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Objective: To investigate the possible impact of the increased use of antidepressants on suicide rates in the Italian region of Friuli Venezia Giulia (FVG). Method: Individual-based data on antidepressants in FVG from 1997 to 2006 were obtained from the regional prescription database, and linked to data on suicide for the same period obtained from the regional health information system. Age and sex were considered. Results: The number of users of antidepressants increased almost fivefold during the study period. Selective serotonin reuptake inhibitors accounted for 71% of the individual users in 2006. The number of defined daily doses (DDD) per patient increased almost sevenfold. In parallel, the suicide rate decreased by one-third in men as well as in women, and in subjects under and over the age of 60 years. Conclusion: Suicide rates in FVG have declined in agreement with the hypothesis that the use of antidepressants may prevent suicide. [ABSTRACT FROM AUTHOR]

Introduction The reduction of the budget allocated to community psychiatry is part of financial needs in times of economic crisis. However, the community psychiatry is based on human resources rather than on technological devices and the economic downturn affects the quality of care in a field where the social and relational capital developed by mental health workers is fundamental. Some authors such as Serge Latouche propose to stem the economic decline with the concept of “degrowth”, a constructive idea but difficult to apply. Objective We would like to analyze whether the economic downturn has consequences only for the organization of psychiatric services or even for people with severe mental disorders. Another issue concerns the possibility that economic downturn increases the social exclusion of vulnerable people. Results People who live on social welfare or disability pension remain on the margins of society but also those supported by families feel increasingly marginalized with respect to the future. Conclusions The provision of mental health services may not meet the implicit and explicit wishes in the demand for health by citizens and society. It's therefore necessary to review the quality management within community psychiatry. [ABSTRACT FROM AUTHOR]

Gender identity disorder is a rare disorder of uncertain etiology (1:30,000 M to F; 1:100,000 F to M). The emphasis of body shape in this disorder suggests that there may be an association with anorexia nervosa. Previous research suggests that eating disorders are related to homosexuality in men although links with female sexual orientation is less clear. This report describes the case of an adolescent 19-year-old biological female transgender patient presented to a Mental Health Center in Trieste. Diagnostically, this patients presents with prominent restricting, purging anorexia that was wed by the desire to obtain and then maintain an idealized prototypal masculine shape. The failure of the realization of this project involves in a self-distructive conduct. The case offers an important opportunity to explore the comorbidity about eating disorders and gender identity disorder. The patient completed this measures: a background measure of his sexual orientation, the Millon Clinical Multiaxial Inventory III (MCMI-III), the Minnesota multiphasic personality inventory (MMPI-2), the Bem Sex Role Inventory, the Eating Disorder Inventory and the Eating Attitude test. This report suggests that the divergence of body image psychopathology may be impacted by gender role orientation, which is consistent with a developing body of research. [ABSTRACT FROM AUTHOR]

Introduction Be a citizen means having rights but also duties and be subject to laws. Educating to legality is essential for mutual respect in the community, for the rules of social life and to exercise own rights of citizenship. A psychiatric patient can commit crimes because of mental disorders but also in absence of psycopathological problem. When a patient commits an offence, it is correct to know whether he was due and if he is actually a danger to society. The law do not allow ignorance but what patients really know about the law is not clear. Objective In this study, we want to investigate the legal knowledge in citizens with mental disorders. Moreover, we want to build pathways to increase compliance with the law. Methods We collected a cohort of 10 offenders and asked them if they were interested in an educational course on legality. We interviewed a sample of patients at risk of breaking the Penal code to assess their basic knowledge. Results The reasons to undertake an educational program on compliance with the law were higher for offenders, maybe for fear of damaging sanctions. Those at risk of being sued for their behavior seemed to have more background than other group. Conclusions It is essential to develop educational programs about crime prevention within the psychiatric field through training courses that increase the knowledge and awareness of effects of the Penal code. Moreover, citizens with mental disorders at risk of crimes should be supported by specific interventions aimed to social ethics. [ABSTRACT FROM AUTHOR]

Introduction It's not easy to choose between different antipsychotics in the treatment of patients with schizophrenia that use drugs of abuse both legal (alcohol, benzodiazepine, anticholinergics) and illicit (heroin, cannabis, cocaine). The use of substances is a powerful risk factor for poor outcome. From CATIE study, we know that the discontinuity is lower with Olanzapine but psychotic patients continue to take drugs of abuse despite medication. Probably, an important aspect is the anhedonia secondarily produced by neuroleptics. Objective We want to evaluate if Paliperidone Palmitate reduces addictive behaviors in a small group of psychotic patient who have agreed to recived injection after the switch from other antipsychotics. Method We have identified four individual with chronic use of drugs of abuse in a Mental Health Center. These subjects were abusing alcohol, cannabis, spice and benzodiazepine. We administered before new treatment and after 2 months the Snaith-Hamilton Pleasure Scale of Snaith et al. (1995) and the Leeds Dependence Questionaire of Raistrick et al. (1994). Results The hedonic tone tends to improve and the addictive behavior decreased. Conclusion The therapy with Paliperidone Palmitato is associated with a reduction of the addictive behaviors but we need studies with a larger number of patients. [ABSTRACT FROM AUTHOR]

This case study intends to describe the features of a serious schizophrenic psychosis in a ethiopian immigrant woman that is arrived in Italy twenty years ago with her italian husband that worked in Ethiopia. This person had a excellent health when she leaves from Africa to Italy in order to live her life in our nation. She had a high cultural level as her family and she get married to husband ongly for love and not for other interest. Today this woman presents a very serious behavioural regression as physical conditions. She is a non-responder to psychopharmacological therapy (first and second generation antipsychotics). There are many problems to treat this chronic condition with hight disability and we must consider the importance of cultural aspects respect to clinical elements. [ABSTRACT FROM AUTHOR]

Introduction In the modern time we have observed the decline of the normative function of father, according to psychoanalitical stydies. Our attempt is to collect some phenomenological remarks abot “Erlebt” of parenthood in fathers with mental disorders followed by the Mental Health Centre and to compare the experiences of these persons. Method We have extracted same reports from conversations with patients in the context of psycotherapic treatment. Results After the birth of a child, the borderline father find the sense of limit and/or boundary in the relationship with own family, especially with own father. Vice versa the bipolar fathers live thorugh a crisis, after the birth of child, above all with regard to own father. [ABSTRACT FROM AUTHOR]

A response by G. Castelpietra, A. Morsanutto, E. Pascolo-Fabrici to a letter to the editor about the article on the increased risk of suicide in patients below 25 receiving antidepressants in the previous issue of the periodical.

Introduction From Charcot studies on Hysteria to recent analysis of the World Health Organization (WHO), mental illness seems to be a matter in which sex and gender play a non-negligible role. In the WHO data on neuropsychiatric disorders, women are prevalent in almost all types of disorder. Objective Primary prevention can only refer to the recognition of social, educational, relational, environmental factors. Few studies have been conducted on the socio-demographic characteristics of the female population relating to psychiatric services. Aims The aims of our research are to evaluate both the demographic and clinical characteristics of women related to mental health services in Trieste and their adherence to rehabilitation programs. Methods The study was conducted by collecting the personal data of clinical users women from the four mental health centers in Trieste and the psychiatric service for diagnosis and treatment (SPDC). In the year 2014, the user attending the mental health department are 4952. Results Data analysis showed that women in charge at the Department of Mental Health is 2731, representing 55% of all users. The predominant age group is between 46 and 65 years (between 17% and 23% for each CSM). The number of women taking part at rehabilitation activities is of 1332 (49%). Conclusions It is considered necessary that the services for mental health sponsor prevention, treatment and rehabilitation around the specific needs of women. [ABSTRACT FROM AUTHOR]

Introduction Sporting practice for psychotic patients have been demonstrated to be efficacious as a rehabilitation tool at various levels, improving social interaction, self esteem, body self consciousness, reduce anxiety and depression, reduce stigma, improve compliance, reduce admission rates, reduce aggressiveness, reduce family burden. Since 1999 the Fuoric'entro Polisportiva was founded in Trieste, with the support of the Department of Metal Health, with the aim of influencing recovery at several levels. Objectives Evaluate the impact on participants' health. Aims Demonstrate the outcome of the rehabilitation program based upon the sporting activity. Methods The research is a descriptive, case-control study, led on 40 patients (20 cases and 20 controls) followed by the Trieste's Metal Health Department. We considered as items living situation, professional condition, gender and age, diagnosis, therapy and its compliance, admissions’ number and duration, main therapeutic interventions, following up a previous study on the same rehabilitation program. Results In the cases’ group there is a stable improvement of the professional and living conditions, compliance and a reduction of admissions’ number and duration. Conclusions A rehabilitation program based on sporting can improve coping abilities, psychopathological conditions, person's 'social functioning”, family burden. [ABSTRACT FROM AUTHOR]

Introduction The rate of non fatal self-injurious behaviour in young people has increase in recent years. Non fatal self-injurious behaviour such as cutting oneself and abuse of substance is often performed without suicidal intent to cope with emotional distress although it is well known to have a close association with future suicidal behaviour. Objectives Evaluating people under 29's suicidal behaviours' rates. Aims Monitoring developments in not lethal self injurious behaviour in the population of adolescents and young adults in Trieste to identify strategies that will guide the prevention of suicidal behaviour in this age group. Methods Retrospective study based on verbal access to emergency, extracts under the headings “self-harm” and “poisoning” during period 2000-2007. We considered as variables the calculation of rates for the age groups 15-19 and 20-29 years, mode of self-injurious act coded according to the parameters of the ICD-10. Results The average rate for the age group 15-19 years was found to be 0.5 cases per 100,000 inhabitants, while for ages 20-29 was found to be 1.3 cases per 100,000 inhabitants. There wasn't a significant difference between the two genders. The methods most frequently adopted were found to be voluntary intoxication and cutting. Conclusions To counter the fragility and risk of self-harm and suicide in adolescents and young adults, our Local Health Company launched in 2014 a dedicated website. The site provides information on the types of conditions that may affect the target population and the self-destructive behaviors. [ABSTRACT FROM AUTHOR]

Introduction Schizophrenia is a chronic disorder which severely limits the social and occupational functioning. Employment, education, relationships, housing and health are among the most frequently stated life and treatment goals among persons suffering from schizophrenia. Rehabilitation for persons with schizophrenia aims at preservation and improvement of psychosocial functions, promotes recovery-oriented interventions and, therefore, serves the central goals of affected persons. Objectives The goals of these models focus on improving knowledge, coping, self-care, social support and self-management strategies. Aims The aims of this cases report is to underline the effectiveness of multidimensional approach, which included drug treatment, psychosocial therapeutic interventions, supported employment, peer-supported housing. Methods We report 8 patients with a early onset psychosis, detected with EriRaos and clinical interview. Results Diagnostically, these patients had a real improvement of their psychosocial functions in areas such as work, social relationship and independent living skills. Conclusions Cognitive functioning, education, negative symptoms, social support and skills, age, work history and rehabilitation service to restore community functioning have proven to be strong predictors for successful psychiatric rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction The evaluation of safety represents the our interest, especially with references to older people that receive at the same time many drugs for psychiatric disorders and physical diseases. The polypharmacy between older people is a frequent phenomenon but little is know about adverse effects of antidepressants. Method We have examined the prescriptions in 10 nursing homes to collect adverse effects, included cause mortality, during a follow up of 2 years. Results The incidence of adverse events with Trazodone is very low, as so compared to other antidepressants. Also, older people, are a special population with high comorbidity. Still it is very difficult to reduce the recurrence to polypharmacy in these field but we must become integrated with general practitioners and other specialists. [ABSTRACT FROM AUTHOR]

Introduction A review of the literature shows that the self-injurious behaviours are more common among females, and suicides among male subjects. A significant difference between the two genders is also reflected in the choice of means used to commit the act of self-injuring, considering the male gender predilection for more violent means. Some recent studies indicate trends that deviate from the above data in the literature or indicate a tendency to an attenuation of these differences. Objectives Reasons for engaging in self-harm behaviours include to regulate emotion and to elicit attention. Correlates of these practices include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors. Aims: the aim of this study is to evaluate the gender difference in self-injurious behaviour. Methods Our retrospective study was conducted making a comparison between a period of time before and after the start of an articulated program of prevention of suicidal behaviors in Trieste, from 1983 to 2007. Results In the '80, the self-injurious behavior were more common among males; after 2000 years this difference has continuously attenuated. This trend is in contrast with findings in the international literature. Even the repeated acts of self-harm were more common among males. Regarding the data on suicides, they were more frequent in male subjects, and this fact has remained stable over time, in accordance with international data. Conclusions More studies are necessary to evaluate gender difference in self-injurious behaviour. [ABSTRACT FROM AUTHOR]

Introduction Narcissistic Personality Disorder (NPD) has a prevalence of 6,2% on general population, with greater rates for men (7,7%) than women (4,8%). It has been frequently associated with substance misuse, Bipolar Disorder (type I and II), anxiety and other personality disorders, but seldom it has been associated with Major Depressive Disorder. Objectives The emphasis put on sex by elder people with NPD hasn't been widely studied in Literature. Frustration on the maintenance of a fixed rate of weekly sexual intercourse with their partners has led to a MDD in two outpatients that, for this reason, came to our Community Mental Health Center (CMHC). Aims Find if the supposed relation between certain Life Events for people with a well-controlled NPD can lead to a MDD can be detected. Methods Both completed the Minnesota Multiphasic Personality Inventory (MMPI-II) that confirmed the co-existence. Results Diagnostically, these patients presented an exaggerated self-appraisal even during the depressive phases, attempts to gain others’ approval and attention, very little interest on others’ thoughts and efforts to gain personal advantages in a depressive frame. Conclusions This report suggest the necessity of further studies on the relation between NPD and MDD when a kind of frustration in important fields of patients’ life occurs. [ABSTRACT FROM AUTHOR]

Introduction The Compulsory Health Treatment (TSO) is an action applicable in case of justified need and clinic emergency, in presence of the refusal to Health Treatment Volunteer (TSV) in a subject suffering from specific illnesses, among which there are severe psychiatric illnesses. Objectives The TSO is the subject of discussion, because it's actually an action that violates – even if only temporarily – the free will of the person. It's a procedure justified by the impossibility of applying alternative practices that ensure a speedy recovery to the subject of his psychic integrity, consistent with the need of the person. Aim The aim of this study is to evaluate the epidemiology of TSO in Trieste between 2011 and 2013. Methods This retrospective study was conducted on 74 TSO performed at the CMHC and the Emergency Unit of Trieste, on 71 people (22 women, 49 men). Data analysis were on gender, diagnosis, TSO's days' number, frequency and significant changes during the TSO, with a comparison of these variables between the data of 2011, 2012 and 2013. Results The number of people under TSO was the same in the three years, with a countertrend of gender (decrease of 30% of women; increase of 46% of men). There was a decrease about days of TSO in the three years. Conclusion It's necessary to implement practices that promote good cooperation from the subject, to establish a contractuality which allows to limit TSO only for time strictly necessary. [ABSTRACT FROM AUTHOR]

Introduction The suicidal behaviours constitute a significant problem in terms of public health, thus a major goal of the WHO is to reduce these behaviours. In the '80s suicide rates and suicide attempts in the Trieste were the highest in Italy, comparable with those of Central Europe. Since the '90s a project was launched to prevent suicidal behaviour and suicide rates and non-lethal self-harm gestures have plummeted. Objectives We study the sociodemographic variables of this phenomenon. Aims The aim of our study is to monitor the performance of non-lethal self-harm over time and identify evidences to implement prevention strategies Methods We conducted retrospective study in the period 01.01.2000- 31.12.2007. We analyzed the records of hospital emergency rooms in Trieste, screened according to the keywords that indicate the diagnosis of access “self-harm” and “voluntary intoxication”. Socio-demographic variables were stratified by age and gender. Outcome variables were evaluated. Data were compared with those of a study conducted from 1993 to 1990. Results The study showed a mean of 85/100,000 inhabitants. The methods most frequently used were drug intoxication and cutting. There was a reduction in hospitalisations rates and an increased number of appointments in the Mental Health Department by the subjects with a suicide attempt history. Conclusions The rates of non-lethal self-harm in the period considered decreased compared to the '80s, while the average age of those who commit the act increased. These data can be used to enhance the primary and secondary prevention strategies. [ABSTRACT FROM AUTHOR]

Introduction Spices-use is continuously increasing in Western Countries, especially for legal reasons. Intoxication has been widely associated with psychotic symptoms. Objectives Here we present a case-report that seems to highlight this possible association between canabimimetics and psychosis, stressing the use of 'Spices” as an instrument of auto-determination in the young patient's opinion. Aims Find if the supposed relation between certain Life Events and Spices use for people with a use consequent to a Dependent Personality traits can lead to an unmasking of a psychosis. Methods Clinical interviews, Eri-Raos, drug-use and literature revision. Results Diagnostically, these patient presented right after a Spice intoxication psychotic symptoms like delusions, strong distress, the feeling of being observed and considered 'mad”, self-isolation that strengthened the need of Spice use and more difficulty (but self-reported need) to stay with others and to self-determinate herself in meaningful relationships. These symptoms have had a strong relief after the establishment of a relationship with our community mental health center (CMHC) and its multidisciplinary staff, that took care whit the patient of the whole life, in particular of the details that were stressful for her. Conclusions This report, being in accordance with others, suggests the necessity of further studies on the relation between Spice-use and psychotic symptoms, in particular for patients with a use that has roots to Dependent Personality Traits. [ABSTRACT FROM AUTHOR]