Modalità di gestione della terapia integrata in ambito psichiatrico. Uno studio 'cross-sectional' su un campione selezionato di psichiatri

Obiettivi. Frequente è l’associazione del trattamento farmacologico alla psicoterapia. Tuttavia, manca univocità rispetto ai criteri di gestione del paziente in terapia integrata. Pertanto, si è ritenuto utile sondare all’interno di un campione di psichiatri psicoterapeuti, quali fossero le metodologie più frequenti. Materiali e Metodi. A 120 psichiatri è stato somministrato un questionario di 10 items volto ad esplorare le modalità di gestione della terapia integrata applicata è stata eseguita un’analisi descrittiva dei dati. Le analisi statistiche sono state effettuate mediante SPSS 13.0® Risultati. Il 35,0% degli intervistati lavora come libero professionista, il 19,17% lavora in ambito pubblico. Due terzi del campione ritiene la terapia integrata una forma di trattamento efficace. In ambito pubblico il trattamento maggiormente applicato è quello di tipo integrato (43,48%), in ambito privato quello di tipo psicoterapeutico (78,57%). Il 75,0% prescrive personalmente la farmacoterapia, mentre il 25,0% delega ad un altro collega questo compito. Nell’85,0% dei casi i farmaci vengono prescritti nelle psicosi con sintomi produttivi, seguono poi i disturbi dell’umore con sintomi psicotici. La classe di farmaci maggiormente somministrata è quella degli antipsicotici, seguita dagli stabilizzatori dell’umore. Conclusioni. Le Terapie Integrate, sono funzionali quando l’intervento farmacologico è congruo con il modello psicoterapico. Gli psicofarmaci vanno utilizzati solo se strettamente necessari e l’utilizzazione va elaborata nel lavoro di psicoterapia. Se possibile, è preferibile un solo terapeuta di riferimento. Clin Ter 2009; 160(3):e39-e4

Comorbidities in rheumatoid arthritis: analysis of hospital discharge records

Objective: Arthritis is often associated with comorbidities. For many of them, such as hypertension, cardiovascular disease, chronic pulmonary disease, and upper gastrointestinal disease, arthritis and its treatment may also represent a risk factor. This study is concerned with an evaluation of the frequency of comorbidities in a cohort of patients with rheumatoid arthritis (RA). Methods: The discharge diagnoses of patients with RA during the period 1 January 1997 to 31 December 2000 were retrieved from the database of the Department of Internal Medicine of the University of Genova, Italy. The diagnosis of RA was made if the patient's discharge record contained the code 714 of the International Classification of Diseases, IX revision, as first 3 numbers. The other diagnoses were also recorded along with demographic data, type and duration of hospital stay, and performed procedures. Results: During the study period, 427 patients with RA were admitted to the hospital for a total number of 761 admissions, which represented 2.2% of total admissions. Ninety-one (21.3%) patients did not have comorbidities, whereas 336 (78.6%) had one or more comorbidities. The most frequently observed comorbidities were cardiovascular diseases (34.6%), including hypertension (14.5%) and angina (3.5%), followed by gastrointestinal (24.5%), genito-urinary (18.7%) and respiratory (17%) diseases. There was a male predominance (p=0.004) within patients with comorbidities, who were significantly older (64.2±3.2 years vs. 57.2±4.2 years; p<0.001) and required longer periods of hospital stay (22.7 days vs. 12.5 days; p<0.001). Conclusions: Comorbidities are present in nearly 80% of RA inpatients. Comorbidity is a good predictor of health outcome, health services utilization, and medical costs. Because RA comorbidity can act as confounder, it should be considered in epidemiologic studies and clinical trials

Psicoterapia psicodinamica e formazione universitaria: problematiche e prospettive

This article proposes a reflection on the problem of psychiatric training taking into consideration the current situation present in Italy where, apart from public (university) schools of specialization, there are a number of private post-graduate schools which qualify one to practice the profession of psychotherapist. By keeping separate the more didactic-educational aspect from the training, there is an attempt to verify how much attention is devoted to the latter because within the university schools more and more students ask for a possibility to discuss clinical cases and understand the sense of a therapeutic relationship. Furthermore, it is necessary to verify, not only the didactical learning of students, but also their personal aptitudes during the four years of specialization. There seems to be an incongruity between the statutes that govern the single private specialization schools that regulate the supervision of clinical cases and in some cases prescribe an obligatory didactic analysis for the student, and what happens in a university context

Valutazione del rischio di dropout in una popolazione di pazienti affetti da disturbi dell'umore

Introduction. The aims of this study are (i) to assess the drop-out rate in an outpatient sample with mood disorder diagnosis in a psychotherapy unit; (ii) to focus clinical and sociodemographic variables related with drop-out; (iii) to delineate a psychopathological profile of the dropping-out patient through the SCL-90-R and OPD scores.Method. The sample of this study includes 90 depressive patients, which came to our service for a psychotherapy. The outcome is classified as drop-out and non drop-out. Each patient is submitted to the multidimensional scale SCL-90-R in the course of the first interview. At the end of the first visit each patient has been evaluated through the first and the fourth OPD axis. A descriptive analysis of all the data collected was made and the principal links between clinical and sociodemographic variables and dropout, between SCL-90-R score and drop-out, and between OPD scores and drop-out were detected. Results. About 42% of the patients were drop-out, of which 89% by the third session.The variables associated with drop-out are: pathological score in the paranoic and interpersonal sensibility scale of SCL-90-R, low compliance scores, low integration of defences, self perception, object's perception and link. Discussion. The drop-out rate in depressive patients turned out to be frequent. The patient's resources in terms of relationship, self-perception and object's perception are strongly related to the drop-out risk. These results are suggestive for the idea that the evaluation of drop-out risk in psychiatric patients must considerate the subjective aspects of the patient besides the clinical features

Impact of dense-water flow over a sloping bottom on open-sea circulation: Laboratory experiments and an Ionian Sea (Mediterranean) example

The North Ionian Gyre (NIG) displays prominent inversions on decadal scales. We investigate the role of internal forcing induced by changes in the horizontal pressure gradient due to the varying density of Adriatic Deep Water (AdDW), which spreads into the deep layers of the northern Ionian Sea. In turn, the AdDW density fluctuates according to the circulation of the NIG through a feedback mechanism known as the bimodal oscillating system. We set up laboratory experiments with a two-layer ambient fluid in a circular rotating tank, where densities of 1000 and 1015ĝ€¯kgĝ€¯m-3 characterize the upper and lower layers, respectively. From the potential vorticity evolution during the dense-water outflow from a marginal sea, we analyze the response of the open-sea circulation to the along-slope dense-water flow. In addition, we show some features of the cyclonic and anticyclonic eddies that form in the upper layer over the slope area. We illustrate the outcome of the experiments of varying density and varying discharge rates associated with dense-water injection. When the density is high (1020ĝ€¯kgĝ€¯m-3) and the discharge is large, the kinetic energy of the mean flow is stronger than the eddy kinetic energy. Conversely, when the density is lower (1010ĝ€¯kgĝ€¯m-3) and the discharge is reduced, vortices are more energetic than the mean flow - that is, the eddy kinetic energy is larger than the kinetic energy of the mean flow. In general, over the slope, following the onset of dense-water injection, the cyclonic vorticity associated with current shear develops in the upper layer. The vorticity behaves in a two-layer fashion, thereby becoming anticyclonic in the lower layer of the slope area. Concurrently, over the deep flat-bottom portion of the basin, a large-scale anticyclonic gyre forms in the upper layer extending partly toward a sloping rim. The density record shows the rise of the pycnocline due to the dense-water sinking toward the flat-bottom portion of the tank. We show that the rate of increase in the anticyclonic potential vorticity is proportional to the rate of the rise of the interface, namely to the rate of decrease in the upper-layer thickness (i.e., the upper-layer squeezing). The comparison of laboratory experiments with the Ionian Sea is made for a situation when the sudden switch from cyclonic to anticyclonic basin-wide circulation took place following extremely dense Adriatic water overflow after the harsh winter in 2012. We show how similar the temporal evolution and the vertical structure are in both laboratory and oceanic conditions. The demonstrated similarity further supports the assertion that the wind-stress curl over the Ionian Sea is not of paramount importance in generating basin-wide circulation inversions compared with the internal forcing

High levels of osteopontin associated with polymorphisms in its gene are a risk factor for development of autoimmunity/lymphoproliferation

The autoimmune/lymphoproliferative syndrome (ALPS) displays defective function of Fas, autoimmunities, lymphadenopathy/splenomegaly, and expansion of CD4/CD8 double-negative (DN) T cells. Dianzani autoimmune/lymphoproliferative disease (DALD) is an ALPS variant lacking DN cells. Both forms have been ascribed to inherited mutations hitting the Fas system but other factors may be involved. A pilot cDNA array analysis on a DALD patient detected overexpression of the cytokine osteopontin (OPN). This observation was confirmed by enzyme-linked immunosorbent assay (ELISA) detection of higher OPN serum levels in DALD patients (n = 25) than in controls (n = 50). Analysis of the OPN cDNA identified 4 polymorphisms forming 3 haplotypes (A, B, and C). Their overall distribution and genotypic combinations were different in patients (N = 26) and controls (N = 158) (P <.01). Subjects carrying haplotype B and/or C had an 8-fold higher risk of developing DALD than haplotype A homozygotes. Several data suggest that these haplotypes influence OPN levels: (1) in DALD families, high levels cosegregated with haplotype B or C; (2) in healthy controls, haplotype B or C carriers displayed higher levels than haplotype A homozygotes; and (3) in AB and AC heterozygotes, mRNA for haplotype B or C was more abundant than that for haplotype A. In vitro, exogenous OPN decreased activation-induced T-cell death, which suggests that high OPN levels are involved in the apoptosis defect

Uno studio sulle caratteristiche di un campione di pazienti internati presso l'Ospedale Psichiatrico Giudiziario di Castiglione delle Stiviere e dimessi nella regione Lazio.

Aim. The aim of this study was: i) To identify socio-demographic and clinical data in a sample of inmates in the Criminal Mental Hospital (CMH) at Castiglione delle Stiviere; ii) to assess the presence of characteristics which could foresee the commission of a crime of psychiatric interest; iii) to assess the frequency of crime repetition. Materials and Methods. This study was carried out on a sample of 38 patients. A descriptive analysis of the sample was carried out and the associations among several variables were analyzed. Results. The sample is characterized by a high frequency of schizophrenia diagnosis (73.0%), the presence of hospitalization before the commission of the crime (68.4%) and the absence of criminal precedents (71.1%). For men the age of the commission of the crime is equal to 33.72±10.6 years and for women to 45.18±11.4 years (p=0.011). The time between the onset and the commission of the crime is longer in patients who have received therapy (treatment) than in those ones with no treatment (p=0.012). About 12% of the sample committed new crimes. Conclusions. The results showed previous criminal acts are not predictive for the commission of new crimes of psychiatric interest. However many patients had previous contacts with community facilities before their first admission to hospital and the treatment extended the interval between the onset of the disease and the commission of the crime. The relapse rate after the discharge was very low if compared with samples coming from other services that offered more custodial rather than rehabilitative facilities