-R, Pimportanza del criterio longitudinale kraepeliniano relativo al decorso adottando una durata minima di un mese per la diagnosi e prospettando la possibilità di una prognosi non necessariamente sfavorevole. Conclusioni - Nel complesso, nell'ICD-10 si tende ad un ampliamento del concetto di schizofrenia, rispetto ad altri sistemi diagnostici più restrittivi, mentre l'enfasi posta sui sin- tomi schneideriani controbilancia questa tendenza e restringe i criteri di inclusion

Classificazione, diagnosi ed ICD-10. III - Le sindromi affettive

Scopo - Presentare un breve profilo storico sui termini nosografici e sui principali modelli di classificazione dei disturbi affettivi descrivendo le caratteristiche più importanti della loro classificazione secondo l'ICD-10, le principali novita introdotte in essa rispetto all'ICD-9 ed infine alcune similarità e differenze tra la classificazione ICD-10 ed il DSM-III-R. Risultati - DalFanalisi della struttura della classificazione di questi disturbi nelFICD-10 emerge con chiarezza la difficoltà di arrivare ad una sistemazione nosografica esauriente sulla base delle conoscenze attuali. L'ICD-10, comunque, ha segnato un significativo progresso rispetto all'ICD-9, ed ha, al tempo stesso incorporato molti degli orientamenti riscontrabili nel DSM-III-R. Conclusioni - L'ICD-10 ha proposto un modello di classificazione che cerca di operare una sintesi tra tradizioni e scuole diverse, e di valorizzare nel contempo, per quanto possibile, i risultati emersi dalle ricerche di queste ultime 2 decad

The dry stone wall of 'Paretone dei Greci': an anthracological approach

International audienceDry stone constructions are a common occurrence in many Mediterranean landscapes. One of these structures known as "Paretone dei Greci" (Taranto, Southern Italy), was subject to an archaeological investigation. Soil and sediment material within this wall, as well as those above and below it, were sampled and processed for archaeobotanical studies. In this manner it was possible to understand its building technique as well as giving it a chronological context. Through an anthracological analysis it was possible to insert the "Paretone" within the surrounding agricultural landscape, thus better highlighting its function in relation to the history of the territor

Construct validity and psychosocial correlates of the Italian version of the 21-item Medical Interview Satisfaction Scale in primary care

BackgroundSatisfaction with the medical interview has been rarely explored in primary care outside the UK, despite evidence suggesting that a trustful doctor-patient relationship is a key ingredient to facilitate treatment adherence and relief from illness-related distress.AimsThe aims of this study are to analyse the construct validity of the Italian version of the Medical Interview Satisfaction Scale (MISS-21) and its correlations with two outcome measures, the Inventory of Depressive Symptomatology - Self-Report and World Health Organization Quality Of Life Brief Version, in patients with mild-to-moderate depression, recruited in primary care practices.MethodThe factor structure underlying the MISS-21 was investigated with principal component analysis, and the internal consistency of the factors was evaluated with Cronbach's alpha. Network analysis was used to investigate the interrelationships among items. The importance of individual items in the network structure was determined with centrality analyses. Correlations of MISS-21 scores with changes in depression and quality of life were analysed with Spearman's correlation coefficient.ResultsThe MISS-21 proved to have a robust four-dimensional factor structure. Cronbach's alpha for the factors ranged from 0.77 to 0.93, suggesting good to excellent internal consistency. The four factors identified were positively correlated with improvement in depressive symptoms and three quality-of-life domains.ConclusionsThe MISS-21 has sound psychometric properties, and comprises four factors related to clinical outcomes, which makes it suitable for clinical and research applications. The central items in the network should be considered as possible targets for quality improvement interventions in primary care

Italian psychiatry – 25 years of change

Italian psychiatry is probably more debated than known in the international arena. Law 180 of 1978, which introduced a radical community psychiatry system, has drawn worldwide attention and debate, with comments ranging from the enthusiastic to the frankly disparaging (Mosher, 1982; Jones et al, 1991). More recently, this interest was marked by a well-attended symposium 'Lessons Learned from Italian Reforms in Psychiatry' held at the 2003 annual meeting of the Royal College of Psychiatrists in Edinburgh

The Insect Type 1 Tyramine Receptors: From Structure to Behavior

Tyramine is a neuroactive compound that acts as neurotransmitter, neuromodulator, and neurohormone in insects. Three G protein-coupled receptors, TAR1-3, are responsible for mediating the intracellular pathway in the complex tyraminergic network. TAR1, the prominent player in this system, was initially classified as an octopamine receptor which can also be activated by tyramine, while it later appeared to be a true tyramine receptor. Even though TAR1 is currently considered as a well-defined tyramine receptor and several insect TAR1s have been characterized, a defined nomenclature is still inconsistent. In the last years, our knowledge on the structural, biochemical, and functional properties of TAR1 has substantially increased. This review summarizes the available information on TAR1 from different insect species in terms of basic structure, its regulation and signal transduction mechanisms, and its distribution and functions in the brain and the periphery. A special focus is given to the TAR1-mediated intracellular signaling pathways as well as to their physiological role in regulating behavioral traits. Therefore, this work aims to correlate, for the first time, the physiological relevance of TAR1 functions with the tyraminergic system in insects. In addition, pharmacological studies have shed light on compounds with insecticidal properties having TAR1 as a target and on the emerging trend in the development of novel strategies for pest control

Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge

<p>Abstract</p> <p>Background</p> <p>The aim of the present study was to assess the characteristics of long-stay inpatients in public and private Italian acute inpatient facilities, to identify risk factors and correlates of the long duration of hospital stay in these patients, and to identify possible barriers to alternative placements.</p> <p>Methods</p> <p>All patients in 130 Italian public and private psychiatric inpatient units who had been hospitalized for more than 3 months during a specific index period were assessed with standardized assessment instruments and compared to patients discharged during the same index period, but staying in hospital for less than 3 months (short-stay inpatients). Assessed domains included demographic, clinical, and treatment characteristics, as well as process of care. Logistic regression analysis was used to identify specific variables predicting inpatient long-stay status. Reasons for delaying patient discharge, as reported by treatment teams, were also analyzed.</p> <p>Results</p> <p>No overall differences between long-stay and short-stay patients emerged in terms of symptom severity or diagnostic status. Admission to a private inpatient facility and display of violent behavior during hospital stay were the most powerful predictors of long-stay. Lack of housing and a shortage of community support were the reasons most commonly cited by treatment teams as barriers to discharge.</p> <p>Conclusion</p> <p>Extra-clinical factors are important determinants of prolonged hospitalization in acute inpatient settings.</p

Stump appendicitis. A case report

AbstractIntroductionToday, the diagnosis of SA is usually not considered as the etiology for right lower quadrant pain in patient with history of appendectomy, resulting in delaying making the correct diagnosis and treatment. Obviously, other more common causes should be excluded first.DiscussionStump appendicitis (SA) was first described by Rose in 1945. The commonest presenting symptom are abdominal pain (right lower quadrant pain 59%, non specific abdominal pain 16%, and central abdominal pain radiating to the right lower quadrant 14%).Presentation of caseA 54-year-old appendectomized woman presented with recent history of abdominal pain with periumbilical pain radiating to the right side and in the right iliac fossa, in the absence of fever, vomiting or other symptoms.Elective colonoscopy revealed appendicular orifice clogged by big fecalith, with hyperemic surrounding mucosa and CT confirmed “stump appendicitis”. After 30 days of therapy with metronidazole 500mg/day and mesalazine 1000mg×2/day, the patient was submitted to surgery and appendectomy was performed, with a specimen of 24mm stump appendicitis.ConclusionSA may well be considered as one of the differential diagnoses of acute right lower abdominal pain even in patients with history of appendicectomy