Historical micronutrient psychiatry: descriptive analysis of patients with pellagra admitted to the “San Lazzaro” asylum in Reggio Emilia (Italy) in the decade 1901-1910

This study aims at describing the socio-demographic and clinical characteristics of the patients affected by pellagra and admitted to the “San Lazzaro” psychiatric asylum (Reggio Emilia, Italy) from 1901 to 1910 besides exploring possible gender differences for the collected information. Data were collected from the admission register and clinical records of those patients who were admitted to the San Lazzaro Psychiatric Hospital receiving a diagnosis of pellagra at their first admission. The pellagrous patient population was characterised by a higher rate of hospitalisation for women (64.3%) and the number of hospitalised patients suffering from pellagra gradually decreased from 1901 (78; 8.3%) to 1910 (8;0.7%). The most common profession for men admitted with pellagra was farmer/agricultural labourer, while most of the women were housewives. A characteristic shared by both the male and female population of inpatients was very high rate of illiteracy: only one patient was recorded as being able to read and write. The generic diagnosis of “mental illness from pellagra” was predominant (70%), while “dementia from pellagra” accounts for 17.85% of the admission diagnoses: no statistically significant differences between men and women were found in the frequency of diagnosis. Half of the patients, both men and women, died while being inpatients. This study confirms previous findings about the case mix of pellagra patients admitted to psychiatric hospital at the beginning of the last century in northern Italy and highlights the significance of the relationship of psychiatry with other medical disciplines and the sociocultural milieu

Can stigmatizing attitudes be prevented in psychology students?

Background: Stigmatizing attitudes have been found among psychology students in many studies, and they are becoming more common with time. Aims: This study examines whether participation in clinical psychology lessons reduces levels of stigmatization in a population of psychology students and whether it leads to any change in stigmatization. Methods: The study is a pre/post evaluation of the effectiveness of clinical psychology lessons (63 hours of lectures) as a tool to fight stigma. The presence of stigmatizing attitudes was detected using the Italian version of the Attribution Questionnaire-27 (AQ-27-I). Stigmatization was described before and after the lessons with structured equation modeling (SEM). Results: Of a total of 387 students contacted, 302 (78.04%) agreed to be involved in the study, but only 266 (68.73%) completed the questionnaires at both t0 and t1. A statistically significant reduction was seen in all six scales and the total score on the AQ-27-I. The models defined by the SEM (pre- and post-intervention) showed excellent model fit indices and described different dynamics of the phenomenon of stigma. Conclusions: A cycle of clinical psychology lessons can be a useful tool for reducing stigmatizing attitudes in a population of students seeking a psychology degree

Validation of the Modena bleeding score in endoscopic sinus surgery

Introduction: The Modena bleeding score is a categorical rating scale that allows the assessment of the surgical field in relation to bleeding during endoscopic surgery. It has recently been presented and validated in the field of endoscopic ear surgery by the present authors. The Modena bleeding score provides five grades for rating the surgical field during endoscopic procedures (from grade 1 − no bleeding to grade 5 − bleeding that prevents every surgical procedure except those dedicated to bleeding control). Objective: The aim of this study was to validate the Modena bleeding score in the setting of endoscopic sinus surgery. Methods: Fifteen three-minute videos of endoscopic sinus surgery procedures (each containing three bleeding situations) were evaluated by 15 specialists, using the Modena bleeding score. Intra and inter-rater reliability were assessed, and the clinical validity of the Modena bleeding score was calculated using a referent standard. Results: The data analysis showed an intra-rater reliability ranging from 0.6336 to 0.861. The inter-rater reliability ranged from 0.676 to 0.844. The clinical validity was α = 0.70; confidence limits: 0.64 − 0.75, corresponding to substantial agreement. Conclusion: The Modena bleeding score is an effective method to score bleeding during endoscopic sinus surgery. Its application in future research could facilitate the performance and efficacy assessment of surgical techniques, materials or devices aimed to bleeding control during endoscopic sinus surgery

Diagnostic agreement between physicians and a consultation-liaison psychiatry team at a general hospital: An exploratory study across 20 years of referrals

Consultation-liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000-2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen\u2019s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions

Affective and sexual needs of residents in psychiatric facilities: A qualitative approach

Background: The affective and sexual needs of psychiatric patients are often under-considered, although they contribute significantly to their general well-being. Such topics are critical for Residential Psychiatric Facilities Users (RPFUs), whose daily life is paced by therapeutic settings. The aim of this paper is to better understand how sexuality and affectivity are expressed by the RPFUs at the Mental Health Department of Modena, within psychiatric residential settings. Methods: Adult RPFUs took part into two audio recorded focus groups. Digital transcripts were analyzed using MAXQDA software in order to perform qualitative narrative analysis, so as to develop a hierarchical code system a posteriori (derived from the data). Results: Eleven participants (eight RPFUs and three investigators) attended the first focus group, and eight participants (5 RPFUs and 3 investigators) attended the second focus group. 175 interventions were analyzed and coded under seven thematic areas: (a) contraception and sexually transmitted disease prevention (N = 17); (b) affective needs (N = 11); (c) personal experiences (N = 61); (d) regulation of sexual relations (N = 18); (e) Mental Health Professionals' (MHPs) openness towards the topic (N = 17); (f) MHPs' responses to RPFUs' sexual behaviors (N = 33); and (g) RPFUs proposals (N = 18). The highlighted topics suggest that affective and sexual relations commonly occur within residential psychiatric facilities, even if mental health services often fail to recognize and address RPFUs' affective and sexual needs as well as to provide effective solutions to manage them. Conclusions: RPFUs expressed a request for support to fulfill their affective and sexual needs and dedicated spaces for sexual activities to relieve their discomfort, while MHPs highlighted a need for awareness, training, and shared problem-solving strategies

Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

The relationship between traumatic life events and increased suicide risk has been well reported in literature. However, the complex nature of suicidality phenomena still hinders our ability to comprehend the mediation mechanism underlying this association. In this study, we examined the mediating role of adult attachment and reflective functioning in the relationship between traumatic life events and suicidal ideation. Nine hundred and fifty Italian adults completed an online survey evaluating traumatic life events, adult attachment, reflective functioning and suicidal ideation. The path analysis showed that the positive relationship between traumatic life events and suicidal ideation was partially mediated by attachment anxiety and reflective functioning. From a clinical point of view, these results support the relevance of evaluating and improving patients’ ability to mentalize as a part of psychotherapeutic intervention aimed at reducing suicidality in people with a history of traumatic experiences and attachment anxiety

Effectiveness and acceptability of psycho-education group intervention for people hospitalized in psychiatric wards and nurses

Objective: To assess effectiveness and acceptability of a Psycho-education Group Intervention (PGI) on a sample of patients admitted to a Psychiatric Inpatient Unit (PIU) and on ward nurses. Methods: Case-control study. PGI was delivered according to the model of Vendittelli and colleagues (2008). Male and female patients aged 18-70 were eligible. Cases attended the PGI, while controls did not. A 5-item ad hoc Likert-scale was used to record ward atmosphere. The Italian version of the Simple Feedback Question Form for people attending Cognitive Behaviour Therapy Group (SFQF-CBTG) was administered to each patient before discharge. The primary outcome was readmission rate after 6 months from discharge, secondary outcomes were ratings of ward atmosphere by nurses and feed-back from people hospitalized. All Statistics were performed with STATA 13.1. Results: Fifty-two patients were enrolled, 17 cases and 35 controls. No significant differences emerged in the primary outcome, though compulsory readmissions were noticeable only among controls. Ratings of ward atmosphere in relation to group activities did not differ. Seventeen SFQF-CBTG were filled in. Most cases reported at discharge to have found the group "helpful", stating that "they would attend it in the future again", and "group topics were not difficult". Conclusions: No evidence emerged in favour or against effectiveness of the PGI for patients and ward nurses, though the intervention was rated as acceptable and feasible

Linee guida per la diagnosi, il trattamento e il supporto dei pazienti affetti da demenza

Il termine demenza descrive una serie di sintomi cognitivi, comportamentali e psicologici che possono includere perdita di memoria, difficoltà di ragionamento e di comunicazione e cambiamenti della personalità che compromettono la capacità di svolgere le attività quotidiane. Nel 2013 un rapporto della Alzheimer’s Society ha rilevato che nel Regno Unito erano circa 815.000 le persone affette da demenza (prevalenza 1/14 abitanti di età >65 anni), un numero destinato ad aumentare sino a 1.143.000 entro il 2025. Nel novembre 2017 erano 456.739 i pazienti con una diagnosi certa di demenza nei registri di medicina generale, rispetto ai 290.000 del periodo 2009-2010, la differenza in gran parte imputabile ad un aumento del numero di diagnosi. Nonostante questo miglioramento nella diagnosi della demenza, si stima che circa 1 caso su 3 non venga riconosciuto correttamente; inoltre, circa la metà delle persone affette da demenza non riceve un adeguato supporto dopo la diagnosi. Questo articolo riassume le raccomandazioni più recenti del National Institute for Health and Care Excellence (NICE) per la valutazione, la gestione e il supporto delle persone affette da demenza e dei loro caregiver. La linea guida (LG) aggiorna e sostituisce integralmente la LG NICE sulla demenza del 2006. Raccomandazioni, dettagli completi delle evidenze e il PDTA sono disponibili sul sito del NICE. Le raccomandazioni del NICE sono basate su revisioni sistematiche delle migliori evidenze disponibili e su una esplicita considerazione della costo-efficacia. Quando le evidenze disponibili sono limitate, le raccomandazioni sono basate sull’esperienza del gruppo che ha prodotto la linea guida – Guideline Development Group’s (GDG) – e sulle norme di buona pratica clinica. I livelli di evidenza delle raccomandazioni cliniche sono indicati in corsivo tra parentesi quadre

Cl service in modena: The Italian experience

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