Quaderni Italiani di Psichiatria最新文献

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L’Ospedale Psichiatrico Giudiziario di Castiglione delle Stiviere: modello sanitario Castiglione司法精神病医院，卫生模式

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/j.quip.2012.06.004

Antonino Calogero , Gianfranco Rivellini , Ettore Straticò

Introduction

The Castiglione delle Stiviere Psychiatric Hospital Center is part of the Carlo Poma Medical Center of Mantova. From 1939 to December 31, 2008, Castiglione delle Stiviere had the status of Forensic Psychiatric Hospital (FPH), and to this day it represents excellence on the national penitentiary medicine scene and stands as a model for the other five forensic psychiatric hospitals, managed by the Ministry of Justice and run as prison hospitals. The special character of Castiglione delle Stiviere derives from the fact that it is an exclusively medical facility, without prison guards, and offers a dignified environment for psychiatric patients who have committed crimes. The “Rainbow” Division of the Castiglione FPH is the sole FPH facility in Italy for women, and therefore is considered a national observatory for female psychiatric patients who have committed crimes. The mission of Castiglione delle Stiviere FPH is to restore mental health via the clinical improvement of symptoms, to lessen or eliminate the danger to society, and thus to make possible a “safe”, and high quality release of the interned patients. All of its work is based on the general principles of dignity, respect, responsibility, autonomy, and liberty. The Hospital Center offers numerous facilities for activities: a painting workshop, library, indoor gymnasium, sport center, coffee bar, outdoor pool, computer lab, woodworking and furniture restoration workshop, bookbinding and printing workshop, and sewing room. The objectives are: to understand and respond to patient needs, to individualize the course of treatment and rehabilitation, to avoid relapses and repeat offenses, and thereby to bring about authentic recovery.

Conclusions

The psychiatric patient who has committed a crime needs to regain a space and an identity within his or her community of origin. The FPH promotes this by offering psycho-educational experiences that restore self-esteem, and interpersonal and social skills, and, where possible, new professional and work skills.

Castiglione delle Stiviere精神病院中心是曼托瓦Carlo Poma医疗中心的一部分。从1939年到2008年12月31日，Castiglione delle Stiviere拥有法医精神病医院(FPH)的地位，直到今天，它在全国监狱医学领域表现卓越，是由司法部管理并作为监狱医院运营的其他五家法医精神病医院的典范。Castiglione delle Stiviere的特殊之处在于，它是一个专门的医疗设施，没有监狱看守，为犯罪的精神病患者提供了一个有尊严的环境。Castiglione FPH的“彩虹”部门是意大利唯一的FPH妇女设施，因此被认为是犯罪的女性精神病患者的国家观察站。Castiglione delle Stiviere FPH的使命是通过临床症状的改善来恢复精神健康，减少或消除对社会的危险，从而使被拘留的病人“安全”、高质量地释放成为可能。它的所有工作都基于尊严、尊重、责任、自主和自由的一般原则。医院中心提供了众多的活动设施:绘画工作室、图书馆、室内健身房、体育中心、咖啡吧、室外游泳池、电脑室、木工和家具修复工作室、装订和印刷工作室、缝纫室。目标是:了解和回应患者的需求，个性化治疗和康复过程，避免复发和重复犯罪，从而实现真正的康复。结论犯罪的精神病人需要在他或她的原籍社区中重新获得一个空间和身份。FPH通过提供心理教育体验来促进这一点，这些体验可以恢复自尊，人际关系和社交技能，并在可能的情况下提供新的专业和工作技能。

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引用次数: 3

Percorsi diagnostico-terapeutici per pazienti psichiatrici negli istituti penitenziari. Strategie dei Dipartimenti di Salute Mentale e delle Cliniche Psichiatriche Universitarie 监狱精神病患者的诊断治疗路径。精神卫生部门和大学精神病院的战略

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/j.quip.2012.07.003

Eugenio Aguglia , Sandro Elisei , Paolo Peloso , Francesco Scapati , Massimo Clerici

Introduction

The Italian Society of Psychiatry conducted a study finalized to get awareness about the problem of Psychiatry in jails and prisons. The aim of this study is to evaluate the prevalence of psychiatric disorders in jails and prisons as well as the procedures and the possibilities to organize psychiatric care and to define diagnostic-therapeutic strategies and pathways shared by the Mental Health Departments and the University Psychiatric Clinics.

Materials and methods

We collected data about the psychiatrist and the psychiatric visits in the first five working days of May 2007 with of a schedule of 31 items.

Results

From the datasets derives that the 24% of prisoners requires a psychiatric visit.

意大利精神病学协会进行了一项研究，最终提高了人们对监狱和监狱中精神病学问题的认识。这项研究的目的是评估监狱和监狱中精神疾病的流行程度，以及组织精神护理的程序和可能性，并确定精神卫生部门和大学精神病学诊所共享的诊断-治疗策略和途径。材料和方法收集2007年5月前5个工作日的精神病医生和精神科就诊情况，共31项。结果从数据集得出，24%的囚犯需要进行精神病学访问。

引用次数: 1

Sommario/Contents Sommario /高兴

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/S0393-0645(12)00052-7

引用次数: 0

Trauma e disturbo post-traumatico da stress nella relazione con i disturbi mentali della popolazione carceraria minorile 与青少年精神疾病的关系

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/j.quip.2012.06.001

Annamaria Lax, Massimo Clerici

Introduction

To investigate the diffusion of trauma and post-traumatic stress disorder (PTSD) in juvenile justice population, giving particular attention to the analysis of the relationships between trauma and mental health problems in consideration of comorbidity with PTSD.

Materials and methods

Our remarks were produced from the analysis of medical and psychiatric literature concerning the subject and availability in the main databases – especially Pubmed – giving priority to more recently published articles and reviews as considered more evocative of the current situation.

Results

Incarcerated adolescents are a deeply victimized population, characterized – when investigated – by higher prevalence of PTSD and trauma-related psychopathology than those reported in general juvenile population. In its tendency to co-occur with several psychiatric disorders, diagnosis of PTSD identifies, within juvenile offenders samples, clusters at risk of developing pathological outcomes in terms of mental health and social behaviour.

Conclusions

Often overlooked and underestimated, the diagnosis of trauma and PTSD histories within juvenile justice system is so tactful and complex as essential for the treatment and prevention of those PTSD-related problems in psychosocial functioning potentially getting worse and chronic if that disorder and its syndromes are misdiagnosed and, therefore, not adequately treated. In this respect it recognizes the importance of realizing integrated and holistic interventions, encouraging the passage from punishing in correctional institute to therapeutic rehabilitation in community.

前言:调查青少年司法人群中创伤和创伤后应激障碍(PTSD)的扩散情况，在考虑PTSD合并症的情况下，重点分析创伤与心理健康问题的关系。材料和方法我们的评论是根据对有关该主题的医学和精神病学文献以及主要数据库(特别是Pubmed)的可用性的分析得出的，优先考虑最近发表的文章和评论，因为它们被认为更能反映当前的情况。结果被监禁的青少年是一个深受伤害的群体，当调查时，他们的特点是PTSD和创伤相关精神病理的患病率高于一般青少年人群。PTSD往往与几种精神疾病同时发生，在青少年罪犯样本中，PTSD的诊断确定了在心理健康和社会行为方面有发展病理结果风险的群体。结论青少年司法系统对创伤和创伤后应激障碍病史的诊断虽然被忽视和低估，但对于治疗和预防与创伤后应激障碍相关的心理社会功能问题至关重要，如果该疾病及其综合征被误诊，则可能会恶化和慢性。在这方面，它认识到实现综合和整体干预的重要性，鼓励从惩教机构的惩罚过渡到社区的治疗性康复。

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引用次数: 0

Doppia diagnosi e profili di gravità: un’indagine nella Casa Circondariale di Perugia 双重诊断和重力剖面:佩鲁贾教区住宅的调查

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/j.quip.2012.06.002

Sandro Elisei , Massimiliano Piselli , Michela Quadrini , Norma Verdolini

Introduction

Dual diagnosis is a common condition in prisons and has got a relapse on the course and on the outcome of the treatment. The study values the prevalence of dual diagnosis among detainees in the Prison of Perugia and the severity ratings associated.

Materials and methods

Addiction Severity Index-X (ASI-X) and Structured Clinical Interview (SCID-I) were administered to 245 newly detainees, seven days after their admission, from August to December 2005. As for statistical analysis, we used t-test for continuous variables and Mann–Whitney U-test for non parametric variables in order to compare the averages, χ²-test to analyze categorial variables and the Fisher's exact test to estimate the odds ratios.

Results

Twenty of the 100 detainees that gave consensus to the study had comorbid substance use and psychiatric disorders. Comparing the averages of the ASI-X's composite scores we found significant differences (p < 0.01) mainly for the areas psychiatric problems, drugs and alcohol between dual diagnosis detainees and no dual diagnosis prisoners.

Conclusions

Severity ratings of the areas that are commonly compromised in subjects with substance use disorders and/or psychiatric disorders are significantly worse in detainees with dual diagnosis, mainly in reference to anxious–depressive symptomatology, difficulty to control aggressive behaviours, drugs prescription and suicide attempts.

双重诊断是监狱中常见的一种情况，在治疗过程和结果上都有复发。该研究重视佩鲁贾监狱在押人员双重诊断的流行程度及其相关的严重程度评级。材料与方法2005年8月至12月，对245名新入院的在押人员在入院7天后进行成瘾严重程度指数- x (ASI-X)和结构化临床访谈(SCID-I)。在统计分析方面，我们对连续变量使用t检验，对非参数变量使用Mann-Whitney u检验来比较平均值，对类别变量使用χ2检验来分析，对优势比使用Fisher精确检验来估计。结果100名在押人员中有20人存在药物使用和精神障碍的合并症。比较ASI-X综合得分的平均值，我们发现显著差异(p <0.01)主要用于精神问题、毒品和酒精双重诊断被拘留者和非双重诊断囚犯之间的领域。结论双重诊断在押人员在物质使用障碍和/或精神障碍患者中常见损害区域的严重程度评分明显更差，主要表现在焦虑抑郁症状、难以控制攻击行为、药物处方和自杀企图方面。

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引用次数: 0

La Psichiatria, il paziente autore di reato e il superamento dell’Ospedale Psichiatrico Giudiziario 精神病学，病人罪犯，司法精神病院

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/j.quip.2012.07.001

Eugenio Aguglia, Luigi Ferrannini

引用次数: 1

Cover 封面

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/S0393-0645(12)00050-3

引用次数: 0

Caratteristiche cliniche, sociodemografiche e criticità nella cura del paziente affetto da patologia mentale detenuto in Italia: studio osservazionale di casi consecutivi della durata di sei mesi 意大利精神病理学患者治疗的临床、社会人口和关键特征:连续6个月病例的观察研究

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/j.quip.2012.07.002

Nazario D’Urso , Federica Cicolari , Valentina Elena Cimolai , Sara Tremolizzo , Filippo Castellano , Milena Provenzi , Maria R. Sergio , Massimo Clerici

Introduction

There are more than 10 million inmates worldwide. Recent studies show that, compared with general population, prisoners have about 2–10-fold higher rate of mental disorders. In order to evaluate severity symptomatology of psychiatric inmates as well as clinical and sociodemographic characteristics, we performed a research on a sample of prisoners secluded in “Casa Circondariale di Monza” referred for a clinical psychiatric assessment.

Materials and methods

Cross-sectional study of consecutive prisoners secluded in “Casa Circondariale di Monza” referred, over a six-month period, for a clinical psychiatric assessment. For whole sample, clinical and sociodemographic characteristics were collected, a clinical diagnosis in according with DSM-IV-TR was formulated and Clinical Global Impressions (CGI), Global Assessment of Functioning (GAF), Positive and Negative Syndrome Scale (PANSS), Hamilton Rating Scale for Depression (HAM-D), Mania Rating Scale (MRS), Hamilton Anxiety Scale (HAM-A) and Barratt Impulsiveness Scale, version 11 (BIS-11) were administered. Moreover, all patients were prospectively followed until the end of the study and main clinical variables were recorded.

Results

In our sample prevalence for a mental disorders was: personality disorders 33.6%; adjustment disorders 26.1%; psychotic disorders 4.2%; mood disorders 10.9%; anxiety disorders 6.7%. Mean total scores obtained at psychometric scales were: GAF 70.5; MRS 3.4; HAM-D 9.1; HAM-A 7.9; BIS-11 68.8; PANSS 42.1; CGI 3.2.

Conclusions

Mainly, prisoners affected by mental disorder showed a moderate symptomatic severity. Psychometric scales have been found useful to identify a subgroup of subjects with an increased risk to make self harm.

全世界有超过1000万的囚犯。最近的研究表明，与一般人群相比，囚犯患精神疾病的比率高出约2 - 10倍。为了评估精神病囚犯的严重症状以及临床和社会人口学特征，我们对被隔离在“Casa Circondariale di Monza”的囚犯样本进行了一项研究，这些囚犯被转介进行临床精神病评估。材料和方法对连续被隔离在“Casa Circondariale di Monza”的囚犯进行横断面研究，为期六个月，用于临床精神评估。收集全部样本的临床和社会人口学特征，制定符合DSM-IV-TR的临床诊断，并实施临床总体印象(CGI)、整体功能评估(GAF)、阳性和阴性综合征量表(PANSS)、汉密尔顿抑郁评定量表(HAM-D)、躁狂评定量表(MRS)、汉密尔顿焦虑量表(HAM-A)和Barratt冲动量表(BIS-11)。此外，所有患者均进行前瞻性随访，直至研究结束，并记录主要临床变量。结果我们的样本中精神障碍患病率为:人格障碍33.6%;适应障碍26.1%;精神障碍4.2%;情绪障碍10.9%;焦虑障碍6.7%。心理测量量表的平均总分为:GAF 70.5;夫人3.4;ham - d 9.1;HAM-A 7.9;BIS-11 68.8;数值42.1;CGI 3.2。结论囚犯精神障碍的症状严重程度以中度为主。人们发现，心理测量量表有助于识别出有自残倾向的亚组受试者。

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引用次数: 1

Assistenza psichiatrica agli autori di reato in Liguria: una realtà in evoluzione 利古里亚对罪犯的精神治疗:一个不断变化的现实

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/j.quip.2012.06.003

Paolo F. Peloso , Maurizio Cechini , Lucio Ghio , Simona Gotelli , Werner Natta , Matteo Respino , Luigi Ferrannini

Introduction

In 1999 a group of psychiatrists of Mental Health Department of Genoa started building up a psychiatric liaison service to the Marassi Institute, the largest prison of Liguria. Over the years, the interest on the issue of forensic psychiatry has been increasing in the Ligurian Mental Health Departments as well as in the meetings of Ligurian Section of Italian Psychiatric Society. At the same time all the aforementioned subjects begun to argue about the shutdown of the forensic hospitals.

Discussion

In the subsequent years the real world psychiatric practice have become increasingly interwoven with legal issues, and nowadays the main questions to address in this field are: the organization of psychiatric care in prisons; the organization of care in the Mental Health Center and Day Hospitals for mentally ill offenders serving their sentence at home; the organization of care in residential facilities as an alternative measure to forensic hospital or imprisonment; the planning of a regional facility, after the shutdown of the forensic hospitals, to admit patients deemed incompetent to proceed by reason of mental insanity, but still at risk of future violence.

1999年，热那亚精神卫生部门的一组精神病医生开始与利古里亚最大的监狱Marassi研究所建立精神病学联络服务。多年来，利古里亚精神卫生部门以及意大利精神病学会利古里亚分会的会议对法医精神病学问题的兴趣不断增加。与此同时，上述所有当事人都开始争论关闭法医医院的问题。在随后的几年里，现实世界的精神病学实践越来越多地与法律问题交织在一起，如今在这一领域要解决的主要问题是:监狱中精神病学护理的组织;在精神卫生中心和日间医院组织照顾在家服刑的精神病罪犯;在住宅设施中安排护理，作为法医医院或监禁的替代措施;在法医医院关闭后，计划建立一个区域设施，接收因精神错乱而被认为没有能力进行治疗，但今后仍有遭受暴力风险的病人。

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引用次数: 0

Progetto “Sulla soglia”: un’esperienza di buona prassi nell’assistenza e nel trattamento dei detenuti con disagio psichico in dimissione dagli istituti penali milanesi “在门槛上”项目:在米兰刑事机构协助和治疗精神病患者方面的良好做法经验

Quaderni Italiani di Psichiatria

Pub Date : 2012-09-01 DOI: 10.1016/j.quip.2012.05.001

Simona Silvestro , Luca Mauri , Claudio Mencacci

Introduction

The “On the Doorstep” project defines an action as a good practice model in treatment of citizens having psychic troubles, kept in custody in the three penal institutions of Milan (San Vittore, Opera and Bollate). The project aims at implementing a model of global action liaising interventions carried out to treat convicts with psychic troubles, kept in custody in the three penal institutions of Milan and the network of external territorial services, by means of some specific actions aimed at fostering social inclusion.

Materials and methods

The complex area the “On the Doorstep” project deals with and individual needs of convicts, enjoying this service, who go back to society after release from prison, are satisfied by a multidisciplinary team, which can act on the numerous issues related to this type of users. Aiming at carrying out a systemic approach, on the one hand it is essential to act with individuals, to support them in pursuing their projects and on the other, it is crucial to carry out an efficient action on the social network.

Results

Between 2009 and 2011, this service operated in favour of approximately 120 users per year. According to an analysis of the type of users involved in this project, 55% of actions have been carried out in favour of individuals with diagnosed psychiatric disease and the remaining 44% in favour of individuals showing psychic troubles due to detention, in particular pending release from the relevant penal institution.

Discussion

The model used by the “On the Doorstep” project is a good practice in terms of actions, involving a thorough and multidisciplinary response to needs identified. Rehabilitation and treatment in prison and on the territory highlight the need of integrated clinical and social pathways that can support an individual for potential re-inclusion.

“On the Doorstep”项目将行动定义为治疗在米兰三所刑罚机构(San Vittore, Opera和Bollate)关押的有精神问题的公民的良好实践模式。该项目的目的是实施一种全球行动模式，通过一些旨在促进社会融合的具体行动，将为治疗被关押在米兰三所刑罚机构和外部领土服务网络中的精神疾病罪犯所采取的干预措施联系起来。材料和方法“家门口”项目的复杂领域涉及罪犯的个人需求，享受这项服务，从监狱释放后重返社会，由一个多学科团队来满足，该团队可以解决与这类用户相关的众多问题。为了实施一种系统的方法，一方面必须与个人一起行动，支持他们追求他们的项目，另一方面，在社会网络上开展有效的行动至关重要。在2009年至2011年期间，这项服务每年约为120名用户提供服务。根据对参与该项目的使用者类型的分析，55%的行动是针对被诊断患有精神疾病的个人，其余44%的行动是针对因拘留而出现精神问题的个人，特别是在从有关刑事机构释放之前。讨论就行动而言，“上门”项目使用的模型是一个很好的实践，涉及对确定的需求进行彻底和多学科的响应。监狱和领土内的康复和治疗强调需要综合临床和社会途径，以支持个人可能重新融入社会。

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