Rivista di psichiatria最新文献

Mental health interventions for Italian prisoners with mental disorder remain a problematic issue, despite radical changes in psychiatric care and a 2008 major government reform transferring mental health care in prison to the National Health Service. Indeed, prison has increasingly become a place of severe psychological distress, where also serious mental illnesses sometimes occur. In this contribution, we commented on the recommendations recently proposed by the Emilia-Romagna Region on how structuring mental healthcare interventions in all regional jails. Moreover, starting from the findings reported in recent epidemiological studies examining the prevalence of mental disorders in Emilia-Romagna prisons, we proposed a new treatment model for mental health and pathological addictions in jail, which took into account the current incidence of inmates with severe mental illness, psychological distress due to incarceration, and substance use disorder. Perhaps, this new intervention model (specifically centered on clinical psychology and case management by intramural mental health professionals) requires a vision able to overcome the classical "medical-centered" approach, which still too often permeates many sectors of public mental healthcare services. In our opinion, if we decide to look at the moon, we shouldn't dwell too much on the finger pointing to it.

Aim: To evaluate the effectiveness of the Falloon Psychoeducational Family Intervention (PFI), originally developed for the management of schizophrenia, afterwards adapted for early psychosis, in terms of adherence to the treatment, low relapse rate, improvement social functioning and stress management.

Methods: This is a one-year, pragmatic, real-world observational study with subjects consecutively recruited at the Campobasso psychiatry ward (SPDC) or Mental Health Center (MHC) starting in November 2020 over an 18 month period. Patients recruited were asked for consent for family members' participation. The effectiveness of the intervention was evaluated in terms of treatment adherence, discontinuity, relapse rates, clinical symptoms assessed by BPRS and PANSS, improvement in social functioning and stress management.

Results: 13 subjects were recruited; 10 males and 3 females, all singles, with a DUP inferior to one year. At the end of the intervention, significant improvements in treatment adherence, absence of drop-outs and relapses, statistically significant improvements in clinical symptoms, social functioning and stress management were found.

Discussion and conclusions: The results clearly show that family psychoeducational intervention according to the adapted Falloon model, specifically focused on crisis and early stress management, is effective in improving treatment adherence, clinical outcome and social life of first-episode psychotic patients. The limit is the lack of a control and randomization.

Introduction: The epidemiological studies on Huntington's disease (HD) in the Asian population suggest that prevalence rates are significantly lower than in the Western population. We conducted a systematic review of epidemiological studies of HD in Asia to compare the level of impact of the disease on the Asian population.

Methods: Original articles and reviews about HD prevalence in the Asian population were found through databases such as Embase, Medline, and PsychInfo. Relevant articles were analysed by scrutinising of references, including specific key words. A meta-analysis was performed on prevalence rates to find the degree of similarities with I2. Point Prevalence was measured as the number of people affected by HD in a 100,000 population and expressed as Point Prevalence (PP)= Number of people affected/100,000 with 95% Confidence Intervals (CI95).

Results: Results from the random-effect meta-analysis show the highest point prevalence of HD in the Middle East with PP=4.0 (CI95=2.90-5.30). The lowest point prevalence was found in the Chinese population with PP=0.25 (CI95=0.16-0.36). Europe remains at a high prevalence compared to Asian countries with PP=1.00 (CI95=0.82-1.19). The overall prevalence in Asia is PP=0.70 (CI95=0.44-1.0).

Conclusion: Our study reveals that HD disease affects the population of Asia to a lesser extent than in Europe. The plausible explanation for differences in prevalence is that in some countries, the affected individuals will not self-refer to HD screening for fear of social stigma, negative influence in marriage, and lack of genetic and neurological testing. Another explanation is that studies that used genetic testing exclusively were able to identify the CAG repeats, subgroups of CAG repeat A1 & A2, and haplogroup C, which has less predisposition to high HD prevalence in Asians compared to the Caucasian population.

War is a complex issue and, as such, observable and studyable from different perspectives, including political, economic, anthropological, sociological, ethnological, etological, historical and psychological. Psychiatry's interest in war has a historical root, just think of the Psychoanalytic Congress held in Budapest in September 1918, on "war neuroses". Current interest is directed to psychic mechanisms operating in the war phenomenon and on the consequences that collective trauma produces in acute, chronic and in subsequent generations.

Aims: This study aims to present an overview of the clinical experience of the counseling service "Sportello Studenti". The service offers free diagnostic and therapeutic psychological assistance to all Tor Vergata University of Rome students.

Methods: Preliminary findings on the prevalence of anxious, depressive, and prodromal symptoms in a subset of participants recruited during the initial three-year period of the service's operation (2019-2022) are presented. Beck's Depression Inventory II (BDI-II), Symptom Checklist-90-Revised (SCL-90-R), Prodromal Questionnaire 16 (PQ-16) and Aberrant Salience Inventory (ASI) have been used to investigate principle psychopathological dimensions.

Results: 261 students aged 18 to 35 completed the assessment (180 female - 69%). Mild widespread depressive symptoms (35.5%) and mild to severe suicide ideation (5.1%) were highlighted. Ninety students (37.2%) result at a higher risk condition for psychosis. A significant statistical correlation between negative psychopathological indicators, such as suicidal thoughts and age, suggests that younger students exhibit higher susceptibility and vulnerability to mental health issues.

Discussion and conclusions: The increasing prevalence of distress among young individuals represents an urgent public health concern that necessitates immediate intervention. It is crucial for countries to adopt a comprehensive approach to promoting psychological and mental health. University counseling services serve as an effective initial intervention to address the negative impact of mental illness on academic performance, social interactions, and emotional well-being in young individuals. They also play a pivotal role in the early identification of individuals at risk of developing severe psychiatric disorders. Sportello Studenti has proven to be a valuable initiative addressing the mental health needs of University of Tor Vergata students, underscoring the significance of promoting psychological well-being.

Aim: The Covid-19 pandemic is having a great impact on the lives of healthcare workers, but its psychological impact on Mental Healthcare Workers (MHWs) remains to be better explored. The aims of the present study were to assess the correlates and predictors of stress and adverse psychological effects in MHWs during the first waves of the Covid-19 pandemic.

Methods: A total of 124 MHWs (psychiatrist/psychiatry resident, nurse, psychologist/psychotherapist, psychiatric rehabilitation therapist/educator, other mental health professional) working in public facilities of the ASST Spedali Civili of Brescia, Italy, was assessed between June 28, 2020 and August 10, 2020 with an online questionnaire that included sociodemographic, professional and Covid-19 exposure information, the Impact of Event Scale - Revised and the Depression Anxiety Stress Scales 21. Multivariate linear regression models were designed to identify individual predictors of post-traumatic, depressive, anxiety and stress-symptoms.

Results: The professional role of nurse, having more years of professional experience and experiencing the death of a patient emerged as predictors of more severe post-traumatic symptoms. The professional role of nurse emerged as the only predictor of more severe depressive symptoms; the professional role of nurse and having more years of professional experience emerged as predictors of more severe anxiety symptoms; more years of professional experience, higher workloads, worse team relationships and experiencing the death of a loved one emerged as predictors of more severe stress symptoms.

Conclusions: Alongside other stressful factors, the professional role of nurse and more years of professional experience emerged as predictors of adverse psychological events. Working as a MHW, particularly with high levels of contact with patients during the Covid-19 pandemic, may be considered strenuous work, requiring dedicated training and interventions to improve resilience.

Key words: Anxiety, Covid-19, depression, mental healthcare workers, stress-related disorder, stressful life events.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a neuropsychological disorder that affects the development of children and adolescents. The causes are not fully known although the origin of the disorder appears to depend on a combination of environmental, social, biochemical, and genetic factors. There is substantial evidence the Covid-19 pandemic caused an increase in mental disorders and therefore in spending related to the treatment of diseases.

Method: We conducted a retrospective cohort study in two international centers of very different origins and cultures, one in Europe (Italy) and one in Central America (Costa Rica), to assess the impact of the Covid-19 pandemic on ADHD medication prescriptions and its costs. The analysis resulting from mining the databases in each individual nation allowed for the actual amounts of defined daily dose (DDD) prescribed and dispensed between the years 2019 and 2022 of methylphenidate and atomoxetine.

Results: The data show that the Italian ADHD medications DDDs and expenditure are aligned with the results in Costa Rica. It was found that from the year 2019 to the year 2022, both methylphenidate and atomoxetine prescriptions grew steadily, confirming a much higher incidence of the condition than in pre-pandemic periods.

Conclusions: Our study shows that the global pandemic had an influence on the increase in the number of ADHD medication prescriptions. Individuals with ADHD are a population of individuals who may be particularly vulnerable to the distress caused by the pandemic, restrictions, and severe physical removal measures that have occurred in recent years.

A recent euthanasia case in Belgium has garnered attention due to its particularly dramatic aspects, sparking clinical and ethical questions about end-of-life choices in cases of mental suffering. A 56-year-old woman, convicted of the murder of her five minor children and sentenced to life imprisonment, has been granted euthanasia for "irreversible psychological suffering". The clinical and psychodynamic aspects of the case, primarily deduced from press reports, are highly complex and give rise to numerous clinical, medico-legal, and bioethical questions. These include inquiries into the true nature of psychopathology, its actual irreversibility, its impact on the ability to express a euthanasia request with adequate awareness, the preserved capacity for self-determination, and broader issues related to end-of-life requests from patients with mental disorders. These aspects are considered in the context of the legislation in various European countries. The unique details of this case underscore the critical challenges associated with these complex issues.

The modern technology contributes to the development of more complex video games, in which the participant can be completely immersed in the game and have the experience of his own presence in the virtual world through his avatar, which assumes the characteristics of the player. A wide range of motives can mediate pleasure in the virtual world. The virtual world provides the illusion of reality. It makes possible to bypass the need for mental processing of connections and transformations that forms a bridge between the inner world of fantasy and objective reality. It is considered that video games shift the focus to control and narcissistic gratification and that communication in virtual reality implies a greater cathexis of skills and performance than emotions and thoughts. Can we understand video games as a type of projective technique? Strategic video games are often among the one of most popular video games. The authors collected data and materials on the mentioned topics from their daily clinical work, and present a case report. Observing video games through virtual spaces and the ways in which young players use them, we can conclude, that they have the capacity to be useful for various aspects of young people's development, but they can also interfere with it.

Background: Borderline personality disorder (BPD) is a complex mental health condition with an altered image of self, impulsive acts, suicidal ideation, and self-harm requiring intensive care in outpatient and inpatient settings. The biopsychosocial (BPS) model adopted in the current study extracted the outcomes of a research about the diagnosis, causes and treatment of BPD. A network model helped link these results in a unitary model with applications in clinical practice for assessment and intervention.

Methods: We conducted a literature review of current studies on the BPS causes of BPD and merged them through meta-synthesis. The results were then elaborated with a psychopathological network analysis for linking the extracted factors with higher degree of centrality in the network and merged in a final comprehensive model.

Results: The theoretical modelisation suggests that BPS causes merged with the diathesis-stress model persistently activate the cortico-limbic system and prefrontal cortex, induce neuroinflammation, and stimulate suicidal and parasuicidal ideation and behaviours modulated by psychological and pharmacological treatment.

Conclusions: Using a network model in psychopathology allowed the merging of data about BPD into a unitary and dynamic pattern which can be helpful to direct assessments and interventions in clinical practice.