The Responsiveness of Mental Health Service Professionals to Two Years of Pandemic Emergency in Italy.

This multicenter cross-sectional study explored the responsiveness of Mental Health Services (MHS) to two years of COVID-19 emergency in Italy. Specifically, the study explored the ability of staff to: acknowledge users' capabilities and value teamwork; reinvent the service and maintain/introduce good practices; and, acknowledge the positive aspects of the pandemic experience. These aspects were investigated in relation to socio-demographic and professional variables. Professionals from 17 MHS of 15 Italian Regions completed an online questionnaire on the MHS transformation during COVID-19. Data were collected at the end of the national health emergency (March 1-April 30, 2022). Most of the 1077 participants said they: paid more attention to users' physical health; revised treatment plans; mediated between user needs and safe work procedures; revalued the importance of gestures and habits; discovered unexpected personal resources in users; and, found positive aspects in the COVID-19 experience. The multivariate analyses showed significant differences in staff opinions related to gender, workplace, professional role, and geographic area of the MHS, covarying with staff work experience. Compared to male staff, female staff perceived MHS as more flexible and capable to maintain best practices, and female staff acknowledged more capabilities to the users. Compared to central and northern Italy staff, southern Italy staff gave more values to teamwork, perceived MHS as more capable to maintain best practices and acknowledged higher positive transformations. These findings may be useful for planning community-oriented MHS in the post-pandemic period, taking into account both the experience gained by staff and the MHS process of adaptation.

SCL-90 empirical factors predict post-surgery weight loss in bariatric patients over longer time periods.

PURPOSE: This longitudinal study examined how pre-intervention psychological health helps predict bariatric surgery (BS) success as percentage of expected body mass index loss (%EBMIL) over shorter to longer periods. METHODS: Adult candidates for BS (N = 334, 67.4% females) completed the Symptoms Checklist 90 (SCL-90) questionnaire; on average, 11 months occurred between the pre-surgery psychological evaluations and the bariatric intervention. We explored the factor structure of the SCL-90 items and inspected how SCL-90 empirical factors compared with SCL-90 scales and general indices predicted %EBMIL at 3-6-month, 1-year, and 2-year follow-up occasions, adjusting for gender, pre-intervention use of antidepressants and actual and ideal BMIs. RESULTS: Factor analysis combined the 90 items into 8 factors, which partially replicated the expected item structure. The SCL-90 empirical factors (but not the SCL-90 scales and indices) contributed to predict BS success. In fact, the Relational Distress factor directly protected from weight regain at 1-year follow-up, indirectly via 1-year %EBMIL at the 2-year follow-up, when it further strengthened the impact of the empirical factor of Generalized Anxiety on the 2-year BS outcome. The results also evidenced a cascade effect of the pre-surgery actual BMI across time as well as unique and direct effects of pre-surgery use of antidepressants and perceived ideal BMI on the 2-year outcome. CONCLUSIONS: SCL-90 empirical factor scores for obese patients are more efficient in anticipating BS success compared with original scale scores. They reveal that relational distress and anxiety are risk factors for postoperative weight loss, in addition to pre-intervention actual BMI, antidepressant therapy, and perceived ideal BMI. LEVEL OF EVIDENCE: III, well-designed cohort.

What does dependency on community mental health services mean? A conceptual review with a systematic search.

PURPOSE: Although community mental health services aim to support patients' autonomy and independence, they have repeatedly been criticised for making patients dependent. Yet, it remains often unclear what exactly is meant with dependency in this context. This review aimed to identify the meaning of the term dependency on community services in the literature. METHODS: A systematic search and conceptual review of papers where dependency is used in the context of community mental health services. Narrative synthesis was used to identify thematic concepts linked to dependency in these settings. RESULTS: Fifteen papers met the inclusion criteria. The analysis identified five different concepts of dependency on community mental health services: dislocation from the outside world; inflexibility and lack of freedom; obligation as resentment or appreciation; living with or without meaningful activities; and security. CONCLUSIONS: The findings suggest that, distinct from the exclusively negative connotation of the term dependency in a conventional medical context, dependency on community mental health services contains both negative and positive aspects. The different aspects might guide the future evaluation of the care provided in such services.

No-Restraint Committed General Hospital Psychiatric Units (SPDCs) in Italy-A Descriptive Organizational Study.

This study describes and explores the application of no-restraint policies in General Hospital Psychiatric Units (GHPUs) in Italy, a country pioneering in deinstitutionalization and psychiatric reform. The research aims to assess the organizational characteristics and effectiveness of no-restraint practices, contributing to the global discourse on humane psychiatric care. Following a purposive sampling approach, a nationwide descriptive study was conducted involving a detailed online survey distributed to 24 GHPUs actively engaged in or aspiring toward no-restraint practices. The survey, comprising 60 items across seven sections, gathered comprehensive data on the structural, organizational, and operational dimensions of the units, along with the prevalence and management of restraint episodes. Results reveal a significant commitment to no-restraint policies, with 14 GHPUs reporting zero restraint incidents in 2022. Despite variations in infrastructure and staffing, a common thread was the implementation of systematic procedures and risk management training aimed at reducing coercive practices. The study identified a correlation between the use of exclusive garden spaces and an increased incidence of restraints, suggesting nuanced factors influencing restraint practices. The findings underscore the viability and ethical alignment of no-restraint practices within psychiatric care, highlighting the crucial role of organizational protocols and training. This research adds empirical weight to the advocacy for restraint-free environments in mental health settings, signaling a paradigm shift toward more humane and rights-respecting psychiatric care.

"Spiceophrenia": a systematic overview of "spice"-related psychopathological issues and a case report.

OBJECTIVES: The use of synthetic cannabimimetics (SC; "spice" drugs) is increasing, especially among teenagers and young adults. In parallel with this, the number of studies describing intoxication episodes associated with psychotic symptoms in SC users is growing. We present both a systematic review of the related literature and a case report, which seems to highlight the existence of a possible association between SC use and psychosis. METHODS: Some 223 relevant studies were here identified and reviewed. Out of these, 120 full text articles were assessed for eligibility, and 41 were finally included in the systematic review. RESULTS: According to the available data from the studies here identified, SC's average age of users was 22.97 years, and the male/female ratio was 3.16:1. SC compounds most often reported in studies using biological specimen analysis were JWH-018, JWH-073, JWH-122, CP-47,497, and JWH-250. Mounting evidence seemed to suggest that psychotic symptoms such as hallucinations and delusions may occur in acute/chronic SC users. CONCLUSIONS: Although a clear causal link may not be here identified, the available evidence suggests that SC can trigger the onset of acute psychosis in vulnerable individuals and/or the exacerbation of psychotic episodes in those with a previous psychiatric history.

Views of Mental Health Professionals on Positive Changes in Service Practices and Staff-User Relationships After One Year of Covid-19 Pandemic in Italy.

This study explored views of mental health services (MHS) professionals regarding positive changes in service practices and organizations, and staff-user relationships after one year of COVID-19 in Italy. Professionals from a community-oriented MHS completed online the Questionnaire on MHS Transformations during the COVID-19 pandemic, a 30-item tool developed by a participatory approach and validated. Of the 184 participants, 91.8% felt it was "true/definitely true" that during the pandemic they had informed users on procedures to reduce contagion risks, and 82.1% stated that they had increased telephone contact with users. Sixty-nine percent of professionals reported that staff revised treatment plans according to new needs of care and 78.6% stated that they had been able to mediate between user needs and safe working procedures. Moreover, 79.4% of respondents stated that they had rediscovered the importance of gestures and habits, and 65% that they had gained strength among colleagues to face fear. Fifty-four percent of participants admitted that they had discovered unexpected personal resources in users. Overall, 59.6% of participants stated that they found some positives in the COVID-19 experience. Perceived positive changes was greater among professionals from community facilities vs. those from hospital and residential facilities. In community-oriented MHS, the pandemic offered an opportunity to change practices and rethink the meaning of relationships between people. This data may be useful in generating a more balanced understanding of COVID-19's impact on MHS and for MHS planning in the pandemic era.