Implementation of Individual Placement and Support in Italy: The Reggio Emilia Experience.

Individual placement and support (IPS) is an evidence-based intervention helping people with mental illness to obtain competitive jobs. In the last decade, European mental health leaders were interested on its implementation. Aim of the study was to assess the IPS feasibility in Italian patients with moderate-to-severe mental illness. To date, no evaluation of IPS has been conducted exclusively in Italy. Participants (n = 95) were clients of community mental health centers of the Reggio Emilia Department of Mental Health. In addition to drop-out rates, we calculated job acquisition, job duration, and total hours per week worked. A crude competitive employment rate of 41.1% and a crude drop-out rate of 30.5% were found over 42-month follow-up period. Using a Kaplan-Meyer survival analysis, the cumulative employment rate increased up to 44% at 12 months and 61% both at 24 and 42 months. This study documents the feasibility of an implementation strategy for introducing the IPS model in the public mental health care system in Italy.

Confabulation affecting Temporal Consciousness significantly more than Knowing Consciousness.

Confabulation, defined as the production of statements and actions that are unintentionally incongruous to the patient's history, background, present and future situation, is a rather infrequent memory disorder, which usually affects patients with significant memory impairment, but may be also observed in patients with normal memory and learning abilities. Confabulation may be selective affecting some cognitive, memory domains while relatively sparing others. In particular, it may affect more Temporal Consciousness, i.e. a specific form of consciousness that allows individuals to remember their personal past, to be oriented in their present world and to predict their personal future, than Knowing Consciousness, i.e. a specific form of consciousness allowing individuals to be aware of past, present and future impersonal knowledge and information. In this study we evaluated confabulations in TC and KC in a group of confabulatory amnesics of various aetiologies. Based on previous studies, it was predicted that confabulations affect significantly more TC than KC. It was also predicted that "Habits Confabulations", i.e. habits and repeated personal events mistaken as specific, unique past and future personal episodes, is the more frequently observed type of confabulation. The results confirmed these predictions and are discussed within the framework of the Memory, Consciousness and Temporality Theory.

Screening for confabulations with the confabulation screen.

The objective of this work is to devise and validate a sensitive and specific test for confabulatory impairment. We conceived a screening test for confabulation, the Confabulation Screen (CS), a brief test using 10 questions of episodic memory (EM), where confabulators most frequently confabulate. It was postulated that the CS would predict confabulations not only in EM, but also in the other subordinate structures of personal temporality, namely the present and the future. Thirty confabulating amnesic patients of various aetiologies and 97 normal controls entered the study. Participants were administered the CS and the Confabulation Battery (Dalla Barba, G., & Decaix, C. (2009). "Do you remeber what you did on March 13 1985?" A case study of confabulatory hypermnesia. Cortex, 45(5), 566-574). Confabulations in the CS positively and significantly correlated with confabulations in personal temporality domains of the CB, namely EM, orientation in time and place and episodic plans. Conversely, as expected, they did not correlate with confabulations in impersonal temporality domains of the CB. Consistent with results of previous studies, the most frequently observed type of confabulation in the CS was Habits Confabulation. The CS had high construct validity and good discriminative validity in terms of sensitivity and specificity. Cut-off scores for clinical and research purposes are proposed. The CS provides efficient and valid screening for confabulatory impairment.

Individual placement and support in Italian young adults with mental disorder: Findings from the Reggio Emilia experience.

AIM: Individual placement and support (IPS) has a considerable body of evidence for its effectiveness in helping people with mental disorder to achieve and maintain competitive jobs. However, little data in young adult populations are currently available, especially in Europe. Aim of this study was to assess the effect of IPS in Italian young adults with moderate-to-severe mental illness, examining the main competitive employment outcomes and drop out rates during a 3-year follow-up period. METHODS: Participants (n = 54) were recruited from patients receiving psychiatric treatment in one of the seven adult Community Mental Health Centers of the Reggio Emilia Department of Mental Health. Together with drop out rates, we investigated job duration (total number of days worked), job acquisition (employment in the labour market for at least 1 day during the follow-up), total hours per week worked, and job tenure (weeks worked on the longest-held competitive job). RESULTS: A crude competitive employment rate of 40.7% and a crude drop out rate of 22.2% over the 3-year follow-up period were found. However, 66% of 42 clients who remained in the program over 3 years gained competitive employment at some time during the 3-year period. CONCLUSIONS: This research shows the feasibility of an IPS intervention model in the public mental health care system in Italy, especially for a young adult target population.

The confabulation battery: Instructions and international data from normal participants.

Confabulation is an unusual sign in neurological and in neuropsychological pathologies. In this article we present an objective neuropsychological instrument, the Confabulation Battery (CB), which allows the quantifying and qualifying of different types of confabulations. The CB was administered to French and Italian normal participants. Data from the present study will allow clinicians and researchers, using the CB, to know how much and in which memory domains their confabulating patients confabulate compared to normal participants. We present international data, instructions and guidelines for the CB, a tool used in different ways worldwide. Not quantifying confabulations, namely not reporting how much and in which domain patients confabulate, can hardly lead to conclusions on the neurocognitive bases of this phenomenon. Following the instructions in this article, versions of the CB can be adapted in different languages and cultures. Quantification and qualification of confabulation is necessary and demanded in order to compare sensibly data from different research and clinical groups.

Different patterns of confabulation in left visuo-spatial neglect.

Confabulating patients produce statements and actions that are unintentionally incongruous to their history, background, present and future situation. Here we present the very unusual case of a patient with right hemisphere damage and signs of left visual neglect, who, when presented with visual stimuli, confabulated both for consciously undetected and for consciously detected left-sided details. Advanced anatomical investigation suggested a disconnection between the parietal and the temporal lobes in the right hemisphere. A disconnection between the ventral cortical visual stream and the dorsal fronto-parietal networks in the right hemisphere may contribute to confabulatory behaviour by restricting processing of left-sided stimuli to pre-conscious stages in the ventral visual stream.

A longitudinal study of confabulation.

Confabulation, the production of statements and actions that are unintentionally incongruous to the subject's history, background, present and future situation, is a rather infrequent disorder, observed in several conditions affecting the nervous system. Little is known about the quantitative and qualitative evolution of confabulation in time. In this study we evaluated longitudinally the evolution of this disorder in a group of severe confabulators, using the Confabulation Battery (CB), a sensitive tool to detect confabulations in various memory domains. It was found that confabulations were stable over time and not temporally limited. It was also found that "Habits Confabulations" (HCs), i.e., habits and repeated personal events mistaken as specific, unique past and future personal episodes, or well-known public events when semantic knowledge is concerned, was the more frequently observed type of confabulation. Confabulations were also more prominent in the domain of Temporal Consciousness (TC), i.e., a specific form of consciousness that allows individuals to remember their personal past, to be oriented in their present world and to predict their personal future, than in Knowing Consciousness (KC), i.e., a specific form of consciousness allowing individuals to be aware of past, present and future impersonal knowledge and information. Confabulations showed also persistence, i.e., confabulations at the same questions over time, and consistency, i.e., same type of confabulation at the same question over time. These findings are discussed within the framework of the Memory, Consciousness and Temporality Theory.

Surgical treatment of class II dento-facial deformity during adolescence: Long-term follow-up.

PURPOSE: The purpose of this study is to evaluate the long-term stability of patients operated during adolescence on the base of clinical measurements and cephalometric analysis. Although, the potential benefits of early orthognathic surgery are known to be a reduction in treatment times and a greater healing potential leading to a better adaptation and stability of the occlusion, muscles, bones and joints, no consensus can be found in literature on the minimum age for surgical correction. MATERIALS AND METHODS: In this study, thirty patients (age ≤ 15) with a class II dento-skeletal malocclusion were selected, of which 11 having a hyperdivergent (II,1) and 19 a hypodivergent (II,2) growth pattern, representing 2 distinct groups with a different treatment plan and long-term behavior. RESULTS AND CONCLUSION: Observing the performance of all parameters over-time, it is seen that subjects belonging to division II,2 have a modification of the growth vectors maintaining the harmonious development between the jaws and the facial aesthetics. Less predictable is the trend in hyperdivergent patients, which are more prone to relapse in the long-term. Early surgery in these patients should be considered in the light of the degree of deformity and its influence felt by the patient on his development of self-image and interpersonal relationship.

Recovery from confabulation after normotensive hydrocephalus shunting.

Confabulation, the production of statements and actions that are unintentionally incongruous to the subject's history, background, present and future situation, is observed in several conditions affecting the nervous system, but it has never been described in normotensive hydrocephalus. In this article we report on a patient with normotensive hydrocephalus who suffered from an amnesic-confabulatory syndrome. After hydrocephalus shunting, both amnesia and confabulation cleared up abruptly. We discuss this finding in terms of a possible disconnection of the hippocampus, due to transitory white matter damage, which may have recovered after hydrocephalus shunting.