Search

Patients with severe mental disorders die on average 20 years prior to the general population. This mortality gap is mainly due to the higher prevalence of physical diseases and the adoption of unhealthy lifestyle behaviors.The LIFESTYLE trial aims to evaluate the efficacy of a new psychosocial group intervention (including psychoeducational, motivational, and problem-solving techniques) focused on healthy lifestyle behavior compared to a brief educational group intervention in a community sample of patients with severe mental disorders. The trial is a national-funded, multicentric, randomized controlled trial with blinded outcome assessments, which is carried out in six outpatient units of the Universities of Campania “Luigi Vanvitelli” in Naples, Bari, Genova, L'Aquila, Pisa, and Rome—Tor Vergata. All patients are assessed at the following time points: baseline (T0); 2 months post-randomization (T1); 4 months post-randomization (T2); 6 months post-randomization (T3); 12 months post-randomization (T4); and 24 months post-randomization (T5). T1 and T2 assessments include only anthropometric tests. The BMI, a reliable and feasible anthropometric parameter, has been selected as primary outcome. In particular, the mean value of BMI at 6 months from baseline (T3) will be evaluated through a Generalized Estimated Equation model. The work hypothesis is that the LIFESTYLE psychosocial group intervention will be more effective than the brief educational group intervention in reducing the BMI. We expect a mean difference between the two groups of at least one point (and standard deviation of two points) at BMI. Secondary outcomes are: the improvement in dietary patterns, in smoking habits, in sleeping habits, physical activity, personal and social functioning, severity of physical comorbidities, and adherence to medications. The expected sample size consists of 420 patients (70 patients for each of the six participating centers), and they are allocated with a 1:1 ratio randomization, stratified according to center, age, gender, and educational level. Heavy smoking, sedentary behavior, and unhealthy diet pattern are very frequent and are associated with a reduced life expectancy and higher levels of physical comorbidities in people with severe mental disorders. New interventions are needed and we hope that the LIFESTYLE protocol will help to fill this gap.Trial registration number: 2015C7374S.

Objective: This study aims to explore relationships between preferred and experienced clinical decision making with service use, and associated costs, by people with severe mental illness.Methods: Prospective observational study of mental healthcare in six European countries: Germany, UK, Italy Hungary, Denmark and Switzerland. Patients (N = 588) and treating clinicians (N = 213) reported preferred and experienced decision making at baseline using the Clinical Decision Making Style Scale (CDMS) and the Clinical Decision Involvement and Satisfaction Scale (CDIS). Retrospective service use was assessed with the Client Socio-Demographic and Service Receipt Inventory (CSSRI-EU) at baseline and 12-month follow-up. Negative binomial regression analyses examined the effects of CDMS and CDIS on service use and inpatient costs at baseline and multilevel models examined these relationships over time.Results: At baseline, staff and patient preferences for active decision making and low patient satisfaction with experienced decisions were associated with longer hospital admissions and higher costs. Patient preferences for active decision making predicted increases in hospital admissions (b = .236, p =.043) over 12 months and cost increases were predicted by low patient satisfaction (b = 4803, p =.005). Decision making was unrelated to medication, outpatient, or community service use.Conclusions: Decision making is related to inpatient service use and associated costs by people with severe mental illness. A preference for shared decision making may reduce healthcare costs via a reduction in inpatient admissions. Patient satisfaction with decisions is a crucial predictor of healthcare costs; therefore, clinicians should maximize patient satisfaction with decision making.

Since its first edition, the Diagnostic and Statistical manual of Mental disorders (DSM) has had a great impact on the scientific community and the public opinion as well. In 2013, the American Psychiatric Association released the fifth edition of the manual and - as for the previous versions - several criticisms raised. In particular, the persistence of the categorical approach to mental disorders represents one of the main debated topics, as well as the introduction of new diagnostic syndromes, which are not based on an adequate evidences. Moreover, the threshold of diagnostic criteria for many mental disorders has been lowered, with the consequence that the boundaries between "normality" and "pathology" is not so clear. In this paper, we will: 1) report the historical development of the DSM from the publication of its first edition; 2) describe the main changes introduced in the DSM-5; 3) discuss critical elements in the DSM-5. The current debate regarding the validity of diagnostic manuals and its criteria is threatening the psychiatric discipline, but a possible solution should be represented by the integration of diagnostic criteria with the in-depth description of patient's psychopathological experiences.

Since its first edition, the Diagnostic and Statistical manual of Mental disorders (DSM) has had a great impact on the scientific community and the public opinion as well. In 2013, the American Psychiatric Association released the fifth edition of the manual and – as for the previous versions – several criticisms raised. In particular, the persistence of the categorical approach to mental disorders rep- resents one of the main debated topics, as well as the introduction of new diagnostic syndromes, which are not based on an adequate evidences. Moreover, the threshold of diagnostic criteria for many mental disorders has been lowered, with the consequence that the boundaries between “normality” and “pathology” is not so clear. In this paper, we will: 1) report the historical development of the DSM from the publication of its first edition; 2) describe the main changes introduced in the DSM-5; 3) discuss critical elements in the DSM-5. The current debate regarding the validity of diagnostic manuals and its criteria is threatening the psychiatric discipline, but a possible solution should be represented by the integration of diagnostic criteria with the in-depth description of patient’s psychopathological experiences.

In this paper we will describe cultural, social and scientific changes occurred in psychiatry in the last years, identifying the new target for mental health professionals. Groups of young psychiatrists from the Italian Psychiatric Association, the European Psychiatric Association and the World Psychiatric Association have established an international network that launched a debate on the future role of psychiatry. In a rapidly changing world, there is the need to: 1) adapt training in psychiatry to the modern world; 2) identify the new target of mental health professionals; 3) enhance the image of psychiatry in the society; 4) overcome stigma towards people with mental disorders. In recent years, socio-cultural and scientific changes have had a significant impact on the psychiatrists' clinical practice. Mental health professionals should deal with these changes appropriately in order to overcome the current "crisis" of psychiatry, which should be considered as a developmental phase rather than a conceptual one. From time to time psychiatry is criticized both from inside and outside the profession. The current crisis was unavoidable due to the recent socio-cultural changes, but it should be considered an opportunity to adapt the profession to modern times.

The discovery of benzodiazepines has represented a milestone in the history of pharmacological treatments and in relation to the management of anxiety, sleep and other psychiatric disorders. After several decades, these agents still represent one of the largest and most widely prescribed groups of medications, not only in the psychiatric clinical practice, but also in the whole medical field. Over the last decade, however, multiple concerns have been raised on the risks related to the prescription of benzodiazepines, for their addictive potential and for cognitive side-effects. Therefore, benzodiazepines are today considered as a double-edge sword, which should be carefully handled and preferentially prescribed by specialists (or at least under their supervision), after an adequate training. Unfortunately, this is not the case in many situations, and the need to improve training on benzodiazepines management has been recently emphasized.

Clinical decision-making is the vehicle for mental health care delivery, and predictors of decision-making experience and adherence are under-researched. The aim was to investigate the relationship between decision topic and kind of involvement in the decision, satisfaction and subsequent implementation, from both staff and patient perspectives.

The subject of the analysis relates the liabilities against the banks arising from the lending to companies in economic distress or default ("concessione abusiva di credito"). Traditional doctrines, from France and Belgium, affirmed that the bank should be considered liable for the damages caused to the creditors of the company. This claim is based on the principle of entrust and deceptive appearance: the creditor negotiates with the company, and trusts the company's solvency, because the bank funded (and keeps on founding) it. Italian courts (see also Cassazione Sezioni Unite 7029-7030-7031/2006) followed the above mentioned interpretation, but determined that the creditor's claim is personal: the bank cannot be sued by the official receiver ("curatore fallimentare"). As a consequence of the above, banks are actually immune from any claim: single creditors do not have the power and information needed to prove the liability. ?Concessione abusive del credito?, under this interpretation, is a rigid and limited tort. Some Authors suggested that the banks, in case of negligent lending, can be considered as shadow directors - interfering in the company's decisions - and can be sued by the official receiver ("curatore fallimentare") for the damages caused to the company itself. This analysis explores another solution, resulting from recent studies in Germany (H. K�TZ, Vertragsrecht, T�bingen, 2009) and Italy (C. MIGLIO, L?autonomia privata nel rapporto di finanziamento bancario, Giust. Civ. 2013, 9, p. 473). Briefly, under this different interpretation, the bank's loan granted to companies defaulted and/or in distress, should be considered void. This different solution considers the ?concessione abusive di credito? a threat to economic public order, generating negative externalities. Italian Constitution states that economic initiatives (?iniziativa economica?) cannot be contrary to public social utility (art. 41 co 2) ? and bank law declares that the bank is obliged to a safe and prudent lending (art. 5 T.U.B.). As a consequence of the above mentioned second interpretation, the banks lose every guarantee, mortgage and surety securing the relevant loans; furthermore the banks can be sued by ?curatore fallimentare? for precontractual liability (art. 1338 c.c.): if someone does not disclose the voidness of a contract (that he knows or should know that it is void) the other part shall be compensated of the relevant damages suffered. The last step of the analysis regards loan agreements executed in the framework of a restructuring procedure. Italian bankruptcy law has developed in the last 10 years three different restructuring procedures: ?piani di risanamento? (art. 67 l.fall.), ?concordato preventivo? (art. 160 l.fall.) and ?accordi di ristrutturazione dei debiti? (art. 182-bis l.fall.). According to the prevailing doctrine, in the context of a restructuring procedure, the bank cannot be considered liable of ?concessione abousiva di credito?: the relevant loan agreement is promoted and fostered by Italian law. But under an economic analysis of such law, a ?no liability? rule is inefficient: the bank could avoid any credit rating and investigation on the condition of the company, allocating the default risk on the other creditors. We suggest that Italian law?s ?favor? should be valued in considering bank?s malice or negligence. Only when the lender knows (or should have known) that the turnaround plan was inconsistent, he should be asked for compensation by the creditors. In this perimeter, the contract should be usually considered enforceable: Italian law encourages lending during the turnaround procedures ? the contract is not contrasting economic public order, but it can be the base of a compensation plea.

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. 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. 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%). 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.

Objectives: Internet has recently become an important source of information on suicide. The few studies carried-out on the role of the Internet on suicidal behaviors have highlighted the rapid spreading of websites promoting suicide, their accessibility and the easy access to information on how to commit suicide. The aim of the study is to: a) conduct a search on Italian websites that can be easily made by anyone seeking information on suicide; b) compare the Italian results with those coming out from an analogue study conducted on English websites. Methods: The search has been performed using the following terms: suicide, methods for suicide, committing suicide, effective ways of suicide, how to commit suicide, suicide without pain, fast suicide. These terms have been included in the 5 most popular Italian search engines: Google, Yahoo, Bing, Virgilio and Libero. The first 10 displayed websites have been listed according to 14 categories. In order to identify accessibility, each website was rated with a score from 1 (very low accessibility) to 10 (maximum level of accessibility). Results: The vast majority of the websites provides information on how to commit suicide and promote or encourage suicide. Only few sites have preventive or deterrence information. The pro-suicide websites appear first in search results and, therefore, they are more accessible. Conclusions: The results of this study highlight the need to have regulations or filters for websites on suicide. Mental health professionals should ask their patients about attitudes about Internet, particularly those who are depressed, with a high risk of suicide, and adolescents. Physicians should help their patients to identify the supporting sources available on the web, so that the use of the Internet could be useful rather than dangerous.