Modalità di gestione della terapia integrata in ambito psichiatrico. Uno studio 'cross-sectional' su un campione selezionato di psichiatri

Obiettivi. Frequente è l’associazione del trattamento farmacologico alla psicoterapia. Tuttavia, manca univocità rispetto ai criteri di gestione del paziente in terapia integrata. Pertanto, si è ritenuto utile sondare all’interno di un campione di psichiatri psicoterapeuti, quali fossero le metodologie più frequenti. Materiali e Metodi. A 120 psichiatri è stato somministrato un questionario di 10 items volto ad esplorare le modalità di gestione della terapia integrata applicata è stata eseguita un’analisi descrittiva dei dati. Le analisi statistiche sono state effettuate mediante SPSS 13.0® Risultati. Il 35,0% degli intervistati lavora come libero professionista, il 19,17% lavora in ambito pubblico. Due terzi del campione ritiene la terapia integrata una forma di trattamento efficace. In ambito pubblico il trattamento maggiormente applicato è quello di tipo integrato (43,48%), in ambito privato quello di tipo psicoterapeutico (78,57%). Il 75,0% prescrive personalmente la farmacoterapia, mentre il 25,0% delega ad un altro collega questo compito. Nell’85,0% dei casi i farmaci vengono prescritti nelle psicosi con sintomi produttivi, seguono poi i disturbi dell’umore con sintomi psicotici. La classe di farmaci maggiormente somministrata è quella degli antipsicotici, seguita dagli stabilizzatori dell’umore. Conclusioni. Le Terapie Integrate, sono funzionali quando l’intervento farmacologico è congruo con il modello psicoterapico. Gli psicofarmaci vanno utilizzati solo se strettamente necessari e l’utilizzazione va elaborata nel lavoro di psicoterapia. Se possibile, è preferibile un solo terapeuta di riferimento. Clin Ter 2009; 160(3):e39-e4

Preliminary experimental/numerical study for the vibration annoyance control of a windshield wiper mechanical system through a Synchronized Switch Shunt Resonator (SSSR) technology

The present work focuses on the study and analysis of vibrations generated by the electrical motor of a wiper system on its support bracket referring to an hatchback vehicle passenger car. In the electric motor of the wiper system there can be present an imbalance transmitting vibrations to the main body via the support bracket. In this paper, after a short resume of available synchronized switch shunt damping methods, a preliminary experimental evalu- ation of their potential performance on noise control of the wiper system is reported. After preliminary experimental measurements of dynamic vibration by the use of vibrometer la- ser both on the real hatchback car then in laboratory environment, a numerical model has been created to evaluate deformations of the support bracket for comparison with the expe- rimental data. This work realizes the preliminary numerical/experimental characterization activity to set up a new application of a control system based on a semi-active technique, called Synchronized Switch Shunt Resonator (SSSR)

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

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

Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents

Objective The validity of current ultra-high risk (UHR) criteria is under-examined in help-seeking minors, particularly, in children below the age of 12 years. Thus, the present study investigated predictors of one-year outcome in children and adolescents (CAD) with UHR status. Method Thirty-five children and adolescents (age 9–17 years) meeting UHR criteria according to the Structured Interview for Psychosis-Risk Syndromes were followed-up for 12 months. Regression analyses were employed to detect baseline predictors of conversion to psychosis and of outcome of non-converters (remission and persistence of UHR versus conversion). Results At one-year follow-up, 20% of patients had developed schizophrenia, 25.7% had remitted from their UHR status that, consequently, had persisted in 54.3%. No patient had fully remitted from mental disorders, even if UHR status was not maintained. Conversion was best predicted by any transient psychotic symptom and a disorganized communication score. No prediction model for outcome beyond conversion was identified. Conclusions Our findings provide the first evidence for the predictive utility of UHR criteria in CAD in terms of brief intermittent psychotic symptoms (BIPS) when accompanied by signs of cognitive impairment, i.e. disorganized communication. However, because attenuated psychotic symptoms (APS) related to thought content and perception were indicative of non-conversion at 1-year follow-up, their use in early detection of psychosis in CAD needs further study. Overall, the need for more in-depth studies into developmental peculiarities in the early detection and treatment of psychoses with an onset of illness in childhood and early adolescence was further highlighted

Validation of an Innovative Viscoelastic Treatment, Integrated on a Real Vehicle Mock-Up for the Internal Vibro-Acoustic Improvement

In the modern transport engineering scenario on large scale, the search for a greater interior comfort is becoming a more increasingly target by all leading companies. Several technological solutions from the aeronautical to the automotive sector, which could allow for the ensuring a high level of efficiency and at the same time safeguarding the environment as well as reducing the manufacturing costs, are carefully under theoretical analysis and experimentation for the achievement of such purposes. The “vibro-acoustic design” of the current and future means of transport is going to become one of the focal points of the technological and commercial challenges which will involve in the coming years the bigger manufacturing houses in the world stage. These trends and next prospects are prompting the exploration for proper both numerical that experimental tools that can support this new ambitious requirement. In this framework, the authors, following depth broad spectrum investigations, have designed and leaded the massproduction of an innovative viscoelastic foam to enhance the sound-absorbing performances than the conventional trim treatments. Noise characterization rational strategies taken on real vehicle have successfully confirmed the results already reached by laboratory tests on the stand-alone components. After a brief digression on the outcomes achieved in the previous works, in this context particular attention it has been rather conferred to the trim-layer assembly in view of the integration in the passengers compartment for the vibro-acoustic qualification

Fully Coupled Fluid–Structure Interaction with Heat Transfer Effects in an Adaptive NACA Airfoil

In the framework of innovative aerodynamics, active airfoils can be developed and exploited based on the integration of shape memory metal alloys (SMAs), allowing for surface adaptation, i.e., shape changes in response to operative thermal inputs, depending on the desired aerodynamic behavior. The purpose of thermally activated shape-changing (TASC) airfoils’ improved capabilities is to offer benefits in terms of aircraft performance and fuel consumption rate. TASC airfoil design hinges upon three intertwined and nonlinear phenomena, namely the solid–fluid–thermal interactions. In this paper, in order to approach the definition of appropriate design parameters, the space of operating variables is explored for the first time by devising a finite element method simulation encompassing the equations of structural motion, energy, and turbulent Reynolds-averaged Navier–Stokes. Such a fully coupled model is then tested by implementing a sensitivity analysis for a preliminary design of a TASC/NACA airfoil. Temperature and velocity distributions are presented and discussed, including new metrics leading to aerodynamic lift calculations. When the efficiency is computed as the lift-to-drag ratio, it is found to vary nonlinearly in the 0–45 range, with the activating power feed in the 0–1000 W range

Car Soundproof Improvement through an SMA Adaptive System

The work at hand focuses on an adaptive system aimed at improving the soundproof performance of car door seals at specific regimes (cruise), without interfering with the conventional opening and closing operations. The idea addresses the necessity of increasing seal effectiveness, jeopardized by aerodynamic actions that strengthen as the speed increases, generating a growing pressure difference between the internal and the external field in the direction of opening the door, and then deteriorating the acoustic insulation. An original expansion mechanism driven by a shape memory alloy (SMA) wire was integrated within the seal cavity to reduce that effect. The smart material was activated (heated) by using the Joule effect; its compactness contributed to the realization of a highly-integrable and modular system (expanding cells). In this paper, the system development process is described together with the verification and validation activity, aimed at proving the functionality of the realized device. Starting from industrial requirements, a suitable solution was identified by considering the basic phenomenon principle and the allowable design parameters. The envisaged system was designed and its executive digital mock-up (CAD, computer-aided design) was released. Prototyping and laboratory tests showed the reliability of the developed numerical models and validated the associated predictions. Finally, the system was integrated within the reference car. To demonstrate the insulation effect, the experimental campaign was carried out in an anechoic room, achieving significant results on the concept value

Shape Memory Alloy—Polymer Composites: Static and Fatigue Pullout Strength under Thermo-Mechanical Loading

This work was carried out within the context of an R&D project on morphable polymer matrix composites (PMC), actuated by shape memory alloys (SMA), to be used for active aerodynamic systems in automotives. Critical issues for SMA–polymer integration are analyzed that are mostly related to the limited strength of metal–polymer interfaces. To this aim, materials with suitable thermo-mechanical properties were first selected to avoid premature activation of SMA elements during polymer setting as well as to avoid polymer damage during thermal activation of SMAs. Nonstandard samples were manufactured for both static and fatigue pullout tests under thermo-mechanical loading, which are made of SMA wires embedded in cylindrical resin blocks. Fully coupled thermo-mechanical simulations, including a special constitutive model for SMAs, were also carried out to analyze the stress and temperature distribution in the SMA–polymer samples as obtained from the application of both mechanical loads and thermal activation of the SMA wires. The results highlighted the severe effects of SMA thermal activation on adhesion strength due to the large recovery forces and to the temperature increase at the metal–polymer interface. Samples exhibit a nominal pullout stress of around 940 MPa under static mechanical load, and a marked reduction to 280 MPa was captured under simultaneous application of thermal and mechanical loads. Furthermore, fatigue run-out of 5000 cycles was achieved, under the combination of thermal activation and mechanical loads, at a nominal stress of around 200 MPa. These results represent the main design limitations of SMA/PMC systems in terms of maximum allowable stresses during both static and cyclic actuation

Youth mental health services in Italy. an achievable dream?

Abstract AIM: "Liberiamo il futuro" (LIF) project was designed to assess psychological problems of adolescents and young adults and to identify individuals at high-risk for developing a psychosis through a collaboration between a University team, Child and Adolescent Mental Health Services and Adult Mental Health Services. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology. METHOD: All help-seeking young people aged 12-35 years residing in the health district involved in LIF were invited to participate in the study and completed a battery of self- report and interviewer-administered measures of psychopathology and functioning at baseline. RESULTS: A total of 338 adolescents and young people (mean age 17.42) participated in the study. The majority of the sample (n = 107, 35%) had an anxiety disorder, followed by mood disorders (n = 62, 21%). Only 35 (12%) participants had no psychiatric diagnosis. After a screening phase, 166 (52%) individuals were assessed to detect the presence of an Ultra High Risk (UHR) state. Of these, 38.60% (n = 64) met UHR criteria. Overall, the majority of the sample resulted moderately functionally impaired at baseline. CONCLUSIONS: LIF project showed that psychological problems, associated with impaired psychosocial functioning, are very common among help-seeking young people. The help-seeking behaviour of young people is in contrast with the barriers presented by the Italian community mental health system that is modelled around adults' requirements. A need of a strong, stigma-free, young oriented system of care for young people up to the mid-20s emerged.AIM: "Liberiamo il futuro" (LIF) project was designed to assess psychological problems of adolescents and young adults and to identify individuals at high-risk for developing a psychosis through a collaboration between a University team, Child and Adolescent Mental Health Services and Adult Mental Health Services. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology. METHOD: All help-seeking young people aged 12-35 years residing in the health district involved in LIF were invited to participate in the study and completed a battery of self- report and interviewer-administered measures of psychopathology and functioning at baseline. RESULTS: A total of 338 adolescents and young people (mean age 17.42) participated in the study. The majority of the sample (n = 107, 35%) had an anxiety disorder, followed by mood disorders (n = 62, 21%). Only 35 (12%) participants had no psychiatric diagnosis. After a screening phase, 166 (52%) individuals were assessed to detect the presence of an Ultra High Risk (UHR) state. Of these, 38.60% (n = 64) met UHR criteria. Overall, the majority of the sample resulted moderately functionally impaired at baseline. CONCLUSIONS: LIF project showed that psychological problems, associated with impaired psychosocial functioning, are very common among help-seeking young people. The help-seeking behaviour of young people is in contrast with the barriers presented by the Italian community mental health system that is modelled around adults' requirements. A need of a strong, stigma-free, young oriented system of care for young people up to the mid-20s emerged