Pub Date : 2012-12-01DOI: 10.1016/j.quip.2012.10.001
Eugenio Aguglia, Luigi Ferrannini, Claudio Mencacci, Massimo Clerici
{"title":"Il perché di un addio","authors":"Eugenio Aguglia, Luigi Ferrannini, Claudio Mencacci, Massimo Clerici","doi":"10.1016/j.quip.2012.10.001","DOIUrl":"10.1016/j.quip.2012.10.001","url":null,"abstract":"","PeriodicalId":101052,"journal":{"name":"Quaderni Italiani di Psichiatria","volume":"31 4","pages":"Pages 155-156"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.quip.2012.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73752081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1016/j.quip.2012.10.003
Mara Scalese, Tiziana Frieri, Paola Rocca
Introduction
Psychoeducation, a non-pharmacological strategy recommended by current guidelines for the treatment of schizophrenia, integrates elements from different psychotherapeutic approaches and promotes improvement of knowledge regarding the disease and coping skills. The aim of this review is to describe the main evidence of efficacy on psychoeducation in schizophrenia on the basis of recent reviews and meta-analyses, and recently published studies on new approaches in the field.
Discussion and conclusions
Psychoeducation can reduce rates of relapse and rehospitalization, improve adherence to treatment and have other positive effects on patients and their families, such as reduction of burden. Single studies have considered culturally sensitive and other new psychoeducational approaches that would be important for therapeutic interventions especially in multiethnic contexts. Future research should therefore focus patients and their families participate in psychoeducational interventions, but also on the minimum effective psychoeducation dose, on those patients with schizophrenia who do not have supporting families willing to partecipate in family psychoeducation, on standardized outcomes and follow-up periods.
{"title":"La psicoeducazione nella schizofrenia: evidenze di efficacia e peculiarità di intervento su pazienti e familiari","authors":"Mara Scalese, Tiziana Frieri, Paola Rocca","doi":"10.1016/j.quip.2012.10.003","DOIUrl":"10.1016/j.quip.2012.10.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Psychoeducation, a non-pharmacological strategy recommended by current guidelines for the treatment of schizophrenia, integrates elements from different psychotherapeutic approaches and promotes improvement of knowledge regarding the disease and coping skills. The aim of this review is to describe the main evidence of efficacy on psychoeducation in schizophrenia on the basis of recent reviews and meta-analyses, and recently published studies on new approaches in the field.</p></div><div><h3>Discussion and conclusions</h3><p>Psychoeducation can reduce rates of relapse and rehospitalization, improve adherence to treatment and have other positive effects on patients and their families, such as reduction of burden. Single studies have considered culturally sensitive and other new psychoeducational approaches that would be important for therapeutic interventions especially in multiethnic contexts. Future research should therefore focus patients and their families participate in psychoeducational interventions, but also on the minimum effective psychoeducation dose, on those patients with schizophrenia who do not have supporting families willing to partecipate in family psychoeducation, on standardized outcomes and follow-up periods.</p></div>","PeriodicalId":101052,"journal":{"name":"Quaderni Italiani di Psichiatria","volume":"31 4","pages":"Pages 157-163"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.quip.2012.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88489503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Integration between primary care and mental health care is critical for health-care systems. Some years ago, the Emilia-Romagna Region undertook a project (the “Leggieri Project”) aimed at rationalizing pathways to care and improving the quality of treatments for common psychiatric disorders. The aim of this study was to monitor and assess local implementation of the stepped care model outlined by the regional project.
Materials and methods
We examined all new cases referred to Bologna Mental Health Centers (MHCs) from 2007 through 2009 (N = 15,534). Data on patients, referrals and treatments were collected from Department of Mental Health's Adult Psychiatry database. Standardized incidence rates, rates of referrals from general practitioners (GPs), and stepped care levels were investigated. We compared patient characteristics and treatments of cases referred by GPs and all other cases. A similar analysis was carried out for groups defined by stepped care level.
Results
The annual incidence of MHC referral ranged from 64.7 to 65.8 per 10,000 adult inhabitants. On the whole, 52% of the new cases were referred to the MHCs by GPs: this rate increased over time from 48% to 54%. As for stepped care, MHC care was planned for 55% of the patients referred by GPs, 14% were managed with joint GP and MHC care, and 31% of the new cases were back-referred after a psychiatric consultation. The differences between these levels of care narrowed over the three-year period: cases managed with psychiatric consultations or joint GP-MHC care increased, while those managed exclusively by the MHC decreased. Almost 50% of all cases involving non-Italian immigrants were referred by GPs, although this rate was lower than that observed among Italian patients. These trends were evident in each departmental area. Patients referred by GPs were more likely to be elderly women with common psychiatric disorders. Among these, the cases managed in MHCs had the most severe diagnoses and received the most intensive and long-lasting treatments.
Conclusions
Integration of primary care and mental health care is increasing and seems to be appropriate. In accordance with the recommendations of the regional project, integrated care is used above all for patients with common psychiatric disorders. Collaborative care for severe disorders requires further investigation. For these disorders, which often affect young patients and are frequently associated with comorbidity and a high risk of chronicity evolution, early detection and integrated care are crucial goals for the immediate future.
{"title":"Integrazione tra cure primarie e salute mentale a Bologna","authors":"Antonella Piazza , Marco Menchetti , Stefano Mimmi , Marco Monari , Cecilia Neri , Emanuela Zanacchini , Ilaria Tarricone , Ivonne Donegani , Domenico Berardi","doi":"10.1016/j.quip.2011.06.007","DOIUrl":"10.1016/j.quip.2011.06.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Integration between primary care and mental health care is critical for health-care systems. Some years ago, the Emilia-Romagna Region undertook a project (the “Leggieri Project”) aimed at rationalizing pathways to care and improving the quality of treatments for common psychiatric disorders. The aim of this study was to monitor and assess local implementation of the stepped care model outlined by the regional project.</p></div><div><h3>Materials and methods</h3><p>We examined all new cases referred to Bologna Mental Health Centers (MHCs) from 2007 through 2009 (<em>N</em> <!-->=<!--> <!-->15,534). Data on patients, referrals and treatments were collected from Department of Mental Health's Adult Psychiatry database. Standardized incidence rates, rates of referrals from general practitioners (GPs), and stepped care levels were investigated. We compared patient characteristics and treatments of cases referred by GPs and all other cases. A similar analysis was carried out for groups defined by stepped care level.</p></div><div><h3>Results</h3><p>The annual incidence of MHC referral ranged from 64.7 to 65.8 per 10,000 adult inhabitants. On the whole, 52% of the new cases were referred to the MHCs by GPs: this rate increased over time from 48% to 54%. As for stepped care, MHC care was planned for 55% of the patients referred by GPs, 14% were managed with joint GP and MHC care, and 31% of the new cases were back-referred after a psychiatric consultation. The differences between these levels of care narrowed over the three-year period: cases managed with psychiatric consultations or joint GP-MHC care increased, while those managed exclusively by the MHC decreased. Almost 50% of all cases involving non-Italian immigrants were referred by GPs, although this rate was lower than that observed among Italian patients. These trends were evident in each departmental area. Patients referred by GPs were more likely to be elderly women with common psychiatric disorders. Among these, the cases managed in MHCs had the most severe diagnoses and received the most intensive and long-lasting treatments.</p></div><div><h3>Conclusions</h3><p>Integration of primary care and mental health care is increasing and seems to be appropriate. In accordance with the recommendations of the regional project, integrated care is used above all for patients with common psychiatric disorders. Collaborative care for severe disorders requires further investigation. For these disorders, which often affect young patients and are frequently associated with comorbidity and a high risk of chronicity evolution, early detection and integrated care are crucial goals for the immediate future.</p></div>","PeriodicalId":101052,"journal":{"name":"Quaderni Italiani di Psichiatria","volume":"31 4","pages":"Pages 180-189"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.quip.2011.06.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75975546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1016/j.quip.2012.05.002
Umberto Albert, Francesca Barbaro, Andrea Aguglia, Giuseppe Maina, Filippo Bogetto
Introduction
Like most human behaviours, saving and collecting possessions can range from totally normal to excessive or pathological. Hoarding, or compulsive hoarding, are the terms used to refer to excessive form of collecting, which is frequent and disabling for both patients and their families. Hoarding can occur in the context of a variety of neurological and psychiatric conditions; nevertheless, in the last twenty years, it has been considered only as a symptom (or dimension) of obsessive-compulsive disorder (OCD). Recent literature data suggest that hoarding could represent an independent disorder. This leads to a complex issue: what relationship exists between hoarding and OCD? The aim of the present study is to identify, through a review of literature data, psychopathological and clinical features to distinguish the different possible conditions when hoarding and OCD coexist.
Materials and methods
We carried out a search on PubMed/MedLine from 1966 to nowadays. We selected both clinical and review studies, written in English.
Results and discussion
There are two conditions when hoarding and OCD coexist: hoarding as a symptom of OCD, epiphenomenon of the other obsessive-compulsive symptoms; or hoarding disorder as an independent clinical entity comorbid with OCD. In this review, we tried to provide handy and practical information useful for clinicians to characterize the presentation of hoarding symptoms. Furthermore, these information should help clinicians to make a differential diagnosis. Despite some clinical evidences about hoarding, there are several questions that remain to be answered; therefore, additional clinical studies are needed with a more homogeneous methodology.
{"title":"Hoarding e disturbo ossessivo-compulsivo (DOC): due entità cliniche distinte in comorbilità o hoarding secondario al DOC?","authors":"Umberto Albert, Francesca Barbaro, Andrea Aguglia, Giuseppe Maina, Filippo Bogetto","doi":"10.1016/j.quip.2012.05.002","DOIUrl":"10.1016/j.quip.2012.05.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Like most human behaviours, saving and collecting possessions can range from totally normal to excessive or pathological. Hoarding, or compulsive hoarding, are the terms used to refer to excessive form of collecting, which is frequent and disabling for both patients and their families. Hoarding can occur in the context of a variety of neurological and psychiatric conditions; nevertheless, in the last twenty years, it has been considered only as a symptom (or dimension) of obsessive-compulsive disorder (OCD). Recent literature data suggest that hoarding could represent an independent disorder. This leads to a complex issue: what relationship exists between hoarding and OCD? The aim of the present study is to identify, through a review of literature data, psychopathological and clinical features to distinguish the different possible conditions when hoarding and OCD coexist.</p></div><div><h3>Materials and methods</h3><p>We carried out a search on PubMed/MedLine from 1966 to nowadays. We selected both clinical and review studies, written in English.</p></div><div><h3>Results and discussion</h3><p>There are two conditions when hoarding and OCD coexist: hoarding as a symptom of OCD, epiphenomenon of the other obsessive-compulsive symptoms; or hoarding disorder as an independent clinical entity comorbid with OCD. In this review, we tried to provide handy and practical information useful for clinicians to characterize the presentation of hoarding symptoms. Furthermore, these information should help clinicians to make a differential diagnosis. Despite some clinical evidences about hoarding, there are several questions that remain to be answered; therefore, additional clinical studies are needed with a more homogeneous methodology.</p></div>","PeriodicalId":101052,"journal":{"name":"Quaderni Italiani di Psichiatria","volume":"31 4","pages":"Pages 164-173"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.quip.2012.05.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80565600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1016/j.quip.2012.07.004
Candida C. Luciano, Domenico Berardi
Introduction
Although their boundaries are discussed from many years, autism and schizophrenia are account as two different clinical entities. This paper presents a review of literature to identify, on one hand, the overlap areas and, on the other hand, distinctive and typical elements of the two disorders.
Discussion
If we see the history of term “autism” and his classification into the Diagnostic and Statistical Manual of Mental Disorders, we can notice that the boundaries between the two disorders are initially vague and then increasingly definite. But, in the years, the diagnostic dimensions have broadened and now we talk about an “autism spectrum” and a “schizophrenic spectrum”.
Conclusions
At the extreme limits of two spectrum, many evidence suggests overlap areas in different levels: clinic, pathogenesis, neuroanatomy, neuropsychology and neuroimaging. Despite these evidences, there is a lack of appropriate instruments to make a correct differential diagnosis.
{"title":"Aree di sovrapposizione ed elementi di diagnosi differenziale tra autismo e schizofrenia. Sintesi della letteratura","authors":"Candida C. Luciano, Domenico Berardi","doi":"10.1016/j.quip.2012.07.004","DOIUrl":"10.1016/j.quip.2012.07.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Although their boundaries are discussed from many years, autism and schizophrenia are account as two different clinical entities. This paper presents a review of literature to identify, on one hand, the overlap areas and, on the other hand, distinctive and typical elements of the two disorders.</p></div><div><h3>Discussion</h3><p>If we see the history of term “autism” and his classification into the <span><em>Diagnostic and Statistical Manual of Mental Disorders</em></span>, we can notice that the boundaries between the two disorders are initially vague and then increasingly definite. But, in the years, the diagnostic dimensions have broadened and now we talk about an “autism spectrum” and a “schizophrenic spectrum”.</p></div><div><h3>Conclusions</h3><p>At the extreme limits of two spectrum, many evidence suggests overlap areas in different levels: clinic, pathogenesis, neuroanatomy, neuropsychology and neuroimaging. Despite these evidences, there is a lack of appropriate instruments to make a correct differential diagnosis.</p></div>","PeriodicalId":101052,"journal":{"name":"Quaderni Italiani di Psichiatria","volume":"31 4","pages":"Pages 174-179"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.quip.2012.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83725221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1016/j.quip.2012.03.004
Umberto Albert, Andrea Aguglia, Francesca Barbaro, David De Cori, Giuseppe Maina, Filippo Bogetto
Objectives
Obsessive-compulsive disorder (OCD), as reported by studies in the literature, has a significant clinical heterogeneity; indeed, authors have moved different subtypes based on the main symptom dimensions, course (episodic vs. chronic), age at onset (early vs. late) and comorbidity (bipolar or tic disorder). Finally, gender has been proposed as a possible subtype. The aim of the study is to evaluate gender-related socio-demographic and clinical differences in a large sample of patients.
Materials and methods
Four hundred fifteen patients with a primary diagnosis of OCD were recruited and evaluated by a semistructured interview. Assessment has been completed with the following rating scales: Y-BOCS, HAM-D, HAM-A, Paykel's scale, SCID-II. The sample was split into two subgroups according to gender.
Results
Males, 217 patients (52.3%), showed an earlier age at onset of obsessive-compulsive symptoms and a significant association with bipolar disorder, sexual obsessions and repetitive rituals. Females showed a correlation between the onset of the disorder and the presence of at least one stressful life event. Also, they were associated with minor depression, eating disorders and washer symptoms.
Discussion
Our study, according to literature data, shows OCD to have specific gender-related differences; to our opinion, however, differences do not completely support the hypothesis of subtyping OCD according to gender. Gender differences seem to be related to other elements such as age at onset; this may be more useful in the future for identifying genetic and environmental predisposing factors and therapeutic strategies.
{"title":"Differenze di genere nel disturbo ossessivo-compulsivo: uno studio clinico su 415 pazienti","authors":"Umberto Albert, Andrea Aguglia, Francesca Barbaro, David De Cori, Giuseppe Maina, Filippo Bogetto","doi":"10.1016/j.quip.2012.03.004","DOIUrl":"10.1016/j.quip.2012.03.004","url":null,"abstract":"<div><h3>Objectives</h3><p>Obsessive-compulsive disorder (OCD), as reported by studies in the literature, has a significant clinical heterogeneity; indeed, authors have moved different subtypes based on the main symptom dimensions, course (episodic vs. chronic), age at onset (early vs. late) and comorbidity (bipolar or tic disorder). Finally, gender has been proposed as a possible subtype. The aim of the study is to evaluate gender-related socio-demographic and clinical differences in a large sample of patients.</p></div><div><h3>Materials and methods</h3><p>Four hundred fifteen patients with a primary diagnosis of OCD were recruited and evaluated by a semistructured interview. Assessment has been completed with the following rating scales: Y-BOCS, HAM-D, HAM-A, Paykel's scale, SCID-II. The sample was split into two subgroups according to gender.</p></div><div><h3>Results</h3><p>Males, 217 patients (52.3%), showed an earlier age at onset of obsessive-compulsive symptoms and a significant association with bipolar disorder, sexual obsessions and repetitive rituals. Females showed a correlation between the onset of the disorder and the presence of at least one stressful life event. Also, they were associated with minor depression, eating disorders and washer symptoms.</p></div><div><h3>Discussion</h3><p>Our study, according to literature data, shows OCD to have specific gender-related differences; to our opinion, however, differences do not completely support the hypothesis of subtyping OCD according to gender. Gender differences seem to be related to other elements such as age at onset; this may be more useful in the future for identifying genetic and environmental predisposing factors and therapeutic strategies.</p></div>","PeriodicalId":101052,"journal":{"name":"Quaderni Italiani di Psichiatria","volume":"31 4","pages":"Pages 190-200"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.quip.2012.03.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88814762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-12-01DOI: 10.1016/j.quip.2012.10.002
Giuseppe Carrà , Francesco Bartoli , Daniele Carretta , Emanuele Scafato , Massimo Clerici , Karl F. Mann
Introduction
In the European Union, alcohol use and substance use disorders are among the top five causes of morbidity and mortality due to neurological disease, with an impact on general population comparable to that of cardiovascular diseases and cancer. However, despite this situation research in the field of Addiction Medicine is hampered, first of all because of a lack of funds and the influence of the European Commission in steering them. In addition, the lack of stable links between research groups working in this field limits the possibility to share related knowledge and experience and the development of training networks. In the summer of 2010, 23 scientific societies from 16 European countries established the European Federation of Addiction Societies (EUFAS), with the aim to deal with these issues and to facilitate the development of prevention, treatment, research and health policy programs in relation to substance use disorders.
Conclusions
EUFAS’ efforts should contribute to the development of research, training and clinical practice in the field of Addiction Medicine, thanks to the collaboration between professionals working in the field, not only within the European Union but also in collaboration with organizations and institutions outside Europe.
{"title":"Perché è importante una federazione europea delle società delle tossicodipendenze?","authors":"Giuseppe Carrà , Francesco Bartoli , Daniele Carretta , Emanuele Scafato , Massimo Clerici , Karl F. Mann","doi":"10.1016/j.quip.2012.10.002","DOIUrl":"10.1016/j.quip.2012.10.002","url":null,"abstract":"<div><h3>Introduction</h3><p>In the European Union, alcohol use and substance use disorders are among the top five causes of morbidity and mortality due to neurological disease, with an impact on general population comparable to that of cardiovascular diseases and cancer. However, despite this situation research in the field of Addiction Medicine is hampered, first of all because of a lack of funds and the influence of the European Commission in steering them. In addition, the lack of stable links between research groups working in this field limits the possibility to share related knowledge and experience and the development of training networks. In the summer of 2010, 23 scientific societies from 16 European countries established the European Federation of Addiction Societies (EUFAS), with the aim to deal with these issues and to facilitate the development of prevention, treatment, research and health policy programs in relation to substance use disorders.</p></div><div><h3>Conclusions</h3><p>EUFAS’ efforts should contribute to the development of research, training and clinical practice in the field of Addiction Medicine, thanks to the collaboration between professionals working in the field, not only within the European Union but also in collaboration with organizations and institutions outside Europe.</p></div>","PeriodicalId":101052,"journal":{"name":"Quaderni Italiani di Psichiatria","volume":"31 4","pages":"Pages 201-204"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.quip.2012.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90687348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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