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1.
Int J Geriatr Psychiatry ; 35(2): 163-173, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31657091

RESUMO

OBJECTIVE: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. METHODS: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant. RESULTS: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care. CONCLUSIONS: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.

2.
Actual. osteol ; 15(2): 94-102, mayo - ago. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1048478

RESUMO

El propósito de la terapia en el desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica (IRC) consiste en restaurar el balance mineral, y, en la osteoporosis, mantener o aumentar la masa ósea. Ambas terapias tratan de evitar la fractura ósea. La mayoría de los osteoactivos están contraindicados en la insuficiencia renal crónica avanzada (estadios 4 y 5), y las terapias son empíricas. Algunos autores opinan que sin anomalías bioquímicas del desorden del metabolismo óseo mineral asociado a la enfermedad renal crónica avanzada se podría intentar el tratamiento estándar para la osteoporosis. Antes de intentar la terapia osteoactiva se debe corregir el desorden mineral óseo que pudiera presentarse asociado a la IRC, y en la indicación del tipo de osteoactivo se sugiere seleccionar al paciente según su estado óseo. Se aconseja que la administración de los antirresortivos se realice a dosis menores con respecto a los que tienen mejor función renal junto con aportes adecuados de calcio y vitamina D, antes y durante el tratamiento para prevenir el riesgo de severas hipocalcemias y un efecto óseo excesivo. Se presenta el caso clínico de una mujer de 65 años, con diagnóstico de osteoporosis de etiología multifactorial, fractura de pelvis, múltiples fracturas vertebrales e insuficiencia renal crónica avanzada, entre otras comorbilidades, y probable enfermedad ósea adinámica. Recibió inicialmente terapia con teriparatide y luego con denosumab, complicándose con hipocalcemia asintomática. (AU)


The purpose of therapy for the bone mineral metabolism disorder associated with chronic kidney disease is to restore the mineral balance; and to maintain or increase bone mass in osteoporosis. The goal of both types of therapy is to avoid bone fractures. Most antiosteoporotic drugs are contraindicated in advanced chronic renal failure (CRF) stages 4 and 5, and the therapies are empirical. Some authors believe that without biochemical abnormalities of the mineral bone metabolism disorder associated with advanced chronic kidney disease, standard treatment for osteoporosis could be attempted. Before attempting antiosteoporotic therapy, the bone mineral disorder that may be associated with CRF must be corrected, and in the indication of the type drug it is suggested that the patient be selected according to their bone status. It is advised that the administration of anti-resorptives be performed at lower doses in individuals with poor renal function compared to those with better renal function together with adequate calcium and vitamin D, before and during treatment to prevent the risk of severe hypocalcemia, and an excessive bone effect. We present the clinical case of a 65-year-old woman with a diagnosis of osteoporosis of multifactorial etiology, pelvic fracture, multiple vertebral fractures and advanced chronic renal failure, among other comorbidities and probable adynamic bone disease. The patient received initial therapy with teriparatide and followed by denosumab administration and exhibited asymptomatic hypocalcemia. (AU)


Assuntos
Humanos , Feminino , Idoso , Distúrbio Mineral e Ósseo na Doença Renal Crônica/tratamento farmacológico , Fraturas Ósseas/prevenção & controle , Osteoporose/terapia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/complicações , Distúrbio Mineral e Ósseo na Doença Renal Crônica/metabolismo , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Cálcio/administração & dosagem , Cálcio/uso terapêutico , Alendronato/uso terapêutico , Teriparatida/administração & dosagem , Teriparatida/efeitos adversos , Teriparatida/uso terapêutico , Difosfonatos/administração & dosagem , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Cinacalcete/uso terapêutico , Ácido Risedrônico/uso terapêutico , Denosumab/administração & dosagem , Denosumab/efeitos adversos , Denosumab/uso terapêutico , Hipocalcemia/prevenção & controle
3.
Front Public Health ; 7: 143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281806

RESUMO

Introduction: Combining a successful career with family planning has become increasingly important in recent years. However, maintaining a relationship, deciding upon the optimal time for pregnancy and other family planning decisions can still be quite challenging, especially for junior doctors whose training is long and demanding. Currently, women form an important part of the medical workforce, and there is noticeable feminization in migration. However, little is known about the personal characteristics of junior doctors in Europe and how these play a role in their decision to migrate. Methods: Survey of psychiatric trainees in 33 European countries, exploring how personal characteristics, such as gender, relationship status and parenthood, impact their attitudes toward migration. Results: 2,281 psychiatric trainees in Europe took part in the study. In this sample, the majority of psychiatric trainees were in a relationship, but only one quarter had children, although there were variations across Europe. Both men and women indicated personal reasons as their top reason to stay. However, women ranked personal reasons as the top reason to leave, and men financial reasons. Single woman were the most likely of all subgroups to choose academic reasons as their top reason to leave. Interestingly, when women were in a relationship or had children, their attitudes toward migration changed. Conclusions: In this study, a low number of psychiatric trainees in Europe had children, with differences across Europe. These findings raise awareness as to the role of parental conditions, which may be favoring or discouraging parenthood in junior doctors in different countries.

4.
Front Psychol ; 9: 1047, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29977223

RESUMO

Background: Aim of the study was the validation of the Bipolar Disorder Rating Scale (BDRS) in an Italian population. Secondary aim was the evaluation of differences between unipolar and bipolar depression and between bipolar I and II depressed patients. Method: 125 Bipolar Disorder and 60 Major Depressive Disorder patients were administered an Italian translation of the BDRS (I-BDRS), Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Temperament and Character Inventory-Revised (TCI-R). Results: I-BDRS showed considerable validity and reliability. Factor analysis found 3 subscales, two linked to depressive symptoms and one to mixed symptoms. Measures concerning depression (MADRS and HAM-D) were positively related to the I-BDRS's subscales, but mostly to the two subscales measuring depression. In mixed symptoms, the mean of the bipolar group was significantly higher than the unipolar group suggesting that the BDRS was able to distinguish between unipolar and bipolar depressed patients. Conclusion: I-BDRS is a valid scale for the measurement of depression in BD patients, with a notable internal consistency (Cronbach's α 0.82), a significant consistency between items/total (Cronbach's α from 0.80 to 0.82) and positive correlation with other scales (MADRS r = 0.67, p < 0.001; HDRS r = 0.81, p < 0.001; YMRS r = 0.46 p < 0.0001). The mixed state sub-scale shows usefulness in differentiating bipolar from unipolar patients. I-BDRS could be a sensitive tool, both in pure depression and in mixed states, and could be used in the everyday screening and treatment of Bipolar Disorder.

5.
Medicina (B Aires) ; 78(2): 127-130, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29659364

RESUMO

Central diabetes insipidus is a rare disease of the hypothalamus and neurohypophysis. It is very unusually found in the adult with type 2 diabetes mellitus. It is manifested by a polydipsic polyuric syndrome, which must be distinguished from the poorly controlled type 2 diabetes mellitus. Given the similarity of both entities and the unusual nature of their coexistence, their suspicion is difficult. The case of a 72-year-old male with type 2 diabetes mellitus with poor insulin control (fasting hyperglycemia greater than 180 mg/dl) who had a long-standing polyuric syndrome is here presented. Hypernatremia and plasma osmolality elevated together with a low urinary osmolality led to the suspicion of diabetes insipidus, which was subsequently confirmed by the dehydration test and the administration of desmopressin sc. With 61% increase in the calculated urinary osmolarity one hour post desmopressin s.c., diabetes insipidus of central type was diagnosed. Nuclear Magnetic Resonance showed a bright spot with normal neurohypophysis, contributing to the diagnosis of the idiopathic form.


Assuntos
Diabetes Insípido Neurogênico/complicações , Diabetes Insípido Neurogênico/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diagnóstico Diferencial , Idoso , Diabetes Insípido Neurogênico/sangue , Diabetes Insípido Neurogênico/urina , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/urina , Gadolínio DTPA , Humanos , Imagem por Ressonância Magnética , Masculino , Concentração Osmolar , Neuro-Hipófise
6.
Medicina (B.Aires) ; 78(2): 127-130, abr. 2018. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-954962

RESUMO

La diabetes insípida central es una enfermedad rara del hipotálamo y de la neurohipófisis, y muy inusualmente se halla en el adulto con diabetes mellitus 2. Se manifiesta por un síndrome poliúrico polidípsico, que debe diferenciarse de la diabetes mellitus mal controlada. Ante la similitud de ambas entidades, y lo infrecuente de su coexistencia, se dificulta su sospecha. Se presenta el caso de un hombre de 72 años de edad, con diabetes mellitus 2 y pobre control de la misma (hiperglucemias de ayuno mayores a 180 mg/dl) que cursó un síndrome poliúrico de larga data. La hipernatremia y la osmolalidad plasmática elevadas, junto a una osmolalidad urinaria baja llevaron a la sospecha de diabetes insípida, que posteriormente se confirmó con la prueba de deshidratación y la administración de desmopresina s.c. Con un aumento del 61% de la osmolalidad urinaria calculada una hora post desmopresina s.c. fue diagnosticada como diabetes insípida del tipo central. La resonancia magnética nuclear mostró una mancha brillante con neurohipófisis normal, contribuyendo al diagnóstico de la forma idiopática.


Central diabetes insipidus is a rare disease of the hypothalamus and neurohypophysis. It is very unusually found in the adult with type 2 diabetes mellitus. It is manifested by a polydipsic polyuric syndrome, which must be distinguished from the poorly controlled type 2 diabetes mellitus. Given the similarity of both entities and the unusual nature of their coexistence, their suspicion is difficult. The case of a 72-year-old male with type 2 diabetes mellitus with poor insulin control (fasting hyperglycemia greater than 180 mg/dl) who had a long-standing polyuric syndrome is here presented. Hypernatremia and plasma osmolality elevated together with a low urinary osmolality led to the suspicion of diabetes insipidus, which was subsequently confirmed by the dehydration test and the administration of desmopressin sc. With 61% increase in the calculated urinary osmolarity one hour post desmopressin s.c., diabetes insipidus of central type was diagnosed. Nuclear Magnetic Resonance showed a bright spot with normal neurohypophysis, contributing to the diagnosis of the idiopathic form.

7.
Medicina (B Aires) ; 77(3): 196-200, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28643676

RESUMO

Primary hyperparathyroidism may have different characteristics. One is the asymptomatic form. This is a mild variant of hypercalcemic hyperparathyroidism, characterized by a calcemia not greater than 1 mg/dl above the upper limit of the method, a high intact parathyroid hormone (iPTH), absence of renal stones, renal function impairement, and osteoporosis, less than 50 years of age, and less than 400 mg/day calciuria. It is not a surgical entity, but its evolution may require it. Twenty-four postmenopausal women, all older than 50 years, with a diagnosis of asymptomatic hyperparathyroidism, were studied. Clinical manifestations, densitometric changes, biochemical parameters and bone remodeling were analyzed and the results were compared with the classic and normocalcemic variants of the disease. Diagnostic criteria were established and observed that only 2 (8.3%) of patients, during a follow up of 44 ± 12 months, had need for a parathyroidectomy. In conclusion, the asymptomatic primary hyperparathyroidism is a benign disorder, of periodic clinical follow-up, which rarely may require surgery.


Assuntos
Doenças Assintomáticas , Doenças Ósseas Metabólicas/diagnóstico , Hipercalcemia/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Osteoporose/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Doenças Ósseas Metabólicas/metabolismo , Cálcio/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Hipercalcemia/metabolismo , Hiperparatireoidismo Primário/metabolismo , Masculino , Pessoa de Meia-Idade , Osteoporose/metabolismo , Hormônio Paratireóideo/metabolismo , Estudos Prospectivos
8.
Medicina (B.Aires) ; 77(3): 196-200, jun. 2017. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-894457

RESUMO

El hiperparatiroidismo primario puede tener diferentes características. Una de ellas es la forma asintomática. Esta es una variante leve del hiperparatiroidismo primario hipercalcémico, que se caracteriza por una calcemia no mayor a 1 mg/dl sobre el límite superior del método, hormona paratiroidea intacta (PTHi) elevada, ausencia de litiasis renal, deterioro de la función renal y de osteoporosis, edad menor de 50 años, y calciuria menor a 400 mg/día. No es una entidad quirúrgica, pero en su evolución puede llegar a serlo. Se estudiaron 24 mujeres postmenopáusicas, todas mayores de 50 años, con diagnóstico de hiperparatiroidismo asintomático, se describieron las manifestaciones clínicas, los cambios densitométricos, los parámetros bioquímicos y del remodelado óseo y se compararon los resultados con las variantes clásica y normocalcémica de la enfermedad. Se establecieron los criterios diagnósticos y se observó que solo 2 (8.3%) de las pacientes, durante un seguimiento de 44 ± 12 meses tuvo necesidad de paratiroidectomía. En definitiva, el hiperparatiroidismo primario asintomático es una alteración benigna, de seguimiento clínico periódico que, en pocas ocasiones, durante el seguimiento puede requerir cirugía.


Primary hyperparathyroidism may have different characteristics. One is the asymptomatic form. This is a mild variant of hypercalcemic hyperparathyroidism, characterized by a calcemia not greater than 1 mg/dl above the upper limit of the method, a high intact parathyroid hormone (iPTH), absence of renal stones, renal function impairement, and osteoporosis, less than 50 years of age, and less than 400 mg/day calciuria. It is not a surgical entity, but its evolution may require it. Twenty-four postmenopausal women, all older than 50 years, with a diagnosis of asymptomatic hyperparathyroidism, were studied. Clinical manifestations, densitometric changes, biochemical parameters and bone remodeling were analyzed and the results were compared with the classic and normocalcemic variants of the disease. Diagnostic criteria were established and observed that only 2 (8.3%) of patients, during a follow up of 44 ± 12 months, had need for a parathyroidectomy. In conclusion, the asymptomatic primary hyperparathyroidism is a benign disorder, of periodic clinical follow-up, which rarely may require surgery.

9.
Med Lav ; 107(4): 284-92, 2016 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-27464901

RESUMO

OBJECTIVES: Workplace violence is a common risk for mental health professionals, and psychiatrists often encounter it in a variety of settings. The aim of this study was to estimate the prevalence and features of violent episodes toward psychiatrists in various mental healthcare system settings. METHODS: All psychiatrists from the Region of Puglia (Apulia) were contacted (N=285) via email and were administered an on-line standardized questionnaire. RESULTS: The response rate by psychiatrists was 57%. The main types of violence revealed were "threats" and "verbal aggression" and, of particular importance, "stalking". Female psychiatrists seemed to be at a higher risk of becoming victims of workplace violence, especially as regards verbal abuse (OR: 2.7, 95% CI: 1.2-6.5, c2 6.7, p=0.0095) and reported more serious psychological consequences with need for rest after the episode of aggression. CONCLUSIONS: Our data confirm that mental health workers, particularly psychiatrists, are healthcare professionals at high risk for workplace violence. Future implementation of preventive strategies with the aim of reducing aggressive episodes towards psychiatrists should be a high priority for managers and policy-makers operating in the Italian healthcare sector.


Assuntos
Saúde do Trabalhador/estatística & dados numéricos , Psiquiatria , Violência no Trabalho/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade
10.
Psychiatry Res ; 238: 150-152, 2016 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-27086225

RESUMO

Access to medical information is important as lifelong scientific learning is in close relation with a better career satisfaction in psychiatry. This survey aimed to investigate how medical information sources are being used among members of the European Federation of Psychiatric Trainees. Eighty-three psychiatric trainees completed our questionnaire. A significant variation was found, and information availability levels were associated with training duration and average income. The most available sources were books and websites, but the most preferred ones were scientific journals. Our findings suggest that further steps should be taken to provide an equal access to medical information across Europe.


Assuntos
Acesso à Informação , Psiquiatria/educação , Europa (Continente) , Humanos , Comportamento de Busca de Informação , Inquéritos e Questionários
11.
Compr Psychiatry ; 66: 59-66, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26995237

RESUMO

BACKGROUND: Social relations can be measured through: a) objective indicators, i.e. the number of social contacts in a given time interval or b) subjective indicators, i.e. feelings of loneliness. Comparing subjective and objective indicators in patients with psychotic and mood disorders may help to understand whether diagnosis-specific interventions should be designed for increasing their social relations. In this study we assessed social contacts outside home, work environments and mental health services, which may be increased by these interventions. We also explored feelings of loneliness which could influence readiness of patients to participate in interventions. METHODS: 100 patients in outpatient mental health care were asked to: a) list their social contacts; b) report their feelings of loneliness on a validated five point Likert scale. Multiple logistic regression models were used to test associations of diagnostic categories with: a) having more than one social contact in the previous week; b) reporting at least moderate feelings of loneliness. RESULTS: Patients had on average 1.7 (SD=1.7) social contacts in the previous week (median=1.0); 77 patients reported at least moderate feelings of loneliness. Patients with psychotic disorders (n=30) showed a statistical trend towards having just one or no contacts in the week before the assessment (Odds ratio, OR=2.246, p=.087). Patients with mood disorders were more likely to report at least moderate feelings of loneliness (OR=2.798; p<.05). CONCLUSIONS: Patients with psychotic disorders, compared to those with mood disorders, may be less likely to report feeling lonely although they tend to have less social contacts. Strategies to enhance social relations of people with psychotic disorders may include approaches to increase patients' drive to establish new social contacts and to emotionally support them in this process.


Assuntos
Relações Interpessoais , Solidão/psicologia , Transtornos do Humor/psicologia , Transtornos Psicóticos/psicologia , Isolamento Social/psicologia , Adulto , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Comportamento Social , Apoio Social , Inquéritos e Questionários
12.
BMC Res Notes ; 8: 560, 2015 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-26459046

RESUMO

BACKGROUND: Social networks are important for mental health outcomes as they can mobilise resources and help individuals to cope with social stressors. Individuals with psychosis may have specific difficulties in establishing and maintaining social relationships which impacts on their well-being and quality of life. There has been a growing interest in developing social network interventions for patients with psychotic disorders. A systematic literature review was conducted to investigate the size of social networks of patients with psychotic disorders, as well as their friendship networks. METHODS: A systematic electronic search was carried out in MEDLINE, EMBASE and PsychINFO databases using a combination of search terms relating to 'social network', 'friendship' and 'psychotic disorder'. RESULTS: The search identified 23 relevant papers. Out of them, 20 reported patient social network size. Four papers reported the mean number of friends in addition to whole network size, while three further papers focused exclusively on the number of friends. Findings varied substantially across the studies, with a weighted mean size of 11.7 individuals for whole social networks and 3.4 individuals for friendship networks. On average, 43.1 % of the whole social network was composed of family members, while friends accounted for 26.5 %. CONCLUSIONS: Studies assessing whole social network size and friendship networks of people with psychosis are difficult to compare as different concepts and methods of assessment were applied. The extent of the overlap between different social roles assessed in the networks was not always clear. Greater conceptual and methodological clarity is needed in order to help the development of effective strategies to increase social resources of patients with psychosis.


Assuntos
Transtornos Psicóticos/psicologia , Apoio Social , Amigos , Humanos
13.
Riv Psichiatr ; 50(3): 110-7, 2015.
Artigo em Italiano | MEDLINE | ID: mdl-26156816

RESUMO

INTRODUCTION: Major depressive disorder is a disabling illness that involves affect and cognition of a person, negatively influencing social and work functioning. Cognitive deficits are often present in depression, although they are often believed to be secondary to typical depressive symptoms. AIM: A detailed literature review has been carried out to assess the cognitive deficits identified in people with major depressive disorder and identify specific assessment tools used for their evaluation. METHODS: Using key-words, we selected papers published on Embase and PubMed/Medline, with a particular reference to those published in the last five years. RESULTS: The literature review confirmed that cognitive deficits are one of the most important causes of social disfunctioning in patients with major depressive disorder. Cognitive deficits can be observed already in the first depressive episode. Assessment tools for cognitive deficits are scarcely used in clinical practice. CONCLUSION: There is a need to identify cognitive deficits in people with major depressive disorder and their relation with social and work functioning, quality of life and risk of relapse as well as to assess the effects of therapeutic intervention on cognitive performance. To achieve this purpose, it is important to use appropriate and sensitive tools for the assessment of cognitive deficits.


Assuntos
Transtornos Cognitivos/etiologia , Transtorno Depressivo/psicologia , Testes Psicológicos , Transtornos Cognitivos/diagnóstico , Humanos , Testes Neuropsicológicos , Valor Preditivo dos Testes , Qualidade de Vida , Recidiva , Comportamento Social
14.
J Psychosom Res ; 78(4): 399-406, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25691225

RESUMO

OBJECTIVE: Several studies indicate increased prevalence of metabolic syndrome (MetS) among patients with psychiatric disorders as well as among individuals with gender dysphoria (GD) treated by cross-sex hormonal treatment. However, the MetS prevalence among hormone treated GD individuals suffering from psychiatric problems has not been detected. METHODS: From a sample of 146 GD patients we selected 122 metabolically healthy individuals in order to investigate the prevalence of MetS after the beginning of the cross-sex hormonal treatment in a 2 year follow-up assessment. Furthermore, we assessed differences in MetS prevalence between hormone treated GD patients with and without concomitant psychiatric problems. RESULTS: When treated with hormone therapy, GD patients reported changes in several parameters which are clustered in MetS, with statistically significant differences compared to baseline. Glyco-insulinemic alterations were more pronounced in male to female patients (MtFs). However, weight gain, waist circumference increases, blood pressure increases, and lipid alterations were similar in MtFs and female to male patients (FtMs). 14.8% of the sample at year 1 and 17.2% at year 2 developed MetS. Among patients with concomitant psychiatric problems, 50% at year 1 and 55% at year 2 developed MetS against 8% at year 1 and 10% at year 2 of patients without concomitant psychiatric problems. CONCLUSION: This study indicates that sex hormones induce MetS in a relatively low proportion of healthy GD individuals and especially during the first year of hormonal treatment. Most importantly, concomitant psychiatric problems are associated with considerably greater MetS prevalence in hormone treated GD individuals.


Assuntos
Identidade de Gênero , Hormônios Esteroides Gonadais/efeitos adversos , Transtornos Mentais/tratamento farmacológico , Síndrome Metabólica/induzido quimicamente , Adulto , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Seguimentos , Hormônios Esteroides Gonadais/administração & dosagem , Humanos , Itália/epidemiologia , Masculino , Transtornos Mentais/complicações , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Prevalência , Circunferência da Cintura
15.
J Alzheimers Dis ; 44(1): 139-51, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25182744

RESUMO

BACKGROUND: A reliable and valid global staging scale has been lacking within dementia care. OBJECTIVE: To develop an easy-to-use multi-dimensional clinical staging schedule for dementia. METHODS: The schedule was developed through: i) Two series of focus groups (40 and 48 participants, respectively) in Denmark, France, Germany, Netherlands, Spain, Switzerland, and UK with a multi-disciplinary group of professionals working within dementia care, to assess the need for a dementia-staging tool and to obtain suggestions on its design and characteristics; ii) A pilot-study over three rounds to test inter-rater reliability of the newly developed schedule using written case histories, with five members of the project's steering committee and 27 of their colleagues from Netherlands, France, and Spain as participants; and iii) A field-study to test the schedule's inter-rater reliability in clinical practice in France, Germany, Netherlands, Spain, Italy, Turkey, South Korea, Romania, and Serbia, which included 209 dementia patients and 217 of their caregivers as participants. RESULTS: Focus group participants indicated a clear need for a culture-fair international dementia staging scale and reached consensus on face validity and content validity. Accordingly, the schedule has been composed of seven dimensions including behavioral, cognitive, physical, functional, social, and care aspects. Overall, the schedule showed adequate face validity, content validity, and inter-rater reliability; in the nine field-sites, intraclass correlation coefficients (ICCs; absolute agreement) for individual dimensions ranged between 0.38 and 1.0, with 84.4% of ICCs over 0.7. ICCs for total sum scores ranged between 0.89 and 0.99 in the nine field-sites. CONCLUSION: The IDEAL schedule looks promising as tool for the clinical and social management of people with dementia globally, though further reliability and validity testing is needed.


Assuntos
Demência/diagnóstico , Cooperação Internacional , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Demência/psicologia , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estatística como Assunto
16.
Riv Psichiatr ; 49(1): 50-5, 2014.
Artigo em Italiano | MEDLINE | ID: mdl-24572584

RESUMO

AIMS: The European Federation of Psychiatric Trainees (EFPT), founded in London in 1992, is an independent international federation of psychiatric trainees' national associations. The EFPT is engaged in several actions in order to pursue its general aims to promote high standards of quality of psychiatric training and promote the collaboration and networking between European psychiatric trainees. METHODS: Member associations constitute the general assembly that meets annually during the European Forum of Psychiatric Trainees. During the Forum, working groups are created and the activities for the next year are planned. RESULTS: Regular activities of the EFPT include the production of statements expressing the standpoint of trainees on educational issues, the conduction of research projects, the creation of new national trainees' associations, the facilitation of networking among European psychiatric trainees and the organization an annual meeting (EFPT Forum). The last EFPT Forum has been organized in Sorrento (Italy) on May 2012. Psychiatric trainees from 37 European countries have registered to this event. DISCUSSION: EFPT activities constitute a opportunity for psychiatric trainees to directly participate in the improvement of their psychiatric training and to establish a network with European colleagues that will contribute to their professonal development.


Assuntos
Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Psiquiatria/educação , Melhoria de Qualidade , Sociedades Médicas , Congressos como Assunto , Coleta de Dados , Educação Médica Continuada/normas , Educação de Pós-Graduação em Medicina/normas , Europa (Continente) , História do Século XX , História do Século XXI , Humanos , Cooperação Internacional , Intercâmbio Educacional Internacional , Itália , Editoração , Pesquisa , Papel (figurativo) , Sociedades Médicas/história , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Inquéritos e Questionários
17.
Expert Rev Neurother ; 14(2): 131-41, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24382132

RESUMO

Although coercive measures have always been part of the psychiatric armamentarium, the ethical dilemma between the use of a "therapeutic" coercion and the loss of patients' dignity is one of the major controversial issues in mental health research and practice. The aims of the present review are to explore the existing literature on predictors of use of coercive measures and to explore the relationship between coercive measures and patient outcome. A literature search was conducted using MEDLINE, PsychyINFO, Scopus, Web of Knowledge and the Cochrane Database. In all selected papers, references were cross-checked to identify other possible eligible papers. The use of coercive measures was predicted by patients' clinical and socio-demographic features, staff characteristics and ward-related factors. Coercive measures have only a limited impact on patients' clinical and social outcome. At the current level of knowledge, coercion is still a controversial issue in mental health practice. Only few studies with a solid methodology have been carried out. Large multicenter and rigorous studies, with long-term follow-ups, are highly needed.


Assuntos
Coerção , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental , Avaliação de Resultados da Assistência ao Paciente , Humanos , Escalas de Graduação Psiquiátrica
18.
Int J Soc Psychiatry ; 60(5): 508-13, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24051155

RESUMO

BACKGROUND AND AIMS: In Italy, the reform of the mental health system in 1978 should have drastically changed the provision of care and pathways of patients seeking to obtain it. The aim of this article is to examine the current pathways to psychiatric care in Italy. METHODS: We used a method developed in the World Health Organization international collaborative studies to investigate pathways to care in 15 Italian mental health centers. We recruited 420 patients with a psychiatric illness and explored the care pathways they took to reach to psychiatric services and the delays from the onset of illness to reaching psychiatric care. RESULTS: The majority of patients (33.8%) had direct access to mental health care, whereas the others arrived to a specialist in psychiatry through general hospitals (20.3%), general practitioners (33.0%) or private practitioners (9.8%). The main diagnosis for referral was neurotic disorder (36.6%), followed by affective disorder (35.4%) and psychotic disorder (11.5%). The delay from onset of illness to psychiatric care was greater for patients with psychotic disorders than for those with affective and neurotic disorders. The most frequently prescribed treatments were pharmacotherapy (56%), psychological support (8%), and psychotherapy (7.0%); 15% of the patients received no treatment. CONCLUSIONS: Our multicenter study shows that although general practitioners and hospital doctors are still the main referral point for mental health care, a greater proportion of patients are first seen in private settings or directly reach mental health centers, compared to previous surveys conducted in Italy. However, a stronger collaboration of psychiatrists with general practitioners and psychologists is still needed.


Assuntos
Serviços de Saúde Mental/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/organização & administração , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Procedimentos Clínicos/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Tempo
19.
Riv Psichiatr ; 48(4): 321-7, 2013.
Artigo em Italiano | MEDLINE | ID: mdl-24056831

RESUMO

AIMS: To assess in a sample of people with mental disorders: 1) fear of crime and perceived insecurity; 2) the association between fear of crime and insecurity; 3) the incidence of crimes. METHODS: Twenty-four Italian mental health centres have been invited to participate in the study from the network of the Early Career Psychiatrists' Committee of the Italian Psychiatric Association. In each participating centre, the first 20 patients consecutively accessing the mental health centre between February and April 2011 have been recruited. All patients have been assessed using validated assessment tools. RESULTS: The final sample consists of 426 patients. They are mostly female (70.1%), with a mean age of 45 years (± 13.5), and with a good level of education. Fifty-two percent of patients have a diagnosis of mood disorders, and 37.8% on anxiety spectrum disorders. About half of the sample declares that the most prominent feeling toward life is uncertainty. Almost all patients report to have at least one big fear, with the most frequently report being: 1) loss or death of a loved one (41.2%); 2) financial constraint (28.4%); 3) physical or mental health problems (26.5%). DISCUSSION AND CONCLUSIONS: Our results show the presence of a common sense of uncertainty among patients, probably as a result of the historical moment we are facing. It is reasonable that this attitude toward life can have a detrimental impact on patients' psychological and physical wellbeing, contributing to high levels of distress. Further studies are needed in order to clarify the possible relationship between fears, uncertainty and mental disorders.


Assuntos
Crime/psicologia , Medo , Transtornos Mentais/psicologia , População Urbana , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/psicologia , Feminino , Hospitais Psiquiátricos , Humanos , Pacientes Internados , Itália , Masculino , Escala de Ansiedade Manifesta , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Amostragem , Sicília , Inquéritos e Questionários
20.
Br J Psychiatry ; 202: 459-62, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23620450

RESUMO

BACKGROUND: How psychiatrists introduce themselves in the first consultation may influence the therapeutic relationship. There is no evidence about what type of introduction patients prefer. AIMS: To assess experimentally patients' preferences for how psychiatrists introduce themselves. METHOD: Twelve psychiatrists were filmed, each with three different introductions: stating name, profession and reason for consultation; the same, plus information on what will happen during the consultation; and the same, plus disclosure of a personal difficulty. Six randomly selected videos, of different psychiatrists, two of each type of introduction, were rated by each of 120 psychiatric in- and out-patients on Likert-type scales. RESULTS: Patients gave the most positive ratings to psychiatrists who introduced themselves with information about what will happen in the consultation rather than ones with briefer introductions or with additional personal disclosure (P = 0.002). Preferences were similar in different subgroups. CONCLUSIONS: Psychiatrists should introduce themselves with information about what they intend to do in the consultation, but without personal disclosure.


Assuntos
Comunicação , Transtornos Mentais/terapia , Preferência do Paciente , Relações Médico-Paciente , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Psiquiatria , Adulto Jovem
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