Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention.

Purpose: Violence against healthcare professionals has become an emergency in many countries. Literature in this area has mainly focused on nurses while there are less studies on physicians, whose alterations in mental health and burnout have been linked to higher rates of medical errors and poorer quality of care. We summarized peer-reviewed literature and examined the epidemiology, main causes, consequences, and areas of intervention associated with workplace violence perpetrated against physicians.

A comparison of Dignity Therapy narratives among people with severe mental illness and people with cancer.

Objective: To examine Dignity Therapy (DT) narratives in patients with severe mental illness (SMI) and a control group of cancer patients.

Methods: 12 patients with SMI (schizophrenia, bipolar disorders, sever personality disorders) and 12 patients with non-advanced cancer individually participated to DT interviews. DT was tape-recorded, transcribed verbatim and shaped into a narrative through a preliminary editing process.

The screen for cognitive impairment in psychiatry in patients with borderline personality disorder.

Cognitive deficits are common in borderline personality disorder (BPD) and appear to be associated with psychopathology, functioning and outcome. The availability of a cognitive screening instrument could be of use in clinical settings in order to assess neurocognition in BPD patients. The Screen for Cognitive Impairment for Psychiatry (SCIP) proved to be reliable in different psychiatric populations, but it has not yet been validated in personality disorders.

Knowledge about risk factors for cancer and cancer risk behavior among patients with severe mental illness.

Objective: To examine knowledge about, perception of and current risk factors for cancer, among patients with severe mental illness (SMI) and to compare these variables with patients without SMI.

Methods: A series of patients affected by SMI (i.e.

Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience.

Purpose Of Review: We summarized peer-reviewed literature on aggressive episodes perpetrated by adult patients admitted to general hospital units, especially psychiatry or emergency services. We examined the main factors associated with aggressive behaviors in the hospital setting, with a special focus on the European experience.

Recent Findings: A number of variables, including individual, historical, and contextual variables, are significant risk factors for aggression among hospitalized people.

The Relationship Between Cognitive Abilities and Trait Clinical Features in Patients With Borderline Personality Disorder.

Very few studies have focused on the relationship between cognitive functions and clinical features in borderline personality disorder (BPD). Subjects with BPD and healthy controls were administered the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test A and B, and the Wisconsin Card Sorting Test. The Brief Symptom Inventory (BSI-53) was used to assess the severity of current symptoms.

Exploring and assessing demoralization in patients with non-psychotic affective disorders.

Background: Demoralization, as assessed through the Diagnostic Criteria for Psychosomatic Research-Demoralization (DCPR/D) interview or the Demoralization Scale (DS), has been found to affect about 30% of patients with medical disorders, while few studies have been done in patients with psychiatric disorders.

Methods: A convenience sample of 377 patients with ICD-10 diagnoses of mood, anxiety, stress-related disorders or other non-psychotic disorders was recruited from two Italian university psychiatry centers. The DCPR/D interview and the Italian version of the DS (DS-IT) were used to assess demoralization and the Patient Health Questionnaire-9 (PHQ-9) to assess depression.

Italian Validation of the Screen for Cognitive Impairment in Psychiatry.

Cognitive impairments have profound implications for the management of severe mental disorders; however, they are rarely assessed in everyday clinical practice due to constraints in time, resource and expertise. Novel and short instruments, such as the Screen for Cognitive Impairment in Psychiatry (SCIP), which overcome such limitations are greatly needed. The study aims to assess the validity and reliability, among healthy subjects, of the Italian translation of the SCIP, a brief, accessible tool to detect cognitive impairments among individuals suffering from mental disorders, as the first step to validate the instrument in clinical settings.

Screening for cognitive impairment in non-affective psychoses: A comparison between the SCIP and the MoCA.

Background: Neuropsychological performance has a strong impact on real-life functioning and clinical outcomes in psychosis. However, conducting lengthy cognitive assessments may not be feasible in routine clinical practice. Brief, reliable and cost-effective tools are highly needed, but few studies are available to guide clinician choice.

Pre-loss symptoms related to risk of complicated grief in caregivers of terminally ill cancer patients.

Purpose: A number of studies have underlined a 10-20% prevalence of complicated grief (CG) among caregivers of cancer patients. The study aimed at examining the relationship between pre-loss criteria for CG and post-loss diagnosis of CG and at evaluating the validity and factor structure of a predictive tool, the Inventory of Complicated Grief (ICG), in order to identify the risk of developing CG in a sample of Italian caregivers.

Methods: Sixty family members of terminally ill patients admitted to hospice and receiving a Palliative Prognostic Score (PaP) predictive 30 day survival time <30% completed the Pre-Death ICG (ICG-PL) (T0).

Exploration of experiences in therapeutic groups for patients with severe mental illness: development of the Ferrara group experiences scale (FE- GES).

Background: Group therapies are routinely provided for patients with severe mental illness. The factors important to the group experience of patients are still poorly understood and are rarely measured. To support further research and practice, we aimed to develop a questionnaire that captures how patients experience groups within a community mental health context.

Working with the 'difficult' patient: the use of a contextual cognitive-analytic therapy based training in improving team function in a routine psychiatry service setting.

The clinical management of 'difficult' patients is a major challenge which exposes mental health teams to an increased risk of frustration and stress and may lead to professional burnout. The aim of the present study was to investigate whether a cognitive-analytic therapy (CAT) based training undertaken by a mental health team working with 'difficult' patients reduced professional burnout symptoms, improved patients' service engagement and increased the levels of team-cohesion. Twelve mental health staff members from different professional and educational backgrounds took part in five 2-hour sessions providing a basic CAT training intervention, an integrative and relational model of psychotherapy for the treatment of borderline personality disorders.

[Diagnostic revision of De Chiricos' case].

An interesting field of psychopathology has been historically oriented towards identifying the links between artistic expression and psychological problems, searching the biographies of various artists for the deep psychological origins of their art. The painter Giorgio De Chirico has been the object of many studies and recently his documented suffering was diagnosed as problems with migraines and temporal epilepsy. However, a precise psychiatric diagnosis is still missing.

Patient opinions on the helpfulness of external rehabilitative activities in residential psychiatric care: a pilot study.

Introduction: This study explores the patient opinions about the helpfulness of the External Rehabilitative Activities (ERA) delivered in two residential facilities for psychiatric rehabilitation.

Methods: We administered a Questionnaire developed to assess general helpfulness, helpfulness of specific therapeutic processes and satisfaction with the ERA to a sample of 46 psychiatric patients participating in at least three external activities.

Results: The External Rehabilitative Activities, tested by the ERA-Questionnaire, were considered helpful or very helpful by most of the patients.

Hopelessness and related variables among cancer patients in the Southern European Psycho-Oncology Study (SEPOS).

Background: Although hopelessness has been studied in cancer, no data are available in non-English-speaking countries.

Objective: The authors sought to amass data from Southern European countries (Italy, Portugal, Spain, and Switzerland) in order to fill this void.

Method: A group of 312 cancer patients completed the Mini-MAC Hopelessness subscale, the Hospital Anxiety and Depression Scale (HADS), the Cancer Worry Inventory (CWI), and a six-item Visual Analog scale (VAS) to measure intensity of physical symptoms, general well-being, difficulty in coping with cancer, intensity of social support from close relationships, leisure activity, and support from religious beliefs.

Depression and serotonin transporter (5-HTTLPR) polymorphism in breast cancer patients.

Background: Mixed evidence in the general population and medically ill patients has suggested that homozygous carriers of the short allele (s/s) of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) may increase the risk of depression in comparison with carriers of the long allele (l/l) or s/l. Given the lack of data in oncology, we examined the relationship of depression with the 5-HTTLPR and psychosocial variables among breast cancer patients.

Methods: A sample of 145 breast cancer patients were studied as regards to depression, psychosocial-related variables (coping, Type D-personality, life events, and social support), and the 5-HTTLPR, which was genotyped by using a standard protocol with DNA extracted from the blood.

[Patient opinions on the experiences of psychiatric hospitalization: a qualitative study].

Introduction: The evaluation of the patients' perspective of psychiatric admission is useful to define what is the therapeutic milieu and important to improve treatment quality.

Aim: This study aimed to explore the patients' perspective of psychiatric admission to a residential unit for intensive rehabilitation treatment.

Methods: A questionnaire, assessing the patients' experiences of psychiatric admission developed from previous studies, has been administered to a series of inpatients at the rehabilitation unit "La Luna", University of Ferrara, Department of Mental Health.

Factor structure of the Brief Psychiatric Rating Scale in unipolar depression.

Background: In clinical practice patients with unipolar depression present with a variety of symptom clusters that may combine together in many different ways. However, only few factor analytic studies used general psychopathology scales to investigate the symptom structure of unipolar depression.

Methods: The study included 163 consecutive inpatients with an ICD-10 diagnosis of depressive disorder (ICD-10 codes F32 to F33).

Effects of supportive-expressive group therapy in breast cancer patients with affective disorders: a pilot study.

Background: So far, no study has tested supportive-expressive group therapy (SEGT) in cancer patients with an established psychiatric diagnosis. The aim of this 6-month follow-up study was to evaluate breast cancer patients with an ICD-10 diagnosis of affective syndromes participating in SEGT and a group of breast cancer patients with no ICD-10 diagnosis.

Methods: A total of 214 patients were examined in the screening phase (T0) using the ICD-10, the Brief Symptom Inventory (BSI), the Mini-Mental Adjustment-to-Cancer Scale (Mini-MAC), the Multidimensional Scale of Perceived Social Support, the Openness Scale and the Cancer Worries Inventory (CWI).

Factors related to admission of psychiatric patients to medical wards from the general hospital emergency department: a 3-year study of urgent psychiatric consultations.

Objective: Emergency Rooms (ER) of Emergency Departments (ED) in General Hospitals (GH) have a role in providing for psychiatric evaluation. The aims of the present study were to examine the decision-making process of consultation psychiatry at the GH-ER and to analyze the differences between psychiatric patients admitted to a medical ward with those admitted to the psychiatry unit and those who are discharged from the ER.

Method: Over a period of 3 years, psychiatric consultations requested by ER of ED physicians to the GH Psychiatric service were recorded by using a form to describe epidemiological and clinical data on the consultation process.

Violent behavior in acute psychiatric inpatient facilities: a national survey in Italy.

Violence committed by acute psychiatric inpatients represents an important and challenging problem in clinical practice. Sociodemographic, clinical, and treatment information were collected for 1324 patients (677 men and 647 women) admitted to Italian public and private acute psychiatric inpatient facilities during an index period in 2004, and the sample divided into 3 groups: nonhostile patients (no episodes of violent behavior during hospitalization), hostile patients (verbal aggression or violent acts against objects), and violent patients (authors of physical assault). Ten percent (N = 129) of patients showed hostile behavior during hospitalization and 3% (N = 37) physically assaulted other patients or staff members.

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia.

Background: One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.

Affective syndromes and their screening in cancer patients with early and stable disease: Italian ICD-10 data and performance of the Distress Thermometer from the Southern European Psycho-Oncology Study (SEPOS).

Background: The assessment of mood and anxiety disorders secondary to cancer by using easy-to-administer instruments has been the object of recent research.

Methods: The aim of this study was to examine the accuracy of the short screening tool developed by the National Comprehensive Cancer Network Clinical Practice Guidelines for Distress Management, (0-10 point-scale Distress Thermometer) (DT) in detecting affective syndrome disorders in Italian cancer patients. The sample consisted of 109 cancer outpatients who were administered the ICD-10 psychiatric interview (CIDI), the DT and the Hospital Anxiety Depression Scale (HADS).