Rivista di psichiatria最新文献

Conduct Disorder is a diagnosis associated with behaviors at risk for the health and development of the subject, with high social costs and with serious consequences for the adolescent's life context. This disorder is predominantly found in the male population. However, girls with Conduct Disorder often have particularly severe and pervasive symptoms, with a high psychiatric comorbidity. The purpose of this article is to summarize the objectives of the project "FemNAT-CD", in order to promote greater knowledge of the clinical characteristics of females who show a Conduct Disorder in adolescence. This paper will describe studies related to FemNAT-CD project concerning neuro-biological, neuro-cognitive and clinical characteristics of Conduct Disorder in female adolescents as well as new psychotherapeutic and pharmacological approaches.

In this study we aimed to describe the relationship between sexual disorders and paranoid thinking describing the historical case of murder of the famous surgeon Antonio Parrozzani and the pathological personality of his murderer. Parrozzani was killed by Francesco Mancini, his patient in the past. Mancini was obsessed by his sexual problems due to hypothetical injuries after an inguinal hernia surgery, made by Parrozzani. Following treatment, the murderer likely lived his surgery as a traumatic event and developed a paranoid thinking against the surgeon, breaking out with the dramatic homicide. Parrozzani's case highlights the strong relationship between paranoia and sexuality, and likewise this relationship can be considered as a prodromic factor for a psychotic onset. Moreover, this case, supported by two psychiatric assessments of murderer, remembers once again the association between violence and paranoia. Therefore, clinicians should take into account the danger of the possible presence of paranoid obsession together with sexual problems, to prevent psychosis onset or violent acts related to paranoid delusions.

Introduction: Attachment styles represent a personality pattern critical to psychological health, with insecure attachment being a central factor in developing psychopathological characteristics of psychosis. However, its downstream psychopathological pathways remain unclear. This study aimed to investigate the putative psychopathological mediators in the relationship between insecure attachment and psychotic features in a non-clinical sample of university students.

Methods: We recruited two non-clinical samples for a total of 978 subjects, 324 males and 654 females, and administered the Relationship Questionnaire (RQ) to assess attachment styles and the Symptom Check-List 90 (SCL-90) to assess psychopathological symptoms. Moreover, the Paranoia and Psychoticism subscales of SCL-90 were combined and used as a measure of Psychosis (PSY). A mediation analysis model was carried out to establish the relationship among variables.

Results: Mediation analysis showed a total effect from RQ-Preoccupied and RQ-Fearful to PSY, respectively, 0.31 and 0.28. Direct effects from the SCL-90-R factor candidate mediator to PSY ranged from 0.51 for somatization to 0.72 for depression and 0.72 for interpersonal sensitivity. Indirect effects ranged from 0.08 for RQ-Preoccupied via hostility to 0.21 for RQ-Preoccupied via depression.

Discussion: Our results show that the effect of insecure attachment on psychosis features is differentially mediated by some psychopathological dimensions, being depression and interpersonal sensitivity the most relevant ones. PSY feature, therefore, is predicted by other specific symptoms in the psychological context of insecure primary relationships.

Conclusions: From a preventive and clinical point of view, our results could be relevant in informing the early-stage psychological treatment of pre-psychotic states and, in general, people experiencing sub-threshold psychotic symptoms.

Law no. 219/2017 represents Italy's most comprehensive regulatory framework aimed at enabling the exercise of the right to therapeutic self-determination and ensuring its best expression even for people without legal or natural capacity, through the tools of informed consent, shared care planning and advance care directives. Nevertheless, some criticalities affect the wording of the law, characterised by a promiscuous and heterogeneous use of the terms referring to capacity and by their interpretability. These criticalities may compromise the benefits of the law provisions at the implementation level, with particular reference to persons who may have a condition of limited capacity due to a psychiatric or cognitive disorder. We analysed the concept of capacity in the law and its critical aspects, both on a hermeneutical and applicative level. The analysis shows the difficulty of reconciling the rigidity of the legal categories of capacity with the changing and multifaceted nature of the clinical conditions. We underlined that possible correctives can come from both the healthcare contexts and legal practitioners and must be aimed at achieving maximum approximation between the formal plan of the law and the real contexts of care.

Aims: This study analyzed the application value of drug combined painting therapy for patients with anxiety disorder by observing the changes in patients' mental and social functions.

Methods: 400 cases with anxiety disorder were recruited, and randomly divided into the experimental group and the control group with 200 cases in each group. Patients in the control group received drug therapy alone, while experimental group was combined with painting treatment on the basis of control group. The Nurses Observation Scale for Inpatient Evaluation (NOSIE) was used for the evaluation of mental and social functioning. Clinical efficacy was evaluated according to the degree of reduction in the Hamilton Depression Scale (HAMD) score.

Results: After 8 weeks of treatment, the experimental group had a lower HAMD score than those in the control group. After 8 weeks of treatment, mental and social functions in both groups improved significantly. And the social competence, social interest and personal cleanliness of the experimental group were better than those of the control group, and the degree of irritability, retardation and depression were lower than those of the control group. In comparison with the control group, the experimental group had a higher cure rate and remarkable response rate.

Conclusions: Painting therapy combined with drug therapy can relieve anxiety symptoms of patients with anxiety disorder, improve their mental and social functions, and improve clinical efficacy.

Aim: To evaluate the psychometric properties of the DISCUS (DISC-Ultra Short), a measure which assesses experienced discrimination among persons with mental disorders.

Methods: Data collected in the three Italian sites (Brescia, Napoli, and Verona) participating at the international project INDIGO-DISCUS. Each Italian site recruited a sample of 50 individuals. Participants were evaluated with the DISCUS. This study evaluated: (a) reliability (internal consistency), (b) validity (convergent and divergent), (c) precision, and (d) acceptability. Participants were also asked to complete three additional measures: Stigma Consciousness, Brief Stigma Coping/Stigma Stress, and Internalized Stigma of Mental Illness (ISMI-10).

Results: Overall, 149 people participated; 55% were males, with mean age of 48 (±12.4) years and on average participants had 12 (±3.4) years of education; only 23% were employed. Internal consistency was found to be good (Cronbach α=0.79). Convergent validity was confirmed (all correlations between DISCUS score and the other measures' scores were greater than 0.30). There was evidence of divergent validity, as the overall DISCUS score was not associated with the variable "sex". Precision showed a high correlation coefficient between the various items and the overall DISCUS score, with only one exception (discrimination when looking for housing), which showed a particularly high frequency of "not applicable" responses. Acceptability [measured with Maximum Endorsement Frequencies (MEF) and Aggregate adjacent Endorsement Frequencies (AEF)] was found to be fair (MEF violated in 2 items; AEF partially violated in 5 item).

Conclusions: The Italian version of the DISCUS is a reliable, valid, precise, and acceptable measure of experienced discrimination to be used in large scale studies in the evaluation of anti-stigma initiatives in Italy.

Introduction: Post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD) are two sibling stress-related disorders. Evidence suggests a worse clinical picture associated with cPTSD in terms of comorbidities and outcomes. However, little is known about the association between cPTSD and psychotic-like experiences (PLEs). In this study, we aim to explore differences in PLEs in a sample of 1010 late adolescents with PTSD and cPTSD symptoms.

Methods: A sample of 1010 late-adolescents and young adults attending the last year of high school was selected. PLEs were assessed using the 16-items Prodromal Questionnaire (PQ-16), PTSD and cPTSD were assessed using the International Trauma Questionnaire (ITQ).

Results: 999 (501 males, 50.15% and 498 females, 49.85%) subjects had complete data on the selected variables. Of these, 91 (9.11%) and 40 (4.00%) screened positive for PTSD and cPTSD, respectively. Mean number of PLEs endorsed in subjects with PTSD, cPTSD and control groups were 7.02 (sd=2.99), 8.17 (sd=3.70) and 4.49 (sd=2.93), respectively. Mean PQ-16 distress score was 5.08 (sd=4.6) in subjects not endorsing PTSD/cPTSD, 10.11 (sd=6.17) in PTSD and 14.51 (sd=9.1) in cPTSD subjects. A linear regression analysis revealed a significant association between PTSD/cPTSD and PLEs scores (respectively, b=4.91 [3.73, 6.10] and b=10.05 [8.40, 11.70]). Such associations were reduced after adjustment for depression, anxiety and dissociation.

Discussion and conclusions: Our results find higher rates of PLEs in late adolescents screening positive for cPTSD and PTSD compared to negative subjects. Furthermore, cPTSD could be more specifically associated with distressing PLEs. These findings add to the vast literature of a worse psychopathological picture associated with cPTSD compared to PTSD, emphasizing the need for a separation between PTSD and cPTSD in terms of diagnosis and possibly treatment.

In mental health care, transition refers to the pathway of a young person from a child and adolescent mental health service (CAMHS) to an adult mental health service (AMHS). In Italy, the age of transition from adolescents to adults' mental health services is at the age of 18. Difficulties in transitioning have shown to favor patients' and families' disengagement and discontinuity of care with pharmacological treatment dropouts. On the other hand, a smooth and effective transition may improve the management of the disease and increase the chances of improvement of young schizophrenic patients. This project of roundtables, including child neuropsychiatrists (CNPs) and adult psychiatrists (Psy) throughout Italy, was aimed at exploring the problems of transition in clinical practice and collecting the proposals to improve transition management. The need to fill some cultural and organizational aspects strongly emerged to improve the transition process of adolescents with schizophrenia to adults' mental health services. On the one hand, specific training programs for both Psy and CNPs on the transition process are hoped for. On the other hand, both Psy and CNPs have expressed a need for shared official protocols, direct handover between the services including a period of shared management, and building of territorial multidisciplinary teams. All these aspects imply having a national mental health policy dedicated to taking charge of young people with mental health disorders, and accompanying them across the border between children and adults' mental health services. Improving transitional care can facilitate not only recovery but also prevention of mental illness for young people. Allocation of resources should aim at matching the epidemiological burden and reducing the heterogeneity between Italian regions.

Aim: The aim is to describe remote multifamily psychoeducational intervention led by REMS "Castore" team (an Italian health care facility for offenders who suffer from mental disorders and socially dangerous) in ASL Roma 5, a local health authority, during covid-19 emergency.

Methods: The applied theoretical models have been the integrated psychoeducational intervention by I. Falloon and the multifamily psychoeducational intervention based on problem solving by F. Veltro. The multifamily psychoeducational intervention was attempted by inpatients' relatives from June to August 2020 with 8 weekly meetings of 90' each led by two psychiatric rehabilitation therapists and healthcare experts. Six families were involved in the study and its members were assessed by questionnaire on family problems, Brief-COPE and general health questionnaire tests. Users were assessed by Level of Expressed Emotion Scale test for their expressed emotion.

Results: Data analysis highlighted the general low level of subjective and objective burden for family members in association with a high perception of that support provided by REMS. Furthermore, the study has shown those coping approaches oriented to the research of practical solutions, acceptance of events and assertive communication.

Discussion: The low subjective and objective burden may be attributed to implicit security conditions in REMS and the absence of tasks mainly carried out by experts. Those coping styles oriented to more practical than emotional approaches suggest an emotional hyper control or stigma perception leading to isolation and loneliness.

Conclusions: The multifamily psychoeducational intervention has allowed a trustworthy relationship with REMS. Considering that the families involved in the study have never benefited by other psychoeducational interventions before, their early involvement appears to be a potential tool for preventing and managing crisis as well as minimizing recidivism.