Rivista di psichiatria最新文献

The introduction of a law on psychiatric oblivion, similar to the recent one for oncological oblivion, presents numerous complexities due to the differences between the two areas of illness, especially in terms of recovery and clinical stability. While a definitive cure is often achievable in oncological diseases, in severe mental disorders, such as schizophrenia or bipolar disorder, complete remission in the absence of therapies is rare. Even in cases of effective treatment response, patients may exhibit subclinical symptoms or cognitive and functional deficits, making the concept of psychiatric oblivion particularly problematic. Some diagnostic categories, such as brief psychotic disorder or postpartum depression, could theoretically benefit from oblivion legislation, given the potentially limited course and frequent absence of relapses. However, for the majority of psychiatric conditions the requirement of a long period of remission without therapy appears difficult to achieve. An alternative could be the introduction of criteria based on the stabilization of maintenance therapy, but this would require a more complex and less easily standardized clinical judgment. Other limitations are the residual vulnerability to relapses, the difficulty in determining a precise medical history and the influence of persistent social stigmatization, which could undermine the effects of oblivion. Therefore, the creation of a law on psychiatric oblivion would require a restrictive and selective approach, focused on specific diagnoses and long-term clinical remission criteria, tailored to the clinical and adaptive peculiarities of mental illness.

Purpose: The Cultural Consultation Service of Bologna (SCC-Bo) is a transcultural psychiatric service situated within the International Protection Service of Bologna since January 2019. From its inception, the SCC-Bo has collected qualitative and quantitative epidemiological data that are stored in a database dedicated to documenting the Service activities and enabling research studies.

Methods: The study recruited 211 refugees and asylum seekers referred to the SCC-Bo from January 2019 to June 2023 and assessed them in the following ways: severity of illness at intake as well as clinical outcomes (CGI scale), diagnosis, and pharmacological therapy.

Results: The people referred to the SCC-Bo from January 2019 to June 2023 were 211: 55,9% (n=120) of them complained of new-onset psychological symptoms of moderate severity, while 26,1% (n=55) of them presented with severe symptoms. Mood disorders were most commonly diagnosed, with psychosis (20,8%, n=44) and PTSD (20,8%, n=44) also occurring frequently. The clinical outcomes improved in most of the refugees or asylum seekers followed by the SCC-Bo.

Discussion: The SCC-Bo is implemented in a unique social milieu such as International Protection Service of Bologna, dedicated to the acceptance of people refugees and asylum seekers. The main goal of the SCC-Bo is to reduce barriers of care related to this peculiar social group providing psychiatric and psychological care as well as a liaison service to local health resources. The findings of this study support the rationale that this peculiar social group may suffer of psychiatric major disorders and may lack of specific clinical support.

Conclusions: The SCC-Bo could be considered a model of psychiatric and psychological care appropriate to the context of the Italian reception of refugees. The SCC-Bo integrates scientific findings of transcultural psychiatric research into the psychological and psychiatric clinical approach towards refugees and asylum seekers.

Aims: This study explores the long-term outcome of Chinese refugees arrived in Italy fleeing reported religious persecution.

Methods: Post-migration living difficulties (PMLD), psychological well-being and language proficiency about 9 years after the first arrival are the outcomes compared in two groups. One group includes persons that had not yet received a form of international protection, still living in Italy without visa (undocumented asylum seekers - UAS). The comparison group includes persons that had received a visa for international protection (refugees - R). The Chinese versions of the World Health Organisation - Five Well-Being Index (WHO-5) and the List of Migration Experiences (LiMEs) were administered.

Results: Three UAS and three R were compared. R reported higher pre-migration traumas and PMLD in the two years after the arrival in Italy. At the evaluation about 9 years later, UAS reported lower scores at the psychological well-being and more PMLD. Moreover, they had not learned Italian, while R were fluent in the host language.

Conclusions: Considering that the main difference between the two groups was having or not received a visa recognizing the reliability of their asylum request, we hypothesize that this is a key variable explaining the long-term well-being and social adjustment of these persons.

Several studies showed the effectiveness of theta/beta Neurofeedback (NF) training (i.e., decrease theta power and simultaneously increase beta power) in treating different psychiatric conditions characterized by impaired cognitive control. However, investigations concerning Gambling Disorder (GD) have not yet been conducted. Thus, the main aim of the present study was to investigate the effectiveness of 11 theta/beta NF sessions in the treatment of a patient with GD. A psychological and neuropsychological assessment was performed before and after NF. A general improvement in symptoms severity (i.e., general psychopathology, dissociative symptoms, and impulsivity) as well as in cognitive performance (i.e., executive functioning) was observed after NF. Moreover, a decrease of theta/beta ratio (i.e., a marker of executive control and cognitive processing capacity) was mainly detected in the mid-frontal cortex at the end of NF training. Taken together our results provide preliminary evidence of the effectiveness of theta/beta NF in enhancing top-down cognitive control in patients with GD.

Aim: Metacognitive Training (MCT) is an effective intervention for treating various psychiatric conditions. This pilot study is a preliminary exploration of the use of an Italian version of MCT-Acute, an adaptation for acute care settings.

Materials and methods: MCT-Acute was administered to inpatients in an acute psychiatric ward, and the outcomes were compared to those of a treated-as-usual (TAU) control group.

Results: The MCT-Acute group showed significantly greater improvements in global functioning (GAF), internalized stigma (ISMI), and social behavior (SBS) compared to the TAU group. The PANSS subscales also improved significantly. At 12 months of follow-up, the MCT-Acute group had a lower readmission rate and better PANSS and GAF scores.

Conclusions: Although preliminary, this study suggests that MCT-ACUTE is a feasible and effective intervention in acute care settings, with benefits that may last months.

Purpose: Treatments for mental disorders, such as pharmacotherapy and psychosocial interventions, do not always guarantee symptomatic remission. The effectiveness of Physical Activity (PA) in improving the psychophysical health of individuals with various mental disorders is well-established; however, its effects on borderline personality disorder (BPD) have yet to be adequately studied. Currently, there are not approved pharmacological treatments for BPD, and access to effective psychotherapeutic interventions remains limited. This study aims to evaluate the efficacy of a PA programme as an adjunctive treatment for patients with BPD, in comparison with a control treatment. Objectives include reducing BPD symptoms and improving PA levels, as well as physical and psychological health.

Methods: PABORD is a randomised controlled trial (RCT) targeting female outpatients aged 18-40 with a diagnosis of BPD. The intervention group (n=32) will participate in a structured 12-week PA programme, supervised by a sports physician and preceded by three psychoeducational sessions on healthy eating habits. The control group (n=32) will receive 8 parallel psychoeducational sessions focusing on PA, diet, and the risks associated with sedentary behaviour. Standardised assessments will be conducted at baseline, at the end of the intervention, and three months post-intervention.

Results: Not yet available.

Discussion and conclusions: The PA programme is expected to outperform the control treatment in terms of health status and PA levels at the end of the intervention. Repeated clinical assessments will aid in identifying psychosocial factors associated with the maintenance of PA. The study may provide valuable insights that could improve therapeutic options for patients with BPD.

Background: Cannabis is the most used recreational drug worldwide. Its use can increase the risk of developing psychotic disorders and exacerbate their course. However, little is known about the relationship between psychosis and withdrawal and the literature is still scarce.

Case presentation: In this study, based on an analysis of 4 patients referred to our mental health department and evaluated between 2019 and 2023, we describe psychotic features emerged after abrupt cannabis withdrawal and we attempt to explore its characteristics.

Conclusion: Although it is difficult to show specific mechanisms underlying the psychopathological alterations in cannabis withdrawal induced psychosis, it is clear that this serious clinical picture could be a risk factor for precipitating psychosis especially in a vulnerable group of patients. Clinicians should be aware of the possibility of a higher risk of psychotic onset associated not only with chronic cannabis use but also with its abrupt cessation.

Although descriptive psychopathology of obsessive-compulsive disorder (OCD) is well-established, this disorder still presents very enigmatic and puzzling aspects. Hence the usefulness for further contributions to better clarify the picture. For example, one of the most problematic manifestations of OCD consists in pathological doubt, whose origin, however, remains unclear. For this purpose, a psychopathological analysis of several cases of OCD, in which decisional uncertainty is involved, is conducted, as well as a rereading of a famous case by Freud. As a result, the existence of a new psychological phenomenon observable in OCD people is suggested. It is proposed to call it: "incompatibility perceived between unbiased commitment and satisfaction for an unexpected and effortless personal benefit" (ICB). In fact, when an OCD subject experiences a sense of commitment, be it interpersonal or impersonal, he/she will experience the satisfaction for an unexpected and effortless benefit that results from the commitment, as incompatible with the commitment itself. As result, the subject will consider the satisfaction for the benefit as true but inacceptable, whereas he/she will consider the sense of commitment as desirable but as false. This phenomenon not only seems to explain at least some cases of indecision typical of OCD, but sheds new light on some important explanatory concepts, such as 'ambivalence', 'self-ambivalence' and 'fear of oneself', called into question over time precisely to explain the varied psychopathology of OCD. Finally, it also seems to have important implications for psychotherapy.

Aims: Interest in the well-being of professionals working in psychiatric patient care contexts is growing in the literature. The aim of this study was to explore the perceived role and work experience of psychologist psychotherapists working in Mental Health Centers (MHC).

Methods: A qualitative research was conducted involving psychologists with a training in psychotherapy working in Lombardy who had at least 3 months of working experience in a MHC. A convenience sample was recruited by email through the Order of Psychologists. From November 2022 to March 2023, 3 focus groups were conducted online and were audio-recorded. In each focus group, a video stimulus was shown, followed by questions on the perceived role and work experience of the participants. Three psychologists analyzed the focus groups' transcripts according to thematic content analysis.

Results: We enrolled 21 psychologists (3 males, with an average age of 44.71 years (SD=9.09) and with an average of 8.49 (SD=8.81) years of work in MHC). Four themes emerged: epistemology of care, services' organization, role of the psychologist and work experience of the psychologist. Results suggest that the epistemology of care embraced, even implicitly, in the MHC contributes to influence the organization of services, the role of the psychologists and their work experience. In MHCs with a biopsychosocial epistemology, the psychologists felt their role was acknowledged and valued by the care team. This leads to experiences of valorization and appreciation.

Discussion and conclusions: Results highlight the importance of the epistemology of care in influencing organization of services and the perceived role and work experience of the psychologists. However, it is also possible that a more circular relationship between the different levels exists, whereby organizational practices could also influence the epistemology of care and the perceived role and work experience of the psychologist. The variety of experiences, within the same Region, suggest that there is a possible cultural and organizational autonomy in MHCs. A reflection on the epistemology of care and organizational practices adopted in MHCs is needed to promote psychologists' well-being at work.

Introduction: Information and communication technologies (ICT) offer many advantages but also have negative aspects. This study explores the level of stress caused by technology and its impact on productivity, analyzing individual perceptions and use of technology.

Methods: This observational study used a questionnaire validated by Tarafdar et al., translated into Italian and administered online. Technological stress factors, role stress, and productivity were analyzed using SPSS 27. Multivariate analysis identified relationships between responses and various variables.

Results: The analysis of 1,746 individuals revealed a significant association between techno-overload, techno-invasion, techno-complexity, techno-insecurity, techno-uncertainty, and demographic and work-related variables. These factors affected productivity. Bivariate and multivariate analyses confirmed the interaction between technology, stress, and work efficiency. In particular, the female gender was associated with techno-overload (p=0.04), techno-invasion, and role conflict (p<0.001). Age was correlated with techno-invasion (p=0.001), techno-complexity (p<0.001), role overload (p<0.001), role conflict (p=0.046), and productivity (p=0.018).

Discussion and conclusions: Technology, while useful, can lead to technostress. The study highlights how various technological stress factors impact gender, age, and work-related stress. This observational study evaluates the phenomenon of technostress, both work-related and non-work-related, experienced by 1,746 individuals. The results particularly indicate that different technological stress factors significantly affect women, age, and work-related stress. Continued research is needed in this field to better understand and clarify the epidemiology, clinical presentation, and causes of the condition.