CMHC adherence to National Mental Health Plan standards in Italy: a survey 30 years after national reform law.

OBJECTIVE: The PROG-CSM (Progetto Centri di Salute Mentale) survey was conducted in all Italian community mental health centers (CMHCs) with the aim of evaluating the extent to which these services adhered to the standards defined by the Italian National Mental Health Plan 1998-2000. METHODS: The policy recommendations of the Italian National Mental Health Plan were translated by a multidisciplinary group of experts into key indicators, including continuity of care, coordination with other community-based services, accessibility, implementation of specific programs, and provision of care. RESULTS: There was high adherence to the standards of the National Mental Health Plan in continuity of care and coordination with other services, but there were lower levels of accessibility and implementation of specific projects. CONCLUSIONS: CMHCs were sufficiently developed throughout Italy, and continuity of care and service coordination levels were satisfactory; however, adherence to the standards was unrelated to the duration of activity of the CMHCs

Distúrbio Pós-Traumático de Stress, qualidade do sono, ansiedade, depressão e qualidade de vida em pacientes oncológicos em tratamento quimioterápico

Objetivos: Avaliação da prevalência de Distúrbio Pós-Traumático de Stress (DPTS), ansiedade e depressão, qualidade do sono e qualidade de vida em pacientes oncológicos consecutivos, durante tratamento quimioterápico em relação à população em geral; avaliação comparativa da prevalência de Distúrbio Pós-Traumático de Stress (DPTS), ansiedade e depressão, qualidade do sono e qualidade de vida em pacientes oncológicos em tratamento adjuvante versus pacientes oncológicos em tratamento por doença metastática. Materiais e métodos: Foram pesquisados pacientes consecutivos em tratamento de quimioterapia por doença neoplástica de acordo com os seguintes instrumentos: o Distúrbio Pós-Traumático de Stress foi avaliado mediante o questionário Impact of Event Scale (IES); os níveis de ansiedade e de depressão mediante a Hospital Anxiety and Depression Scale (HADS); a qualidade do sono com o auxílio do Pittsburgh Sleep Quality Index (PSQI); a qualidade de vida através do Functional Assessment of Cancer Therapy – General (FACT-G).Resultados:Foram avaliados 173 pacientes, dos quais, 61 (35,3%) em tratamento de quimioterapia adjuvante e 112 (64,7%) em tratamento quimioterápico por doença metastática. Na população global, a supremacia de Distúrbio Pós–Traumático de Stress foi de 8%; a de distúrbio do sono 30%; a de ansiedade 15 - 20%; de depressão 15%. A prevalência na população em estudo do Distúrbio Pós–Traumático de Stress foi maior em relação aos dados presentes na literatura (45,1% versus 8%); a dos distúrbios do sono maior (62,8% versus 30%); a da ansiedade maior (40% versus 15 – 20%); a da depressão maior (31,1% versus 15%). Não foram encontradas diferenças significativas no que se refere à prevalência de Distúrbio Pós-Traumático de Stress (P=0,768), dos distúrbios do sono (P=0,978), da ansiedade (P=0,351), da depressão (P=0,958) e da qualidade de vida (P=0,675), nos pacientes em tratamento de quimioterapia por doença metastática em relação aos pacientes em tratamento adjuvante.Conclusões: A prevalência dos distúrbios psicológicos na população em estudo se apresenta significativamente maior em relação a da população em geral; esse dado confirma a necessidade de intervenção psiquiátrica de consulta e de ligação (liaison) nos pacientes neoplásticos em tratamento quimioterápico. Tal necessidade não difere entre os pacientes em tratamento adjuvante e os que estão em tratamento por doença metastática, não havendo diferenças significativas na incidência dos distúrbios avaliados entre os dois grupos acima

DO NEUROPSYCHOLOGICAL AND SOCIAL COGNITION ABILITIES IN SCHIZOPHRENIA CHANGE AFTER INTENSIVE COGNITIVE TRAINING? A PILOT STUDY

Objective: Schizophrenia is characterized by significant cognitive deficits on attention, memory, executive function, language and/or sensory motor skills. In addition, patients’ profile is frequently characterized by marked deficits in the domain of social cognition. Cognitive rehabilitation aims has recently become an essential component of the rehabilitation process in schizophrenia. However, to date is not clear whether cognitive rehabilitation impacts positively only on the cognitive deficits specifically trained, or whether the positive effects of rehabilitation training may extend also to other domains such as social cognition abilities. Thus, in the present pilot study, we wanted to see whether an intensive cognitive training, in addition to improving neuropsychological abilities, would also have had an impact on social cognition skills. Method: Ten patients affected by schizophrenia were randomly assigned to two groups: a treatment group (n = 5) undergoing an intensive computerized cognitive training, and a control group (n = 5) undergoing an unstructured computerized control intervention. A detailed neuropsychological, clinical, functional and social cognition assessment was performed before and after the intervention for all the patients. Results: A significant longitudinal effect in the treatment group was found for the BACS verbal memory (p = 0.016), and for the comic strip task – non-social (p = 0.032). A trend towards a significant effect was found for the FAB (p = 0.056). Single-case analysis via modified t-test was conducted too. Conclusions: Our preliminary results showed a significant improvement in the cognitive domain after a structured cognitive training. In addition, an improvement in some social cognition abilities was observed too, even if the impact of the cognitive intervention on these abilities was less evident. Implications for further research were discussed

Comparison of experienced burnout symptoms in specialist oncology nurses working in hospital oncology units or in hospices.

OBJECTIVE: This study aimed to clarify the differential contributions of situational and individual factors to burnout symptoms experienced by two independent groups of specialist oncology nurses working in oncology hospital units or in hospices. METHOD: The study involved a group of specialist oncology nurses working in hospital oncology units (n = 59) and a group of specialist oncology nurses working in hospices (n = 33). Participants were invited to provide demographic data, and indicate the clinical setting in which they worked and their work experience; the Italian versions of the Maslach Burnout Inventory (MBI) (a measure of burnout symptoms), the Hospital Anxiety and Depression Scale (HADS) (a measure of anxiety and depression), and the Attachment Style Questionnaire (ASQ) (a measure of relational style) were then administered. RESULTS: The two groups of nurses were well matched for age, work experience, and levels of anxiety and depression. Regarding their relational style, the two groups only differed significantly on two subscales of the ASQ (i.e. "Confidence" and "Relationships as Secondary"). The two groups significantly differed in the levels of all burnout symptoms investigated (emotional exhaustion, depersonalization, and personal achievement), with nurses working in hospital units showing higher levels of burnout symptoms. Interestingly, multivariate regression analyses showed that the institutional factor (clinical setting in which nurses worked) clearly emerged as the only factor that influenced the level of all burnout symptoms, whereas the contribution of individual factors was less significant. SIGNIFICANCE OF RESULTS: These findings help to clarify the differential contributions of institutional and individual factors to burnout symptoms in specialist oncology nurses, and corroborate the need for interventions to contain nurses' burnout symptoms

Development and validation of a patient-physician relationship index in the advanced cancer setting

BACKGROUND: The quality of the relationship between patient and medical staff is crucial in oncological settings. We have developed and validated a short, self-administered questionnaire to measure patients' satisfaction with their relationship with the physician: the Patient-Physician Relationship Index (PPRI). MATERIALS AND METHODS: Content validity was evaluated by a two-stage (development and judgment) process. One hundred and nine cancer patients with metastatic disease were assessed during the second cycle of chemotherapy and 59 were reassessed eight weeks later. Quality of life and anxiety and depression were also evaluated. RESULTS: The PPRI is monofactorial. Cronbach's alpha coefficient was 0.81. Sensitivity to change was shown by the correlation with changes in patients' conditions. The PPRI scores were only weakly correlated with the majority of the EORTC and HAD subscale scores. CONCLUSION: The PPRI is an easy-to-use, self-administered questionnaire, developed in a population of patients with advanced cancer. It has good internal consistency and sensitivity to change

Age of Onset of Mood Disorders and Complexity of Personality Traits

The aim of the present study is to evaluate the link between the age of onset of mood disorders and the complexity of the personality traits. Methods. 209 patients with major depressive or manic/hypomanic episodes were assessed using the Structured Clinical Interview for DSM Axis I diagnoses and the Millon Clinical Multiaxial Inventory-III (MCMI-III). Results. 17.2% of the patients had no elevated MCMI-III scores, 45.9% had one peak, and 36.9% had a complex personality disorder with two or more elevated scores. Mood disorders onset of 29 years or less was the variable most related to the complexity of personality disorders as indicated from a recursive partitioning analysis. Conclusions. The relationship between mood disorders and personality traits differ in reference to age of onset of the mood disorder. In younger patients, maladaptive personality traits can evolve both in a mood disorder onset and in a complex personality disorder, while the later development of a severe mood disorder can increase the personality symptomatology. Our results suggest a threshold of mood disorder onset higher compared to previous studies. Maladaptive personality traits should be assessed not only during adolescence but also in young adults to identify and treat potential severe mood disorders

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