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The literature on the psychiatric aspects of HIV-1 infection is reviewed. The whole range of psychiatric disorders described in HIV-1 infected subjects, from HIV-1 dementia to adjustment disorders, is covered, along with the AIDS-related psychopathology which may develop in subjects without HIV-1 infection. © 1990, Cambridge University Press. All rights reserved.

Il 31 marzo 2015 è entrata in vigore la Legge 81/2014 che ha decretato la definitiva e storica chiusura dei sei Ospedali Psichiatrici Giudiziari in Italia. Con tale legge viene tracciato un nuovo assetto assistenziale che prevede la messa in funzione di strutture alternative ai vecchi ospedali, quali le Residenze per Emissione delle Misure di Sicurezza (REMS), ma soprattutto viene promosso un nuovo approccio curativo-riabilitativo nei confronti della persona affetta da disturbo mentale autrice di reato, pericolosa socialmente, approccio finalizzato al recupero sociale con tempi misurati sui bisogni assistenziali personalizzati. Dopo aver descritto sinteticamente quanto accade all’estero, il lavoro evidenzia gli aspetti positivi della legge che, nel suo complesso, è da considerare innovativa e ineludibile. Vengono passate in rassegna le principali criticità, quali: la mancata riforma del codice penale; l’equazione ritenuta non corretta tra infermità mentale e malattia mentale e pericolosità sociale; l’accertamento della pericolosità sociale, in base alle sole qualità soggettive della persona; la creazione delle REMS, ritenute costose e impostate principalmente su criteri di sicurezza e meno su quelli della cura e della riabilitazione, il ritardo nella loro costruzione e il ricorso a strutture residenziali alternative; i confini incerti della responsabilità professionale. Vengono poi proposte diverse azioni che possono sostenere l’applicazione della Legge 81: azioni informative rivolte alla popolazione; azioni formative per gli operatori; potenziamento dell’attenzione sulla popolazione forense; attuazione di protocolli d’intesa e collaborazione con la magistratura.Viene sollecitato un impegno fattivo delle società scientifiche nell’affrontare tale tematica, con particolare riferimento alle società che si occupano di riabilitazione, coinvolte nelle problematiche relative all’identificazione dei percorsi di cura e riabilitazione che seguono al superamento degli OPG The date of March 31, 2015, following the Law 81/2014, has marked a historical transition with the final closure of the six forensic psychiatric hospitals in Italy. This law identifies a new pathway of care that involves small-scale high therapeutic profile facilities (Residenze per la Esecuzione della Misura di Sicurezza, REMS) instead of the old forensic psychiatric hospitals. The Law promotes a new recovery-oriented rehabilitation approach for the persons with mental disorders who committed a criminal offence, but lack criminal responsibility and deemed as socially dangerous. After a brief description of what happens abroad, this article highlights the positive aspects of the law that, as a whole, has to be considered innovative and unavoidable. The main debated problems are also reviewed, including the lack of changes to the Criminal Code; the improper equation between insanity and mental illness and social dangerousness; the evaluation of "socially dangerousness", based solely on "subjective qualities" of the person, assessed out of his/her context, without paying attention to family and social conditions suitable for discharge; the expensive implementation of the REMS, mainly based on security policies and less on care and rehabilitation, the delay in their construction, and the search for residential alternatives structures; the uncertain boundaries of professional responsibility. Finally, several actions are suggested that can support the implementation of the law: information programs addressed to the general population; training activities for mental health professionals; systematic monitoring and evaluation of the outcomes of the care provided to the forensic psychiatric population; implementation of Agreement Protocols and a better cooperation with the judiciary. Scientific societies dealing with psychosocial rehabilitation need to be involved in such issues relating to the identification of the best care and rehabilitation pathways, which should be implemented following closure of forensic psychiatric hospitals.

Although residential facilities (RFs) have largely replaced mental hospitals (MHs) in most developed countries for the long-term residential care of severely impaired patients, the process of care in RFs has not been well studied. The aim of this paper is to investigate the process of care in 265 RFs, representing 19.3% of all RFs in Italy, and to devise a classification of RFs based on process characteristics. Structured interviews were conducted with the manager and staff of each RF. Residents were evaluated using standardized rating instruments. Most RFs had specific admission criteria, with one third having a waiting list that averaged about 3 months. There was no formal limitation to the length of stay in three quarters of RFs, and turnover rates were very low. Although a homelike atmosphere was found in many RFs, most facilities had restrictive rules on patients’ daily lives and behaviours. RFs carried out several external activities targeted at integrating patients within the local community. Standardized assessment instruments and written treatment plans were rarely used. A cluster analysis based on the levels of restrictiveness and the standardization of the process of care classified RFs into five groups that differed with respect to daily staff coverage, size, geographical distribution and proportion of former MH residents. No significant intercluster differences were associated with the current clinical and psychosocial characteristics of residents, or with several other outcome variables. This study provides naturalistic evidence of the heterogeneity of the process of residential care on a large scale. Future efforts should focus on developing an empirical classification of RFs, as well as on national and international standards of care and staffing to address patients’ needs.

In order to study the effector and regulatory functions of lymphocytes in mood disorders, bipolar type, the production of Interleukin 2 (IL-2), soluble receptor of IL-2 (IL-2R), Interleukin 6 (IL-6) and Tumor Necrosis Factor (TNF) were assayed in serum of bipolars, schizophrenics and healthy subjects. The study failed to find out any difference regarding lymphokine production in mental disorders.

The study of cytokine production represents a mean for exploring the immune function, because of their crucial involvement in the immune response. In schizophrenia, the literature reports contradictory results about "in vivo" and "in vitro" IL-2, sIL-2R and TNF production, in medicated and untreated schizophrenics. However, methodological concerns, regardinf sample size, control group composition, immune variables, assay technique, experimental deisgn and data analysis, limit the interpretation and generalization of these data. In our study we assessed the production of IL-2, sIL2R, TNF and IL-6 in a group of schizophrenic patients.

Associazione fra schizofrenia ed alterazioni del sistema immunitario

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