Exploration of psychometric properties of the Italian version of the Core Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE).

There is an increasing need of outcome measures for young people suitable to evaluate treatments and routine settings. However, measures must show suitable psychometric characteristics for such use. This is the first psychometric evaluation of the Italian version of the Core Young Person Clinical Outcomes in Routine Evaluation (YP-CORE). Data are reported for a clinical sample, aged 11-17 (n=175) and non-clinical sample, aged 11-17 (n=206). Analyses included acceptability, confirmatory factor analysis, internal reliability, influence of gender and age on cutoff scores and reliable change. The YP-CORE acceptability was good, with a very high completion rate (98.7% fully completed). Internal consistency was good: the overall Cronbach's alpha value (α) equal to 0.75 (95% confidence interval=0.69-0.80). The measure was sensitive to change (Cohen dz=1.35). The Italian version of the YP-CORE showed acceptable psychometric properties is suitable for use in services for young people as a change/outcome measure.

Early Eye Movement Desensitisation and Reprocessing (EMDR) intervention in a disaster mental health care context.

'Early psychological intervention' is defined as commencing treatment within three months of the traumatic event, with the aim to prevent or treat posttraumatic stress disorder, ongoing distress or acute stress disorder. In natural disaster situations, specific issues may limit the amount of time available for treatment and the possibility of interventions. Eye Movement Desensitisation and Reprocessing (EMDR) can be used without regard to these limits. The aim of the study is to evaluate the effects of EMDR, Recent Traumatic Episode Protocol (R-TEP) provided within three months of the traumatic event to a large sample of individuals exposed to the earthquake that hit Emilia Romagna Region (Northern Italy) in 2012. This study is based on a retrospective review of medical records collected during the activities of psychological and psychosocial unit in the immediate aftermath of earthquake. In total, 529 participants completed the Impact of Event Scale Revised (IES-R) (pre e post treatment). In order to provide a comparison similar to a waitlist-like control group, a method of cohort analysis was applied. In addition, possible time dependent effect was tested. ET (early-treated sample, participants treated within one month after the earthquake) and LT (late-treated sample, participants treated after the first month from the earthquake) reported at post-treatment an improvement to a level below the IES-R cutoff (65.8% of the ET sample and 64.02% of the LT sample). Control group analogue and time-outcome correlation suggest that positive changes in symptoms were likely due to the treatment provided and not merely to the time lapse from the traumatic event. The results of this study suggest that EMDR is a viable treatment option in response to a disaster crisis and in reducing psychological distress of acutely traumatized individuals within the context of a natural disaster.

[Psychopharmacological treatment: patients' knowledge about their medication]. / Conoscenza del trattamento farmacologico da parte di pazienti con disturbi psichici.

AIMS: To identify knowledge about medication in a sample of patients admitted in a residential psychiatric rehabilitation unit. METHODS: All consecutive patients admitted in a psychiatric rehabilitation unit during January 2000-April 2001 were interviewed about the medications prescribed; in particular they were asked about names, daily dose, therapeutic and side effects of the psychotropic drugs they took. RESULTS: 74 patients were surveyed about their knowledge of the psychopharmacological treatment they took. Most patients demonstrated a good knowledge about drugs' name (77%) and daily dose (74.3%); one-quarter (25.7%) had some understanding about the reason why the medications were prescribed and theirs intended effects while only 5.4% was able to indicate the side effects of medications prescribed. Overall, 21.6% of patients could correctly indicate drugs' name, daily dose and therapeutic effects of all medications they took. CONCLUSIONS: The results of our study indicate the importance in clinical practice to devote particular attention to the patients' understanding of provided information about treatment and the crucial role of strategies, aimed at improving compliance and maximize the effects of therapeutic interventions.

Inter and intra individual variations in physicians' verbal behaviour during primary care consultations.

It is well established that most medical interviews in primary care are characterised by a scarcity of patient-centred interventions and a predominance of doctor-centred behaviours. Less information is available on the intra- and inter-individual variability between the physicians' use of these categories. The study aimed to examine the impact of physician, physician's attribution of emotional distress, patients' GHQ-12 status and gender on the frequency of doctor and patient-centred verbal behaviours. A matched pair design involved six General Practitioners (GPs) and 238 patients. GPs'speech was classified using nine main categories derived from the Verona medical interview classification system (VR-MICS/D). Frequencies of the behaviours were calculated as percentages of total utterances per interview. Parametric and non-parametric ANOVAs were performed with GHQ-12 score, GP attribution of psychological distress, gender, and the six GPs as main factors. GPs varied in their use of the various interviewing behaviours. GHQ-12 status had no impact on GPs' interview behaviour, while GPs' distress attribution was associated with an increase of closed psychosocial questions and a decrease of closed medical questions. Within comparisons showed that each GP tended to change very little and only as a function of attribution: four out of six GPs increased closed psychosocial questions with patients they thought to be distressed. Patients' gender did not significantly alter GPs' interviewing behaviour. The variability in the use of specific verbal behaviours among GPs indicates a highly individualised approach and the lack of a common interview strategy. The fact that GPs' interviewing styles did not change according to patient characteristics, such as emotional distress, but only according to attribution further indicates that GPs untrained in communication techniques tend to use a predominant doctor-centred approach to the medical interview.

[Clinical practice in mental health and educational needs in general practice]. / Pratica clinica in salute mentale e bisogni di formazione in medicina generale.

AIM: To obtain information regarding general practitioners' perception of their practice in mental health care, opinions, difficulties and educational needs. METHODS: All general practitioners attending the last annual session of continuing medical education (October-December 2000) were asked to complete the questionnaire regarding: 1) perception of current practice in mental health care and difficulties in managing mental health problems; 2) opinions regarding their practice; 3) educational needs and perception of benefit from strategies to improve mental health care. RESULTS: 254 general practitioners completed the questionnaire (response rate 70%). 81.4% recognize their role in mental health care and 89.9% report they should develop the necessary skills to deal with mental health problems, perceived as difficult to treat in general practice (77.3%). Educational priorities concern mainly anxiety, depression and somatization; further competences and skills are mainly necessary in doctor-patient communication and psychopharmacological treatment. Main difficulties concern the involvement degree with the specialists (44%) and the time patients need during the consultations (40.4%). Information about local mental health services, supervision and discussion with specialists and continuing medical education are considered useful to improve mental health care. CONCLUSIONS: As regard their role in mental health care, general practitioners perceive a lack of knowledge and skills. Relationship with specialists and mental health services, daily practice characteristics and time necessary to deal with patients represent barriers detracting from optimal mental health care in general practice.