Secondary school teachers and mental health competence: Italy-United Kingdom comparison.

AIM: The aim of this study was to evaluate the differences between teachers' knowledge about early psychosis among three different Italian cities and a UK sample. METHODS: The sample consisted of 556 secondary school teachers from three different cities in Italy (Milan, Rome and Lamezia Terme) and London (UK). The research was based on the Knowledge and Experience of Social Emotional Difficulties Among Young People Questionnaire. The Italian version of the questionnaire was used in Italy. RESULTS: Overall, 67.6% of English teachers, 58.5% of Milan's teachers, 41.8% of Rome's teachers and 33.3% of Lamezia Terme's teachers were able to recognize psychotic symptoms from a case vignette. Logistic regression analysis showed that 'city' was the only independent variable significantly related to the correct/wrong answer about diagnosis. CONCLUSIONS: We found statistically significant differences between the three Italian samples and the UK sample regarding teachers' knowledge about first signs of psychosis. English teachers showed a better knowledge than Italian teachers in general. Teachers from Milan, where a specific early detection program was established in 2000, seemed to be more familiar with early signs of psychosis than teachers in the other two Italian towns.

[Ulysses contract in psychiatry]. / Il contratto di Ulisse in psichiatria.

Over the last twenty years we have witnessed a growing focus on the rights of the ill people. The debate on informed consent and a new redefinition of the therapeutic relationship is constantly evolving. With this article, we propose a critical literature review of the so-called "Ulysses contract" or "psychiatric advance directives". It refers to the will that a subject expresses in writing, or orally, about the treatments he or she wishes or does not wish to be subject to if the time comes when it may be impossible to express his/her consent. This can especially occur in those with psychiatric disorders with serious clinical involvement and remitting-relapse (typically bipolar disorder, but also chronic delusional disorders and schizophrenia). In this context, the question is whether during intercritical periods the patient may or may not leave instructions to their care-givers. This aspect opens up to a series of interdisciplinary problems. In this article, we want to show the complexity of this debate from a clinical, ethical, legal and psychodynamic point of view, emphasizing the strengths and the major criticisms of the psychiatric advance directives for each area.

[Comorbidity of hysterical pathologies associated with gynecological diseases: historical perspectives and current evidence]. / Comorbilità di patologie dello spettro isterico con patologie dell'apparato ginecologico: nozioni storiche ed evidenze attuali.

BACKGROUND: In spite of a large amount of observations made in Psychiatric Day-Hospital of Sapienza University of Rome relating to comorbidity between sexual and gynecological disorders and hysteria, we have attempted to quantify the incidence of this phenomenon in order to assess their significance. METHODS: A retrospective study was conducted on medical records of patients hospitalized at the Day-Hospital of the Policlinico Umberto I in Rome between 1989 and 2009. RESULTS: It seems to be confirmed the hypothesis of a high frequency of correlating these disorders, although the results lead to a number of critical reflections on its significance and the method adopted. CONCLUSIONS: This research needs larger and more accurate future investigations, cause the type of study was made without direct information.

Intramuscular aripiprazole in the acute management of psychomotor agitation.

STUDY OBJECTIVE: To assess acute efficacy and safety of 9.75 mg of intramuscular (IM) injections of the atypical antipsychiatric aripiprazole in patients with schizophrenia or bipolar disorder and acute agitation. DESIGN: Open-label trial of IM injections of aripiprazole and 24-hour monitoring of clinical response in patients with major psychoses and acute agitation. Partial analysis of blood levels of the administered drug to correlate with clinical response. SETTING: Acute psychiatric care wards in a single university hospital. PATIENTS: A total of 201 acutely agitated patients (79 with schizophrenia and 122 with bipolar disorder I). INTERVENTION: Aripiprazole 9.75 mg IM injection. MEASUREMENTS AND MAIN RESULTS: We evaluated clinical response using the Excitatory Component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation/Calmness Evaluation Scale (ACES), and the Clinical Global Impressions scale (CGI). Assessments were conducted 30, 60, 90, and 120 minutes and 24 hours after the first injection for PANSS-EC and ACES, and 2, 4, 6, and 24 hours for CGI. Response was at least a 40% decrease in PANSS-EC scores. We measured serum aripiprazole and dehydroaripiprazole levels in a subsample. IM aripiprazole significantly improved clinical measures. PANSS-EC improved progressively, starting after 30 minutes. ACES improved after 90 minutes and continued thereafter. Effects were sustained, with steadily decreasing CGI scores, until the 24th hour. Response rate was 83.6% after 2 hours, but with repeat injections, it rose to over 90% with no differences among diagnostic groups. Although there were gender differences in the response to individual PANSS-EC items, the responses were similar overall. Neither clinical monitoring nor patient reporting revealed any side effects. No therapeutic window was identified, and levels did not correlate with any clinical measure. CONCLUSION: Aripiprazole was effective and safe in reducing acute agitation in patients with bipolar disorder or schizophrenia. Our results compare favorably to double-blind trials, probably due to higher expectations in trials involving no placebo arm. Absence of side effects could be related to the short observation time.

[The representation of Italian psychiatry in Italian Treccani Encyclopedia in 1930's]. / La rappresentazione della psichiatria Italiana nella Enciclopedia Italiana Treccani degli anni Trenta.

The article reconstruct the situation of Italian psychiatry around 1930, using as unusual sources the pages of the Enciclopedia Italiana di Scienze, Lettere e Arti. This important work, conceived in 1925 and finished in 1937, is due - as well known - to the strong interest of Giovanni Gentile and to his capacity to involve in the project a great part of Italian intellectual world, without any ideological preclusion. The section devoted to Medical Sciences, including Psychiatry, was directed by Nicola Pende (1880-1970) and Giacinto Viola (1870-1943). A prevalent positivistic approach to science is well testified by their specific attention to preventive and social medicine, researches in Genetics and in biotypological constitutions. Psycopathological and psycological lemmas are very limited, underlying the medical disinterest towards contemporary philosophy and psycology.

[History of psychiatric legislation in Italy]. / Riflessioni sulla legislazione psichiatrica Italiana.

The different models of mental illness which have followed one another in Italian psychiatry have been linked to the history of psychiatric legislation and its various attempts at reform. The first law of the newly United State which unified legislations and former procedures, whose prevalent psychiatric theories were those that referred to degeneration, was the law 36/1904 that set up the asylums. Accordingly psychiatric praxis was focused on social protection and custody, given that the mentally ill was seen as incurable; Fascism added the inmate's obligation to be enrolled in the judicial register. Afterwards numerous attempts to reform the psychiatric legislation were made that eventually gave rise to law 431/1968 which paved the way to territorial psychiatry. Law 180/1978 changed the organization of Italian psychiatry abolishing asylums and the concept of dangerousness, including psychiatry in the National Health Service but adopting an idea of mental illness as simply social unease.