La personalizzazione dei trattamenti psicoterapeutici nei disturbi dell’umore

Objective. This article introduces the concept of “personalization of the treatment”, concept that is connected to the idea that patients with the same descriptive-nosographic diagnosis but different for others variables, can profit in different way of the different types of treatment. Exists an ample literature regarding pre-treatments predictors related to social-demographics variables, personality dimensions, cognitive and psychodynamic constructions, relational patterns, attachment patterns and severity of the symptoms; what has not been resolved yet is the problem of superiority of a treatment compared to another in the care of a disease. Therefore, considering that fitting the therapeutic relationship and the type of intervention to the specific needs and to patient’s characteristics, increases treatment’s efficiency, this article intends to evaluate the points of strenght and the weakness of main psychotherapic interventions and to highlight the therapeutic factors related to intervention models. Methods. Have been taken into account therapeutic factors with demonstrated or likely effectiveness, taken from the final report of the 29th APA Task Force based on the therapeutic relationship empirically supported (Norcross, 2001). We also take in consideration the list of mediators of outcome for the mood disorders identified by Beutler. It is assessed how the main approach taken into consideration the therapeutic factors and mediators of change identified by literature in their pathological models (Karasu, 1996). Results. Considering the typology of interventions from the point of view of the therapeutic factors, it’s possible to observe that general differences lose part of their importance, because of the valorization of the role of common factors. Moreover come out different aspects of mood disorder and, probably, different clinical typologies of patients. Conclusions. The article is a first step in understanding how and for who works the various components that characterize the psychotherapeutic treatment, pointing out quite precisely the problems that the research itself has raised, with its results and highlighting the necessity to work on the relationship between types clinical, mediators of change, characteristics of therapist and treatment

Eating disorders subtypes in a sample of young females using the OPD system : Preliminary results

Objectives: Clinical experience with patients suffering from eating disorders (EDs) shows that the same symptom can cover different types of mental functioning, with very different prognosis. This study aims to investigate the existence of recurrent diagnostic configurations on an adolescent sample normalized for the DSM-IV diagnosis of ED, using the Operationalized Psychodynamic Diagnosis system (OPD-Task-Force 2008: Operationalized Psychodynamic Diagnosis OPD-2 Manual of Diagnosis and Treatment Planning in order to improve the therapeutic strategies. In a previous study we found that OPD can show different recurrent psychodynamic configurations independently from the DSM-IV diagnosis. In subsequent research we found that OPD can also show different psychodynamic configurations in a population affected by eating disorder and different configurations for each personality disorder. Method: The sample is made up of 50 consecutive non-selected young women (age between 16-25 years) coming to a nutritional day hospital at the Department of Clinical Nutrition of the H. Niguarda-Milan and visited by an OPD-II trained interviewer of the psychiatric university unit of the same hospital. We present the preliminary results of a study with a 300 patient sample, in which there will be three evaluations (T0 - T1 18 months - T2 36 months follow up) using the following tools: OPD-2, SCL-90, EDI-2, BUT, suited clinical anamnestic schedule. We performed two different factor analyses with the Varimax rotation, the first one using OPD Axis I (Experience of Illness) variables, the second one among the factors extracted in Axis I and the Axis III (Conflicts) and Axis IV (Structure) variables. Results: We obtained in the first step of analysis four different recurrent psychodynamic configurations, that we called Configurations, that represent the patient psychological, somatic and social theory of illness. In the second step we've found two recurrent psychodynamic configurations, that we called Organizations, that represent more stable organizations of illness that could contribute to create the high outcome variability in this disorder. Conclusions: These results suggest the existence of different subtypes of patients with EDs, that differ not only with respect to the symptomatology, but also with respect to underlying psychodynamic features. Our hypotheses are that patients with different configurations and organizations need different therapeutic approaches, and that the frequent treatment failures with patients with EDs are due to the lack of an appropriate differential diagnosi

Internet adiction disorder o internet related psychopathology?

In this paper we present the state of the art of the Internet Addiction Disorder (IAD) and some alternative theoretical models critical with the category of Internet addiction. The review of the literature shows that IAD is an umbrella concept, and that there is not a common definition. In our society in which a great deal of activity is carried out online, it is not useful to talk about a generic Internet addiction. In this paper we show the theoretical and methodological issues of IAD construct that induced some researchers to shift the focus to specific psychopathology related to the Internet. New systematic studies on specific activities about dysfunctional conducted online are necessary. Prevention and treatment strategies should lean towards more functional navigation styles rather than to a general reduction of Internet use

Il progetto OPD-Milano (Diagnosi Psicodinamica Operazionalizzata) : studio di attendibilit\ue0 tra giudici nella versione italiana

Goals: The present study introduces the Milan-OPD research project. The project, focused on the use of the OPD Italian version, was born by the requirement to assign the more adequate treatment to a specific patient, a requirement also emerging in the recent literature. We are here presenting the first step of this project, the inter-rater reliability study in the OPD Italian version. Methods: Two independent and OPD trained groups evaluated the interview transcriptions of 20 consecutive not-selected patients, coming for a psychiatric consultation conducted following OPD interview guidelines by a trained interviewer. The inter-rater reliability has been calculated using two different statistical algorithms, Coehn\u2019s Kappa (Cohen, 1960) and Linear Weighted Kappa (Cohen, 1968). Results: Reliability values are 0.65, 0.56, 0.62 (Weighted Kappa) for Axis I, Axis III, Axis IV, respectively, and 0.63, 0.61 (Cohen\u2019s Kappa) for Axis II and Axis III main conflicts, respectively. Conclusions: The results show a good reliability for Axis I, Axis II, Axis III main conflicts, Axis IV, and a moderate reliability for Axis III. The results are compatible with the international OPD literature and comparable to field trials studies with ICD-10 and DSM-IV

Il progetto OPD-Milano: nuove configurazioni diagnostiche clinicamente significative

Obiettivi: Il presente studio si propone di ricercare, con l\u2019uso del OPD, configurazioni dimensionali ricorrenti, indipendenti dalla diagnosi nosografica descrittiva. In particolar modo la presenza di organizzazioni ripetute collegate con l\u2019\u201cesperienza di malattia e presupposti per il trattamento\u201d e la loro correlazione con i fattori presenti sugli altri assi OPD. Metodi: Il campione risulta costituito da 50 pazienti consecutivi non selezionati rivoltisi per una visita di consultazione psichiatrica e valutati da operatori addestrati. Abbiamo in seguito eseguito un\u2019analisi fattoriale con il metodo Varimax, tra le variabili OPD, sia all\u2019interno dell\u2019Asse I, sia tra tutte le variabili dei primi quattro assi. Risultati: Dall\u2019analisi fattoriale \ue8 emersa la presenza di tre configurazioni ricorrenti, denominate \u201cOrganizzazioni dell\u2019esperienza di malattia\u201d, delle quali una correla con fattori presenti in altri assi, portando alla caratterizzazione del \u201cpaziente deficitario\u201d. Essa \ue8 una tipologia diagnostica che si caratterizza per la particolare gravit\ue0 del quadro clinico e per la difficolt\ue0 di intervento. Trasversalmente alle organizzazioni si \ue8 osservata la presenza di un \u201cFattore motivazione\u201d, il quale pu\uf2 essere presente in ognuna delle configurazioni portando ad una ulteriore specificazione diagnostico-terapeutica. Conclusioni: L\u2019individuazione empiricamente fondata di dimensioni diagnostiche complesse che si basano su fattori prognosticamente significativi e che trascendono dalla pura descrizione sintomatologica ci porta a ipotizzare delle modalit\ue0 di intervento terapeutico specifiche per diverse tipologie di pazienti