261 research outputs found
Epidemiology and evolution of the diagnostic classification of factitious disorders in DSM-5
No full textIvano Caselli, Nicola Poloni, Marta Ielmini, Marcello Diurni, Camilla Callegari Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy Abstract: A systematic search for all case reports and case series of adult patients with factitious disorders (FD) in the databases MEDLINE, Scopus, and PsycINFO was conducted. FD is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of a patient, without any obvious gain. The clinical and demographic profile of patients with FD has not been sufficiently clear. Thus, the aims of this study were to outline a demographic and clinical profile of a large sample of patients with FD and to study the evolution of the position of FD in the Diagnostic and Statistical Manual of Mental Disorders. One thousand six hundred thirty-six records were obtained based on key search terms, after exclusion of duplicate records. Five hundred seventy-seven articles were identified as potentially eligible for the study, of which 314 studies were retrieved for full-text review. These studies included 514 cases. Variables extracted included age, gender, reported occupation, comorbid psychopathology, clinical presentation, and factors leading to the diagnosis of FD. In the sample, 65.4% of patients were females. Mean age at presentation was 33.5 years. A health care profession was reported most frequently (n=113). Patients were most likely to present in psychiatry, neurology, emergency, and internal medicine departments. The broad survey of sociodemographic profile of the sample has highlighted some important points for early diagnosis and early psychiatric treatment. The study showed that the patients did not meet Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria in 11.3% of cases. Keywords: fabricated illness, factitious disorder, medically unexplained symptoms, Munchausen syndrom
Somatic symptom disorders in hospitalized patients: clinical features and health care costs
No full textBackground and objectives. Somatic Symptoms Disorder (SSD), formerly known as somatoform
disorder, is a mental disorder which manifests as physical symptoms that cannot be explained fully
by a general medical condition. In current literature, Medically Unexplained Physical Symptoms
(MUPS) are intended as physical symptoms without a medical explanation. The research provides
for the collection of data from hospitalized patients presenting MUPS, aiming to draw a clinical and
socio-demographic profile of these patients, to estimate economic costs related to hospital
management, and to explore psychopathological correlates of SSD. Materials and methods. The
cross-sectional study consists in the evaluation of data referring to all hospitalized patients admitted
between 2008 and 2018 in the wards of a teaching hospital in Northern Italy. Results. Data referring
to 273 hospitalized patients presenting MUPS have been detected. The sample shows a prevalence of
female, married, and worker patients. The most frequent ward involved are Neurology, Internal
Medicine and Short Unit Stay. The most common symptoms found are headache, pain, syncope and
vertigo. The overall estimated cost of hospitalization for patients with MUPS is 475'409.73 €. No
evidence that a history of medical disease is associated with a diagnosis of SSD. A personality
disorder diagnosis in patients with MUPS is associated with increased probability of having a
diagnosis of SSD. A marginally significant positive association also emerges with anxiety disorders,
but not with depressive disorder. Conclusions. The research provides the investigation of a large
number of patients with MUPS and a financial estimate of related hospitalization costs. Moreover, it
allows to study clinical, socio-demographic and psychopathological correlates involved in SSD
A naturalistic study on the relationship among resilient factors, psychiatric symptoms, and psychosocial functioning in a sample of residential patients with psychosis
No full text Nicola Poloni, Daniele Zizolfi, Marta Ielmini, Roberto Pagani, Ivano Caselli, Marcello Diurni, Anna Milano, Camilla Callegari Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy Objective: Resilience is a multidimensional process of adaptation aimed to overcome stressful or traumatic life experiences; only in the last few years it has been considered as a personal resource in psychosis and schizophrenia. This study aimed to assess the relationship between intrapersonal and interpersonal resilience factors and schizophrenia, particularly whether and how resilience can improve the course of psychotic illness. Patients and methods: In this observational study, all patients recruited had to fulfill the following inclusion criteria: diagnosis of schizophrenia spectrum disorder (Diagnostic and Statistical Manual of Mental Disorders-5); aged between 18 and 65 years; provided written informed consent; to be clinically stable (Clinical Global Impression Scale <3); history of illness ≥5 years; to be compliant with antipsychotic therapy over the last year; and regular submission to periodic monthly psychiatric visits. Patients were evaluated through the following scales: Resilience Scale for Adults (RSA) for resilience; Brief Psychiatric Rating Scale-Anchored version (BPRS-A), Scale for the Assessment of Negative Symptoms (SANS), and Scale for the Assessment of Positive Symptoms (SAPS) for psychotic symptomatology; and Life Skills Profile (LSP) for psychosocial functioning. ­Statistical analysis was performed by SPSS. Partial correlations were evaluated to assess the relationship between RSA total scores and subscores and BPRS-A, SANS, SAPS, and LSP total scores, removing the common variance among variables. Then, a series of hierarchical multiple linear regression models were used to examine the association between resilience, psychopathology, and psychosocial functioning. Results: A statistically significant negative correlation among intrapersonal resilience factors and BPRS-A total score emerged, predicting psychiatric symptoms severity and explaining approximately 31% of the BPRS-A variance; otherwise, only the interpersonal resilience factors associated with social support were statistically and positively correlated with LSP total score, predicting psychosocial functioning and explaining the 11% of LSP variance. Conclusion: The specific contribution that resilience factors may have in predicting the severity of symptoms and the extent of psychosocial functioning emphasizes the importance of personalizing treatment for patients affected by schizophrenia, promoting personal resources, and translating them into better outcomes. Keywords: resilience, personal resources, psychosis, schizophrenia, residential patients, psychosocial functionin
Pharmacogenetic Tests in Reducing Accesses to Emergency Services and Days of Hospitalization in Bipolar Disorder: A 2-Year Mirror Analysis
No full textDespite the enormous costs associated to mood disorders’, few studies evaluate potential cost saving from the use of pharmacogenetic tests (PGT). This study compares 12 months before the execution of the PGT versus 12 months after, in terms of number and days of hospitalization and accesses to emergency services, in a sample of 30 patients affected by bipolar disorder. Secondarily, the study gives an economic value to the data based on the diagnosis-related group (DRG). Patients included in the study were required to be aged ≥18 years, sign an informed consent, have a score of Clinical Global Impression item Severity (CGIs) ≥3, and have a discordant therapy compared to the PGT in the 12 months preceding it and a therapy consistent with it for the following 12 months. Cost saving has been evaluated by paired t-tests in a mirror analysis. Statistically significant differences in all the comparisons (p < 0.0001) emerged. Important cost saving emerged after the use of PGT (€148,920 the first year versus €39,048 the following year). Despite the small sample size and lack of a control group in this study, the potential role of PGT in cost saving for the treatment of bipolar disorder treatment emerged. To confirm this result, larger and clinical trials are needed
Efficacy of short-term psychodynamic psychotherapy (STPP) in depressive disorders: A systematic review and meta-analysis
No full textIntroduction: Depression is a common illness worldwide and can severely interfere with daily and work functioning. Both pharmacological and psychotherapeutics interventions are used for adult depression. The aim of the review is to evaluate the efficacy of short-term psychodynamic psychotherapy (STPP) comparing with different types of intervention. Materials and methods: A systematic review with meta-analysis on the efficacy of STPP in depressive disorders was conducted. Results: Meta-analysis results confirm the superiority of STPP versus no interventions. The average effect size of depressive symptoms severity at the end of the treatment is -0.91 (95 % CI: -1.49 - -0.33) in favor of STPP, while for clinical improvement of depressive symptoms is -0.78 (95 % CI: -1.56 - 0.01). Results confirm a net superiority of STPP to usual treatments unstructured. A mild superiority of efficacy of STPP on support psychotherapy emerged. Comparison of the efficacy of STPP vs cognitive-behavioral psychotherapy (CBT) shows little superior in case of STPP. No substantial differences in efficacy in case of STPP than control interventions emerged. Antidepressant pharmacotherapy is resulted to be slightly more effective to STPP. Discussion: While all the other results confirm current literature, this review shows no superiority of combined treatment than STPP only. Limitations: The review has some limitations such as the lack of moderation analysis and the high heterogenicity of the type of the studies. Conclusions: The results confirm the efficacy of STPP in depressive disorders endorsing the guidelines of National Institute for Health and Clinical Excellence
Reperti ossei recuperati nell'alveo del fiume Po e conservati presso il "Museo Archeologico" di Ostiglia (MN). Riconoscimento e determinazione tassonomica
No full textSono stati analizzati circa 200 reperti ossei raccolti dal gruppo Archeologico Ostigliense (G.A.O.) durante i periodi di secca del fiume Po, in una vasta area compresa tra Correggio Micheli e Isola Bianchi (Mn), dagli anni '90 al 2005. Il materiale osteologico informa sulla fauna della Pianura Padana, costituita da specie principalmente domestiche e in accordo con il panorama faunistico attuale, fatta eccezione per un reperto appartenebte alla specie Alces alces
Revisione tassonomica della collezione osteologia del “Dott. Daniele Benfatti”
No full textSono stati presi in esame un centinaio di pezzi provenienti dalla collezione osteologica del dott. Daniele Benfatti, recentemente scomparso. I reperti ossei sono stati raccolti tra aprile e settembre 2003 durante il periodo di secca del fiume Po, nei territori di Quingentole, Ostiglia e Sermide (Mantova). Essi forniscono informazioni sulla fauna vertebrata della Pianura Padana di epoche passate. interessante la presenza dell'alce (Alces alces), del bisonte (Bison sp.) e del ghiottone (gulo gulo), caratteristici di un paleoambiente completamente diverso dall'attuale
Evaluation of the burden management in a psychiatric day center: distress and recovery style
No full textAim: In psychiatric rehabilitation the individual treatment plan can be formulated from tools that provide a multidimensional assessment of the patient. This study aims to analyze the relationship between distress and recovery style (integration and sealing over) from the psychosis. Assuming that this relationship affects the burden management, the study has the additional target of gaining more elements to direct the formulation of more effective therapeutic / rehabilitation programs. Methods: The study was carried out in a psychiatric day center, semi-residential structure of mental health services of the National Health System in Italy. 45 patients enrolled have been evaluated by the Neuropsychiatric Inventory (NPI - Italian version) and Integration / Sealing Over Scale (ISOS - Italian version), within three months (March-June 2014). Results: In the sample, the symptoms which cause a greater distress in the health workers, in an absolute sense, are uninhibition, irritability and apathy. Moreover, the results indicate that depression and anxiety cause a greater degree of distress in sealer patients. Discussion and conclusion. Uninhibition, irritability and apathy were more burdensome for mental health workers, because they require a greater engagement in the therapeutic relationship. Anxious and depressive symptoms cause a greater degree of distress in the sealers patients, reporting lower endurance of the denial of psychosis. The data seem to prove that knowing, differentiating and deepening the different aspects of the recovery style of each patient enable us to estimate the burden management, starting from the taking in charge, and to reduce the distress and the risk of burn out of the mental health workers
A case of reversible splenial lesion syndrome (Resles) related to neuroleptic malignant syndrome in a schizophrenic patient
No full textObjective: Reversible splenial lesion syndrome (RESLES) is a rare clinico-radiological condition characterized by a transient lesion in the splenium of the corpus callosum. Method: A systematic search of the literature has highlighted a possible correlation between this rare condition and neuroleptic malignant syndrome (NMS) despite only few cases have been reported. Results: This paper reports a case of RESLES syndrome in a 36-years old male patient with NMS who was undergoing psychiatric treatment for schizophrenia. Conclusions: The reported clinical case highlights the possibility of including NMS as one of the differential diagnosis in RESLES syndrome
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