Il percorso di superamento dell’OPG e i suoi effetti nell’applicazione delle misure di sicurezza

Law 180/1978 determined the closure of Psychiatric Hospitals and the transition of public services to a model of community psychiatry in Italy. This change did not affect the Forensic Psychiatric Hospitals, which were closed many years later with Law 81/2014. Twenty years of judgments concerning defendants with substantially diminished or excluded criminal responsibility by reason of insanity are evaluated. The authors analyzed the possible relations between the frequency of the application of psychiatric security measures and the jurisprudential pronouncements and actions by the legislator occurred in the same period. Security measures have increased in a manner not specifically related to a single event among those taken into consideration; in particular, non-custodial measures have risen steadily from 8.5% in 2001 to 88.2% in 2019. The consequences of this trend for the activity of the Departments of Mental Health are discussed, also in light of the ongoing debate on the outcomes of the reform.In Italia la legge 180/1978 determinò la chiusura degli Ospedali Psichiatrici e il passaggio dei servizi pubblici ad un modello di psichiatria di comunità. Tale cambiamento non ha interessato gli Ospedali Psichiatrici Giudiziari che sono stati chiusi molti anni dopo con la legge 81/2014. Gli autori, attraverso l’analisi di 20 anni di sentenze riguardanti persone con vizio parziale o totale di mente, hanno messo a confronto le variazioni della frequenza di applicazioni delle misure di sicurezza psichiatrica con le pronunce giurisprudenziali e gli interventi del legislatore registrati nello stesso periodo. Le misure di sicurezza sono aumentate in maniera non connessa specificatamente a un singolo evento tra quelli presi in considerazione; in particolare quelle di tipo non detentivo sono aumentate costantemente passando dall’8,5% del totale nel 2001 all’88,19% nel 2019. Le conseguenze di questo incremento per l’attività dei Dipartimenti di salute mentale sono discusse, anche alla luce del dibattito in corso sugli esiti della riforma.

Living in Contaminated Sites: Which Cost for Psychic Health?

In this paper, we would like to offer a psychoanalytically oriented perspective on the psychic costs of most documented technological disasters (e.g. oil spill and nuclear accidents) or industrial pollution (e.g. asbestos manufacturing). We report a brief literature review about the relationship between Contaminated Sites (CSs) and mental health. The articles were selected from the most important medical and psychological databases: MEDLINE/Pubmed, PsycINFO and Proquest Psychology Journal. After electronic searches, we have manually reviewed reference lists from the identified publications. Literature review reveals that despite the specific kind of technological disasters (i.e. nuclear accidents, oil spill, asbestos manufacturing), the cost of survival is pretty much the same: anxiety, somatizations, rage, depression and post-traumatic conditions, which undermine one’s own sense of psychic integrity. This cost seems to be even higher when people have to fight an invisible and boundless enemy, which threaten not only themselves but also their own children. Clinicians, mental health services and policy makers need to reflect upon these traumatic conditions in order to activate and promote a thinking process that can give rise to a new capability of containing all the experiential aspects that have remained alien, dissociated and unthinkable until that moment. Qualitative approaches and multi-dimensional analysis could lead a deeper understanding of the psychic dynamics and unconscious life in CSs. DOI: 10.5901/mjss.2015.v6n4s3p20

O monitoramento das inclusões residenciais em Psiquiatria: resultados preliminares da atividade da unidade de monitoramento e planejamento clínico

Introduction: Planning and Monitoring Unit Clinical (UMPC) has clinical epidemiological purposes, but mainly for evaluating and improving the quality of service. Objective: To describe the journeys of patients to residential care for mental health services. Method: The routes were analyzed from twopoints of view: based on the management structure and the type of intervention (these two criteria were intertwined) and based on the type of structure. 213 patients were followed. The first analysis of pathways was performed considering the residential subdivision of the Department offer residentialbased management and intervention. Results: A significant number of these patients remains inserted for several years, it can be stated that the rehabilitative program running inside the supporting structures, allow improving or at least maintaining the autonomy acquired. Conclusion: The fact thatthere are numerous passages of protected structures, administered by the Department, the support structures, such as groups of Apartment, the Accommodation Support, indicates a good capacity of rehabilitation programs, working in the community, to prepare patients to new projects characterized bygreater autonomy and personal independence.Descriptors: Psychosocial rehabilitation; Autonomy; Health Services

Presence and significant determinants of cognitive impairment in a large sample of patients with Multiple Sclerosis

This work was supported by FISM - Fondazione Italiana Sclerosi Multipla (www.aism.it) - Cod. 2009/R/17.Objectives: To investigate the presence and the nature of cognitive impairment in a large sample of patients with Multiple Sclerosis (MS), and to identify clinical and demographic determinants of cognitive impairment in MS. Methods: 303 patients with MS and 279 healthy controls were administered the Brief Repeatable Battery of Neuropsychological tests (BRB-N); measures of pre-morbid verbal competence and neuropsychiatric measures were also administered. Results: Patients and healthy controls were matched for age, gender, education and pre-morbid verbal Intelligence Quotient. Patients presenting with cognitive impairment were 108/303 (35.6%). In the overall group of participants, the significant predictors of the most sensitive BRB-N scores were: presence of MS, age, education, and Vocabulary. The significant predictors when considering MS patients only were: course of MS, age, education, vocabulary, and depression. Using logistic regression analyses, significant determinants of the presence of cognitive impairment in relapsing-remitting MS patients were: duration of illness (OR = 1.053, 95% CI = 1.010-1.097, p = 0.015), Expanded Disability Status Scale score (OR = 1.247, 95% CI = 1.024-1.517, p = 0.028), and vocabulary (OR = 0.960, 95% CI = 0.936-0.984, p = 0.001), while in the smaller group of progressive MS patients these predictors did not play a significant role in determining the cognitive outcome. Conclusions: Our results corroborate the evidence about the presence and the nature of cognitive impairment in a large sample of patients with MS. Furthermore, our findings identify significant clinical and demographic determinants of cognitive impairment in a large sample of MS patients for the first time. Implications for further research and clinical practice were discussed.Publisher PDFPeer reviewe

Quality of Life, Anxiety and Depression in Soft Tissue Sarcomas as Compared to More Common Tumours: An Observational Study

The aim of this study is to compare the quality of life and the levels of anxiety and depression in a relatively large group of subjects undergoing chemotherapy for soft tissue sarcoma and a control group of subjects undergoing chemotherapy for the most common types of cancer. 56 soft tissue sarcoma affected patients and 56 patients with common tumours, homogeneous in regards to stages of disease and sociodemographic characteristics, were enrolled in two oncological centres in Turin, Italy. Quality of life was assessed by Functional Assessment of Cancer Therapy-General and anxiety and depression by Hospital Anxiety and Depression Scale. All patients had ongoing chemotherapy. The comparison between the two groups shows no difference in either quality of life or in anxiety and depression. There are instead gender differences, since females in the group of common tumours show higher levels of anxiety in comparison to those affected by sarcomas, while males show, at a lower degree, the opposite trend. This study suggest that levels of Quality of Life, anxiety and depression are similar in rare and common tumours. The majority of patients are able to cope with the disease in an adaptive manner. However, for some patients the disease poses a threat to their physical and mental integrity; psychological support of these patients may reduce the development of significant morbidity and help patients to better manage the course of the disease and the effects of the treatment

Neuropsychological measures in patients with MS and healthy controls.

*<p>p<0.05;</p>**<p>p<0.01;</p><p>df = degrees of freedom; NS = Not Significant; PASAT = Paced Auditory Serial Addition Test; SDMT = Symbol Digit Modalities Test; SPART = Spatial Recall Test; SPART–D = Spatial Recall Test-Delayed; SRT–CLTR = Selective Reminding Test-Consistent Long Term Retrieval; SRT–D = Selective Reminding Test-Delayed; SRT–LTS = Selective Reminding test-Long Term Storage; TIB–errors = Brief Intelligence Test-Errors; TIB–IQ = Brief Intelligence Test–Intelligence Quotient; WAIS–Voc = WAIS Vocabulary; WLG = Word List Generation.</p