Search

Copyright of Italian Journal of Nursing (IJN) / Giornale Italiano di Infermieristica is the property of Collegio IPASVI MI-LO-MB - Ordine Professioni Infermieristiche MI-LO-MB and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

How will the network of Italian mental health services be structured in view of the health care reorganization drawn up by Ministerial Decree no. 77/2022 and by the State-Regions Agreement of December 21, 2022, on the "new methodology for calculating the personnel needs of the National Health System"? Changes concern organizational and structural aspects and the personnel standards needed for the full functioning of the community mental health system. It is undoubtedly a step forward to promote the overcoming of inter-regional inequalities and to quantify personnel needs in an area of public health which in the last decade has seen an increase in the demand for care, made exponential by the effects produced by the COVD-19 pandemic, conflicts and economic crisis. The estimates proposed show that the full application of the standards would lead to an expenditure for mental health equal to 3.6% of the public health funding. [ABSTRACT FROM AUTHOR]

Today the growing demand for Mental Health Services capable of providing high-quality services of care, combined with sustainable spin-offs at the economic level, requires new knowledge, new skills and new attitudes, also by virtue of the emergence of new issues, which pose high challenges. In the face of these challenges, most training curricula are inadequate, since they do not offer specific training to stimulate the interest of students or trainees, nor do they provide the necessary encouragement, awareness, essential support and fundamental information to start such a complex job as that of integrated and multidimensional treatment of mental disorders in the community. A radical rethinking is needed on both the content and the manner in which training programs are offered, taking into account the most up-to-date evidence-based acquisitions, in the light of the biopsychosocial paradigm and promoting the training of the entire Community Mental Health Center, in order to ensure that at whatever point of the Mental Health Center network a citizen receives the same quality of treatment and the same intervention methodology. [ABSTRACT FROM AUTHOR]

Some problems addressed in the book Ritorno a Basaglia? La deistituzionalizzazione nella psichiatria di ogni giorno [“Back to Basaglia? The deinstitutionalization in everyday psychiatry”] (Peloso, 2022) are discussed. The issue of whether it may be useful for today Italian psychiatry to look back to Basaglia and more generally to the years of struggle that led to the promulgation of Law 180/1978, and whether this is still possible in Italy and in a world that have changed in so many respects, is addressed at three levels: the levels of the mental health professional, of psychiatric services, and of social inclusion. It is concluded that certainly the egalitarian, libertarian and solidarity instances that favored deinstitutionalization and the movement against exclusion seem to have lost strength today, and this makes everything more difficult, especially at the third level. However, probably this is not yet true to the point of inhibiting personal responsibility and the “choice” that each one can make: therefore, Basaglia and his years remain, in many respects, an important point of reference both for mental health professionals and the organization of mental health services. [ABSTRACT FROM AUTHOR]

There is a full-blown crisis of the mental health system recognized by all but explained in a non-unanimous way. Two approaches are described, “denotative” and “connotative”, on the basis of which two theses called, respectively, “unfinished symphony” and “beyond the Law 180”, are developed. The first refers to an incomplete reform process that has generated aporias, contradictions, fallacies and paradoxes with which many psychiatrists identify several factors such as the folowing: changes in the need for care, “manufacturig defects” of Law no. 180/1978, problems of psychiatric services, difficult relationship between public psychatric services and the private sector, increasing admissions and days of hospitalizations in residential facilities, lack of fight against mental health stigma, stress of mental health professionals and their insufficient training, limited resources. The “depot effect” of these factors, releasing and amplifying other criticalities, leads to a lower credibility linked to a diminished “perceived value” of the mental health system, and testifies to an epistemic crisis linked to a change of the original ideology that could not be transformed into science due to the halting of a reform process that should go beyond Law no. 180 of 1978. If ideology in mental health becomes science, the challenge of the psychiatry reform will be won and the mental health crisis will be resolved. [ABSTRACT FROM AUTHOR]

Copyright of Mediterranea - Ricerche Storiche is the property of Mediterranea-Ricerche Storiche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The first session of a therapeutic group brings with it a great deal of anguish, which rests its foundation on the fear of unknown and contagion, of the diffusion of the self within an environment that is felt as unknown but as dangerous. On the other hand, the first long pause of group work, that of the summer holidays, brings with it the anguish of separation, which manifests itself in the last sessions and in the first ones upon returning from the summer as a threat to the group container. In fact, the summer break tests the relationship between container and contained, explaining the critical issues but also defining its structure and transformative possibilities. This work, which discusses a group held for more than two years in a Mental Health Service and made up of eight members, mostly women, psychiatric patients in their first psychotherapy experience, contains some notes on the first group session and on that of the return from the first summer break, thus trying to compare these two fundamental group anguishes. The group, held some years ago, is in fact at first put to the test by the terror of the concrete entry of "madness" within itself and then, in an attempt to cure both existential loneliness and the anguish of abandonment, by friendly dynamics among members. [ABSTRACT FROM AUTHOR]

This article aims to illustrate an experience of online therapeutic groups concerning mental health care during the first lockdown due to the Covid-19 pandemic. A questionnaire has been conceived and designed to understand the interactions and emotions experienced during these months in a different group setting. The objective is to examine the experiences of three different groups of patients and operators who assisted them, in order to improve the understanding and the discussion on the limits and potentials of an online therapeutic context. This article is an extension of a previous work on the same patients (Capani, 2020) and is aimed to deepen the scientific debate previously started on this group setting. [ABSTRACT FROM AUTHOR]

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The aim of the present research is to assess the satisfaction levels of participants in a multifamily psychoanalysis group conducted within a territorial mental health service, following the model developed by Argentine psychoanalyst Jorge García Badaracco., Methods: To evaluate participant satisfaction in the therapeutic group, an anonymous satisfaction questionnaire was adopted and administered during each multifamily therapy session between 2016 and 2019. The sample consisted of designated patients and their family members participating in the groups., Results: The results obtained from measuring participant satisfaction during the specified time period indicate a consistent and increasing level of satisfaction with the group activities conducted by all participants., Discussion and Conclusions: The obtained results indicate that the experience of multifamily psychoanalysis seems to be well-received and positively perceived by both users and family members, thereby contributing to an overall increase in satisfaction with the mental health service. The measurement of subjective satisfaction ratings in scientific literature is explored in relation to satisfaction, adherence, compliance, and treatment persistence, and can also be included as part of a broader set of variables aimed at identifying objective indicators of intervention outcomes in multifamily psychotherapies.

The involvement of users and stakeholders in the co-creation of services for citizens presents some critical issues when applied to prevention. In healthcare, the perimeter of effective and appropriate interventions is defined by guidelines and users often lack the tools to discuss its boundaries. It is necessary that the selection of possible interventions does not appear arbitrary, agreeing from the outset on which criteria and sources will be adopted. Furthermore, in prevention, what is identified as a need by the health service is not always perceived as such by potential users. The different assessment of needs leads to perceiving possible interventions as undue interferences in lifestyle choices.

The purpose of this essay is to analyze the role of 'psy' knowledges in the changeover of mental health services. These welfare services are shifting into paradigm of 'community care' and reshaping the role of users' and professionals ' knowledges, as we can see in the participation of mental health services users in providing relief and support. The first part of the essay concentrates on the case of Irina, a user of neuropsychiatric service for childhood and adolescence I work for in a high school as a 'tutor for social integration'. In the second part of the essay I will analyze this process with tools from the sociology of expertise and intervention. The ethnographic study of this case will show a deep contradiction between the declared 'opening' of community care services to user's knowledges and the real gap of power that yet regulates the structure and the meaning of social intervention. [ABSTRACT FROM AUTHOR]

Objective: The co-occurrence of obsessive-compulsive disorder (OCD) in patients with schizophrenia (SCH) or schizo-affective disorder (SAD) is frequent and disabling. Data on the effectiveness of serotonin reuptake inhibitors in patients with SCH or SAD and OCD comorbidity are limited and controversial, and to date no study exploring the effectiveness of cognitive-behavioral therapy (CBT) for patients with this comorbid condition has been conducted. The purposes of this open naturalistic study were to examine the adherence to, and the effectiveness of CBT for OCD in patients with stabilized SCH or SAD. Method: Twenty-one consecutive patients with SCH or SAD and OCD comorbidity were enrolled. CBT for OCD was conducted in a naturalistic setting. Primary outcomes were: adherence rate (percentage of patients who did not drop out during the trial), and the OCD remission rate, (Y-BOCS total score < 16). Secondary outcomes were OCD response (a decrease ≥ 25% in the total Y-BOCS score from baseline to 1 year), and improvement (CGI-I score of ≤ 2). An intent-to-treat analysis was conducted. Results: Five patients (23%) dropped out from the study. At one year, 52% (11/21) of the patients were rated as much or very much improved; 33% (7/21) were responders, and 19% (4/21) were remitters. Conclusions: Our findings showed good CBT adherence for SCH/SA patients with OCD comorbidity, and suggest that CBT may be a helpful treatment strategy for OCD in these difficult-to-treat patients. [ABSTRACT FROM AUTHOR]

The paper aims to discuss the narrative as a methodological device within a clinical setting for psychological intervention. The authors present the narrative as a process of meaning of the experiences. It is always achieved within a cultural context and generates a specific relational proposal towards the interlocutor. From the psychological and clinical point of view, the interest of this contribute concerns the several possibility of transformation of the narrative process, as the goal is not the production of coherent and well packaged narratives. In order to understand complexity and dynamics of the narrative process is necessary to assume perspectives able to capture aspects, specific processes and dynamics of signification. In the light of these intentions, directions for study and use of narratives as a clinical tool are presented in this work. Starting from the contribution of the semiotic disciplines, narrative is observed through different axes of signification (paradigmatic, syntagmatic, pragmatic, pathemic axis) along which it is possible to observe the meaning making through the organization of the text. Furthermore, the distinction between history, telling and narrative/discourse is used in psychological terms to distinguish between different hermeneutics frames and the activating of specific psychological functions (referential, plot and enunciation). This distinction is used to grasp and discuss the reflexive processes and the processes of transformation of the relation between continuity/discontinuity in order to mean experiences and subjective implication within relationships. [ABSTRACT FROM AUTHOR]

Aim: In urban contexts, Mental Health Services are increasingly involved in the assessment of users with a heterogeneous ethnic and cultural background. These characteristics of migrants can exert an influence on access to healthcare, diagnostic evaluation, and use of therapeutic resources. The present work aimed to compare these differences among individuals who received their first clinical evaluation at the Mental Health Outpatient Service of Prato in 2019-2021, exploring variations across time, among the entire non-native population, and based on their continent of origin., Methods: In the abovementioned clinical population, socio-demographic data, the type of evaluation received, and the primary diagnostic classification were retrieved. Their absolute and relative frequencies were registered, and differences based on the origin of migrants were explored., Results: Of 3,992 assessments, 485 (12.1%) involved non-natives from 60 different countries, with a lower mean age as compared to the Italian counterpart, and a heterogeneous gender prevalence based on the continent of origin. The percentage of migrants increased from 11.8% to 14.2% across time, with a higher proportion of psychiatric evaluations and a lower implementation of multi-professional interventions. As compared to native individuals, a higher proportion of adjustment, psychotic, substance-related, somatic, conversive, dissociative, and post-traumatic disorders was observed., Discussion and Conclusions: The access of migrants to the Public Mental Health outpatient facility proved to be remarkably lower than expected, based on the composition of the general population. Given the proportional increase in the requested evaluations, it is necessary to promote a reflexion on the specificity of the emergent psychopathology, and on difficulties in access to psychotherapy: a trans-cultural approach to mental health may require adequate resources for the management of these distinctive needs.

The study deals with immigrant families' mental health and their access to public mental healthrelated services, and aims at pointing out the main problems associated with the reception and assistance to immigrants. We consider international scientific articles discussing this issue published in the years 2010- 2011, and our focus is primarily on the strategies followed by mental health agencies in order to assist the entire immigrant family unit, thus providing support for both parents and children. Access to mental health services and facilities is examined on the basis of the users' viewpoint and the mental disorders reported as well as the quality of the available services and the factors affecting dropout. We also investigate the aspects which prove to be potentially stressful in the immigration experience. As indicated in the study, the first challenge mental health care providers have to face is to facilitate access and utilization of services for the immigrants who experience sociocultural isolation and economic deprivation. [ABSTRACT FROM AUTHOR]

In the treatment of Obsessive-Compulsive Disorder the relational aspects play a central role, both those related to the interpersonal context of the patient's life and those related to the therapist-client relationship. In particular, in this article, the therapeutic relationship is discussed. It is analysed in which way it can be used by the clinician in a strategical way to pursue the therapeutic purposes, just like the different strategies of intervention that the therapist has at his disposal, talking about the principal phases of psychotherapy, from the early interviews to the end of the therapy. [ABSTRACT FROM AUTHOR]

This paper describes the impasses occurring in the treatment of Obsessive-Compulsive Disorder, being the special object of our analysis the patient's representations. In particular we shall try to answer the following questions: how does the obsessive-compulsive patient evaluate the psychological help provided by the psychotherapist? Which are the peculiar evaluations that hinder or even nullify this kind of help? We shall answer starting from one of the most substantiated thesis in the field of clinical cognitivism, the one according to which the obsessive symptomatology can be traced back to evaluations due to an hypertrophic sense of responsibility (Arntz et al. 2007; Ladouceur et al. 1997; Lopatka & Rachman 1995; Mancini et al. 2004; Salkovskis 1985, 1989; Salkovskis & Forrester 2002; Shafran 1997) and more specifically to a fear of moral guilt (Basile e Mancini 2011; Gangemi et al. 2007; Mancini 2005; Mancini & Gangemi 2004; Mancini et al. 2008; Rachman 1993; Shafran et al. 1996; Shapiro & Stewart 2011). We shall maintain, consistently with the above-mentioned thesis and on the basis of the clinical observation, that it is possible to explain most of the resistances to change and of the relational deadlocks as effects of evaluations amenable to those very same psychological structures implied in the genesis of the obsessive symptomatology (Saliani & Mancini 2010) and we shall provide, through clinical examples and excerpts of self-dialogue reported by patients, a thorough description of these kind of evaluations occurring in the various phases of treatment. [ABSTRACT FROM AUTHOR]

Copyright of Archivio di Etnografia is the property of Pagina Societa Cooperativa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archivio di Etnografia is the property of Pagina Societa Cooperativa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archivio di Etnografia is the property of Pagina Societa Cooperativa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses changes and reforms in the Italian approach to mental health and psychiatric care during the period from 1968 to 1978. Topics discussed include the May 13, 1978 Italian government reform known as the Mariotti Act and its impact on the approach of the Italian government and medical community towards the treatment of mental illness, the movement towards de-institutionalization of of asylums and mental health care in Italy during this time, and the role of Gorizia asylum director Franco Basaglia in promoting these changes.

The article discusses the history of mental health care facilities in the Italian-Tirol region on the border of Italy and Austria in the period between 1804 and 1882. Topics discussed include the creation of mental asylums in the Trentino region in the first half of the 19th century, legal and government regulations concerning the admission and treatment of patients, and the history of the transfer of patients from asylums in the Lombardy-Venetia region to the facility at Hall in Tyrol in the Tirol region.

Aim: To report on: 1) the modification process occurred within the Psychiatric Service of Bolzano toward an early, intensive, specific and multimodal system of care for patients experiencing their first psychotic episode and their family members; 2) the 12-month clinical and social course of a sample of patients referred to the "Early Intervention Project"., Methods: Longitudinal naturalist study evaluating the 12-month clinical and outcome of a cohort of first-episode psychosis patients consecutively referred to the "Early Intervention Project" implemented within the Psychiatric Service of Bolzano. Socio-demographic characteristics, housing situation and occupational status, interventions offered (medical intervention, psychotherapy, psychoeducation to family members, social intervention) and hospital admissions were drawn from electronic medical records. Levels of psychopathology and global functioning were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Global assessment of Functioning (GAF), respectively., Results: During the first five years of activity (2012-2017) 116 patients had been referred to the Project. At 12 months 83.6%were still in charge, 7.76% moved to another area, 8.5% have abandoned the intervention. No significant difference in terms of age and gender was found between patients who remained in the project and those who lost contact. All patients had received specific integrated treatment; moreover, 16% had received intensive residential care. Notably, only 13.5% have had a hospital readmission over the 12 months of intervention. The PANSS total, positive and negative scores displayed significant reduction from baseline (BL) to follow-up (FU); in parallel, increase in GAF score from BL to FU was observed. All patients employed at BL were able to keep their job at FU; 17% of all patients unemployed at baseline were employed at FU., Discussion and Conclusion: The "Early Intervention Project" implemented in Bolzano was found to ensure integrated, multidisciplinary and early treatment, as defined by the most recent international guidelines, which produced significant improvement in both clinical and social outcomes in a cohort of first-episode psychosis patients.

The area of mental health is directly affected by the pandemic and its consequences, for various reasons: 1-the pandemic triggered a global lockdown, with dramatic socioeconomic and therefore psychosocial implications; 2-mental health services, which treat by definition a fragile population from the psychological, biological and social points of view, have a complex organizational frame, and it was expected that this would be affected (or overwhelmed) by the pandemic; 3-mental health services should, at least in theory, be able to help guide public health policies when these involve a significant modification of individual behaviour. It was conducted a narrative review of the publications produced by European researchers in the period February-June 2020 and indexed in PubMed. A total of 34 papers were analyzed, which document the profound clinical, organizational and procedural changes introduced in mental health services following this exceptional and largely unforeseen planetary event.Among the main innovations recorded everywhere, the strong push towards the use of telemedicine techniques should be mentioned: however, these require an adequate critical evaluation, which highlights their possibilities, limits, advantages and disadvantages instead of simple triumphalist judgments. Furthermore, should be emphasized the scarcity of quantitative studies conducted in this period and the absence of studies aimed, for example, at exploring the consequences of prolonged and forced face-to-face contact between patients and family members with a high index of "expressed emotions".

Objectives: to figure out if there are differences in access to psychiatric services between Italian and immigrant paediatric populations., Design: we analysed the data of the year 2012 from the Banca dati del disagio psichico, a database on psychological distress created by the Epidemiological Unit of the Local Health Unit Milan 1 (Lombardy, Northern Italy). The database is based on a data warehouse system that integrates health and social data, and gives the opportunity to calculate the prevalence rates of the main clusters of psychiatric diseases according to ICD-10 categories., Setting and Participants: the sample includes 162,197 residents younger than 18 years (minors), divided into 4 subgroups depending on the place of birth (Italy or abroad) and citizenship (Italian or foreign)., Main Outcome Measures: we calculated the standardised treated prevalence of the 11 clusters of mental diseases in the 4 subgroups and evaluated the Standardised Prevalence Ratio (SPR) and their confidence intervals using as reference the Italian paediatric population with Italian citizenship., Results: in 2012, 7.2%minors were diagnosed a mental illness or accessed mental health services or were prescribed psychotropic medicines. We found the lowest SPRs of psychiatric illnesses in immigrants (0.91 born in Italy; 0.74 born abroad) and the higher in Italians born in foreign Countries (1.34). In particular, migrant minors born in Italy have lower SPR of developmental disorders (0.84) and behaviour and emotional disorders (0.68), but higher SPR of mental retardation (1.52) and anxiety disorders (1.36). Migrant minors born abroad have lower SPR of developmental disorders (0.52), but higher rates of mental retardation (1.30). Italians born in foreign Countries show a SPR for personality disorders and mental retardation of 4.86 and 2.02, respectively., Conclusions: immigrant minors have a lower prevalence of psychiatric diseases than Italian minors; however, Italians born in foreign Countries show a higher prevalence of psychiatric disorders.

Aim: Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient., Methods: Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study., Results: Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study., Conclusions: There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

Aim: The objective of this study was to evaluate the occurrence of dissociative symptoms in outpatients affected by mood or anxiety disorder and their potential implication in general psychopathology and treatment response., Methods: The sample was recruited at Italian and Spanish psychiatric outpatient services. The sample consisted in 40 (13 Male, 27 Female) outpatients, 22 Italians (55%) and 18 Spanish (45%). Inclusion criteria were the Axis I diagnosis of any DSM-IV-TR mood or anxiety disorder and Clinical Global Impression/Global Severity Index (CGI) baseline scores > or = 3 and Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A) baseline scores > or = 18. General psychopathology, dissociative symptoms and personality traits were respectively assessed by the self-report symptom inventory Symptom Check-List 90 (SCL-90), the Dissociative Experience Scale (DES) and the Cloninger's Temperament and Character Inventory (TCI)., Results: Dissociative symptoms emerged as relatively frequent in mood and anxiety disorders. Globally, depression symptoms seem to correlate positively with the dissociative experiences and the severity of global psychopathology. Dissociative symptoms seem to correlate positively with some personality traits and the severity of global psychopathology and should receive further investigation in clinical practice, as might be a predictor of poor response to conventional drug treatment.

Introduction: On national territory, the psychiatric divisions "open doors" that are using not restraint methods (not key closed) are still a minority. Most psychiatric divisions in Italy have their doors closed and use methods of physical restraint. To work in psychiatric divisions "open doors" the nursing staff needs advanced preparation levels. They have to use relational techniques to build an empathic relationship with the patient even in situations of acute crisis., Aim: In this study has been explored and analyzed formative needs of the professional staff in psychiatric division "open doors" with the aim to understand which skills are requested to work in these structures., Materials and Methods: Were used a questionnaire and an interviews that have involved 78 nurses in psychiatric division., Results: The subjects on which staff would be trained are: psychiatric nursing, aggressiveness management, legal risks in psychiatric divisions "open doors", cognitive-behavioural therapy, empowerment., Conclusions: Where are practiced the "no restraint methods" and the "open doors", physical aggressions are more rare and also escapes don't happen frequently. Working with the "open doors" means more humanity and a more relaxed atmosphere, less dangerous situations and less aggressive behaviour.

Actually, a lot of mental health services in Italy don't give comparable informations about professional risks evaluation, as violent acts against operators during their work activity in Psychiatric services. The most frequent surveys are those derived from medical reports of hospitals (ISTAT modules). However, these surveys are not available to make an analysis purposive for prevention: often the medical reports are incomplete or they are not fill out. Moreover, the reports are often written for generic causes, so they couldn't support quality indicators. On the contrary, the number and the characteristics of violent acts, evaluated with standardized instruments and shared with other services, give informations those could implement the constitution of Quantitative Indicators and support quality indicators. However, our opinion is that cards of free descriptions are not sufficient to evaluate violent acts, because they can be filled out briefly, without attention to important items, as which in the SOAS-R Rating Scale and in two Scales we suggest: a card of anamnestic interview and a card for evaluation of organizing parameters. Essential and inalienable aspect is the obligatoriness of the report, which serves to make the operators to be more unafraid during work time, and can obviate the problem of subjective behaviour of larger tolerance in an operator than in others, and this fact could make invaluable also quality indicators.

Aim: Many patients drop-out from treatment after a single contact; however, characteristics have only rarely been investigated. We aimed at estimating the frequency of early drop-out and identifying possible risk factors., Methods: The study was performed at the Palestrina Mental Health Centre, located near Rome, Italy. The clinical charts of all first-time attenders who did not come back during a 7-year index period (2000-2006) were reviewed and information was collected on sociodemographic factors, psychiatric history, clinical presentation, and process of care., Results: During the index period, 97 of 1.001 first-time attenders dropped out after the first contact. We excluded patients with symptoms of organic (N = 9) or severe mental disorders (N = 3). Of the remaining 85 patients, 49 presented with symptoms related to life events or situations ("reactive symptoms", RS), while 36 had "non-reactive symptoms" (NRS). Eighty-five randomly selected patients with comparable conditions (psychogenic reaction; anxiety, dysthymic or somatoform disorder; ICD-9 code 300.x, 308.x, 309.x) who came back to visit were included as controls. First-only contact patients tended to present with RS more often (58% vs. 43%) than controls. Therefore, the analyses were stratified for reactivity of symptoms. Among patients with NRS, first-only contact patients tended to be younger than controls. Among patients with RS, time until the next appointment tended to be longer in first-only contact patients than in controls. No other differences were observed between first-only contact patients and controls on sociodemographic variables, source of referral, and previous treatment history., Discussion: The occurrence of early drop-out was relatively low. The higher prevalence of RS among first-only contact patients may suggest a greater disposition towards conflict or ambivalence in interpersonal situations. Patient-perceived service availability, in the form of shorter appointment delay, seems to promote maintenance of contact. Younger patients who tend to be at higher risk of early drop-out deserve increased clinical attention.