Psychiatry In Italy Research Articles

Consultation-Liaison Psychiatry in Italy: historical development and models of intervention

AbstractThe birth of Consultation-Liaison (CLP) in Italy was made possible thanks to Act 180/1978, which started a 20-year-process that led to closing asylums and fostered the implementation of small psychiatric units within the general hospitals. In the meantime, Italian CLP grew steadily, fostered also by the enactment of two “Objective Mental Health Care” Plans (1994-1996 and 1998-2000), that led to the implementation of the organizational model of the mental health department (MHD).As far as psychiatric referrals are concerned, the first Plan states that the MHD covers all territorial and hospital-based activities, in order to assure, among other services, the integration with hospital (with special attention paid to the Emergency Department and to consultation activity in non-psychiatric hospital wards) and general medicine (as well as other sectors, including mother and child health care). With respect to psychiatric referral, the Second Plan states that “In the 24 months following the entry into force of the Plan, MHDs will adopt guidelines and procedure concerning several issues, including consultation-liaison activity in non-psychiatric hospital wards (which also includes mental health care for “psychiatric” patients hospitalized for non-psychiatric disease in the general hospital) and in Department of Addictions (for alcohol and other substances use disorders. According to the second Plan, Community Mental Health Services (CMHCs) provide, among other performances, CLP activity for general practitioners. Inside general hospitals, psychiatric referrals to non-psychiatric wards are provided by inpatient psychiatric units, when CLP Services are not available. Since a standard definition of psychiatric consultation is not available, the one provided by the Italian region Emilia-Romagna will be used. The Region includes “consultation” among mental health services provided by CMHCs, and defines it as follows: “Psychiatric or psychological assessment carried out upon request from other [non psychiatric] Departments. The consultation includes both clinical interview with the patient and the medical report for the department that referred the patient.” The ways to identify consultation as one among other types of services provided by the MHD are defined, to count the overall number of consultations and monitor the clinical activity of health professional working in the different branches of the MHD. The following types of consultations are reckoned: consultations requested by general practitioners (who work within the Primary Care Department); consultations requested by the Department of Addiction (a branch of the MHD); and consultations requested by the Department of Child-Adolescent Psychiatry (which, as the previous one, is a branch on the MHD).Disclosure of InterestNone Declared

Debating asylum psychiatry: Did Szasz misrepresent the Basaglian psychiatric project?

The Italian anti-institutional psychiatric movement is closely associated with the name of F. Basaglia, whom Szasz in his 188-page essay on antipsychiatry labels a 'real phony' (in similar terms to others considered antipsychiatrists such as D. Cooper, R. Laing, E. Goffman and M. Foucault). Specifically, Szasz says of Basaglia and his work in psychiatry that it's a 'prevarication-illusion about the end of asylum psychiatry in Italy'. The aim of this paper is to determine whether Szasz's assessments were reliably based on scholarly knowledge of Basaglia's psychiatric work, or can better be attributed to Szasz's misrepresentation of his Italian colleague. In considering this question, the paper is timely but, more importantly, it is also unique in considering Basaglia and Szasz together. It is beyond the scope of this article to examine Basaglia's career in detail, and references to it will be made only to clarify Szasz's assertions regarding Basaglia. As I will show here, Szasz misconstrued the Basaglian project for a new kind of psychiatry, and for the transformation and closure of the old asylum system. This erroneous view of Basaglia by Szasz is partly associated with his idea that Basaglia and other antipsychiatrists were supported by the modern socialist-therapeutic State.

Rethinking hospital psychiatry in Italy in light of COVID-19 experience.

BACKGROUNDItaly retains a distinctive organization of mental health services according to a community-based model of care with a multidisciplinary team serving a well-defined catchment area under the coordination of the local department of mental health. The coronavirus disease 2019 (COVID-19) pandemic is forcing Italian mental health services to develop new organizational strategies at all levels of care in order to face the associated challenges.AIMTo explore factors associated with changes in psychiatric admissions to an inpatient psychiatric unit located in Lombardia Region, Italy.METHODSAll hospital admissions (n = 44) were recorded to an inpatient psychiatric unit during a three month national lockdown in Italy in 2020 and compared with those occurring over the same time period in 2019 (n = 71). For each admission, a 20-item checklist was completed to identify factors leading to admission. Statistical analyses were performed using Statistical Package for Social Sciences for Windows, release 11.0. Chi-square test (or Fisher’s exact test) and Mann-Whitney U-test were applied, where appropriate.RESULTSHospital admissions dropped by 38% during the COVID-19 pandemic. No significant differences were found in demographics, clinical variables associated with hospital admissions and length of stay between 2019 and 2020. Compared with 2019, a significantly greater proportion of hospital admissions in 2020 were related to difficulties in organizing care programs outside the hospital (chi-square = 4.91, df 1, one-way P = 0.035) and in patients’ family contexts (chi-square = 3.71, df 1, one-way P = 0.049). On the other hand, logistic and communication difficulties pertaining to residential facilities and programs were significantly more common in 2019 than in 2020 (chi-square = 4.38, df 1, one-way P = 0.032).CONCLUSIONAdmissions to the inpatient psychiatric unit dropped significantly during the COVID-19 pandemic in 2020, with difficulties in organizing care programs outside the hospital and in patients’ family contexts occurring more frequently compared with 2019.

'Dementia praecocissima': the Sante De Sanctis model of mental disorder in child psychiatry in the 20th century.

The aim of this article is to describe the nosographical contribution of the Italian psychiatrist Sante De Sanctis (1862-1935) to early twentieth-century child psychiatry. De Sanctis first proposed the category of 'dementia praecocissima' in 1906, and it was recognized by Kraepelin. Dementia praecocissima has its roots in a theoretical and methodological conception of mental disorder based on 'psycho-physical proportionalism' and the 'law of circle'. This article deals with De Sanctis's model, which has so far been neglected by historiographers; it shows the pioneering role that this Italian psychiatrist played in child psychiatry in Italy.

Evolution of forensic psychiatry in Italy over the past 40 years (1978–2018)

In Italy, following the closure of psychiatric hospitals in 1978 and the release of psychiatric patients into community care, there was a mismatch between common psychiatric patients and the convicted mentally ill who were sentenced to serve in state forensic psychiatric hospitals. The recent closure of such structures following the Prime Minister's Decree of April 1, 2008, fostered the need to create new structures. These are called “REMS,” and they are based in the community and led by psychiatrists and healthcare staff who may rely on the collaboration of public security staff. This act completed a course of progressive deinstitutionalization of all psychiatric patients. However, some problems remain, and persons regarded as “partially mentally disabled” at the time of crime perpetration must serve part of their sentence in prison and the rest in the aforementioned structures or in psychiatric rehabilitation communities, depending on their claimed “social dangerousness.” Psychiatric services now face the ambiguity of treating persons who are considered dangerous by court orders, while the civil law criteria for involuntary hospitalization is based only on the need of care. The complete closure of forensic hospitals may be considered a decisive step forward in the humanization of society, but there are still some issues to address to make it work better. The implementation of multidisciplinary teams and effective psychotherapy, psychoeducational, and rehabilitation interventions can help.

Dibattiti - La fine di un'illusione

A distanza di 40 anni dalla Legge 180/1978 che ha riformato la psichiatria in Italia, vengono esaminati alcuni suoi punti centrali per valutare quanto di fatto siano stati attuati: il superamento del concetto di pericolosità, la limitazione alla cronicità istituzionale, la attenuazione dello stigma, la centralità del lavoro sul territorio e la collocazione del ricovero ospedaliero all'interno dell'ospedale generale. Emerge il mancato raggiungimento di questi obiettivi, per limiti intrinseci alla legge, per limiti profondi nel mondo psichiatrico nel costruire nuovi modelli e per una difficoltà a costituirsi come interlocutori forti all'interno di una gestione della Sanità sempre più frammentata e ospedalizzata.

Migration, violence, and the role of psychiatry in Italy

Immigration to Italy has been increasing exponentially in the last decades due to the international political changes and conflicts in the Middle East. The relationship between immigration and crimes is a debated issue, and violent radicalization of second or third generations of migrants is under increased scrutiny. Consequently, many politicians and political parties use nationalist and xenophobic language. Inevitably, this will have an impact on reactions of the larger population, as well as that of migrants. Psychiatry can have a major role in dealing with immigrants’ health needs, and also assessing risk and preventing violent behaviours due to mental disorders. It is possible to prevent some radicalization by employing strategies of education, leading to better integration of immigrants in the community (based on education, housing, work, etc.). However, often specialist services for migrants are lacking, and mental healthcare professionals may remain poorly trained. Italy is one of the major countries in Southern Europe with a large number of illegal and legal migrants; thereby, creating a major pressure on the resources. It is important to understand the links between globalization, migration, and violence in Italy, in order to prevent future radicalization. It is also useful for psychiatrists to act as advocates for migrants to help reduce xenophobia and discrimination supported by some national cultural and political movements. Ethno-psychiatric facilities should be promoted, as well as policies of support, integration, and prevention should be employed to promote legal migration through the European countries.

The practice of consultation psychiatry in Italy: A multi-centre study

The practice of consultation psychiatry in Italy: A multi-centre study

Italian colonial psychiatry: outlines of a discipline, and practical achievements in Libya and the Horn of Africa.

This article describes the establishment of psychiatry in Italy's former colonies during the period 1906-43, in terms of the clinical and institutional mechanisms, the underlying theories and the main individuals involved. 'Colonial psychiatry' (variously called 'ethnographic', 'comparative' or 'racial' psychiatry) - the object of which was both to care for mentally afflicted colonists and local people and also to understand and make sense of their pathologies - received most attention in colonial Libya, starting in the first months of the Italian occupation (1911-12) and then taking institutional form in the 1930s; in the colonies of what was known as 'Italian East Africa', on the other hand, less was said about psychiatric care, and practical achievements were correspondingly limited.

I nomi della follia

We present the results of a research on the language of psychiatry in Italy between the nineteenth century and the twentieth century. In it, we describe the origins of the terminology of this branch of medicine and the network of synonyms, hypernyms and hyponyms which were used to describe mental illness in the beginnings of modern psychiatry. Furthermore, we give an overview on the names of the psychiatric hospitals and of the asylums, as well as on the description and the names of the instruments used in the observation or in the treatment of mental illness. What emerges from the study is a rich and differentiated terminology, part of a terminological framework in which the international language of science still predominant at the time, the French, plays a leading role, accompanied in psychiatric ambit by German and English.

Photography and radical psychiatry in Italy in the 1960s. The case of the photobook Morire di Classe (1969).

In the 1960s Franco Basaglia, the Director of a Psychiatric Hospital in a small city on the edge of Italy (Gorizia), began to transform that institution from the inside. He introduced patient meetings and set up a kind of Therapeutic Community. In 1968 he asked two photographers – Carla Cerati and Gianni Berengo Gardin – to take photos inside Gorizia and other asylums. These images were then used in a photobook called Morire di Classe (To Die Because of your Class) (1969). This article re-examines in detail the content of this celebrated book and its history, and its impact on the struggle to reform and abolish large-scale psychiatric institutions. It also places the book in its social and political context and as a key text of the anti-psychiatry movement of the 1960s.

Primary care psychiatry in Italy.

In Italy, the importance of integrating primary care and mental health has only recently been grasped. Several reasons may explain this delay: a) until 2005, primary care physicians worked individually instead of in group practices, without any functional network or structured contacts with colleagues; b) community mental health centers with multiprofessional teams were well structured and widespread in several regions but focused on people with severe and persistent mental disorders; and c) specific national government health policies were lacking. Only two regions have implemented explicit policies on this issue. The "G. Leggieri" program started by the Emilia-Romagna region health government in 1999 aims to coordinate unsolicited bottom-up cooperation initiatives developing since the 1980s. In Liguria, a regional work group was established in 2010 to boost the strategic role of collaborative programs between primary care and mental health services. This article describes the most innovative experiences relating to primary care psychiatry in Italy.

Thirty-five years of community psychiatry in Italy.

The Italian Psychiatric Reform of 1978 is reviewed here in terms of national/regional mental health (MH) policies and with the help of epidemiological data. The reform law was essentially a framework one, and Italy's 21 regions were called to draft detailed organizational norms and to implement their systems. This explains a relevant interregional variability, despite several national MH plans. In a recent survey, compliance with national standards found homogeneous implementation on structural parameters but quite a variable one on functional parameters (continuity, coordination, accessibility, specialization). Epidemiological data show the impact of regional variability on the quality of treatment provided. Because of discrepancies among regional information systems, we analyze data from six Italian regions, where regional case registers have long been implemented, focusing on adult population prevalence and incidence rates and outpatient-inpatient care. Indicators of service use and some national MH documents are discussed in relation to the system's future prospects.

University psychiatry in Italy. Organisation and integration of university clinics and the National Health Service.

In the Italian psychiatric system, community-based care has become increasingly important and widespread since the national reform of 1978. This report aims to provide an overview of the involvement of university medical schools in this process, considering their responsibility for teaching and training specialist practitioners and professionals. The study was carried out between early 2010 and February 2011. An 18-items, self-administered, questionnaire was designed to investigate the number of faculty members that are responsible both for running a clinical ward and for providing communitybased healthcare. Nine out of 53 faculty members (17%) manage a Mental Health Department, 9 (17%) manage a University Department, and 2 (3.8%) manage both types of department. Less than half of the teachers have full responsibility (hospital and community); however the percentage reaches 73.2% if we include the hospital wards open to the community emergencies. The remaining 26.8% have no responsibility for community psychiatry. Moreover there were undoubtedly still too many universities with specialisation schools that are without an appropriate network of facilities enabling them to offer complex psychiatric training. As expected, there were several types of healthcare management that were not uniformly distributed throughout Italy and there were also marked differences between mental health care provision in the North, Centre, and South of Italy. The university involvement in clinical responsibility was great, but at the management level there was a lack of equality in terms of clinical care, which risks being reflected also on the institutional functions of teaching and research.

State of psychiatry in Italy 35 years after psychiatric reform. A critical appraisal of national and local data

Thirty-four years have elapsed since the passing of the Italian Law 180, the reform law that marked the transition from a hospital-based system of care to a model of community psychiatry that was designed to be an alternative to, rather than to complement, the old hospital-centred services. The main principle of Law 180 is that psychiatric patients have the right to be treated the same way as patients with other diseases and only voluntary treatments are allowed, with a few exceptions that are strictly regulated. The main features and consequences of the Italian reform are initially reviewed; national and local level experiences and epidemiological data are then analysed in order to highlight and disentangle the ‘active ingredients’ of the Italian experience. A public health attitude with the capacity to network good practice in service organization by giving voice to successful experiences and promoting health service research, apart from some local services, is still generally lacking. Furthermore, it is still difficult to provide an evidence-based reply to the question: can à l’Italienne community-care be exported elsewhere?

Psicoterapia, psicoanalisi e psichiatria nei primi anni 1960. Appunti per una storia

Pier Francesco Galli descrive alcuni sviluppi della psicoterapia, della psicoanalisi e della psichiatria in Italia nei primi anni 1960, in particolare riguardo al progetto culturale del Gruppo Milanese per lo Sviluppo della Psicoterapia da lui fondato (che nel 1978 prenderŕ il nome di Psicoterapia e Scienze Umane). Vengono discussi, tra gli altri, i seguenti temi: l'inserimento di nuove tecnologie e discipline (come la psicologia e la sociologia) nella cultura italiana del dopoguerra, il ruolo degli intellettuali, la formazione alle professioni di aiuto e la diffusione della psicoanalisi, il lavoro di équipe nei servizi psichiatrici, il ruolo delle case editrici, i corsi di aggiornamento organizzati a partire dal 1962, la cultura della psichiatria descrittiva importata nei primi anni 1980 dagli Stati Uniti col DSM-III, la aziendalizzazione della Sanitŕ, e cosě via.

How Law 180 in Italy has reshaped psychiatry after 30 years: past attitudes, current trends and unmet needs

Law 180 eliminated psychiatric hospitals for the care of people with chronic psychosis in Italy. After 30 years, we review the consequences for the practice of psychiatry in Italy and parallels for England and Wales. We argue that the substitution of legal/political direction for clinical leadership means psychiatrists may cease to merit the privileges and responsibilities of being doctors.

Analytical psychology and psychiatry in Italy today

The aim of this article is to offer some reflections on the potential of analytical psychology in the field of psychiatric cure of psychotic patients mostly in the context of public mental health services. It will do so by drawing on Italian past and present experiences, as well as investigating future perspectives. The Italian mental health legislation which has been in force for 32 years now is still of particular value and shows how the clinical, political, economic and hermeneutic realms are interconnected and worthy of attention especially in the therapy of psychosis. Analytical psychology can and must set itself up as the organiser of meaning between the different fields of psychiatry, depth psychology and socio-psychiatry. Analysed in his social and political context, the therapy of the psychotic patient makes of individuation a political as well as a therapeutic act of searching for the Self of both individuals and systems. This would signal the return of analytical psychology to its roots in psychiatry from which it rose up and from which it split off as a result of grave inadequacies on both sides.

General hospital psychiatry in Italy: an update

! SIPC affiliation to the Italian Society of Psychiatry and the EACLPP ! Website: www.sipc.it; marked as blink of interestQ by the websites of the EACLPP, APM, SIP, and SIMP ! Research activities [3,4] ! Editorial activities [books and scientific journals (Psichiatria di Consultazione, CIC Editore; La Psichiatria nella Pratica Medica, CIC Editore; Ricerche in Psichiatria, CIC Editore] ! Young Researcher SIPC Awards (1999; 2003) for an original article on CLP by young researchers ! Two multicenter investigations on CLP in Italy Introduction

The Modena Consultation–Liaison Psychiatry Service, Italy

The Reform Law 180, approved in Italy in 1978, had – and still has – great national and international significance for its dramatic consequences on both clinical and health organisational aspects of psychiatry: the law, in short, had the great effect of bringing psychiatry back to medicine, to the community and to the general hospital. This was the starting point of other relevant events, one of which was the establishment of the specialty of consultation-liaison psychiatry in Italy (Cazzulloet al, 1984). Since then, consultation-liaison psychiatry has gradually developed worldwide and in Italy as a super-specialised branch of psychiatry, able to put into practice – to operationalise – the great psychosomatic tradition in its three interrelated strands of clinical, teaching and research activities. The report that follows is strongly influenced by this historical background.