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Lo studio muove dallo scorcio trentennale di sperimentazione dell’applicazione concordata della pena, investigandone l’evoluzione – normativa e giurisprudenziale – e interrogandosi sulle molteplici contraddizioni che vi si registrano. Constatato come l’instabilità dell’istituto derivi, almeno in parte, da una congenita ambiguità della sua fisionomia, collocata a cavallo tra le esigenze di deflazione processuale e l’area della punibilità, l’indagine ricostruisce, alla luce della sedimentazione normativa e giurisprudenziale, i frequenti fenomeni di attrito tra le due dimensioni in parola: l’una più portata a interventi di ampliamento del ricorso al rito; l’altra più esposta a pulsioni restrittive, ispirate a logiche di difesa sociale. L’analisi non manca di verificare le ricadute sulla materia dei progressivi processi di armonizzazione europea in ambito penale: sia dal punto di vista della giurisprudenza della Corte europea dei diritti dell’uomo, sia per ciò che concerne la produzione normativa eurounitaria.

Psychogenic non-epileptic seizures (PNES) are paroxysmal events that resemble clinical signs and symptoms of epileptic seizures (ES), but are not associated with ictal epileptiform abnormalities in the EEG pattern. The neurobiological theory assumes that an organic cause may lead to an interruption of neuronal pathways assigned to control, affecting the subject’s ability to be oriented in space and time and to be in command of his/her actions. The case describes the history of an adolescent with lesional temporal lobe epilepsy (TLE) and PNES. PNES were correlated with long periods of discontinuation of the normal relationship with the external environment, automatic writing in a state of partial impairment of consciousness and a slow return to normality. After the surgical removal of a right temporal lobe dysplasia, along with a large decrease in ES, PNES completely disappeared. This type of evolu-Clinical Cases and Reviews in Epilepsy 2016; 1(2):149-154 149 tion is unusual and in contrast with previous literature data showing the onset of PNES after brain surgery. The history of this case could be in line with a neurobiological basis of the onset of some types of PNES, although further studies with functional and structural neuroimaging are needed to confirm our hypothesis

Despite the poor evidence supporting the use of coercive procedures in psychiatry wards and their “psychological damage” on patients, the practice of restraint is still frequent (6-17%) and varies 10-20 times among centers. Methods. We searched the PubMed, Embase and PsychInfo databases for papers published between January 1 1990 and March 31 2010 using the key words “restraint”, “constraint”, “in-patient” and “psychiatry wards” and the inclusion criteria of adult samples (studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescence or the elderly, men/women only, personality disorders and mental retardation were excluded), the English, French, Italian or German languages, and an acute setting. Results. The prevalence of the use of restraint was 3.8-20% (not different from previous data), despite the attempts to reduce the use of restraint. The variables most frequently associated with the use of coercive measures in the 49 studies included in this review were male gender, young adult age classes, foreign ethnicity, schizophrenia, involuntary admission, aggression or trying to abscond, and the presence of male staff. Conclusions. Coercive measures are still widely used in many countries (albeit to a greater or lesser extent) despite attempts to introduce alternatives (introduction of special protocols and nurses’ training courses) in some centers that should really be tested in large-scale multicentre studies in order to verify their efficacy

Goals of the case-control study is to evaluate the prevalence of PNES among persons referring to a secondary epilepsy center and to investigate through Rorschach Test the psychological traits of both the two groups: people with PNES only and people with PNES and epileptic seizures, compared with a control group of persons with epileptic seizures only. 240 persons have been screened with a semistructured questionnaire. 97 are considered at risk of PNES and 54 were observed by a psychiatrist consultant. All persons with PNES (7) suffer or suffered from an Anxiety Disorder and 57% have or had a Depressive Disorder. In the history of persons with epileptic seizures only these disorders were present in 33%. 19 people have been subjected to the Rorschach Test and it has been seen that persons with PNES tend to focus on their body as a vehicle to communicate a deep suffering

Background: The presence of a post-traumatic psychiatric disorder in patients with acute injuries may have adverse effects on outcomes. Aim: In this study our aims were: 1) to assess the frequency of psychiatric disorders after a cerebrovascular accident or traumatic injury requiring rehabilitation; 2) to examine whether there was any correlation between psychiatric disorders and patients' baseline demographic and clinical variables. Design: The study consisted of two phases: the first was cross-sectional and the second prospective with a 12-month follow-up. The period of recruitment was two years. The results of the first phase are presented here. Setting: The study sample consisted of a consecutive series of patients admitted to hospital because of an acute cerebrovascular accident or a traumatic injury and referred for a rehabilitation program. Two inpatient Rehabilitation Hospitals were involved in the study. Population: The sample consisted of 230 consecutive patients with a recent cerebrovascular accident or trauma included in a rehabilitation program. Methods: The sample included: 89 men (39%) and 141 women (61%) aged 20-97 years. Psychiatric disorders and motor disabilities were assessed through psychiatric interview and the Mini-International Neuropsychiatric Interview Plus (MINI Plus) and, respectively, with the Functional Independent Measure (FIM). In case of Post-Traumatic Stress Disorder (PTSD), severity was assessed through the Davidson's Trauma Scale. Psychiatric disorders were correlated to demographic and clinical variables through univariate and multivariate analyses, the latter with logistic regression models. Results: The most frequent entry diagnoses were traumatic fracture (41.3%) and stroke (37.0%). Ninetythree patients (40.4%) had one or more psychiatric disturbances at study entry, the commonest being depression (56 cases, 24.7%) and anxiety (23 cases, 10.0%). PTSD was present in 8 cases (3.5%). A history of psychiatric disorder was reported by 55 patients (24.2%) Compared to the rest of the study population, these subjects had more psychopathologic complaints (P

Objective. To evaluate the refusal of the prosthesis in order to highlight elements in determining the acceptance/rejection of the prosthetic devices, and its role on rehabilitation program. Methods. A literature review through a search of the database Medline for studies published between October 2007 and May 2020 using the key words "prosthesis", "limb", and "accept"*. Results. Nine studies were included. Women appear to be more concerned about discomfort in using body-powered devices and about prosthesis cosmetic appearance. Level of limb amputation was considered relevant for prosthesis rejection only for the upper limb. Children fitted with prosthesis before two years old were less likely to abandon the prosthesis, preschool children have a lower drop-out prevalence compared to adults and school-age children. Conclusions. Understating the factors for rejections is crucial for more favorable health outcomes; multiple psychological factors should be considered during the rehabilitation process of individuals with limb amputation. Rehabilitation should consider psychosocial assistance for acceptance and perception of body representation and its discrepancy with the real body.

This work points out the main differences in the semantic expressions used by patients with psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES). In reference to the body as a phenomenological entity, in ES the concept of the body-object prevails while in PNES the body, with all its life attributes, predominates. In description of seizures and in similitudes and metaphors used, ES patients focus on the description of the attack, trying to close the "gap" with a big effort, while patients with PNES concentrate on the context and on the presence of bystanders. Patients with PNES are unable to describe their own attack, since this it is not at the core of their distress, but rather the manifestation of something else, which is hiding the extreme anguish associated with experiences of the past that cannot be revealed (expressed). In the case of ES, instead, the ability to talk and the willingness to elaborate on the emotions become useful tools for facing the disease, an entity perhaps unsurmountable but at least manageable, to the benefit of everyone. In general, we can say that the experience of a disease (real or symbolic) deserves constant attention because it gives us the opportunity not only to probe the depth of the emotional experiences but also the psychic structure of the individual in front of us. A cure would not be a cure without considering such fundamental elements. It would become a sterile exercise of prescribing medications without paying attention to the person, which is the best way of preserving dignity in a state of illness.

The differential diagnosis between cognitive impairment and functional cognitive impairment (depression) is complex and difficult, especially in the early stages of the disease. The aim of our study was to test linguistic analysis as a diagnostic tool to support clinical, and test-based diagnoses for this differential diagnosis. We enrolled 13 patients, requesting a diagnostic consultation in a Alzheimer Evaluation Unit. A provisional diagnosis through a neuropsychological evaluation (interview and neuropsychological tests) was made at baseline, while a definitive diagnosis was provided after six months, or, if not possible, after 12 months. The linguistic analysis was performed at T0 in blind by a linguist. Patients' language was studied at linguistic (morphological, syntactical, lexical literal and textual) and conversational (verbiage and humor) level. The correspondence rate between the linguistic analysis at T0 and the definitive diagnosis was 76.9%, compared to 58.4% between the neuropsychological équipe analyses at T0 and definitive diagnosis. There is no single patognomonic phenomenon for cognitive impairment or depression, but rather a linguistic cluster can lead to a diagnosis with a fairly good reliability.

Objective The objective of this review was to examine the possible link between psychological trauma in a patient's medical history and the onset of psychogenic nonepileptic seizures (PNES). Methodology An electronic search of published reports was made using the search engines PubMed-MedLine, EBSCO, PsycINFO, SFX, and Embase and the keywords “PNES”, “psychogenic seizures”, “sexual abuse”, and “trauma”. Results A correlation emerged between history of childhood trauma and the presence of PNES. Antecedent trauma was more frequent in females than in males and in patients exhibiting psychiatric disorders but was inversely correlated with cognitive impairment. Conclusions In the presence of PNES, it is important to accurately investigate the patient's medical history in search of psychological trauma, particularly in women and in patients with psychiatric disorders.

The restoring of equilibrium after a traumatic event makes it possible to give a new significance to patients’ existence, and healthcare professionals simultaneously find themselves very close to questions of pain and disability. For these reasons, we introduced weekly group meetings of healthcare professionals and patients suffering from vascular, traumatic or neurological accidents, and meetings of professionals only at the Neurocognitive Rehabilitation Day Hospital of the University of Milan Bicocca. The aim of this paper is to identify possible indicators of changes in patients’ existence through a conversational analysis, describing the experience at the light of methodological approach and reporting the results of a pilot observational study. The patient meetings began in October 2011 and led to a process of greater closeness and trust that was expressed by means of words, gestures, emotional participation, and non-verbal communication. The pilot considers the evolution of indicators in a sample of 14 patients for a period of 9 months and a timeframe of 3 months. Supportive interventions decreased while elements of sharing progressively increased, leading to progressive increased consciousness of both self and the disease. The group of professionals found that being together allowed them to distinguish performance as the use of their technical skills from understanding the other and his/her experience as part of their own, and not only linked to the disease. The professionals’ reflections on their experiences led to the emergence of two possible ways of looking at a patient: as somebody other than me or somebody other like me.

Aim: In neurology, the differential diagnosis between cognitive and functional cognitive impairment is one of the most complex and diffi cult especially in early stages of the disease. Conversation analysis (CA) study social interaction embracing both verbal and non-verbal conduct in situations of everyday life. Our study aims to evaluate the possibility of using linguistic analysis to support clinical, and test-based diagnoses for the differential diagnosis between cognitive impairment and psychiatric diagnosis resembling dementia. Methods:13 subjects requesting an initial consultation in a Alzheimer Evaluation Unit. A provisional diagnosis through a neuropsychological evaluation, was made at the baseline, after six months (gold standard), and, if necessary, after 12 months. The linguistic analysis was performed in a blind study by a linguist at T0. Patients language was studied at linguistic and conversational level. Results: Linguistic analysis at T0 has shown a correspondence rate with the gold standard diagnosis in 76.9% of cases (sensibility-80%, specifi city-75%, PPV-67% NPV-86%). The correspondence rate between the neuropsychological équipe analyses at T0 with the gold standard was 58.4%.Discussion: The linguistic diagnosis was able to establish the presence of cognitive impairment earlier than the diagnosis made by the neuropsychological équipe. A linguistic cluster of patognomonic phenomenon can lead to a diagnosis with a good degree of reliability, thus a trained linguist is needed. Conclusion: New studies using this methodology, and on larger patient populations are needed in order to confi rm the use of this technique and, if necessary, to refi ne it with the addition of words linked to emotions.

Nowadays the role of psychiatry among the medical disciplines is difficult to identify. Three major changes are responsible for the current confusion: “the loss of a cultural reference; the fragmentation of psychiatry after the closure of the mental hospitals, and the increased application of neuroscience and neuropharmacology to the practice of psychiatry. To that one should add a major cultural change within the family. This includes the emphasis on immediate gratification, and the disappearance of the figure of the leader, most of the time impersonated by the father. Instead of liberating the psychiatric patient from the stigma of the disease, the combination of these factors has lead to a new form of ostracism. The new psychiatric patient is a person unable to adapt to rapidly changing social rules imposed by competing cultural influences. These claims control and power on social rules as competing forces, whose strength relies on confrontation rather than dialogue, on subjugation rather than consensus. After reviewing the ongoing challenges of psychiatry, the article explores the interaction of medical and humanistic sciences in the creation of a psychiatry at the service of the human being as a unique entity, endowed with a unique mission.

Sembra un dato pacifico che il giudizio di seconda istanza sia connaturale al nostro sistema processuale. Invero, dopo un’attenzione dottrinale, legislativa e giurisprudenziale concentrata per almeno un decennio dal varo del nuovo codice di procedura penale sul giudizio penale di primo grado, poi culminata nella riforma dell’art. 111 Cost. – che, come noto, ha fissato le linee guida del giusto processo (con la legge costituzionale n. 2 del 1999) 1 – e nella c.d. legge attuativa sul giusto processo (n. 63 del 2001), è andata aumentando, nel dibattito scientifico, l’attenzione per un ripensamento funditus delle impugnazioni e, in particolare, della fisionomia del giudizio penale di secondo grado, proprio alla luce della ribadita scelta normativa in senso accusatorio del sistema.