Phenomenology of Somatization in Immigrants: An Idealtypical Approach.

INTRODUCTION: Somatization in immigrants is frequent but standard studies do not differentiate between various forms of somatization. In this qualitative study, we used an idealtypical approach with the aim of phenomenologically differentiating between different forms of somatization in immigrants. METHODS: The clinical description of the ideal types was based on seven levels: medical examination; description of somatization symptoms; the patients' own interpretation of their somatic experience; concomitant psychopathological phenomena; genetic understanding; clinician's interpretation; and course and treatment. RESULTS: Five different ideal typologies of patients emerged: anxious hypochondriasis, somatization with cultural features playing a pathogenetic role, culturally shaped somatization (through pathoplastic effects), somatization as part of adjustment reactions due to migratory living difficulties, and somatization as post-traumatic reaction. CONCLUSION: These differences are useful to highlight the complex interrelationship between socioeconomic, migratory, cultural, and value factors in the construction of somatization among immigrants. Implications for research methodology, nosology, clinical management, and organization of medical facilities are also discussed.

Unitary psychosis (Einheitspsychose): A conceptual history.

AIMS: The objective of this paper is to explore the evolution of the forms of madness and the model that accounts for it over time. The classical distinction between several categories of mental disorders is contrasted with the idea of unitary psychosis. METHODS: Historical conceptual analysis. The concept of unitary psychosis is explored in its basic features. Its origins in the nineteenth century and developments during the twentieth century are considered. RESULTS: Following the publication of Kraepelin's fundamental handbook, the debate was shaped as pro or against the Kraepelinian dichotomy between dementia praecox and manic-depressive illness. However, the origins of the concept of unitary psychosis as well as some more recent developments are independent from it. CONCLUSIONS: This article argues that, when viewed pragmatically, both positions (the pluralist and the unitary) bring advantages that can be complementary rather than mutually exclusive. The pluralist position allows us to recognize the qualitative differences between phenomena and structures of experience, while the unitary model prevents us from reifying them. This is achieved by paying attention to the diachronic evolution and the pathogenetic dynamics.

Impact of the COVID-19 pandemic on Italian students' mental health and relationships: differences between adolescent males and females.

BACKGROUND: The negative effects of the COVID-19 pandemic on the mental health of young people have been reported, often with possible differences between the sexes. This study explores the impact of the COVID-19 pandemic on the differences in mental health status and healthy behaviors between adolescent males and females. METHODS: An online questionnaire exploring sociodemographic characteristics, living conditions, mental health, behaviors, and relationships during the implementation of the COVID-19 social restriction measures, was administered to 16-18 years old high school students living in the metropolitan area of Turin. The World Health Organization-5 Well-Being Index (WHO-5) questionnaire was used to evaluate self-perceived psychological health status. Descriptive analyses of the sample were carried out by sex. Chi-squared test and the associated P value were evaluated. The spatial sign method was used to assess multivariate differences by sex. RESULTS: Seventy-two Italian high school students completed the questionnaire. Sixty-eight percent of the students reported psychological problems, more often females (86% vs. 50%). Those living with multiple cohabitants and in dwellings with less personal space reported lower well-being. Females were also more likely to report stress when talking about COVID-19, difficulties in concentration and in falling asleep, daytime sleepiness, less physical activity, and concerns about losing control of eating. Finally, females spent more time with family members and, compared to males, found it harder to spend time and share experiences with friends and schoolmates. CONCLUSIONS: The pandemic has greatly impacted adolescents in terms of their mental well-being, routines, relationships with friends, and sleeping and eating patterns. Females reported more stress, boredom, bad mood, eating concerns, reduced relationships with friends, and possible difficulty in falling asleep than did males. These issues should be addressed when developing and promoting support programs, particularly at school.

Two years of COVID-19. Impacts on accessibility of a mental health service for immigrants and individuals in socio-economic difficulties.

OBJECTIVES: Mental health services utilization decreased dramatically during the COVID-19 pandemic. For persons who are highly vulnerable and at risk of health and social care exclusion, restrictions negatively affected the accessibility to treatments and their mental conditions. METHODS: All psychiatric and psychological interviews carried out at National Institute for Health, Migration and Poverty (INMP) Italy from January 2018 to February 2022 were included in the study. To measure services use, an interrupted time-series analysis using March 2020 as the starting data of COVID-19 pandemic period was considered, and first visits vs follow-up session numbered. RESULTS: A significant decrease was observed in March 2020 due to the lockdown restrictive measures (p<0.001). Later on, the number of psychological interventions significantly increased (p<0.05), whereas the increment of the psychiatric interventions was not significant. By the end of February 2022 the number of visits returned to pre-COVID-19 levels, although recovery was slower than expected, especially for psychiatric visits. CONCLUSIONS: After a dramatic drop during the lockdown, access to mental health out-patient clinics slowly returned to pre-pandemic levels in the next two years. Considering that mental health needs have increased during the pandemic, mental health services should improve their efforts to reduce barriers of access and to implement outreach referral.

The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics.

Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud-based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self-referentiality and permeated self-world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re-establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.

Psychopathological effects of the Coronavirus (Sars-CoV-2) imposed lockdown on vulnerable patients in treatment in a mental health outpatient department for migrants and individuals in poor socioeconomic conditions.

BACKGROUND: The effects of Sars-Cov-2 pandemic may increase vulnerability of migrants. AIMS: To investigate the effects of the governmental lockdown on the mental health of vulnerable migrants in treatment at an outpatient department. METHOD: In a telephone survey post-migration living difficulties and psychopathological symptoms were investigated, particularly post-traumatic thoughts and nightmares, anxiety, depression, feelings of tension and irritability, other sleep problems, as well as COVID-19 related fears. Psychopathological changes during the lockdown were detected and rated by clinicians. Rates of treatment discontinuation and reasons why were also recorded. RESULTS: Of 103 eligible patients, 81 answered the phone call and were included in the study. Mental symptoms were frequent but not as severe as expected. About 32% of patients in psychopharmacological treatment and almost 52% of patients in psychotherapy had discontinued treatment. Patients who were globally considered to have worsened if compared to their pre-coronavirus mental health conditions had in fact higher scores on several mental symptoms but mild specific fears about coronavirus issues, similar to those of patients improved or stable. Worsening was significantly associated with unemployment, lack of VISA, and treatment discontinuation. Shifting the way of providing psychotherapy into a web-based modality was significantly more frequent in stable/improved patients. CONCLUSION: Findings suggest that concrete life problems and treatment discontinuation more than the coronavirus fear, have predominantly affected the mental health conditions of our patients.

Influence of post-migration living difficulties on post-traumatic symptoms in Chinese asylum seekers resettled in Italy.

BACKGROUND: Little is known about mental health and resettlement difficulties of Chinese asylum seekers fleeing China due to religious persecutions. AIM: This study explores main post-migration living difficulties (PMLD) in this population, with a focus on their role in post-traumatic stress disorder (PTSD). METHODS: A total of 67 patients (95.52% women, mean age 34.75 ± 7.63) were included in the study. The Harvard Trauma Questionnaire (HTQ) was used to assess PTSD, the List of Migration Experiences (LiMEs) was used for pre-migration and post-migration experiences (potentially traumatic events as well as living difficulties). The t-test was used to examine the differences in pre-migration and post-migration mean scores. Logistic regression was used to test the effect of pre-migration traumatic experiences (PMTE) and most frequent PMLD on having a PTSD. RESULTS: A total of 49 patients scored above the HTQ cut-off score for PTSD. As expected, traumatic experiences were concentrated in the pre-migration phase, while living difficulties were present in both phases but more frequently in the post-migration period. PMTE were significantly related to PTSD (OR 1.29, p = .01). However, three PMLD ('Feeling that you do not know where you will lend up tomorrow', 'Loneliness and boredom' and 'Not being able to find work') showed a significant interaction with PMTE, suggesting that their presence in the post-migration phase has a modulation effect by increasing the likelihood of PTSD. CONCLUSION: This study extends to Chinese asylum seekers the previous evidence that PMLD have a significant role in the likelihood to have a PTSD after landing in the host country.

The influence of Max Weber on the concept of empathic understanding (Verstehen) in the psychopathology of Karl Jaspers.

This paper explores key concepts in the writings of Weber in the years preceding the publication of the first edition of Karl Jaspers' Allgemeine Psychopathologie, focusing on the concept of understanding (Verstehen). This is a key hermeneutic concept and is discussed within the larger context of the epistemological and methodological reflections of both authors. They similarly tried to import the understanding within the humanistic disciplines as a rigorous but anti-reductionist scientific method. However, while Weber tried to mix explanation and understanding according to a legal metaphor, Jaspers retained Dilthey's sharper distinction between explanation in natural sciences and understanding in humanistic sciences. Finally, Jaspers' understanding is relatively more empathic, while Weber's understanding is more rationalistic.

The Impact of Translational Neuroscience on Revisiting Psychiatric Diagnosis: State of the Art and Conceptual Analysis.

This paper reviews translational research in psychiatry, focusing on those programs addressing the problem of the validity of psychiatric diagnoses. In medicine in general, and in psychiatry in particular, the term "translational" is used with different meanings. A conceptual analysis suggests that there are at least seven different types of translational research in psychiatry: T1 ("bench-to-bedside" development of tools and treatments), T2 (application of animal models to human psychiatry), T3 (papers focusing on the mind-brain gap, studying biological, neurobiological and cognitive dysfunctions), T4 (personalised therapies and prediction of treatment responses), T5 ("bedside-to-bench" translation of population data for laboratories), T6 (implementation of treatments at the population level, including accessibility and quality of services), and T7 (improving translational knowledge in residents' trainings and researchers' careers). Concerning the problem of validity of psychiatric diagnoses, new neurocognitive models like the Research Domain Criteria project are considered, in particular the translational program of cross-validation aimed at reducing the gap between neuroimaging data and psychopathological scores derived from rating-scales. It is shown that these programs are useful, filling some of the current research gaps, but it is also stressed that they carry implicit realist and reductionist assumptions. It is finally suggested that the formation of mental symptoms is a complex process involving both neurocognitive and semantic factors, which raises doubts about the possibility of complete translations, without residuals.

Neural functional correlates of empathic face processing.

OBJECTIVES: Empathy is a human trait related to the ability to share someone else's feelings, and emotional face processing is one of its measures. Functional Magnetic Resonance Imaging (fMRI) studies showed significant neural correlates of empathic face processing. We aimed to identify those brain areas most consistently involved in empathy for emotional faces. METHODS: We carried ALE meta-analysis of whole-brain data from fMRI studies during empathic face-processing tasks. We included 23 studies conducted on a total of 568 participants (247 males and 321 females, mean age 32.2 years). RESULTS: Emotional vs. control faces processing significantly correlated with activations of the left anterior cingulate cortex (BA 32), right precentral gyrus (BA 6), left amygdala, right superior frontal gyrus (BA 9), left middle occipital gyrus (BA 37), right insula (BA 13), left putamen, and left posterior cingulate cortex (BA 31). CONCLUSIONS: Empathy is a complex process correlating with bi-hemispheric cortico-limbic activations involved in emotional cue processing, self-other/same-different discrimination, perspective-taking, theory of mind, emotional arousal, and decision-making.

Obesity is associated with lack of inhibitory control and impaired heart rate variability reactivity and recovery in response to food stimuli.

Recent theories compare obesity with addiction in terms of lack of inhibitory control in both clinical populations. The present study hypothesized impaired inhibition in obese patients reflected both in executive functions and reduced vagal tone (indexed by a decrease in heart rate variability; HRV) in response to food stimuli. Twenty-four inpatients with obesity (19 women) and 37 controls (24 women) underwent ECG monitoring during baseline, food stimuli viewing, and a recovery phase. Tests and questionnaires assessing inhibitory control and psychopathological dispositions were also administered. As hypothesized, patients were characterized by deficits in all the tests measuring inhibitory capacities. Results also show greater HRV reduction and impaired HRV recovery in response to food stimuli in obese patients compared to controls. The drive to eat experienced by obese patients in the absence of caloric need may rely on impairments in inhibitory and vagal functioning. Results are discussed in terms of implications for therapy.

Empathy in the early 20th century: Moritz Geiger and the importance of conceptual clarification.

This article discusses Geiger's review of empathy, expressed in a lecture at the IV German Congress of Experimental Psychology in 1910. It deals with the key psychological question of how it is possible to know the minds of others. This question is complex and needs clarification, so Geiger divided it into 3 basic questions: The first is phenomenological (what is the conscious experience of empathy?); the second relates to the psychological function performed by the empathic act; and the third question asks whether and how empathy is acquired during personal development. Finally, Geiger introduces a distinction between basic empathy and reliving. Geiger's conceptual clarification is discussed and its relevance for the psychology and philosophy of his time is considered, as well as its possible influence on Jaspers' General Psychopathology. Finally, the current debate in the neurocognitive science of empathy is examined in light of Geiger's conceptualization. (PsycINFO Database Record

The hermeneutics of mental symptoms in the Cambridge School / A hermenêutica de sintomas mentais na Escola de Cambridge / L’herméneutique de symptômes mentaux selon l’École de Cambridge / La hermenéutica de los síntomas mentales en la Escuela de Cambridge / Die Hermeneutik der psychischen Symptome gemäß der Schule von Cambridge / 精神症状在剑桥学派的解释学

Current Psychiatry is in crisis. Decades of neuroscientific research have not yet delivered adequate explanations or treatments. One reason for this failure may be the wrongness of its central assumption, namely that mental symptoms and disorders are natural kinds. The Cambridge School has proposed that a new Epistemology must be constructed for Psychiatry, and that this should start with the development of a new model of mental symptom-formation. ‘Mental symptoms’ should be considered as hermeneutic co-constructions occurring in a intersubjective space created by the dialogue between sufferer and healer. Subjective experiences (caused either by neurobiological or psychosocial upheaval) penetrate the awareness of sufferers causing perplexity and/or distress. To understand, handle and communicate these experiences, sufferers proceed to configure them by means of templates borrowed from their own culture. Importantly, however, the same neurobiological information can be configured into different symptoms; and different neurobiological information into the same symptom. Therefore, ‘mental symptoms’ are dissimilar hybrid combinations of neurobiological and cultural information. To be ethical, therapeutic interventions must take into account such dissimilarities. Blind manipulation of the brain in all cases should be considered as counterproductive.

A Psiquiatria atual está em crise. Décadas de pesquisa neurocientífica ainda não resultaram em explicações ou tratamentos adequados. Uma das razões para esse fracasso pode ser sua hipótese central equivocada, ou seja, de que os sintomas e desordens mentais são tipos naturais. A Escola de Cambridge propôs a construção de uma nova epistemologia para a Psiquiatria, que deve começar com o desenvolvimento de um novo modelo de formação de sintomas mentais. “Sintomas mentais” devem ser considerados uma coconstrução hermenêutica que ocorre em um espaço intersubjetivo criado pelo diálogo entre paciente e médico. Experiências subjetivas (causadas por convulsão neurobiológica ou psicossocial) penetram na consciência dos pacientes, causando perplexidade e/ou sofrimento. Para entender, manipular e comunicar essas experiências, os pacientes seguem para configurá-las por meio de modelos emprestados de sua própria cultura. É importante notar, no entanto, que a mesma informação neurobiológica pode ser configurada em diferentes sintomas e diferentes informações neurobiológicas, no mesmo sintoma. Portanto, “sintomas mentais” são combinações híbridas diferentes de informações neurobiológicas e culturais. Para serem éticas, intervenções terapêuticas devem levar em conta essas diferenças. A manipulação cega do cérebro deve, em todos os casos, ser considerada contraproducente.

La psychiatrie contemporaine est en crise. Des décennies de recherche neuroscientifique n’ont pas été capables de produire ni des explications, ni des traitements appropriés. Cet échec est peut-être partiellement dû à l’ambiguïté de son hypothèse centrale, selon laquelle les symptômes et les troubles mentaux sont des types naturels. L’École de Cambridge propose la construction d’une nouvelle épistémologie pour la psychiatrie, à commencer par l’élaboration d’un nouveau modèle de formation de symptômes mentaux. Ceux-ci doivent être considérés comme des co-constructions herméneutiques qui se produisent dans un espace intersubjectif créé par le dialogue entre le patient et le médecin. Des expériences subjectives (qui résultent de bouleversements neurobiologiques ou psychosociaux) pénètrent la conscience des patients et causent la perplexité et/ou la souffrance. Pour comprendre, gérer et communiquer ces expériences, les patients les configurent à l’aide de modèles empruntés à leur propre culture. Cependant, il est important d’observer qu’une unique information neurobiologique peut être configurée par de différents symptômes et que des informations neurobiologiques différentes peuvent à leur tour être configurées par un seul symptôme. Par conséquent, « les symptômes mentaux ¼ sont des combinaisons hybrides différentes, composées d’informations neurobiologiques et culturelles. Pour pouvoir respecter l’éthique, les interventions thérapeutiques doivent prendre en compte ces différences. La manipulation aveugle du cerveau doit, dans tous les cas, être considérée comme solution contre-productive.

La Psiquiatría actual está en crisis. Décadas de investigación neurocientífica aún no han entregado explicaciones o tratamientos adecuados. Una de las razones a las que se le atribuye este fracaso puede ser la injusticia de su supuesto central, es decir, que los síntomas y desórdenes mentales son tipologías naturales. La Escuela de Cambridge ha propuesto que una nueva epistemología debe ser construida para la Psiquiatría y que esto debería empezar con el desarrollo de un nuevo modelo de formación del síntoma mental. Los “síntomas mentales” deberían ser considerados una co-construcción hermenéutica que se da en un espacio intersubjetivo creado por el diálogo entre el paciente y quien cura. Las experiencias subjetivas (ya sean causadas por trastornos neurobiológicos o psicosociales) penetran la consciencia de los pacientes causando perplejidad y/o angustia. Para entender, controlar y comunicar estas experiencias, los pacientes proceden a configurarlas a través de plantillas tomadas de su propia cultura. Cabe destacar, sin embargo, que la misma información neurobiológica puede ser configurada en diferentes síntomas y diferentes informaciones neurobiológicas en el mismo síntoma. Por lo tanto, los “síntomas mentales” son combinaciones híbridas disímiles de informaciones neurobiológicas y culturales. Para ser éticas, las intervenciones terapéuticas deben tener en cuenta tales disimilitudes. La manipulación del cerebro debería ser considerada, en todos los casos, contraproducente.

Die zeitgenössische Psychiatrie befindet sich in Krise. Jahrzehnte neuro¬wissen¬schaftlicher Forschung haben weder angemessene Erläuterungen, noch Behandlungen geliefert. Einer der Gründe für dieses Versagen könnte die Ambiguität ihrer zentralen Hypothese sein, nämlich dass psychische Symptome und Störungen natürliche Typen sind. Die Schule von Cambridge schlägt nun vor, eine neue Erkenntnistheorie für Psychiatrie zu erstellen, die mit der Entwicklung eines neuen Modells der psychischen Symptombildung beginnen müsste. „Psychische Symptome“ sind demnach hermeneutische Co-Konstruktionen, die sich in einem intersubjektiven Bereich manifestieren, der durch den Dialog zwischen Arzt und Patient geschaffen wird. Subjektiven Erfahrungen (die entweder durch neurobiologische oder psychosoziale Änderungen verursacht werden) dringen in das Bewusstsein des Patienten und verursachen Verwirrung und/oder Leiden. Um diese Erfahrungen zu verstehen, zu verarbeiten und mitzuteilen, konfiguriert sie der Patient mit Hilfe von Modellen, die aus seiner eigenen Kultur entlehnt werden. Es muss hier jedoch beachtet werden, dass die gleiche neurobiologische Information in unterschiedliche Symptome konfiguriert werden kann und dass andererseits verschiedene neurobiologische Informationen mittels eines einzigen Symptoms konfiguriert werden können. Daher sind „psychische Symptome“ abweichende hybride Kombinationen, die aus neurobiologischen und kulturellen Informationen bestehen. Um der Ethik gerecht zu werden, müssen therapeutische Interventionen diese Unterschiede berücksichtigen. Blinde Gehirnmanipulation muss in allen Fällen als kontraproduktiv angesehen werden.

当前精神病学正处于危机之中。几十年神经科学的研究还没有提供足够的解释或处理。其中一个可能导致此失败的原因是其核心假设的不正确性：精神症状和疾病是自然种类。剑桥学派提出了需要构造精神病学的一个新认识论，而这应该开始于发展精神症状形成的一个新模式。对于“心理症状”的考虑应由患者和医者在对话时共同建设的一个主体间的空间。主观经验（由任何神经生物学或心理状态所产生的）穿透患者的意识而导致困惑和/或痛苦。为了理解，处理和交流这些经验，患者会借鉴自己文化的内容设置此经验的意义。可是重要的是，同样的神经...

[The concept of "understanding" (Verstehen) in Karl Jaspers]. / El concepto de "comprensión" (Verstehen) en Karl Jaspers.

This article explores the relationship between empathy and psychopathology. It deals with the concept of "understanding" in Jaspers' General Psychopathology, 100 years after the publication of its first edition. The Jaspersian proposal has the person and his/her experience as its primary object of study, just as in Ortegas' vital reason. Jaspers' understanding is not rational but empathetic, based on the co-presence of emotional content and detailed descriptions. Jaspers' methodology is essentially pluralistic, considering both explanation and understanding, necessary for psychopathology. Despite certain limits, the concept of understanding is the backbone of the psychopathological reasoning, and has proven useful over a century of clinical practice. However, it needs a review covering the recent epistemological and clinical findings. "To be understandable" is a relational property that emerges from a semiotic process. Therefore, an effective psychology should encompass an inter-subjective process, and get away from strict rationalism.

El concepto de "comprensión" (Verstehen) en Karl Jaspers / [The concept of \"understanding\" (Verstehen) in Karl Jaspers].

This article explores the relationship between empathy and psychopathology. It deals with the concept of "understanding" in Jaspers’ General Psychopathology, 100 years after the publication of its first edition. The Jaspersian proposal has the person and his/her experience as its primary object of study, just as in Ortegas’ vital reason. Jaspers’ understanding is not rational but empathetic, based on the co-presence of emotional content and detailed descriptions. Jaspers’ methodology is essentially pluralistic, considering both explanation and understanding, necessary for psychopathology. Despite certain limits, the concept of understanding is the backbone of the psychopathological reasoning, and has proven useful over a century of clinical practice. However, it needs a review covering the recent epistemological and clinical findings. "To be understandable" is a relational property that emerges from a semiotic process. Therefore, an effective psychology should encompass an inter-subjective process, and get away from strict rationalism.

[Integrated day-hospital treatment in subjects with overeating disorders]. / Il trattamento integrato in day-hospital per i disturbi del comportamento alimentare caratterizzati da iperalimentazione.

BACKGROUND: The efficacy of a multidisciplinary, intensive and integrated day-hospital treatment was evaluated in a group of overeaters (bulimia nervosa, binge eating disorder, obesity without binging). METHODS: The study sample included 72 subjects consecutively admitted to DH who were evaluated at the first contact with the service, on admission, after 5 weeks of treatment, and at discharge. The primary outcome was the total score at the Eating Disorder Inventory (EDI), and the secondary outcome was change in body mass index (BMI). The effects of the duration of treatment on results were also assessed. The improvement of EDI and BMI was compared between the two groups of bingers and non-bingers. RESULTS: Four patients dropped during the treatment period. In the whole sample, both EDI and BMI improved significantly after 5 weeks (p=0.00) and continued to improve until the end of treatment (p=0.00). The duration of treatment did not have a significant impact on BMI improvement (p=0.07), but significantly affected EDI improvement (p=0.006), although only during the treatment period. No significant differences were observed between obese/overweight bingers and non-bingers in BMI improvement (p=0.41), whereas EDI improvement was higher in bingers (p=0.02). CONCLUSIONS: The relatively good compliance and the efficacy data suggest that in overeating subjects resistant to previous outpatient treatments a more intensive DH treatment may be useful. Our findings show that such a multidisciplinary therapeutic-rehabilitative treatment significantly improves both total EDI score (especially in bingers) and BMI.

Traumatic events, post-migration living difficulties and post-traumatic symptoms in first generation immigrants: a primary care study.

OBJECTIVES: To study potentially traumatic events (PTE), post-traumatic stress disorder (PTSD), anxiety, depression, somatization and post-migration living difficulties (PMLD) in primary care immigrants. DESIGN: Patients self-rated transculturally validated questionnaires. Those with and without PTSD were compared on all variables. The influence of the number of PTE and of PMLD on PTSD was measured. RESULTS: 391 patients completed the questionnaires. Prevalence of PTSD was 10.2%. PTE and PMLD were frequent in the whole sample but more common in PTSD subjects. Either the number of PTE and of PMLD significantly increased the likelihood to have a PTSD. CONCLUSIONS: PTE, PMLD, PTSD and related conditions (anxiety, depression and somatization) are frequent among immigrants in primary care, and either PTE and PMLD significantly influence resulting psychopathology. The implications in clinical practice are discussed.

Philosophy of clinical psychopharmacology.

The renewal of the philosophical debate in psychiatry is one exciting news of recent years. However, its use in psychopharmacology may be problematic, ranging from self-confinement into the realm of values (which leaves the evidence-based domain unchallenged) to complete rejection of scientific evidence. In this paper philosophy is conceived as a conceptual audit of clinical psychopharmacology. Its function is to criticise the epistemological and methodological problems of current neopositivist, ingenuously realist and evidence-servant psychiatry from within the scientific stance and with the aim of aiding psychopharmacologists in practicing a more self-aware, critical and possibly useful clinical practice. Three examples are discussed to suggest that psychopharmacological practice needs conceptual clarification. At the diagnostic level it is shown that the crisis of the current diagnostic system and the problem of comorbidity strongly influence psychopharmacological results, new conceptualizations more respondent to the psychopharmacological requirements being needed. Heterogeneity of research samples, lack of specificity of psychotropic drugs, difficult generalizability of results, need of a phenomenological study of drug-induced psychopathological changes are discussed herein. At the methodological level the merits and limits of evidence-based practice are considered, arguing that clinicians should know the best available evidence but that guidelines should not be constrictive (due to several methodological biases and rhetorical tricks of which the clinician should be aware, sometimes respondent to extra-scientific, economical requests). At the epistemological level it is shown that the clinical stance is shaped by implicit philosophical beliefs about the mind/body problem (reductionism, dualism, interactionism, pragmatism), and that philosophy can aid physicians to be more aware of their beliefs in order to choose the most useful view and to practice coherently. In conclusion, psychopharmacologists already use methodological audit (e.g. statistical audit); similarly, conceptual clarification is needed in both research planning/evaluation and everyday psychopharmacological practice.