Rivista di psichiatria最新文献

Aim: In urban contexts, Mental Health Services are increasingly involved in the assessment of users with a heterogeneous ethnic and cultural background. These characteristics of migrants can exert an influence on access to healthcare, diagnostic evaluation, and use of therapeutic resources. The present work aimed to compare these differences among individuals who received their first clinical evaluation at the Mental Health Outpatient Service of Prato in 2019-2021, exploring variations across time, among the entire non-native population, and based on their continent of origin.

Methods: In the abovementioned clinical population, socio-demographic data, the type of evaluation received, and the primary diagnostic classification were retrieved. Their absolute and relative frequencies were registered, and differences based on the origin of migrants were explored.

Results: Of 3,992 assessments, 485 (12.1%) involved non-natives from 60 different countries, with a lower mean age as compared to the Italian counterpart, and a heterogeneous gender prevalence based on the continent of origin. The percentage of migrants increased from 11.8% to 14.2% across time, with a higher proportion of psychiatric evaluations and a lower implementation of multi-professional interventions. As compared to native individuals, a higher proportion of adjustment, psychotic, substance-related, somatic, conversive, dissociative, and post-traumatic disorders was observed.

Discussion and conclusions: The access of migrants to the Public Mental Health outpatient facility proved to be remarkably lower than expected, based on the composition of the general population. Given the proportional increase in the requested evaluations, it is necessary to promote a reflexion on the specificity of the emergent psychopathology, and on difficulties in access to psychotherapy: a trans-cultural approach to mental health may require adequate resources for the management of these distinctive needs.

The early identification of anorexia (AN) and bulimia nervosa (BN) in the general population represents a crucial strategy to avoid their chronicization and clinical worsening. This pilot-study aims to test the validity of a new screening tool (DiCA33) dedicated AN/BN risk in online settings, based on the Italian version of EAT-26, a self-report questionnaire for measuring AN/BN symptoms. First analyses excluded the effect of demographic factors on results and suggested a limited explanation power of the mere total scores of DiCA33 for risk detection. Alternatively, a selection of risked items from the DiCA33 checklists (as evidenced on EAT-26 scores), then combined in a subscale, showed a necessary sensitivity for screening purposes. The DiCA33-subscale constitutes a reliable and useful index for the early and quick detection of AN/BN risk in young Italian female population, composed mainly by students. Considering the non-diagnostic nature of this tool, subsequent rigorous and psychiatric evaluations are necessary for positive cases to confirm the risk. Further studies may validate the tool even recruiting patients with eating disorders to improve tool specificity.

Purpose: Current guidelines, due to potential toxicity and lack of clinical evidence, do not recommend the use of lithium in the treatment of Anorexia Nervosa (AN). Scarce evidence is available on the use, side effects, and tolerability of this drug in children and adolescents with AN, a population characterized by specific clinical, metabolic, and hydro-electrolytic balance features. Here we report a case series of children and adolescents hospitalized for AN and treated with lithium.

Methods: Case series reporting the use of lithium in 7 female young patients with AN. Reasons for introduction, dosages, formulation, plas-ma levels, adverse drug reactions (ADR) and modifi-cations of electrocardiogram (EKG) and plasma levels of glucose, cholesterol, creatinine, urea, sodium, and thyroid-stimulating hormone (TSH) were assessed. Re-sults. Reasons for the introduction of lithium included unstable mood, insufficient compliance with nutri-tional programs, and psychomotor agitation. In all of the patients an improvement on target symptoms was observed. Lithium was started at 171.4 (+/-56.7) mg/day, up to 600.0 (+/-173.2) mg/day. The most frequent scheme was three times daily. The mean plasmatic concentration was 0.6 (+/-0.3) mmol/L at one month. One pa-tient experienced polyuria, polydipsia and dry mouth, and another showed increased creatinine kinase. No major modifications of EKG, glucose, cholesterol, cre-atinine, urea, sodium emerged.

Conclusions: In this sample of children and adolescents hospitalized for AN, lithium was administered to improve psychiatric symptoms impairing compliance. All the patients experienced an improvement on these symptoms after being admin-istered lithium. ADR were reported in 2 cases. These data should be investigated in wider populations and controlled studies.

Background: Psychiatry has been affected by the 'Brain Drain' phenomenon for decades, with professionals usually migrating from lower- to higher-income countries. Whilst Italy faces a decreasing Psychiatric workforce in the near future, little is known about the factors that influence migration of Psychiatry trainees in Italy.

Aim: To explore the migration tendencies of Psychiatry trainees training in Italy.

Methods: A cross-sectional survey was disseminated to Psychiatry trainees in Italy.

Results: The vast majority (84.2%) of the trainees had 'ever' considered leaving Italy, and more than half (60.4%) considered leaving the country 'now'. Only a quarter (25.3%) had taken 'practical steps' towards migration. Male trainees were more likely to have 'ever' considered leaving Italy. Trainees without children were more likely to have 'ever' considered leaving and more likely to consider leaving 'now'. More southern Italian trainees were considering leaving the country 'now' compared to those from the centre-north. 'Academic' and 'work' reasons were the two most cited factors given both as a reason for wanting to leave Italy and as conditions that should be improved in the country. The main reason cited to remain in the country was personal.

Conclusions: Several Psychiatry trainees in Italy consider migration as a possibility, mainly driven by work and academic reasons. The main factor keeping trainees in Italy was personal reasons. Highlighting the reasons why trainees leave is crucial to facing these issues and either finding ways to encourage trainees to remain or finding other solutions for the medical shortage.

Reviewing the history of theories associated with psychotherapy establishes that motivational psychotherapy (MPT) has been centered on environmental mind, lies, selfishness, and rich mind, which are often rooted in previous theories but portrayed in an effectively different manner. By creating new concepts in the field of psychotherapy, MPT provides a useful and practical way to treat psychological problems. The analytical method has been also exploited to reflect on the theory of MPT. The results of this study revealed that MPT, recruiting the concept of rich mind, opens a new path for clients to effortlessly remove many problems in order to reach perfection and nurture their soul.

Objectives: The dimensional approach to psychopathology has been proposed to reliably evaluate suicidality. Potential gender modulation of psychopathological dimensions associated to suicide attempts was investigated.

Methods: 91 subjects who committed a near-lethal suicide (SA group) and 374 who did not (nSA group) were recruited in a Psychiatric Intensive Care Unit regardless of their categorical diagnosis. The Hamilton Depression Rating Scale (HAM-D), the Brief Psychiatric Rating Scale - Expanded version (BPRS-E) and the Scale for Rapid Dimensional Evaluation (SVARAD) were administered at the admission. A Factorial Multivariate ANOVA was conducted according to General Linear Model: Sex and Suicidality were input as fixed factors, HAM-D, BPRS-E and SVARAD scores as dependent variables.

Results: Men with SA (MSA) displayed significant lower scores in SVARAD Activation dimension compared to women with SA (FSA) (p=0.049), men without SA (MnSA) (p<0.001) and women without SA (FnSA) (p<0.001). Both SA groups displayed significant higher scores compared to nSA groups in regard of Depression item (BPRS-E) (p<0,001). The MSA group displayed significant lower scores in Psychomotor agitation (HAM-D) compared to FSA (p=0,044), MnSA (p<0,001) and FnSA (p<0,001).

Conclusions: By means of multifactorial statistics sex resulted a moderator of the relation between activation/agitation and suicidality, despite categorical diagnosis.

Introduction: Many forms of mental disorders, especially psychotic disorders are characterized also by a worsening of sexual functioning. The main aim of this study was to validate in the Italian context the Arizona Sexual Experience Scale (ASEX), a very useful international tool to assess sexual dysfunction in people suffering from mental illness.

Methods: Seventy-three patients suffering from psychotic spectrum disorders were recruited. We administered the Italian version of ASEX, adequately translated by two expert bilinguals. After 15 days we administered once again the test for test-retest reliability.

Results: Validation of ASEX revealed Cronbach's coefficients >0.70 in both single items as in the total score. In addition, the test-retest reliability revealed Pearson's coefficients >0.50 in the various domains. Confirmatory factor analysis revealed good fit indexes for the two factors model of ASEX (SRMR=0.54; CFI=0.974; RMSEA=0.135).

Discussion: This study represents the first validation in the Italian psychiatric context of a very useful specific tool for the sexual assessment in people suffering from mental illness. Our analysis after the ASEX administration revealed good psychometric characteristics in terms of confirmatory factor analysis, internal consistency, and test-retest reliability.

Conclusions: On the basis of our results and consideration, we strongly suggest the use of ASEX in clinical context to assess the sexual function of patients with severe mental disorders.

Background: To explore the psychological status of patients with amputation injury and to evaluate the effects of psychological interventions based on magnetic resonance imaging (MRI) and X-ray characteristics.

Methods: Two hundred patients admitted from June 2016 to May 2019 were randomly assigned into control and observation groups (n=100). Routine care was performed for both groups, based on which observation group was given psychological interventions. Coping style, compliance to examinations, mental stress, degree of perceived control, degree of anxiety, degree of depression, incidence rate of adverse events, and satisfaction with nursing services were compared.

Results: After interventions, the score of positive coping, score of compliance to examinations and Control Attitudes Scale-Revised (CAS-R) score were significantly higher, whereas the score of negative coping, Chinese perceived stress scale (CPSS) score, self-rating anxiety scale (SAS) score and self-rating depression scale (SDS) score were lower in observation group than those in control group. The score of positive coping, score of compliance to examinations and CAS-R score were significantly elevated, while the score of negative coping, CPSS score, SAS score and SDS score reduced in both groups (p<0.05). The satisfaction rate was significantly higher in observation group than that in control group (p<0.05). The incidence rate of these adverse events was significantly lower in observation group than that in control group (p<0.05).

Conclusion: Psychological interventions before MRI and X-ray examinations are conducive to adjustment of the mental state of patients receiving replantation of a severed limb, thus improving the compliance to examinations, completion rate and image quality.