Mixed states: Still a modern psychopathological syndrome?

The aim of this review is to evaluate whether the DSM-5 concept of mixed features \u201cspecifier\u201d provides a definition that reflects the richness and multiplicity of this psychopathological picture pointing out the historical development, clinical concepualisation and proposed therapeutic approach to mixed states. We review and discuss the recent evidence on the presence of mixed features during mania and depression and summarise findings on the conceptualisation of mixed states. Electronic searches of all English-language papers were performed in the MEDLINE and PUBMED database using and cross-listing key words: mixed state, mixed features, bipolar disorder, major depressive disorder, mania, hypomania, depression. The mixed categorical-dimensional concept used in the DSM- 5 broadens the concept of mixed episodes, introducing substantial changes to the diagnosis of mixed states. This definition appears more appropriate for less severe forms of mixed states presenting clear and detectable mood symptoms with evident improvement compared to the DSM-IV, as the possibility of classifying depression \u201cwith mixed features\u201d. The transition from the classical definition of mixed states to the one reported in the DSM-5 has determined a complex modification of the concept of mixed state. The DSM-IV-TR description, based on the co-presence of symptoms of opposite polarity, was extremely reductive and did not capture the sub-syndromal symptoms of the opposite pole experienced in bipolar and major depressive disorders. The DSM-5 definition of mixed features \u201cspecifier\u201d represents a valid tool to improve the recognition and proper treatment of bipolar mixed patients, reducing misdiagnosis and mistreatment associated with chronic and repetitive exposure to antidepressants and sedatives, although the mixed categorical-dimensional concept does not adequately reflect some overlapping mood criteria, such as mood lability, irritability and psychomotor agitation

La Traslazione del paziente, con disturbo mentale e comportamento violento, verso il terapeuta

We described eleven typical clinical cases of patients’ translational typology with mental disorder and violent behaviour towards the therapist. The clinical cases described exhibit neurotic and psychotic translation linked to translation linked to mental disorder and translation linked to the aetiology and to the dynamics of violent behaviour. The objective of this clinical study is to enrich the psychiatric diagnosis and therapeutic pathways of patients with mental disorder and violent behaviour and to avoid iatrogenic error by using the concept of translation in its widest understanding

La Controtraslazione del terapeuta verso il paziente con disturbo mentale e comportamento violento

We described thirteen typologies of the therapist countertransference toward the patient with mental disorder and violent behavior. The purpose of this study is to improve: a) the ability of the therapist to mentalize emotions without any passing to the act; b) the recognition of the patient transference; c) the recognition of the countertransference related to mental disorder and violent behavior

Reattività inadeguata del terapeuta nei confronti del paziente a rischio suicidario = Therapist’s reactions on the treatment of suicidal patients

In the present study, we describe fourteen therapists’ reactions (Avoidance, Rejection, Suicidal collusion, Overinvolvement, Overprotection, Loss of patients’ responsibilities, Loss of therapists’ responsibilities, Reaction to the feeling of being exploited, Creation of dependency, Manipolatory acting out, Feeling of undergoing an iniquity, Patients psychopathology inflation, Therapists’ psychopathology inflation, Suicidal Burnout Syndrome), based on emotions, behaviors and cognitivity, toward patients with suicidal risk. These responses can interfere with a correct assessment and management of suicidal risk in psychiatric patients. The purpose of the present clinical study was to improve therapist’s professional skills through the recognizement and management of his own responses to suicidal patients

Il Colloquio con il detenuto: aspetti antropologici

During the clinical interview – both criminological and psychiatric – between the prisoner and who works in the mental health (psychiatrist, criminologist, psychologist, etc.) in the context of a prison, a lot of features can make this therapeutical relation very difficult: first of all, the suspiciousness and the prejudices of people who works in the mental health against the prisoners and vice versa. Then, for a better understanding, it is useful to consider the prisoner, deprived of his freedom and forced to long imprisonment, connected to his behaviours, values, rules and choices, tightly related to a “subculture of prison” and so different from “life out of the prison”. The clinical interview is the way how who works in a mental health context makes the first therapeutical intervention and it has got very specific features. Some of the elements will be examinated, particularly by an anthropological and cultural point of view (psychological processes, cultural context, etc.), in order to go deeper into the understanding of the clinical interview with the prisoner, but also in order to aid a specific therapeutical intervention

Clinical, diagnostic and forensic features of a REMS patient's sample

INTRODUCTION: Residential Services for the Execution of Security Measures (REMS) are specialist psychiatric units for forensic patients created in 2015 after OPG (Italian Security Psychiatric Forensic Hospitals) have been closed. AIMS: to describe the clinical, diagnostic and forensic features of patients and evaluate the relevance of 3 elements: use of alcohol and substance, antisociality, cognitive disability. A further aim is the evaluation of the level of pre and post admission diagnostic concordance. METHODS: A specific database has been set for the purpose of the study, which collects data of patients admitted in 5 years of activity of the unit. Data have been analysed through a descriptive approach. RESULTS: 4 main clusters have been identified: Psychosis, Use of Alcohol/Substance Disorder, Personality Disorder, Cognitive Disability. Alcohol/substance use, antisociality, cognitive disability elements are relevant in the sample. Diagnostic concordance level pre- and post- admission is overall good, sometimes partial. CONCLUSIONS: alcohol/substance use, antisociality and cognitive disability, often in comorbidity mode, represent core features in part of the sample. This finding emphasizes a complexity level which is linked to social and judicial aspects, in addition to the health component