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Silvia FERRARI

Professore Associato
Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze sede Policlinico

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Pubblicazioni

2024 - The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study [Articolo su rivista]
Castellini, Giovanni; Tarchi, Livio; Cassioli, Emanuele; Ricca, Valdo; Abbate Daga, Giovanni; Aguglia, Andrea; Albert, Umberto; Atti, Annarita; Barlati, Stefano; Blasi, Giuseppe; Carmassi, Claudia; Carrà, Giuseppe; De Fazio, Pasquale; De Panfilis, Chiara; Di Lorenzo, Giorgio; Ferrari, Silvia; Goracci, Arianna; Gramaglia, Carla; Luciano, Mario; Nanni, Maria Giulia; Martinotti, Giovanni; Menchetti, Marco; Menculini, Giulia; Nivoli, Alessandra; Pinna, Federica; Pompili, Maurizio; Rosso, Gianluca; Signorelli, Maria Salvina; Sambataro, Fabio; Sampogna, Gaia; Sani, Gabriele; Serafini, Gianluca; Tosato, Sarah; Ventriglio, Antonio; Viganò, Caterina; Volpe, Umberto; Fiorillo, Andrea
abstract

Background: A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency. Methods: An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers-80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors. Results: A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress. Conclusions: The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.

2023 - "Historia magistra vitae": How is the psychiatric rehabilitation technician trained in psychiatry's history? [Articolo su rivista]
Ferrazzi, Giulia; Catellani, Sara; Ferrari, Silvia; Marchi, Mattia; Pingani, Luca
abstract

2023 - "Somewhere Between an Actual Disease and a Disease": A Grounded Theory Study on Diagnosing Functional Neurological Disorders From a Multi-Informant Perspective [Articolo su rivista]
Sireci, Francesca; Moretti, Valentina; Cavallieri, Francesco; Ferrari, Silvia; Minardi, Valentina; Ferrari, Francesca; Balestra, Giulietta Luul; Ghirotto, Luca; Valzania, Franco
abstract

Functional Neurological Disorders are characterized by sensory-motor or cognitive symptoms. Recent research has revealed their complex nature involving biological, psychological, and social factors. Care requires a multidisciplinary approach, which, to date, has yet to be considered. A Constructivist Grounded Theory study was conducted to understand the reasons behind this, exploring Functional Neurological Disorders diagnosis, communication, and understanding from multiple perspectives (patients and healthcare professionals). The core category was "negotiating Functional Neurological Disorders meanings and care amid a dissatisfying dichotomy," with sub-categories: i) seeking to "word" the disease, ii) exposing reductionism, and iii) a pluralist vision emerging. Diagnosing and communicating Functional Neurological Disorders is a process of negotiating meanings and care that hinges on participants' diverse ontological perspectives regarding the condition. Results highlight the difficulty in finding common ground and achieving mutual understanding among the various viewpoints, creating a challenge in establishing a unified approach to Functional Neurological Disorders care. In this context, only a few healthcare professionals emphasized the potential benefits of increased integration. A shift is required from a reductionist to an integrated biopsychosocial perspective to develop a more cohesive approach. Defining a medical paradigm through dialogue with teams and patients is essential in addressing Functional Neurological Disorders effectively. Furthermore, the required interdisciplinary approach holds the potential to mitigate the dissatisfaction arising from fragmented and compartmentalized care (the "dissatisfying dichotomy") experienced by our participants. It signifies a comprehensive strategy that could address the concerns of all involved parties and enhance the overall quality of care provided.

2023 - Association between anxious-depressive symptoms and metabolic syndrome and its single components: an Italian cross-sectional study among primary care outpatients [Articolo su rivista]
Rioli, Giulia; Mattei, Giorgio; Bursi, Serena; Padula, Maria Stella; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian M.
abstract

2023 - COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond [Articolo su rivista]
Schaefert, Rainer; Stein, Barbara; Meinlschmidt, Gunther; Roemmel, Noa; Blanch, Jordi; Boye, Birgitte; Carqueja, Eduardo; De Matteis, Tiziano; Dineen, Peter; Doherty, Anne M; Ferrari, Silvia; Lanvin, Victoria; Lee, William; Lemmens, Gilbert M D; Lemogne, Cédric; Małyszczak, Krzysztof; Mendes-Pedro, António; Nejatisafa, Ali-Akbar; Räsänen, Sami; Rosen, Benjamin; Simões do Couto, Frederico; Syngelakis, Markos; Tarricone, Ilaria; Van der Feltz-Cornelis, Christina M; Huber, Christian G; Fazekas, Christian; Vitinius, Frank
abstract

Objective: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. Methods: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. Results: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVIDpsyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions

2023 - Efficacy and tolerability of desvenlafaxine in the real-world treatment of patients with major depression: a narrative review and an expert opinion paper [Articolo su rivista]
Sampogna, G.; Caraci, F.; Carmassi, C.; Dell’Osso, B.; Ferrari, S.; Martinotti, G.; Sani, G.; Serafini, G.; Signorelli, M. S.; Fiorillo, A.
abstract

IntroductionMajor depressive disorder (MDD) is a common severe mental disorder, requiring a tailored and integrated treatment. Several approaches are available including different classes of antidepressants various psychotherapeutic approaches, and psychosocial interventions. The treatment plan for each patient with MDD should be differentiated on the basis of several clinical, personal, and contextual factors.Areas coveredDesvenlafaxine - a serotonine-noradrenergic reuptake inhibitor (SNRI) antidepressant - has been approved in the United States in 2008 for the treatment of MDD in adults, and has been recently rediscovered by clinicians due to its good side-effect profile and its clinical effectiveness. A narrative review on efficacy, tolerability and use of desvenlafaxine in clinical practice was carried out. The keywords: 'major depression', 'depression,' 'desvenlafaxine,' 'efficacy,' 'clinical efficacy,' 'side effects', 'tolerability,' 'elderly patients', 'consultation-liaison', 'menopausal', 'young people', 'adolescent' were entered in PubMed, ISI Web of Knowledge, Scopus and Medline. No time limit was fixed, the search strategy was implemented on May 10, 2023.Expert opinionDesvenlafaxine should be listed among the optimal treatment strategies for managing people with MDD, whose main strengths are: 1) ease of dosing; 2) favorable safety and tolerability profile, 3) absence of sexual dysfunctions, weight gain and low rate of discontinuation symptoms; 4) low risk of drug-drug interactions.

2023 - Involuntary Hospitalizations in an Italian Acute Psychiatric Ward: A 6-Year Retrospective Analysis [Articolo su rivista]
Di Lorenzo, Rosaria; Reami, Matteo; Dragone, Diego; Morgante, Martina; Panini, Giulia; Rovesti, Sergio; Filippini, Tommaso; Ferrari, Silvia; Ferri, Paola
abstract

Purpose: We evaluated the differences between demographic (age, sex, nationality, employment, housing, schooling, support administrator), clinical (hospitalization reason, aggressive behaviour, length of hospitalization, psychiatric diagnosis and comorbidities, psychiatric medications, discharge destination, “revolving door” hospitalizations) and environmental (pre-and pandemic period) variables in voluntary (VHs) and involuntary hospitalizations (IHs) in an acute psychiatric ward during a 6-year period. Patients and Methods: We retrospectively collected the selected variables concerning the hospitalizations of subjects over 18 years of age in the Service for Psychiatric Diagnosis and Care of Mental Health and Drug Abuse Department in Modena from 01/01/2017 to 31/12/2022. Results: We observed a progressive and sharp reduction in the number of VHs (n = 1800; 61.41%) during the pandemic and a stability of IHs (n = 1131; 38.59%), which in 2022 became prevalent. We highlighted the following differences between VHs and IHs: an increase in hospitalization length in IHs (14.25 mean days ± 15.89 SD) in comparison with VHs (8.78 mean days ± 13.88 SD), which increased more during the pandemic; an increase in aggressive behavior in IHs, especially during the pandemic (Pearson Chi2 = 90.80; p = 0.000); a prevalence of schizophrenia and bipolar disorders (Pearson Chi2 = 283.63; p = 0.000) and more frequent maladaptive social conditions among subjects in IHs. Conclusion: During the 6-year observation period, we underscored a trend of increasingly reduced recourse to VHs, whereas IHs increased even in the pandemic. Our results suggest that IHs in Psychiatry represented an extreme measure for treating the most severe psychopathological situations such as schizophrenia and bipolar disorders, characterized by aggressive behaviour and precarious social conditions, which needed longer stay than VHs, especially during the pandemic.

2023 - Mental health of transgender people in prison: a systematic review and meta-analysis [Articolo su rivista]
Marchi, M.; Corbellini, I.; Vaccari, E.; Pingani, L.; Ferrari, S.; Amaddeo, F.; Converti, M.; Fiorillo, A.; Mirandola, M.; Pinna, F.; Ventriglio, A.; Galeazzi, G. M.
abstract

This systematic review aims to explore the condition of Transgender Inmates (TGI) in correctional facilities (CF), focusing on their mental health, their access to Gender-affirming Treatments (GAT), and their placement within the CF. Medline, Embase, Scopus, PsychInfo, and CINAHL were searched for studies on TGI in CF. Pooled Odds Ratios (ORs) with 95% confidence interval (95%CI) were estimated through inverse variance models with random-effects. A narrative synthesis of each study’s findings was also performed since only a few studies included a control group. Thirteen studies were selected and four considered in the meta-analysis, corresponding to 1,255 TGI and 174,314 controls. Although limited by the small number of studies, the meta-analysis showed that TGI have a higher risk of depression, post-traumatic stress disorder, and suicide attempts during detention than the controls (OR = 3.07, 95% CI = 1.33–7.06; OR = 2.23, 95% CI = 1.46–3.43; OR = 2.25, 95% CI = 1.46–3.49, respectively). Limited access to GAT and housing based on sex assigned at birth rather than gender identity were additional challenges for TGI, threatening their safety and self-affirmation. Our findings highlight the critical role of incarceration as a social determinant of health for TGI. A comprehensive policy reform and staff education should be promoted to foster inclusive and supportive correctional environments and improve safety and health of TGI.

2023 - Microaggression toward LGBTIQ people and implications for mental health: A systematic review [Articolo su rivista]
Marchi, Mattia; Travascio, Antonio; Uberti, Daniele; De Micheli, Edoardo; Quartaroli, Fabio; Laquatra, Giuseppe; Grenzi, Pietro; Pingani, Luca; Ferrari, Silvia; Fiorillo, Andrea; Converti, Manlio; Pinna, Federica; Amaddeo, Francesco; Ventriglio, Antonio; Mirandola, Massimo; Galeazzi, Gian M
abstract

Background: Research suggests that microaggressions detrimentally impact the mental health of members of marginalized social groups. Aims: The aim of this systematic review was to assess the exposure to microaggressions and related implications on mental health of Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) people. Method: Medline, Scopus, PsycINFO, CINAHL, and EMBASE were searched until January 2023. Studies reporting data on the exposure to microaggressions toward LGBTIQ people were identified. Meta-analyses of rates of exposure to microaggression and of the association between microaggressions and mental health outcomes were based on odds ratio (OR) and standardized mean difference (SMD) with 95% confidence intervals (95% CI), estimated through inverse variance models with random effects. Results: The review process led to the selection of 17 studies, involving a total of 9036 LGBTIQ people, of which 6827 identifying as cisgenders, and 492 as heterosexuals, were included in the quantitative synthesis. Overall, LGBTIQ people showed an increased risk of microaggression (SMD: 0.89; 95% CI [0.28, 1.50]), with Transgender people having the highest risk (OR: 10.0; 95% CI [3.08, 32.4]). Microaggression resulted associated with risk of depression (SMD: 0.21; 95% CI [0.05, 0.37]), anxiety (SMD: 0.29; 95% CI [0.17, 0.40]), suicide attempts (OR: 1.13; 95% CI [1.08, 1.18]), alcohol abuse (OR: 1.32; 95% CI [1.13, 1.54]), but not to suicidal ideation (OR: 1.56; 95% CI [0.64, 3.81]) and cannabis abuse (OR: 1.44; 95% CI [0.82, 2.55]). The quality of the evidence was limited by the small number of studies. Conclusions: LGBTIQ people are at higher risk of microaggressions compared with their cisgender/heterosexual peers, which may lead to mental health consequences. This evidence may contribute to public awareness of LGBTIQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs and destigmatizing efforts) as parts of tailored health-care planning aimed to reduce psychiatric morbidity in this population.

2023 - Post-traumatic stress disorder among LGBTQ people: a systematic review and meta-analysis [Articolo su rivista]
Marchi, Mattia; Travascio, Antonio; Uberti, Daniele; De Micheli, Edoardo; Grenzi, Pietro; Arcolin, Elisa; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian M
abstract

Aims: Lesbian, gay, bisexual, transgender and queer people (LGBTQ) are at increased risk of traumatization. This systematic review aimed to summarize data regarding the risk of post-traumatic stress disorder (PTSD) for LGBTQ people and their subgroups. Methods: Medline, Scopus, PsycINFO and EMBASE were searched until September 2022. Studies reporting a comparative estimation of PTSD among LGBTQ population and the general population (i.e., heterosexual/cisgender), without restrictions on participants' age and setting for the enrolment, were identified. Meta-analyses were based on odds ratio (OR and 95% confidence intervals [CI]), estimated through inverse variance models with random effects. Results: The review process led to the selection of 27 studies, involving a total of 31,903 LGBTQ people and 273,842 controls, which were included in the quantitative synthesis. Overall, LGBTQ people showed an increased risk of PTSD (OR: 2.20 [95% CI: 1.85; 2.60]), although there was evidence of marked heterogeneity in the estimate (I2 = 91%). Among LGBTQ subgroups, transgender people showed the highest risk of PTSD (OR: 2.52 [95% CI: 2.22; 2.87]) followed by bisexual people (OR: 2.44 [95% CI: 1.05; 5.66]), although these comparisons are limited by the lack of data for other sexual and gender minorities, such as intersex people. Interestingly, the risk of PTSD for bisexual people was confirmed also considering lesbian and gay as control group (OR: 1.44 [95% CI: 1.07; 1.93]). The quality of the evidence was low. Conclusions: LGBTQ people are at higher risk of PTSD compared with their cisgender/heterosexual peers. This evidence may contribute to the public awareness on LGBTQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs, counselling, and destigmatizing efforts) as parts of a tailored health-care planning aimed to reduce psychiatric morbidity in this at-risk population.

2023 - Psychiatric symptoms in Long-COVID patients: a systematic review [Articolo su rivista]
Marchi, Mattia; Grenzi, Pietro; Serafini, Valentina; Capoccia, Francesco; Rossi, Federico; Marrino, Patrizia; Pingani, Luca; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

2023 - The impact of COVID-19 quarantine on mental health: an observational study from an outpatient service for non-psychotic patients in Russia (Moscow) [Articolo su rivista]
Zinchuk, M.; Beghi, M.; Castelpietra, G.; Ferrari, S.; Pashnin, E.; Guekht, A.
abstract

We aimed to compare psychiatric hospital visits during the COVID-19 quarantine period with the same period in 2019, to reveal the predictors of underutilization of mental health services. We then investigated the fluctuation of telemedicine service during the quarantine period. The retrospective study included patients with non-psychotic mental disorders who consecutively visited the Moscow clinic. The number of outpatient visits, inpatient admissions, sociodemographic factors were analyzed. We assessed the sample within two periods -the "quarantine period" (March 30 -June 9, 2020) and "control period" (March 30 -June 9, 2019). Psychiatric visits decreased in older, retired and disabled persons, and increased among the unemployed. In multivariate analysis, the reduction became significant for the number of inpatient admissions. Telemedicine calls gradually increased from the start of the service, but decreased towards the end of the quarantine. In conclusion, referrals to outpatient and inpatient psychiatric services decreased during the quarantine period, with newly established TMS potentially compensating for that decrease. The strongest factor associated with visits during the pandemic is employment status.

2023 - Unmet Psychosocial Needs of Health Care Professionals in Europe During the COVID-19 Pandemic: Mixed Methods Approach [Articolo su rivista]
Hummel, Svenja; Michelsen, Ina; Zafar, Ali; Moritz, Steffen; Benoy, Charles; Lemogne, Cédric; Almeida, Rosa; Losada, Raquel; Ribeiro, Oscar; Frisardi, Vincenza; Tarricone, Ilaria; Ferrari, Silvia; Dechent, Frieder; Huber, Christian G; Weidt, Steffi; Mayer, Gwendolyn; Schultz, Jobst-Hendrik
abstract

Background: The COVID-19 pandemic severely affected everyday life and working conditions for most Europeans, particularly health care professionals (HCPs). Over the past 3 years, various policies have been implemented in various European countries. Studies have reported on the worsening of mental health, work-related stress, and helpful coping strategies. However, having a closer look is still necessary to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff. Objective: This study aimed to obtain quantitative information on job-related stressors of physicians and nurses and the coping strategies of HCPs and nonmedical staff at 2 periods of the COVID-19 pandemic. By further analyzing qualitative comments, we wanted to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff on different levels of experience. Methods: A cross-sectional survey was conducted at 2 time points during the COVID-19 pandemic in several European countries. The first study period (T1) lasted between April 1 and June 20, 2020, and the second study period (T2) lasted between November 25, 2021, and February 28, 2022. On a quantitative level, we used a questionnaire on stressors for physicians and nurses and a questionnaire on coping strategies for HCPs and nonmedical staff. Quantitative data were descriptively analyzed for mean values and differences in stressors and coping strategies. Qualitative data of free-text boxes of HCPs and nonmedical staff were analyzed via thematic analysis to explore the experiences of the individuals. Results: T1 comprised 609 participants, and T2 comprised 1398 participants. Overall, 296 participants made 438 qualitative comments. The uncertainty about when the pandemic would be controlled (T1: mean 2.28, SD 0.85; T2: mean 2.08, SD 0.90) and the fear of infecting the family (T1: mean 2.26, SD 0.98; T2: mean 2.02, SD 1.02) were the most severe stressors identified by physicians and nurses in both periods. Overall, the use of protective measures (T1: mean 2.66, SD 0.60; T2: mean 2.66, SD 0.60) and acquiring information about COVID-19 (T1: mean 2.29, SD 0.82; T2: mean 1.99, SD 0.89) were identified as the most common coping strategies for the entire study population. Using thematic analysis, we identified 8 themes of personal experiences on the micro, meso, and macro levels. Measures, working conditions, feelings and emotions, and social climate were frequently mentioned topics of the participants. In T1, feelings of isolation and uncertainty were prominent. In T2, feelings of exhaustion were expressed and vaccination was frequently discussed. Moreover, unmet psychosocial needs were identified. Conclusions: There is a need for improvement in pandemic preparedness. Targeted vocational education measures and setting up of web-based mental health support could be useful to bridge gaps in psychosocial support needs in future crises.

2022 - "It's All COVID's Fault!": Symptoms of Distress among Workers in an Italian General Hospital during the Pandemic [Articolo su rivista]
Mastroberardino, Michele; Cuoghi Costantini, Riccardo; De Novellis, Antonella Maria Pia; Ferrari, Silvia; Filippini, Costanza; Longo, Fedora; Marchi, Mattia; Rioli, Giulia; Valeo, Laura; Vicini, Roberto; Galeazzi, Gian Maria; D'Amico, Roberto; Vandelli, Paola
abstract

Background: Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have been faced with specific stressors endangering their physical and mental health and their functioning. This study aimed to assess the short-term psychological health of a sample of Italian HCWs and the related influencing factors. In particular, the study focused on the differences related to HCWs' gender and to having been directly in charge of COVID-19 patients or not. Methods: An online survey was administered to the whole staff of the Modena General University Hospital three months after the onset of the pandemic, in 2020. Demographic data and changes in working and living conditions related to COVID-19 were collected; mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R). Results: 1172 out of 4788 members returned the survey (response rate = 24.5%), the male/female ratio was 30/70%. Clinically significant symptoms assessed according to the DASS-21 emerged among 21.0% of the respondents for depression, 22.5% for anxiety and 27.0% for stress. Symptoms suggestive of a traumatic reaction were reported by 19.0% of the sample. Symptoms of psychological distress were statistically associated with female gender, job role, ward, changes in lifestyle, whereas first-line work with COVID-19 patients was statistically associated with more stress symptoms. HCWs reported a significant level of psychological distress that could reach severe clinical significance and impact dramatically their quality of life and functioning. Conclusions: Considering the persistence of the international emergency, effective strategies to anticipate, recognize and address distress in HCWs are essential, also because they may impact the organization and effectiveness of healthcare systems.

2022 - Can a negative religious causal attribution of mental illness affect the phenomenon of public stigma? [Articolo su rivista]
Pingani, L.; Pinelli, G.; Coriani, S.; Ferrari, S.; Fierro, L.; Giberti, S.; Mattei, G.; Nasi, A. M.; Evans-Lacko, S.; Wesselmann, E. D.; Galeazzi, G. M.
abstract

This study assessed, through an exploratory approach, how religion-based negative causal attributions of mental illness may be associated to stigmatising attitudes and behaviours that contribute to public stigma in an Italian convenience sample. All participants (N = 311; average age = 33 years, 38.6% male) completed a set of three questionnaires: Religious Beliefs and Mental Illness Stigma Scale, the Attribution Questionnaire 27 and the Mental Health Knowledge Schedule. The study found support for two specific models. The Responsibility model involved four key predictors: participant age, the influence of religious beliefs in everyday choices, religious beliefs about the connection between morality/sin and mental illness and having participated in seminars about mental illness stigma. The Dangerousness model involved three exogenous variables: participating in mental illness stigma seminars, religious beliefs about morality/sin and mental illness, and participant age. This study allows the identification of variables that seem to activate or attenuate the models of “Personal Responsibility” and “Dangerousness”.

2022 - Changes of consultation-liaison psychiatry practice in Italian general hospitals: A comparative 20-year multicenter study [Articolo su rivista]
Zerbinati, L.; Palagini, L.; Balestrieri, M.; Belvederi Murri, M.; Caruso, R.; D'Agostino, A.; Ferrara, M.; Ferrari, S.; Minervino, A.; Milia, P.; Nanni, M. G.; Pini, S.; Politi, P.; Porcellana, M.; Rocchetti, M.; Taddei, I.; Toffanin, T.; Grassi, L.; Bellucci, J.; Bergamelli, E.; Attilio Campagna, V.; Cherubini, M.; Folesani, F.; Gancitano, M.; Giannetti, F.; Giovanna, G.; Gullotta, B.; Massa, L.; Montardi, G.
abstract

Introduction: Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry (CLP) activity in Italy (SIPC-2—2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1—1998). Methods: We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same ad hoc 60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation-related, interventions and outcome. Results: Compared with participants from the previous study, SIPC-2-2018 participants were significantly older (d = 0.54) and hospitalized for a longer duration (d = 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (Φ = 0.13), antipsychotics (Φ = 0.09), mood stabilizers (Φ = 0.24), and less often benzodiazepines (Φ = 0.07). Conclusion: CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy.

2022 - DIFFERENZE DI GENERE NELLA COMORBILITÀ TRA SINTOMATOLOGIA ANSIOSO-DEPRESSIVA, SINDROME METABOLICA E ADENOMI COLORETTALI [Abstract in Atti di Convegno]
Rioli, Giulia; Bonamici, Caterina; Mancini, Stefano; Mattei, Giorgio; Alboni, Silvia; Sena, Paola; Roncucci, Luca; Fiore, Gianluca; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

2022 - Delirium in COVID-19 and post-liver transplant patients: an observational study [Articolo su rivista]
Fiore, Gianluca; Ferrari, Silvia; Cutino, Anna; Giorgino, Claudia; Valeo, Laura; Galeazzi, Gian M.; Marchi, Mattia
abstract

2022 - Depressive disorders [Capitolo/Saggio]
Ferrari, S; Blanch, J; Lavasani, S; Beall, Sc; Gibson, Sj; Magarini, Fm; Alboni, S
abstract

Major Depressive Disorder (MDD) and other disorders on the depressive spectrum are more prevalent among HIV-infected individuals than in the general population. These illnesses have a significant impact on prevention, engagement and adherence to HIV care, prognosis, illness-related disability, and quality of life. Diagnosis of depressive disorders may be delayed, and management may be inadequate, due to interfering factors such as overlapping symptoms, co-morbid neurocognitive disorders, and risk of drug-drug interactions. Not only do HIV infection and disorders on the depressive spectrum act as mutually reciprocal risk factors, but their concomitance may provide an etiopathogenetic model; co-morbid depressive disorders may contribute to understanding the complex role played by the neuro-endocrine-immune system in the development, maintenance, and chronicity of psychiatric symptoms. Many neurobiological pathways are involved, including the HPA axis and the gut microbiome. Various therapeutic options are available for MDD among HIV-infected patients, including antidepressant medications, other psychopharmacological interventions, and non-pharmacological strategies. Antidepressants are safe and appropriate for the care of persons with HIV and co-morbid depressive disorders. The recognition and treatment of depressive symptoms and disorders among HIV-infected persons is a major clinical goal, considering the high prevalence of this co-morbidity and its impact on prognosis and perceived quality of life.

2022 - Differenze di genere nella comorbilità tra sintomatologia ansioso-depressiva, sindrome metabolica e adenomi colorettali [Abstract in Rivista]
Rioli, G.; Bonamici, C.; Mancini, S.; Mattei, G.; Alboni, S.; Sena, P.; Roncucci, L.; Fiore, G.; Pingani, L.; Ferrari, S.; Galeazzi, G. M.
abstract

2022 - Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from 4 centres in Italy [Articolo su rivista]
Beghi, M.; Ferrari, S.; Brandolini, R.; Casolaro, I.; Balestrieri, M.; Colli, C.; Fraticelli, C.; Di Lorenzo, R.; De Paoli, G.; Nicotra, A.; Pischiutta, L.; Tedeschini, E.; Castelpietra, G.
abstract

Objectives: An observation of the Emergency Room (ER) admissions during the lockdown. Methods: We monitored admissions to the ER requiring psychiatric evaluation during the 2020 lockdown (March 9th-May 3rd, 2020) compared to the same period of 2019, in four sites of Northern Italy (ASST Lariana, AUSL Modena, ASU Friuli Centrale and AUSL Romagna). Number of admissions, baseline demographic and clinical variables were extracted from the clinical databases. Results: A 20.0% reduction of psychiatric referrals was observed across the sites (24.2% in ASST Lariana, 30.5% in AUSL Modena, 12.0% in ASU Friuli Centrale and 14.5% in AUSL Romagna). This reduction peaked at 41.5% in the first month of the lockdown. Being homeless as well as with a dual diagnosis (OR 1,67, CI: 1.02–2.74), while living in a residential facility and admission for a depressive episode Being homeless (OR 2.50, CI: 1.36–4.61) and having a dual diagnosis (OR 1,67, CI: 1.02–2.74) were significantly associated with an increase in ER admission, while living in a residential facility (OR 0.48, CI: 0.31–0.74), having a depressive episode (OR 0.36, CI: 0.18–0.73) and a diagnosis of anxiety disorder (OR 0.60, CI: 0.36–0.99) were significantly associated with a decrease. Conclusions: During lockdown, a decrease in psychiatric referrals was observed.

2022 - Gender differences in Anxious-depressive symptomatology, Metabolic Syndrome and Colorectal Adenomas among outpatients undergoing colonoscopy: a cross-sectional study according to a PNEI perspective [Articolo su rivista]
Rioli, Giulia; Mattei, Giorgio; Bonamici, Caterina; Mancini, Stefano; Alboni, Silvia; Cannazza, Giuseppe; Sena, Paola; Roncucci, Luca; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

2022 - High Depression Symptomatology and Mental Pain Characterize Suicidal Psychiatric Patients [Articolo su rivista]
Pompili, Maurizio; Innamorati, Marco; Erbuto, Denise; Luciano, Mario; Sampogna, Gaia; Abbate-Daga, Giovanni; Barlati, Stefano; Carmassi, Claudia; Castellini, Giovanni; De Fazio, Pasquale; Di Lorenzo, Giorgio; Di Nicola, Marco; Ferrari, Silvia; Goracci, Arianna; Gramaglia, Carla; Martinotti, Giovanni; Nanni, Maria Giulia; Pasquini, Massimo; Pinna, Federica; Poloni, Nicola; Serafini, Gianluca; Signorelli, Maria; Tortorella, Alfonso; Ventriglio, Antonio; Volpe, Umberto; Fiorillo, Andrea
abstract

2022 - IL RUOLO DELL’INFIAMMAZIONE SISTEMICA CRONICA E DELLA VIA METABOLICA DELLE CHINURENINE NELLA COMORBIDITÀ TRA ANSIA, DEPRESSIONE E SINDROME METABOLICA: RISULTATI DI UNO STUDIO CROSS-SECTIONAL [Abstract in Atti di Convegno]
Rioli, Giulia; Bonamici, Caterina; Macini, Stefano; Mattei, Giorgio; Alboni, Silvia; Sena, Paola; Roncucci, Luca; Fiore, Gianluca; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

2022 - Il ruolo dell'infiammazione sistemica cronica e della via metabolica delle chinurenine nella comorbidilità tra ansia, depressione e sindrome metabolica: risultati di uno studio cross-sectional [Abstract in Rivista]
Rioli, G.; Bonamici, C.; Macini, S.; Mattei, G.; Alboni, S.; Sena, P.; Roncucci, L.; Fiore, G.; Pingani, L.; Ferrari, S.; Galeazzi, G. M.
abstract

2022 - L'impatto dello stigma [Capitolo/Saggio]
Pingani, Luca; Coriani, Sandra; Ferrari, Silvia; Maria Nasi, Anna; Galeazzi, Gian Maria
abstract

2022 - Mid-term psychiatric consequences of the COVID-19 pandemic: a 4 months observational study on emergency room admissions for psychiatric evaluation after the (first) lockdown period in Italy [Articolo su rivista]
Beghi, M.; Ferrari, S.; Biondi, L.; Brandolini, R.; Corsini, C.; De Paoli, G.; Sant'Angelo, R. P.; Fraticelli, C.; Casolaro, I.; Zinchuk, M.; Pashnin, E.; Urh, L.; Castelpietra, G.; Cornaggia, C. M.
abstract

Purpose: The aim of our study is to evaluate the number and the features of admissions to the emergency room (ER) requiring psychiatric consultation, in the period between May 4th and August 31st 2020. Methods: We carried out a retrospective longitudinal observational study examining the 4 months following the initial lockdown imposed during the COVID-19 outbreak (May 4th and August 31st 2020). More specifically, the ER admissions leading to psychiatric referral were reviewed at all seven public hospitals of AUSL Romagna (Emilia Romagna region, Italy). Socio-demographic variables, history of medical comorbidities or psychiatric disorders, reason for ER admission, psychiatric diagnosis at discharge, and actions taken by the psychiatrist were collected. Results: An 11.3% (p = 0.007) increase in psychiatric assessments was observed when compared with the same period of the previous year (2019). A positive personal history of psychiatric disorders (OR:0.68, CI: 0.53–0.87) and assessments leading to no indication for follow-up (OR: 0.22, CI: 0.13–0.39) were significantly less frequent, while there was a significant increase of cases featuring organic comorbidities (OR: 1.24, CI: 1.00–1.52) and suicidal ideation/self-harm/suicide attempt (OR: 1,71, CI: 1.19–2.45) or psychomotor agitation (OR: 1.46, CI: 1.02–2.07) as reason for admission. Conclusions: Our results showed an increase in ER psychiatric consultations compared to the previous year, underlying the increased psychological distress caused by the lockdown.

2022 - Poor sleep quality may contribute to dysfunctional illness perception, physical and emotional distress in hospitalised patients: results of a national survey of the Italian Society of Consultation‐Liaison Psychiatry [Articolo su rivista]
Palagini, Laura; Zerbinati, Luigi; Balestrieri, Matteo; Belvederi Murri, Martino; Caruso, Rosangela; D'Agostino, Armando; Ferrara, Maria; Ferrari, Silvia; Minervino, Antonino; Massa, Lucia; Milia, Paolo; Miniati, Mario; Maria Giulia, Nanni; Petrucci, Alessandra; Pini, Stefano; Politi, Pierluigi; Porcellana, Matteo; Rocchetti, Matteo; Taddei, Ines; Toffanin, Tommaso; Grassi, Luigi
abstract

2022 - Suicide risk in medically ill inpatients referred to consultation-liaison psychiatric services: A multicenter study [Articolo su rivista]
Balestrieri, M.; Rucci, P.; Murri, M. B.; Caruso, R.; D'Agostino, A.; Ferrari, S.; Nanni, M. G.; Palagini, L.; Pini, S.; Politi, P.; Rocchetti, M.; Zerbinati, L.; Grassi, L.
abstract

Background: The aim of this multicenter study was to investigate the suicide risk in medically ill patients admitted to six Italian hospitals for whom a consultation-liaison intervention was requested. Methods: Participants completed socio-demographic and clinical report forms and the Brief Illness Perception Questionnaire. Suicidality was assessed using the P4 screener that investigates the presence of Past suicide attempts, Plans to commit a suicide, Probability of completing suicide, and Preventive factors. Participants were categorized as being at no, low or high suicide risk. Univariate and multivariable associations of categorical and continuous variables with suicide risk were investigated using multinomial logistic regression. Results: Of the 641 inpatients, with mean age 60 years (SD = 16.9) and 49.2 % male, 13.2 % were at high suicidal risk (HR), 7.6 % low risk (LR) and 79.2 % no risk. Contacts with psychiatrists in the previous six months were associated with LR and HR (OR = 2.159 and 2.634, respectively), ongoing benzodiazepine use was associated with a threefold likelihood of LR (OR = 3.005), and the experienced intensity of illness symptoms was associated with LR and HR (OR = 1.257 and OR = 1.248, respectively). CL psychiatrists prescribed appropriate psychotropic drugs and activated liaison interventions and psychological support for the level of suicidal risk. Limitations: The use of self-report measures bears the risk of recall bias. Conclusions: Our findings based on psychiatric consultations in the general hospital underscore the need to include suicide risk in the routine assessment of inpatients referred to CL psychiatric services and to plan an appropriate management of suicidal risk after discharge.

2022 - The Effect of the Use of Hearing Aids in Elders: Perspectives [Articolo su rivista]
Monzani, Daniele; Nocini, Riccardo; Presutti, Maria Teresa; Gherpelli, Chiara; Di Berardino, Federica; Ferrari, Silvia; Galeazzi, Gian Maria; Federici, Gaia; Genovese, Elisabetta; Palma, Silvia
abstract

: Older adults with hearing loss have difficulties during conversation with others because an elevated auditory threshold reduces speech intelligibility, especially in noisy environments. Listening and comprehension often become exhausting tasks for hearing-impaired elders, resulting in social isolation and depression. The aim of the present study was to investigate the advantages of hearing aid use in relation to relief from listening-related fatigue, which is still controversial. Participants included a sample of 49 hearing-impaired elders affected by presbycusis for whom hearing aids were prescribed. The Modified Fatigue Impact Scale was used to assess cognitive, physical and psychosocial fatigue. The vitality subscale of the Short Form Health Survey 36 and a single item of the multi-dimensional Speech, Spatial and Quality Hearing Scale ("Do you have to put a lot of effort to hear what is being said in conversation with others?") were also used. The Cognitive Failures Questionnaire was used to investigate daily errors related to lack of memory and reduced mindedness. Hearing aids rehabilitation resulted in improved speech intelligibility in competing noise, and a significant reduction in cognitive and psychosocial fatigue and listening effort in conversation. Vitality was also improved and a significant reduction in the Cognitive Failures Questionnaire scores was observed. Findings from the study indicate that the use of hearing aids in older impaired-listeners provide them not only with an increased auditory function but also with a reduction in listening-related fatigue and mindedness.

2022 - The Relationship Between Mental Pain, Suicide Risk, and Childhood Traumatic Experiences: Results From a Multicenter Study [Articolo su rivista]
Pompili, Maurizio; Erbuto, Denise; Innamorati, Marco; Luciano, Mario; Sampogna, Gaia; Abbate-Daga, Giovanni; Barlati, Stefano; Carmassi, Claudia; Castellini, Giovanni; De Fazio, Pasquale; Di Lorenzo, Giorgio; Di Nicola, Marco; Ferrari, Silvia; Gramaglia, Carla; Nanni, Maria Giulia; Pasquini, Massimo; Pinna, Federica; Poloni, Nicola; Serafini, Gianluca; Signorelli, Maria; Ventriglio, Antonio; Volpe, Umberto; Fiorillo, Andrea
abstract

: : Objective: Mental pain and exposure to maltreatment are significant risk factors for suicidal behavior. This study aimed to investigate whether mental pain could be associated with a recent suicide attempt and whether it could mediate the relationship between childhood traumatic experiences and suicide risk in psychiatric patients. : Methods: A multicenter observational study was organized as a joint project with representatives of numerous mixed Italian academic and clinical settings. Between December 2017 and March 2020, batteries of tests were administered to patients, assessing suicidal ideation and behavior, mental pain (usual and worst mental pain in the past 15 days), depression, and childhood maltreatment. : Results: A total of 2,137 psychiatric patients (1,313 women and 824 men) were included in the final sample, and 315 reported having attempted suicide in the last 3 months. Suicide attempters (compared to nonattempters) had higher odds of reporting worse mental pain (odds ratios [ORs] between 1.02 and 1.17; P < .001) and suicidal intent with/without a specific plan (ORs between 11.57 and 11.77; P < .001). They also had higher odds of having a personality disorder (borderline personality disorder: ORs between 2.65 and 3.01; P < .001; other personality disorders: ORs between 1.96 and 2.28; P < .01) and major depression (ORs between 1.62 and 1.70; P < .05). Childhood trauma was associated with suicide risk directly (standardized effects between 0.06 and 0.07; P < .01) and indirectly through mental pain (usual mental pain: standardized indirect effect = 0.11, P < .001; worst mental pain in the past 15 days: standardized indirect effect = 0.12, P < .001). : Conclusions: Mental pain constitutes a crucial framework for assessing the individual need for psychiatric help. Assessing mental pain allows identification of the main ingredient of suicide risk and puts the clinician in a strategic position to unlock some motives behind the wish to die. Further research is needed to learn if childhood adversities may interact with adult mental pain and thus foster suicide risk.

2022 - The effect of ketamine on cognition, anxiety, and social functioning in adults with psychiatric disorders: A systematic review and meta-analysis [Articolo su rivista]
Marchi, Mattia; Magarini, Federica Maria; Galli, Giacomo; Mordenti, Federico; Travascio, Antonio; Uberti, Daniele; De Micheli, Edoardo; Pingani, Luca; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

Background: It has been shown that ketamine can improve suicidality and depression. Evidence for other dimensions of psychopathology is lacking. We undertook a systematic review to investigate the effect of ketamine on cognition, anxiety, quality of life, and social functioning in adults with psychiatric disorders. Methods: PubMed (Medline), Scopus, PsycINFO, and EMBASE were searched up to April 2022. Randomized controlled trials (RCTs) on ketamine [or its S (+) enantiomer] reporting data on cognition, anxiety, quality of life, social functioning in adults with psychiatric disorders were included. Standardized mean difference (SMD) was used for summarizing continuous outcomes. Results: Twenty-two reports were included in the final selection, of which 20, corresponding to 1,298 participants, were included in the quantitative synthesis. Affective disorders were the predominant diagnostic category. Median follow-up time was 21 days. The evidence was rated moderate to very low. In most trials, ketamine was administered intravenously or as adjuvant to electro-convulsant therapy (ECT). Only 2 trials of intranasal esketamine were identified. The effect of ketamine on depression was confirmed (SMD: −0.61 [95% CI: −1.06; −0.16]). Furthermore, by pooling results of 6 RCTs, ketamine may be effective in reducing anxiety symptoms (SMD: −0.42 [95% CI: −0.84; 0.003]), particularly when administered not within ECT (5 trials; SMD: −0.58 [95% CI: −1.07; −0.09]). However, there was moderate heterogeneity of results. Patients treated with ketamine also had an improvement in social functioning (SMD: −0.31 [95% CI: −0.52; −0.10]), although the estimate was based only on 2 studies. No difference to comparators was found with respect to cognition and quality of life. Conclusion: Alongside the antidepressant effect, ketamine may also improve anxiety and social functioning in adults with affective disorders.

2022 - The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study [Articolo su rivista]
Marchi, Mattia; Artoni, Cecilia; Longo, Fedora; Magarini, Federica Maria; Aprile, Giovanni; Reggianini, Corinna; Florio, Debora; De Fazio, Giovanna Laura; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

According to the WHO, detainees attempt suicide ten times more than the general population.

2021 - Diagnostic agreement between physicians and a consultation-liaison psychiatry team at a general hospital: An exploratory study across 20 years of referrals [Articolo su rivista]
Marchi, M.; Magarini, F. M.; Mattei, G.; Pingani, L.; Moscara, M.; Galeazzi, G. M.; Ferrari, S.
abstract

Consultation-liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000-2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.

2021 - Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from the AUSL Romagna, Italy [Articolo su rivista]
Beghi, M.; Brandolini, R.; Casolaro, I.; Beghi, E.; Cornaggia, C. M.; Fraticelli, C.; De Paoli, G.; Ravani, C.; Castelpietra, G.; Ferrari, S.
abstract

Objectives: An observation of the admissions to the emergency room (ER) requiring psychiatric evaluation during the lockdown and investigation of the demographic and clinical variables. Methods: Retrospective longitudinal observational study of ER accesses for psychiatric evaluation was performed, comparing two periods (9 March–3 May 2020 vs. 9 March–3 May 2019). Data (number of admissions, key baseline demographic and clinical variables) were extracted from the ER databases of referral centres in a well-defined geographic area of North-Eastern Italy (Cesena, Ravenna, Forlì, and Rimini). Results: A 15% reduction of psychiatric referrals was observed, together with a 17% reduction in the total number of patients referring to the ER. This reduction was most evident in the first month of the lockdown period (almost 25% reduction of both referrals and patients). Female gender (OR: 1.52: 95%, CI: 1.12–2.06) and being a local resident (OR: 1.54: 95%CI: 1.02–2.34) were factors associated with the decrease. Conclusions: Lockdown changed dramatically health priorities in the local population, including people with mental health. We speculate that our observations do not only refer to the confinement due to the lockdown regime but also to fear of contagion and adoption of different coping strategies, especially in women.Key-points During lockdown 15% reduction of psychiatric visits and >17% reduction in the number of psychiatric patients referring to the ER was observed. in the first four weeks of the lockdown almost 25% reduction of both visits and patients was observed Female gender and being a local resident were factors associated with the decrease.

2021 - First-episode Psychosis and Migration in Italy: Results from a Study in the Italian Mental Health Services (Pep-Ita Study) [Articolo su rivista]
Tarricone, I.; D'Andrea, G.; Storbini, V.; Braca, M.; Ferrari, S.; Reggianini, C.; Rigatelli, M.; Gramaglia, C.; Zeppegno, P.; Gambaro, E.; Luciano, M.; Ceregato, A.; Altamura, M.; Barrasso, G.; Primavera, D.; Carpiniello, B.; Todarello, O.; Berlincioni, V.; Podavini, F.; Morgan, C.; Murray, R. M.; Di Forti, M.; Muratori, R.; Berardi, D.
abstract

Background: Migrants present high rates of psychosis. A better understanding of this phenomenon is needed. Methods: We conducted a multicentre First-Episode Psychosis (FEP) prospective study over two years (January 2012–December 2013) to evaluate first-generation migrants presenting with FEP at the participating Community Mental Health Centers (CMHCs). Results: 109 FEP migrants were identified. Almost half of them were highly educated, employed and in a stable affective relationship. The average age was 32.8 (± 9.8) years, and the average length of stay in Italy was 8.6 (± 8.8) years. About 2/3 of patients were referred to CMHCs following Emergency Department access or psychiatric admission. Conclusions: Our finding of a “high functioning portrait” of FEP migrants allow us to hypothesize that a high burden of negative psychosocial factors is likely to be needed for the FEP onset. Furtherly, mental health services should implement more appropriate resources and organizational methods to respond to migrants’ health needs.

2021 - Group clinical supervision in adult mental health settings [Articolo su rivista]
Galletti, Martina; Moscara, Maria; Mattei, Giorgio; Balducci, Jessica; Sacchetti, Andrea; Venturi, Giulia; Visentini, Chiara; Ferrari, Silvia; Galeazzi, Gian M.
abstract

2021 - Irrational beliefs about COVID-19: A scoping review [Articolo su rivista]
Magarini, F. M.; Pinelli, M.; Sinisi, A.; Ferrari, S.; De Fazio, G. L.; Galeazzi, G. M.
abstract

Since the emergence of the recent Coronavirus Disease of 2019 (COVID-19) and its spread as a pandemic, there has been a parallel spread of false and misleading information, known as an infodemic. The COVID-19 infodemic has induced distrust in scientific communities, governments, institutions and the population, and a confidence crisis that has led to harmful health behaviours, also impacting on mental health. The aim of this study is to provide a scoping review of the scientific literature about COVID-19-related misinformation and conspiracy theories, focusing on the construction of a conceptual framework which is useful for the interpretation of the conspiracy theory phenomenon surrounding COVID-19, and its consequences. Particular socio-environmental conditions (i.e., low educational level, younger age), psychological processes and attitudes (such as low levels of epistemic trust, the avoidance of uncertainty, extraversion, collective narcissism, and a conspiracy-prone mindset), and contextual factors (e.g., high levels of self-perceived risk and anxiety) seem to underpin the adherence to beliefs that are not solely the domain of paranoids and extremists but a widespread phenomenon that has caused important health, social and political consequences.

2021 - Is orthorexia nervosa a feature of obsessive-compulsive disorder? A multicentric, controlled study [Articolo su rivista]
Vaccari, G; Cutino, A; Luisi, F; Giambalvo, N; Navab Daneshmand, S; Pinelli, M; Maina, G; Galeazzi, G M; Kaleci, S; Albert, U; Atti, A R; Ferrari, S
abstract

The term orthorexia nervosa (ON) was coined to describe altered thoughts and behaviours related to healthy eating. The prevalence of ON was found to scale up to almost 90% among high-risk populations (ballet dancers, athletes, and health workers). ON seem to share psychopathological aspects with both Eating Disorders (ED) and Obsessive-Compulsive Disorder (OCD). The aim of the study was to analyse the frequency and intensity of ON symptoms among subjects diagnosed with OCD, hypothesising that they would be higher than in two control groups (subjects with anxiety-depressive disorders and general population).

2021 - L'associazione tra fumo di tabacco e crisi economiche in Italia [Articolo su rivista]
Mattei, G.; Leone, E.; Venturi, G.; Pingani, L.; Ferrari, S.; Galeazzi, G. M.; De Vogli, R.
abstract

OBJECTIVES: to analyse the association between smoking behaviour and economic crises in Italy between 1993 and 2015. DESIGN: ecological study, carried out on data of the Italian National Institute of Statistics, by means of fixed-effect panel regressions. SETTING AND PARTICIPANTS: the rate of smoking prevalence (disaggregated by gender and age) and the unemployment rate (disaggregated by gender and referring to individuals aged 15 or more) were collected for each of the twenty Italian regions. Also, percentage fluctuations of the national real gross domestic product (GDP) were collected to identify the years of severe economic crisis. MAIN OUTCOME MEASURES: number of people who smoke per 100 people with the same features. RESULTS: among men, increased regional unemployment rate was associated with increased smoking behaviour only in the group aged 25-34 years. Differently, severe economic crises were associated with increased smoking in almost all age groups, except for men aged 15-24 years. A 1-point decrease in GDP was associated with 0.75 more smokers aged 15 years or more. The highest coefficient was reported among men aged 35-44 years, where a 1-point decrease in GDP was associated with 1.16 more smokers (every 100 men). This age group is also featured by the second highest prevalence of tobacco smoking (36.8%). Among women, a 1-point increase in the regional unemployment rate was associated with 0.08 less smokers every 100 women. Similarly, periods of severe economic crisis at national level were associated with reduced smoking behaviour among women aged 15 years or more, specifically those aged 15-24 years. Differently, women aged 25-34 and 65 years or more showed an association similar to that reported among men. In these groups, a 1-point decrease in GDP was associated with 0.67 and 1.08 more smokers every 100 women. While among the latter the prevalence of tobacco smoking is the lowest, among the former it is the third highest prevalence (21.69%). Therefore, increased smoking behaviour due to economic crises seems to occur especially among women aged 25-35 years old, as happens among men. CONCLUSIONS: men in almost all age groups and women aged 25-34 and 65 years or more represent vulnerable groups in which smoking behaviour may increase in times of economic hardship. Therefore, specific policies should be implemented to prevent this occurrence, as well as the negative health outcomes of tobacco smoking.

2021 - Past, present and future of the Modena Consultation-Liaison Psychiatry Service [Articolo su rivista]
Ferrari, S.; Marchi, M.; Mattei, G.; Moscara, M.; Galeazzi, G. M.; Pingani, L.
abstract

2021 - Preliminary results of a multidisciplinary italian study adopting a psycho-neuro-endocrine-immunological (Pnei) approach to the study of colorectal adenomas [Articolo su rivista]
Mancini, S.; Alboni, S.; Mattei, G.; Rioli, G.; Sena, P.; Marchi, M.; Sacchetti, A.; Boarino, V.; Roncucci, L.; Galeazzi, G. M.; Ferrari, S.
abstract

Background and aim of the work: Colorectal mucosal precancerous lesions, metabolic syndrome (MetS) and psychiatric disorders may share a common low-grade local and systemic inflammation. Aim is to report on preliminary data concerning a research adopting a psycho-neuro-endocrine-immune (PNEI) approach to study outpatients undergoing colonoscopy. Methods: A sample of patients undergoing colonosco-py was cross-sectionally investigated. Data on colorectal adenomas, MetS, early atherosclerosis, anxious-de-pressive symptoms, personality traits, and inflammatory markers were statistically analyzed. Results: Sixty-two patients were recruited (female 50%, mean age: 60.8±9.4 years). The prevalence of adenomas and MetS was respectively of 45.2% and 41.9%. Anxiety and depressive symptoms were detected in 16 (32.7%) and 9 (18.4%) subjects, respectively. The presence of adenomas positively correlated with male sex (p=0.01), age (p<0.01), IL-6 (p=0.03), hsCRP (p=0.04), and MetS (p=0.03); it was also associated with hsCRP concentra-tion (aOR=3.81, p=0.03). Conclusions: Proinflammatory atherogenic status, psychological traits, increased mucosal inflammation, and metabolic parameters may share a common a pathogenic mechanism, worth studying.

2021 - Psychiatric Emergencies During the Covid-19 Pandemic: A 6-Month Observational Study [Articolo su rivista]
Di Lorenzo, R; Frattini, N; Dragone, D; Farina, Riccardo; Luisi, Filippa; Ferrari, Silvia; Bandiera, G; Rovesti, Sergio; Ferri, Paola
abstract

Background: The new SARS-CoV-2 has caused an ongoing pandemic. Health prevention measures to contain the outbreak are profoundly affecting the physical and mental health as well as personal freedom of the population. Aim: To evaluate psychiatric emergencies in a 6-month period during the COVID-19 pandemic in 2020 compared to those of the corresponding period of the previous year. Methods: This monocentric observational study preliminarily collected variables of the urgent psychiatric consultations (UPCs) carried out in emergency room (ER) from 1-3-2020 to 31-8-2020 and the socio-demographic and clinical characteristics of patients who required UPCs in the 6-month period, comparing these data with those collected from 1-3-2019 to 31-8-2019. The data, collected in alpha-numeric code, were statistically analyzed through STATA 12-2011. Results: This research reported a reduction of both UPCs and hospital psychiatric admissions. Concomitantly, we observed an increase of UPCs required by people already being treated by psychiatric and other health services, residents in psychiatric facilities and non-Italians. In 2020, differently from 2019, the most frequent reasons for urgent psychiatric consultations were aggressive behavior and adjustment disorders with anxiety and depressive mood. Conclusion: This preliminary study suggests that, during the COVID-19 epidemic, urgent psychiatric consultations in ER were reduced, except for the most vulnerable people due to their clinical and/or social conditions.

2021 - Time Waits for No One: Longitudinal Study on the Effects of an Anti-Stigma Seminar on the Psychology Student Population [Articolo su rivista]
Pingani, Luca; Evans-Lacko, Sara; Coriani, Sandra; Ferrari, Silvia; Filosa, Maria; Galeazzi, Gian Maria; Lorenzini, Mattia; Manari, Tommaso; Musetti, Alessandro; Nasi, Anna Maria; Franceschini, Christian
abstract

2021 - Translation and validation of an Italian language version of the Religious Beliefs and Mental Illness Stigma Scale (I-RBMIS) [Articolo su rivista]
Pingani, Luca; Giberti, Sara; Coriani, Sandra; Ferrari, Silvia; Fierro, Lucia; Mattei, Giorgio; Maria Nasi, Anna; Pinelli, Giorgia; Wesselmann, Eric D.; Galeazzi, Gian Maria
abstract

The aim of this study is to validate the Italian version of the Religious Beliefs and Mental Illness Stigma Scale (I-RBMIS): a self-report measure of religious beliefs that may contribute to stigma regarding mental disorders. Scale validation included: linguistic validation; pilot test for understandability; face validity; factor analysis as test of dimensionality; Kaiser–Meyer–Olkin test to evaluate sample sampling adequacy; internal consistency was assessed using Cronbach’s alpha; scale validity was assessed through concurrent criterion validity using as gold standard the Italian version of Attribution Questionnaire 27 and mental health knowledge schedule; A total of 311 people agreed to participate in the study. Face validity showed that 13 items out of 16 were completely understandable while only three items (4, 9 and 13) highlighted small lexical concerns. The average compilation time was under 4 min. Bartlett’s test for sphericity was statistically significant (Χ2 = 1497.54; df = 120; p < 0.001). Cronbach's alpha values were acceptable both for the entire questionnaire (0.80) and for the morality/sin subscale (0.73), whereas it was slightly below the standard cutoff for the spiritually oriented causes/treatments (0.68). Scale validity showed a positive correlation between I-RBMIS and AQ-27-I, and a negative correlation between I-RBMIS and MAKS-I. I-RBMIS demonstrated good psychometric properties to assess stigmatizing religious beliefs toward mental illness in general population.

2021 - “Shedding Light on Light”: A Review on the Effects on Mental Health of Exposure to Optical Radiation [Articolo su rivista]
Bertani, Davide Elia; De Novellis, Antonella Maria Pia; Farina, Riccardo; Latella, Emanuela; Meloni, Matteo; Scala, Carmela; Valeo, Laura; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

In relation to human health and functioning, light, or more specifically optical radiation, plays many roles, beyond allowing vision. These may be summarized as: regulation of circadian rhythms; consequences of direct exposure to the skin; and more indirect effects on well-being and functioning, also related to lifestyle and contact with natural and urban environments. Impact on mental health is relevant for any of these specifications and supports a clinical use of this knowledge for the treatment of psychiatric conditions, such as depression or anxiety, somatic symptom disor-der, and others, with reference to light therapy in particular. The scope of this narrative review is to provide a summary of recent findings and evidence on the regulating functions of light on human beings’ biology, with a specific focus on mental health, its prevention and care.

2020 - Analisi retrospettiva di una serie di stalker violenti [Analisi retrospettiva di una serie di stalker violenti] [Articolo su rivista]
Sgarbi, C.; Mattei, G.; Sinisi, A.; Gallocchio, F.; Ferrari, S.; Galeazzi, G. M.; De Fazio, L.
abstract

Stalking is often complicated by violent acts, which can be severe or even lethal. We analysed data collected in 2010 for the “Stalking and Risk of Violence” project, summarized in a database of 59 cases of stalking resulting in severe violence. A descriptive analysis and uni – and multivariate logistic regression analyses were carried out on the sample, in order to identify factors associated with severe violence. The univariate analysis revealed that substances abuse, previous convictions, threating behaviours, a low level of education in the stalker were often accompanied by a violent outcome. The multivariate analysis showed that previous contact of the stalker with mental health centres was associated with substance abuse, lurking and the homicidal outcome of the stalking. Further research is needed to confirm these findings in prospective cohorts and to take them into account in prevention programs

2020 - Anxiety, depression and personality traits in Italian medical students [Articolo su rivista]
Bertani, Davide E.; Mattei, Giorgio; Ferrari, Silvia; Pingani, Luca; Galeazzi, Gian Maria
abstract

Background. Anxiety and depressive symptoms are common worldwide and, according to the World Health Organization, their prevalence has increased in the last decades. Further, dysfunctional personality traits are frequently coupled with anxiety and depressive symptoms. The prevalence of these symptoms is particularly relevant in medical students. Methods. This study assessed the prevalence of anxiety and depressive symptoms in Italian medical students from the University of Modena and Reggio Emilia, by using the Hospital Anxiety and Depression Scale (HADS). Personality traits were assessed as well by employing the Personality Inventory for DSM-5, Brief Form (PID-5-BF), to explore their association with anxiety and depressive symptoms. A self-administered questionnaire was sent by e-mail to all the 944 students and 459 (48.6%) were enrolled. Besides the HADS and the PID-5-BF, the questionnaire included items concerning everyday life activities such as sports and academic features such as the years of attendance and average marks. Results. A high prevalence of anxiety (n=92; 20%), depression (n=32; 7%), and comorbid anxiety-depressive symptoms (n=218; 47%) was reported. Multiple binary logistic analysis showed increased levels of anxiety and depression to be associated with personality traits, namely detachment and negative affect, and use of cognitive enhancers. On the other hand, sports activities, social activities and distraction were related to lower levels of symptoms. Conclusions. Symptoms of depression and anxiety are common among Italian medical students and specific interventions should be implemented to target them.

2020 - Clinical and Socio-demographic Variables Associated with the Outcome of Vocational Rehabilitation Programs: A Community-Based Italian Study [Articolo su rivista]
Mattei, G; Venturi, G; Alfieri, S; Colombini, N; Ferrari, S; Rigatelli, M; Starace, F; Galeazzi, G M
abstract

This study aims to identify clinical and socio-demographic variables associated with the outcome of vocational rehabilitation programs (VRPs). All users of an Italian Community Mental Health Centre (CMHC) included in VRPs delivered according to the model of Supported Employment in years 2011-2016 were retrospectively enrolled. Fifty users who ended the program with employment were compared with fifty users who dropped out, with respect to clinical and socio-demographic variables. VRPs lasting less than 6 months and oriented toward the competitive labor market had a higher probability of employment. Among users who successfully ended the VRP, the median of health interventions significantly decreased after employment. In the same group of users, less non-health interventions strictly linked to the VRP were required, when compared with users who dropped out. We conclude that employment is associated with improvement of users' clinical conditions and reduced workload for the CMHC.

2020 - Experiences, opinions and current policies on users' choice and change of the allocated primary mental health professional: A survey among directors of community mental health centers in the Emilia-Romagna region, Italy [Articolo su rivista]
Rioli, G.; Ferrari, S.; Henderson, C.; Galeazzi, G. M.
abstract

Background: The subject of how the initial allocation of the primary mental health professional (PMHP) in community mental health services is made and the frequency and management of users' requests to choose and/or change their allocated PMHPs has been scarcely investigated. The present paper is aimed at exploring the experiences and opinions of directors of community mental health centers (CMHC) on this topic. Methods: A cross-sectional survey was conducted. Electronic ad hoc questionnaires with both multiple choice and open-ended questions were e-mailed to the institutional addresses of CMHC directors in the Emilia-Romagna Region (Northern Italy) with the consent of their heads of department and the Ethical Committee. Quantitative data were analysed by means of Microsoft Excel software and STATA 14.2 (College Station, TX), while the qualitative analysis was performed using the Nvivo12 software. Results: Twenty-eight questionnaires were collected (response rate: 71.8%) that were equally distributed between males and females. For the initial PMHP allocation, casual allocation by "fixed-rota" was commonly performed (39.3%). Moreover, hope for a change of prescription by a different psychiatrist was the most frequent reason for users' requests to change their PMHP. In two mental health departments only (Parma and Bologna), written guidelines to manage users' requests of change of PMHP were available. In this context, most participants classified the explored topics as relevant and believed that written policies, especially if shared with users, could be useful. Conclusions: In Emilia-Romagna CMHCs, neither users nor professionals were generally involved in the initial choice of the PMHP. Further national-level studies should be conducted in order to confirm this finding. Additionally, written and shared guidelines for managing users' request to choose/change their PHMP may be useful.

2020 - Investigating the association between physicians self-efficacy regarding communication skills and risk of “burnout” [Articolo su rivista]
Messerotti, Andrea; Banchelli, Federico; Ferrari, Silvia; Barbieri, Emiliano; Bettelli, Francesca; Bandieri, Elena; Giusti, Davide; Catellani, Hillary; Borelli, Eleonora; Colaci, Elisabetta; Pioli, Valeria; Morselli, Monica; Forghieri, Fabio; Galeazzi, Gian Maria; Marasca, Roberto; Bigi, Sarah; D’Amico, Roberto; Martin, Peter; Efficace, Fabio; Luppi, Mario; Potenza, Leonardo
abstract

2020 - Is Consultation-Liaison Psychiatry ‘Getting Old’? How Psychiatry Referrals in the General Hospital Have Changed over 20 Years [Capitolo/Saggio]
Ferrari, S; Mattei, G; Marchi, M; Galeazzi, Gm; Pingani, L
abstract

2020 - Is consultation-liaison psychiatry ‘getting old’? How psychiatry referrals in the general hospital have changed over 20 years [Articolo su rivista]
Ferrari, S.; Mattei, G.; Marchi, M.; Galeazzi, G. M.; Pingani, L.
abstract

There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000–2019 (N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.

2020 - Off-label prescription of psychotropic medications in a sample of Italian psychiatrists working in private practice: a cross sectional study [Articolo su rivista]
Bonamici, Caterina; Guicciardi, Alessia; Curti, Alex; Atti, Anna Rita; Balducci, Jessica; Mattei, Giorgio; Valle, Letizia; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

Background Off-label prescription refers to the use of a drug outside the terms of its Marketing Authorization. According to the literature, this practice is particularly common in clinical psychiatry. Objective To describe patterns of off-label prescription in a sample of Italian psychiatrists working in private practice. Methods An ad hoc questionnaire was developed and sent by e-mail to a sample of Italian psychiatrists working in private practice in the Region Emilia-Romagna. The questionnaire assessed frequency of off-label prescription, reasons associated with it, diagnostic categories more often associated with such practice, main sources of information used to support off-label prescription, and psychotropic agents most commonly prescribed off-label, as well as medical-legal implications. Data were analysed by means of univariate and multivariate ordered logistic regressions. Results Fifty psychiatrists (female: 44%) out of 129 who received the e-mail invitation responded (response rate: 39%). Off-label prescription was found to be inversely proportional to clinicians’ age (OR = 10.53 [95% CI 2.13-52.13]). Most commonly, second-generation antipsychotics (SGAs) were prescribed to patients diagnosed with personality disorders (PDs) (OR = 0.08 [95% CI 0.02-0.36]). A higher rate of off-label prescription was also associated to relying more on pharmaceutical sales representatives (OR = 0.58 [95%CI 0.01-0.30]) or personal professionals’ clinical experience (OR = 0.05 [95% CI 0.01-0.36]) and less on other colleagues’ experience (OR = 11.80 [95% CI 4.16-33.50]) as source of information. Conclusions Off-label prescription is common, especially among young psychiatrists, who frequently rely on previous personal clinical experience, especially when prescribing SGAs for treating patients with PDs. Respondents pointed to the need for further research and training on the topic addressed by the present study.

2020 - Stigma on Mental Health among High School Students: Validation of the Italian Version of the Attribution Questionnaire-27 (AQ-27-I) in a High School Student Population [Articolo su rivista]
Ferrari, Silvia; Bressi, Cinzia; Busnelli, Elisa; Mattei, Giorgio; Pozzoli, Sara; Oliva, Anna; Galeazzi, Gian Maria; Pingani, Luca
abstract

2020 - The choice and the change of the allocated primary mental health professional in community-based mental health services: A focus-group qualitative study [Articolo su rivista]
Rioli, G.; Ferrari, S.; Vandelli, R.; Giambalvo, N.; Minarini, A.; Artoni, C.; Galli, G.; Galeazzi, G. M.
abstract

Objectives It is generally agreed that it is important to take into consideration users' preferences in the choice of their allocated primary mental health professional (PMHP). Our aim was to explore experiences of users, care givers and psychiatrists on users' initial choice and request of change the PMHP in Community Mental Health Services (CMHSs). Methods Three focus groups were conducted in March-May 2017 in two CMHSs in Modena, Northern Italy. Transcripts were analyzed using MaxQda 11. Results Six users, 7 psychiatrists and 5 care givers were enrolled. Casual or fixed allocation is commonly performed (so-called “fixed rota”). Lack of empathy and a bad therapeutic relationship seem to be the most important reasons to change the PMHP. Conclusions Neither users nor professionals are generally involved in the initial choice of the PMHP. The availability of evidence-based guidelines for managing users' request to choose/change the PHMP may improve quality of care.

2020 - Users' choice and change of allocated primary mental health professional in community-based mental health services: A scoping review [Articolo su rivista]
Rioli, Giulia; Ferrari, Silvia; Henderson, Claire; Vandelli, Riccardo; Galli, Giacomo; Minarini, Alessandro; Galeazzi, Gian Maria
abstract

Background. The recovery model in mental health care emphasizes users’ right to be involved in key decisions of their care, including choice of one’s primary mental health professional (PMHP). Aims. The aim of this paper was to provide a scoping review of the literature on the topic of users’ choice, request of change and preferences for the PMHP in community mental health services. Method. A search of Pubmed, Cochrane Library, Web of Science and PsycINFO for papers in English was performed. Additional relevant research articles were identified through authors’ personal bibliography. Results. 2774 articles were screened and 38 papers were finally included. Four main aspects emerged: 1) the importance, for users, to be involved in the choice of their PMHP; 2) the importance, for users, of the continuity of care in the relationship with their PMHP; 3) factors of the user/PMHP dyad influencing users’ preferences; 4) the effect of choice on treatments’ outcomes. Conclusions. While it is generally agreed that it is important to consider users’ preferences in choosing or requesting to change their PMHP, little research on this topic is available. PMHPs’ and other stakeholders’ views should also be explored in order to discuss ethical and practical issues.

2020 - Why candidates for liver transplantation should be considered as frail patients [Articolo su rivista]
Moscara, M.; Mattei, G.; Ferrari, S.; Galeazzi, G. M.
abstract

2019 - Acquired Hearing Loss, Anger, and Emotional Distress: The Mediating Role of Perceived Disability [Articolo su rivista]
Ferrari, Silvia; Monzani, Daniele; Gherpelli, Chiara; Mackinnon, Andrew; Mongelli, Francesca; Federici, Gaia; Forghieri, Matilde; Galeazzi, Gian Maria
abstract

The aim of the study was to test whether acquired hearing loss (AHL)-related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory-2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA-Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action.

2019 - Bio-psycho-social complexity of patients undergoing pre-orthotopic liver transplant compared to other clients of a consultation-liaison psychiatry service. [Abstract in Atti di Convegno]
Mattei, Giorgio; Ferrari, Silvia; Galletti, Martina; Rioli, Giulia; Perrone, Daniela; Moscara, Maria; Cavana, Silvia
abstract

2019 - Minority stress and mental health among LGBT populations: an update on the evidence [Articolo su rivista]
Mongelli, Francesca; Perrone, Daniela; Balducci, Jessica; Sacchetti, Andrea; Ferrari, Silvia; Mattei, Giorgio; Galeazzi, Gian M.
abstract

INTRODUCTION: In the past five years, researchers have increasingly turned to the study of mental health outcomes in LGBT populations. The present paper summarizes recent literature on the relationship between minority stress experienced by sexual minorities and mental health. EVIDENCE ACQUISITION: PsycINFO, PubMed, and the EBSCO Psychology and Behavioral Science Collection were searched for papers concerning minority stress and mental health disparities in LGBT populations, published between 1 January 2014 and 30 June 2018. All collected papers were screened using the following criteria: study involving >50 individuals; written in English; focusing on clinical outcomes of depression, suicidality, and substance use in relation to experienced minority stress. EVIDENCE SYNTHESIS: Sixty-two papers were included in this review. Findings are reported under three main headings: studies primarily focused on depression, studies concerning suicidality and suicide attempts, and papers analyzing the correlation between substance use and minority stress in LGBT populations. The included studies supported the minority stress model as a framework to better explain disparities in mental health outcomes in sexual minority populations. Higher rates of depression, suicidality, and substance use are reported in LGBT populations, as are the related minority stressors analyzed. CONCLUSIONS: Sexual minorities still face numerous mental health disparities. Research indicates that the levels of minority stressors positively predict mental health outcomes. Specific policies designed to support the civil rights of sexual minorities may help to overcome such inequalities.

2019 - Personality traits and physical activity may be involved in colorectal carcinogenesis: preliminary data from a cross-sectional study on patients undergoing colonoscopy [Articolo su rivista]
Marchi, Mattia; Mattei, Giorgio; Mancini, Stefano; Roncucci, Luca; Galeazzi, Gian M.; Ferrari, Silvia
abstract

The preliminary results of a study aiming at assessing potential risk factors for carcinogenesis, including metabolic and inflammatory parameters, life-style, psychosocial and personality traits, according to a holistic approach are here reported and briefly described. The presence of at least one adenoma was significantly associated to the TCI Self Transcendence (ST) domain (OR=1.36, p=0.04) and to the absence of regular physical activity (OR=0.14, P=0.03), that may suggest pathways to definition of high risk for metabolic syndrome and carcinogenesis.

2019 - Psychiatric referral in the terminally ill patient [Articolo su rivista]
Mattei, Giorgio; Colantoni, Alessandra; Visentini, Chiara; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

The distinction between physiological and dysfunctional emotions in end-of-life care may be hard, for a twofold reason: on the one hand, the patient as a subject, with specific clinical features, personality, system of values; on the other hand, the clinical judgment by involved health professionals, particularly their specific cut-offs in discrimination between normal suffering and psychopathology. Both excessive/untimely medicalization and underestimation of medical conditions such as anxiety, depression, suicidal ideation, and insomnia may be a risk while dealing with end-of-life patients. Prompt, reliable psychiatric diagnosing contributes significantly to the major goal of dignity in death. The aims of a psychiatric consultation for patients with end-stage diseases should be: controlling concomitant psychiatric symptoms, managing pain and physical symptoms, assisting patient and relatives in the crisis-management, mediating conflicts between patient, family and ward personnel, and planning advocacy.

2019 - Stability of Psychiatric Diagnoses in Candidates to Liver Transplantation Referred to a Consultation-Liaison Psychiatry Service [Articolo su rivista]
Mattei, Giorgio; Moscara, Maria; Balducci, Jessica; Cavana, Silvia; Cherubini, Melissa; Piemonte, Chiara; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

Objective: To investigate the stability over time of the psychiatric diagnoses among candidates to liver transplantation referred to a consultation-liaison psychiatric service. Method: Descriptive study, carried out at the Consultation-Liaison Psychiatry Service (CLPS) placed at the Modena (Italy) General University Hospital. All patients waiting for liver transplantation and repeatedly referred to the CLPS were enrolled. The observation period was from 1 January 2008 to 31 December 2013. Pearson’s coefficients were calculated to measure diagnostic stability (index referral vs. last referral). Results: One hundred patients were assessed (males 67%; mean age 53 ± 7 years old). The mean number of referrals for patients was 3 ± 2. The stability rate of psychiatric diagnosis was 64%. The following diagnoses or conditions were all significantly stable (i.e., all featured by r > 0.5 and p < 0.05): Adjustment disorder, depressive disorder, comorbid anxiety/depressive disorder, substance use disorder (including alcohol), absence of any disorder, and presence of any disorder. Conclusions: The good level of diagnostic stability displayed in the sample may be a function of the clinical and organizational “style” of the CLPS, namely the focus on identifying the prevailing personality traits, defensive mechanisms, and relational patterns.

2019 - The Association Between Symptoms of Anxiety, Depression, and Cardiovascular Risk Factors: Results From an Italian Cross-Sectional Study [Articolo su rivista]
Rioli, Giulia; Tassi, Silvia; Mattei, Giorgio; Ferrari, Silvia; Galeazzi, Gian Maria; Mancini, Stefano; Alboni, Silvia; Roncucci, Luca
abstract

Cardiovascular diseases, anxiety, and depression are among the most frequent clinical conditions in the Western world, often in comorbidity. Evidence regarding a shared pathophysiology suggests a mediating role by chronic systemic inflammation. The aims of this study were to measure the association between anxiety and depressive symptoms, cardiovascular risk factors, and inflammatory markers. Outpatients aged 40 years or more undergoing colonoscopy after positive fecal occult blood test were enrolled; the following data were collected: body mass index, blood pressure, blood glucose, lipid profile, C-reactive protein (CRP) level, carotid thickness, Hospital Anxiety and Depression Scale, Temperament and Character Inventory, INTERdisciplinary MEDicine Self-Assessment, and 36-Item Short-Form Health Survey scores. Fifty-four patients were enrolled; 30.2% had anxiety symptoms, 18.9% depressive symptoms, and 9.4% concomitant anxiety-depressive symptoms. Anxiety symptoms were associated with low high-density lipoprotein levels. Depressive symptoms were associated with CRP levels, providing supporting evidence for the role of inflammation in the pathophysiology of depression.

2018 - A European research agenda for somatic symptom disorders, bodily distress disorders, and functional disorders: Results of an estimate-talk-estimate delphi expert study [Articolo su rivista]
van der Feltz-Cornelis, Christina M.; Elfeddali, Iman; Werneke, Ursula; Malt, Ulrik F.; Bergh, Omer Van den; Schaefert, Rainer; Kop, Willem J.; Lobo, Antonio; Sharpe, Michael; Söllner, Wolfgang; Löwe, Bernd; Allaz, Anne-Françoise; Ancane, Gunta; Bendix, Marie; Berney, Alexandre; Blanch, Jordi; Boye, Birgitte; Burton, Chris; Cardoso, Graça; Cathébras, Pascal; Cosci, Fiammetta; Dantoft, Thomas Meinert; Enck, Paul; Ferrari, Silvia; Fink, Per; Fortes, Sandra; Fritzsche, Kurt; Frostholm, Lisbeth; Geiser, Franziska; Gündel, Harald; Guthrie, Else; Henningsen, Peter; Hüsing, Paul; Hyphantis, Thomas; Jenewein, Josef; Kenedi, Chris; Keller, Monika; Khohlova, Ksenya; Kohlmann, Sebastian; Kotsis, Konstantinos; Lahmann, Claas; Lemogne, Cédric; Pohontsch, Nadine; Weigel, Angelika; Rief, Winfried; Hartman, Tim Olde; Nater, Urs; Natsov, Ivo Ivanov; Nedelcu, Laurentiu; Noll-Hussong, Michael; Urrutia, Amanda Rodriguez; Rantis, Konstantinos; Rosendal, Marianne; Rosmalen, Judith; Rymaszewska, Joanna; Sandlund, Michael; Schröder, Andreas; Shedden-Mora, Meike; Slawomir, Czachowski; Stauder, Adrienne; Stoyanov, Drozdstoy; Syngelakis, Markos; Stelcer, Boguslaw; Tomas-Aragones, Lucia; Terp, Inger Merete; Tkalcic, Mladenka; Toussaint, Anne; Zurowski, Mateusz
abstract

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe.

2018 - Are patients with pre-orthotopic liver transplant psychiatric consultation different in bio-psycho-social complexity from other consultation inpatients? A study from a Consultation-Liason Psychiatric Service. [Abstract in Rivista]
Cavana, S; Mattei, G; Rioli, G; Galletti, M; Perrone, D; Moscara, M; Galeazzi, Gm; Ferrari, S.
abstract

Are patients with pre-orthotopic liver transplant psychiatric consultation different in bio-psycho-social complexity from other consultation inpatients? A study from a Consultation-Liason Psychiatric Service.

2018 - Efficacy of animal assisted therapy on people with mental disorders: an update on the evidence [Articolo su rivista]
Spattini, Ludovica; Mattei, Giorgio; Raisi, Francesca; Ferrari, Silvia; Pingani, Luca; Galeazzi, Gian M.
abstract

INTRODUCTION: Animal assisted therapy (AAT) is a structured form of animal assisted intervention (AAI), which specifically adopts animals in healthcare services and education facilities, to achieve therapeutic goals. Although such interventions are widely used, nowadays, evidence supporting them is still largely lacking. A previously published review of the literature highlighted some promising effects of AAT on people presenting psychiatric disorders, though the quality of the studies included was generally low. In order to provide an update of recent evidence, the aim of this study was to systematically review randomized controlled trials (RCTs) published since 2000, involving people affected by mental disorders and receiving AAT. EVIDENCE ACQUISITION: The following databases were searched: CINHAL, EBSCO Psychology and Behavioural Science Collection, PubMed and Web of Science. 115 papers were obtained and screened: 28 were from CINHAL, PsycINFO and Psychology and Behavioural Science Collection altogether, 15 from PubMed and 72 from Web of Science. In addition to this, grey literature and references of already published reviews and meta-analyses on the topic were searched, resulting in the addition of 6 further articles. After screening, 10 RCTs were included in this review. EVIDENCE SYNTHESIS: Studies involving outpatients were more frequent than those involving inpatients; sample size was generally low. The majority of studies adopted scales routinely used in clinical trials, with a good level of validity and reliability. Five out of ten studies reported significant differences in the main outcomes favouring AAT. Most of the studies did not include any follow-up; yet, where prospective data were available, the benefits of AAT appeared long lasting. Drop-out rates were higher in studies involving outpatients. However, the only trial which enrolled both inpatients and outpatients showed a higher drop-out rate among the inpatients group, possibly due to their more severe psychopathology. CONCLUSIONS: Though a paucity of available studies partly limits our findings, AAT seems to improve empathy, socialization and communication, and to favour therapeutic alliance among patients who have difficulties with therapeutic programs adherence. AAT appears to be a feasible and well-received intervention, potentially with few or no side effects reported. However there is a need for further studies with larger sample sizes and high-quality research standards.

2018 - Mental health, work and care: the value of multidisciplinary collaboration in psychiatry and occupational medicine [Articolo su rivista]
Mattei, Giorgio; Venturi, Giulia; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

Objectives To investigate the relation between work and mental health in a multidisciplinary fashion. Methods This overview is based on books and articles purposely extracted from national and international literature published in the fields of psychiatry, occupational medicine, economics and labor law, written in Italian and English, without time limits; it is part of the BUDAPEST-RP Project launched in 2010 to study the effects of the economic crisis on the Italian population. Results Some features of work and the labour market in the context of the Fourth Industrial Revolution (desynchronization of time, increased external control, need of orderliness in the work relationships-i.e., decreased tolerance of work-conflicts, e.g., between the employer and the Unions-, hypernomia and heteronomy) mirror some psychopathological aspects of the pre-morbid personality prone to develop depression, and may act as environmental risk factors. This, coupled with increased unemployment and precariousness, especially affecting the young, prompt to finding evidence-based strategies to promote employment of people affected by mental disorders, seriously hit by unemployment in the years following the Great Recession. Conclusions Work organization is the common denominator between the work environment conceived as a risk or protective factor for psychiatric disorders and the use of work in the field of psychiatric rehabilitation, by means of vocational rehabilitation programs. Given the intrinsic complexity of this common ground, networking is required between professionals of different backgrounds, to develop a multidisciplinary approach in the fields of care, research and education, and to foster a better integration between occupational health and psychiatry.

2018 - Metabolic Syndrome, Anxiety and Depression in a Sample of Italian Primary Care Patients [Articolo su rivista]
Mattei, Giorgio; Padula, Maria Stella; Rioli, Giulia; Arginelli, Lodovico; Bursi, Roberto; Bursi, Serena; Epifani, Antonio Matteo; Pingani, Luca; Rigatelli, Marco; Rosato, Francesca Maria; Sacchetti, Andrea; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

This cross-sectional study aimed at measuring the correlation and association of anxiety, depression and comorbid anxiety-depression symptoms with metabolic syndrome (MetS) in a sample of Italian primary care patients who attended their General Practitioner clinics over a 1-month period in 2013. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depressive symptoms. The sample was made up of 129 patients (57% women; mean age, 61 ± 12 years). The prevalence of MetS varied from 40% (Adult Treatment Panel III-Revised criteria) to 48% (International Diabetes Federation criteria). The prevalence of symptoms of anxiety, depression and comorbid anxiety and depression was, respectively, 26%, 2%, and 15%. MetS (defined according to Adult Treatment Panel III-Revised criteria) was associated with comorbid anxiety-depressive symptoms (odds ratio [OR] = 3.84, 95% confidence interval [CI] = 1.26–11.71), but not with anxiety or depressive symptoms only. Out of the individual components of MetS, enlarged waist circumference was associated with anxiety symptoms (OR = 4.22, 95% CI = 1.56–11.44).

2018 - Stakeholders' views on vocational rehabilitation programs: a call for collaboration with Occupational Health Physicians [Articolo su rivista]
Mattei, Giorgio; Sacchi, Valentina; Alfieri, Salvatore; Bisi, Antonella; Colombini, Niccolò; Ferrari, Silvia; Giubbarelli, Giuseppe; Gobba, Fabriziomaria; Modenese, Alberto; Pingani, Luca; Rigatelli, Marco; Rossetti, Marisa; Venturi, Giulia; Starace, Fabrizio; Galeazzi, Gian Maria
abstract

The triple-dip recession taking place in Italy in 2008-2014 impacted negatively on health, mainly by increasing the rate of unemployment. This increased the prevalence of mental health disorders, while reducing the number of available places on vocational rehabilitation programs (VRPs) delivered by the psychiatric services.

2018 - The effects of psychoeducational family intervention on coping strategies of relatives of patients with bipolar i disorder: Results from a controlled, real-world, multicentric study [Articolo su rivista]
Sampogna, Gaia; Luciano, Mario; Del Vecchio, Valeria; Malangone, Claudio; De Rosa, Corrado; Giallonardo, Vincenzo; Borriello, Giuseppina; Pocai, Benedetta; Savorani, Micaela; Steardo, Luca; Lampis, Debora; Veltro, Franco; Bartoli, Francesco; Bardicchia, Francesco; Moroni, Anna Maria; Ciampini, Giusy; Orlandi, Emanuele; Ferrari, Silvia; Biondi, Silvia; Iapichino, Sonia; Pompili, Enrico; Piselli, Massimiliano; Tortorella, Alfonso; Carrà, Giuseppe; Fiorillo, Andrea
abstract

Background: Psychoeducational family intervention (PFI) has been proven to be effective in improving the levels of family burden and patients’ personal functioning in schizophrenia and bipolar disorders (BDs). Less is known about the impact of PFI on relatives’ coping strategies in BD. Methods: A multicenter, controlled, outpatient trial funded by the Italian Ministry of Health and coordinated by the Department of Psychiatry of the University of Campania “Luigi Vanvitelli” has been conducted in patients with bipolar I disorder (BD-I) and their key relatives consecutively recruited in 11 randomly selected Italian community mental health centers. We aim to test the hypothesis that PFI improves problem-oriented coping strategies in relatives of BD-I patients compared to the Treatment As Usual (TAU) group. Results: The final sample was constituted of 123 patients and 139 relatives. At baseline assessment (T0), the vast majority of relatives already adopted problem-oriented coping strategies more frequently than the emotion-focused ones. At the end of the intervention, relatives receiving PFI reported a higher endorsement of adaptive coping strategies, such as “maintenance of social interests” (odds ratio [OR]=0.309, CI=0.04–0.57; p=0.023), “positive communication with the patient” (OR=0.295, CI=0.13–0.46; p=0.001), and “searching for information” (OR=0.443, CI=0.12–0.76; p=0.007), compared to TAU relatives, after controlling for several confounders. As regards the emotion-focused coping strategies, relatives receiving the experimental intervention less frequently reported to adopt “resignation” (OR=-0.380, CI=-0.68 to -0.08; p=0.014) and “coercion” (OR=-0.268, CI=-0.46 to -0.08; p=0.006) strategies, compared to TAU relatives. Conclusion: PFI is effective in improving the adaptive coping strategies of relatives of BD-I patients, but further studies are needed for evaluating the long-term benefits of this intervention.

2018 - Use and Propensity to Use Substances as Cognitive Enhancers in Italian Medical Students [Articolo su rivista]
Pighi, Marcella; Pontoni, Giancarlo; Sinisi, Arianna; Ferrari, Silvia; Mattei, Giorgio; Pingani, Luca; Simoni, Elena; Galeazzi, Gian Maria
abstract

International media has paid attention to the use of substances by healthy subjects to enhance cognitive performance. Medical students are liable to use cognitive enhancers (CE) with the aim of improving academic performance. The study explored use and attitudes toward the use of CE in Italian medical students. The authors anonymously surveyed 433 medical students of the University of Modena and Reggio Emilia with an ad hoc 36-items questionnaire. CE were broadly defined as any substance taken with the purpose of improving cognitive functions, from readily available beverages and substances, such as coffee, tea, energy drinks, and supplements to prescription only medication, such as psychostimulants and modafinil. Response rate was 83.8% (n = 363). While the majority of the students (74.7%; n = 271) said that they had used substances to improvecognitivefunctions,only2students(0.6%)reportedtheuseofprescription-onlymedications in the last 30 days. Main reasons for not taking prescription-only drugs were concerns about safety and side effects, reported by 83.3% of students (n = 295). A positive attitude toward use was held by 60.3% (n = 219) subjects. The surveyed Italian medical students used many substances as CE, but this did not seem to apply significantly to psychostimulants. A multivariable analysis showed that the followingvariableswererelatedtothepropensitytousesubstancesasCE:malegender,self-reported memory impairment, concerns about worsening of cognitive performance, lifetime use of at least one illegal substance, use of any substance (both legal or illegal) in the last 30 days.

2017 - A systematized review of atypical antipsychotics in pregnant women: Balancing between risks of untreated illness and risks of drug-related adverse effects [Articolo su rivista]
Tosato, Sarah; Albert, Umberto; Tomassi, Simona; Iasevoli, Felice; Carmassi, Claudia; Ferrari, Silvia; Nanni, Maria Giulia; Nivoli, Alessandra; Volpe, Umberto; Atti, Anna Rita; Fiorillo, Andrea
abstract

Objective: To summarize risks related to (1) illness and (2) secondgeneration antipsychotic (SGA) treatment in pregnant women and their offspring. Concerning illness-related risks, we focused on bipolar disorder and schizophrenia, psychiatric disorders for which SGAs are preferentially prescribed. Data Sources: PubMed, Ovid, Scopus, PsycINFO, and Cochrane Library were searched from the date of the first available article to October 2015 using the following key terms: pregnancy OR gestation OR bipolar disorder OR schizophrenia. We also included cross-references from identified articles. Study Selection: We included 49 English-language articles regarding illnessrelated and SGA-related risks in bipolar disorder and schizophrenia. First, searches were done for epidemiologic or experimental studies (from January 2000 to October 2015), then for systematic reviews and meta-analyses. Data Extraction: Data were extracted independently, after removing duplicates and studies that were not relevant or not pertinent. Results: Abrupt discontinuation of treatment-exposed mothers with bipolar disorder or schizophrenia led to a high risk of relapses during pregnancy. Both bipolar disorder and schizophrenia were linked to a slightly increased risk of obstetric complications for mothers (schizophrenia) and the newborn (bipolar disorder and schizophrenia), although data on drug exposure during pregnancy were not given in the majority of studies. Maternal morbidity (schizophrenia but not bipolar disorder) may be associated with the worst neonatal outcomes (stillbirth, neonatal or infant deaths, and intellectual disability). Untreated bipolar disorder and schizophrenia may be considered independent risk factors for congenital malformations, while SGAs were not associated with increased recurring defects in fetuses. Evidence regarding the potential effects of SGAs on child neurodevelopment remains reassuring. Conclusion: After taking into account the parents' will and after they provide informed consent, the most reasonable and less harmful choice for treating future mothers with bipolar disorder or schizophrenia appears to be maintaining them at the safest minimum dosage.

2017 - Alcohol drinking patterns in young people: A survey-based study [Articolo su rivista]
Martinotti, Giovanni; Lupi, Matteo; Carlucci, Leonardo; Santacroce, Rita; Cinosi, Eduardo; Acciavatti, Tiziano; Sarchione, Fabiola; Verrastro, Valeria; Diotaiuti, Pierluigi; Petruccelli, Irene; Ferrari, Silvia; Nanni, Maria G; Pinna, Federica; Volpe, Umberto; Saggino, Aristide; Janiri, Luigi; Leggio, Lorenzo; Di Giannantonio, Massimo
abstract

Binge drinking represents a major clinical and public health concern. Here, we investigated the prevalence of binge drinking and its related consequences, in a population of young adults. A questionnaire was administered to a sample of 4275 healthy subjects. In the overall sample, the percentage of binge drinkers was 67.6 per cent; among regular alcohol users, 79.5 per cent reported episodes of binge drinking. Among binge drinkers, several serious consequences were identified (staggering and stuttering, amnesia, loss of control, aggressiveness, sexual disinhibition). Raising awareness about the seriousness of binge drinking may help health care providers to identify cases early on and provide appropriate treatments.

2017 - An Italian observational study on subclinical cardiovascular risk factors and depressive symptomatology. A suggestion for the potential utility of a sinergic cardio-psychiatric perspective [Abstract in Rivista]
Tassi, S.; Rioli, Giulia; Mattei, Giorgio; Mancini, Stefano; Alboni, Silvia; Roncucci, Luca; Sena, Paola; Mariani, Francesco; Marchi, Mattia; Fabbrizi, Andrea; Feltri, L.; Visentini, Chiara; Pollutri, Gabriella; Artoni, Cecilia; Saraceni, Serena; Galli, Giacomo; Spiga, Giulia; Minarini, Alessandro; Perrone, Daniela; Galletti, Martina; Giambalvo, Nina; Montardi, Giulia; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

Introduction Growing evidence has been collected over the complex, intertwined pathophysiological connection among subclinical cardiovascular (CV) disease, i.e. atherosclerosis, systemic low pro-inflammatory states and psychiatric disorders/symptomatology (anxiety, depression), with controversial results. Aim Aim of this study was to investigate the possible link between subclinical CV risk factors (atherosclerosis), depressive symptoms, and inflammation. Methods Cross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C reactive protein), LPS (bacterial lipopolysaccharide), ultrasound carotid intima-media thickness (c-IMT). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13. Results The 54 patients enrolled were equally distributed by gender. CV risk factors were common in the study population, with 33 patients (61.11%) with hypertension, 14 (25.93%) with hyperglycaemia, 20 (37.4%) with hypertriglyceridemia, 19 (35.19%) with low HDL and 64.81% with overweight. High levels of PCR were found in 24 subjects (44.44%). Right c-IMT was increased in 26.41% of the sample, and 11.32% had an atheromatous plaque. Left c-IMT was increased in 24.53% of patients, with a plaque in 7.55% of them. Clinically relevant depressive symptoms were found in the 18.87% of the sample and were statistically significantly associated with PCR (OR = 28.63; P = 0.01). Conclusions Evidence contributing to the so-called “inflammation theory” of depression and supporting the association between mood and CV disorders was here collected, supporting the need for a multidisciplinary approach to the diagnosis and treatment of such conditions, assuming a clinically-translated PNEI (psycho-neuro-endocrino-immunological) perspective.

2017 - An update on Current Clinical Management of Eating Disorders. [Articolo su rivista]
Spattini, Ludovica; Rioli, Giulia; Longo, Fedora; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

This paper aims to review the most updated literarature on the clinical management of Eating Disorders.

2017 - An update on intimate partner violence and mental health [Articolo su rivista]
Rioli, Giulia; Sgarbi, Chiara; Moretti, Valentina; Sinisi, Arianna; DE FAZIO, Giovanna Laura; Giambalvo, Nina; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

INTRODUCTIONː Intimate partner violence (IPV) is a problem worldwide and a human rights issue. The present paper summarizes recent literature on the relationship between IPV and mental health, exploring risk factors for psychiatric patients to be victims and/or perpetrators of violent behavior in intimate relationships. EVIDENCE ACQUISITION: A search of PubMed, PsychINFO and Cochrane Library databases was performed, looking for papers concerning IPV and psychiatry published between 2011 and 2016. Papers were retrieved and reviewed according to PRISMA statement guidelines. Only research papers with sample sizes >50 adult subjects were included, leading to a first selection of 1486 records. Titles and abstracts were independently screened by three pairs of researchers, following predefined criteria agreed by the authors, yielding 93 articles for review. EVIDENCE SYNTHESIS: Mental disorders, especially posttraumatic stress disorder (PTSD) and depression, are associated with risk for perpetrating IPV. Confounding factors of this association are substance use/dependence, childhood adversity, previous IPV perpetration. Psychiatric patients are at high risk of becoming victims of IPV, but specific risk factors for victimization in this population have been poorly investigated. Rates of PTSD, depression, anxiety and substance use disorders are higher among IPV victims than in the general population. Interpersonal variables and social factors play a key role both in the onset and in the recovery from mental disorders in the aftermath of IPV. CONCLUSIONS: Individuals suffering from a mental disorder are prone to be both victims and perpetrators of IPV. Further research efforts are needed to elucidate the risk factors for victimization, in order to devise effective risk management strategies.

2017 - Assessment of biopsychosocial complexity and health care needs: Measurement properties of the INTERMED self-assessment version [Articolo su rivista]
Van Reedt Dortland, Arianne K. B; Peters, Lilian L.; Boenink, Annette D.; Smit, Jan H.; Slaets, Joris P. J.; Hoogendoorn, Adriaan W.; Joos, Andreas; Latour, Corine H. M.; Stiefel, Friedrich; Burrus, Cyrille; Guitteny Collas, Marie; Ferrari, Silvia
abstract

Objective: The INTERMED Self-Assessment questionnaire (IMSA) was developed as an alternative to the observer-rated INTERMED (IM) to assess biopsychosocial complexity and health care needs. We studied feasibility, reliability, and validity of the IMSAwithin a large and heterogeneous international sample of adult hospital inpatients and outpatients as well as its predictive value for health care use (HCU) and quality of life (QoL). Methods: A total of 850 participants aged 17 to 90 years from five countries completed the IMSA and were evaluated with the IM. The following measurement properties were determined: feasibility by percentages of missing values; reliability by Cronbach a; interrater agreement by intraclass correlation coefficients; convergent validity of IMSA scores with mental health (Short Form 36 emotional well-being subscale and Hospital Anxiety and Depression Scale), medical health (Cumulative Illness Rating Scale) and QoL (Euroqol-5D) by Spearman rank correlations; and predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models. Results: Feasibility, face validity, and reliability (Cronbach a = 0.80) were satisfactory. Intraclass correlation coefficient between IMSA and IM total scores was.78 (95% CI =.75-.81). Correlations of the IMSAwith the Short Form 36, Hospital Anxiety and Depression Scale, Cumulative Illness Rating Scale, and Euroqol-5D (convergent validity) were-.65,.15,.28, and-.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency department visits, hospitalization, outpatient visits, and diagnostic examinations) after 3-and 6-month follow-up. Results were comparable between hospital sites, inpatients and outpatients, as well as age groups. Conclusions: The IMSA is a generic and time-efficient method to assess biopsychosocial complexity and to provide guidance for multidisciplinary care trajectories in adult patients, with good reliability and validity across different cultures.

2017 - Assessment of eating disorders with the diabetes eating problems survey - revised (DEPS-R) in a representative sample of insulin-treated diabetic patients: a validation study in Italy [Articolo su rivista]
Pinna, Federica; Diana, Enrica; Sanna, Lucia; Deiana, Valeria; Manchia, Mirko; Nicotra, Eraldo; Fiorillo, Andrea; Albert, Umberto; Nivoli, Alessandra; Volpe, Umberto; Atti, Anna Rita; Ferrari, Silvia; Medda, Federica; Atzeni, Maria Gloria; Manca, Daniela; Mascia, Elisa; Farci, Fernando; Ghiani, Mariangela; Cau, Rossella; Tuveri, Marta; Cossu, Efisio; Loy, Elena; Mereu, Alessandra; Mariotti, Stefano; Carpiniello, Bernardo
abstract

The purpose of the study was to evaluate in a sample of insulin-treated diabetic patients, with type 1 or type 2 diabetes, the psychometric characteristics of the Italian version of the DEPS-R scale, a diabetes-specific self-report questionnaire used to analyze disordered eating behaviors.

2017 - Association of blood pressure with anxiety and depression in a sample of primary care patients [Abstract in Rivista]
Sacchetti, A.; Mattei, Giorgio; Bursi, S.; Padula, MARIA STELLA; Rioli, Giulia; Ferrari, Silvia
abstract

Introduction According to international scientific literature, and as summarized in the guidelines of the International Society of Hypertension, lowering of blood pressure can prevent cardiovascular accidents. Some studies suggest that hypertension, anxiety, and depression might be inversely correlated. Objective To investigate whether blood pressure is associated with anxiety and depression. Methods Cross-sectional design. Male and female primary care patients were enrolled, aged 40–80. Criteria of exclusion adopted: use of antidepressants or antipsychotics; previous major cardiovascular event; psychosis or major depression; Type 1-DM; pregnancy and hereditary disease associated to obesity. Anxiety and depression symptoms were assessed using HADS. Waist circumference, hip circumference, blood pressure, HDL, triglycerides, blood sugar, hypertension, albumin concentrations and serum iron were also assessed. Results Of the 210 subjects, 84 were men (40%), mean age was 60.88 (SD ± 10.88). Hypertension was found to correlate significantly to anxiety (OR = 0.38; 95% CI = 0.17–0.84), older age (OR = 3.96; 95% CI = 1.88–8.32), cigarette smoking (OR = 0.35; 95%CI = 0.13–0.94), high Body Mass Index (OR = 2.50; 95% CI = 1.24–5.01), Waist-hip ratio (OR = 0.09; 95% CI = 0.02–0.46) and the Index of comorbidity (OR = 16.93; 95% CI = 3.71–77.29). Conclusions An inverse association was found between anxiety and hypertension, suggesting the need to clinically manage these two dimensions in a coordinated way. Other findings are well known and already included in prevention campaigns. Further research is needed, also to better understand and explain the causative pathways of this correlation.

2017 - Attempted suicide: Study of the phenomenon in a sample of patients in the province of Modena [Abstract in Rivista]
Bisi, L.; Bolondi, Marisa; Mattei, Giorgio; Sacchetti, A.; Ferrari, Silvia
abstract

Introduction Attempted suicide consists in a self-damaging nonfatal behaviour, with an explicit or implicit evidence of the intent to die. It has a multifactorial aetiology: presence of psychiatric disorder, particularly major depression and other non-psychiatric components, like a series of stressful events. Aim To describe suicidal behavior among patients who attempted suicide. Methods Cross-sectional study. Patients admitted to three hospitals in the Province ofModena(Italy) after having attempted suicide were enrolled. Observation time: August 2015–August 2016 (13 months). Descriptive statistics made with STATA 13.0. Results A total of 187 subjects (female 65%) were enrolled in the period of time considered. Forty-one percent were aged 45–64; 43.7% had higher education; 50.4% were unemployed; 49.6% had regular income. Common means to attempt suicide were drugs (64%), weapons (11%), precipitation (10%), other (6%), choking (4%). Recent stressful events were reported by the 83.4% of respondents, namely: family conflicts (29%), economic problems (17%), personal health problems (11%), health problems affecting a family member (5%), emotional separation (9%), job loss (7%), other (22%), alcohol abuse (27%), substance abuse (4%). The main psychiatric diagnoses were: depressive disorder (56.67%), personality disorder (20%), psychotic disorder (6.67%), bipolar disorder (5.33%), behavioural disorders (2.67%), anxiety disorders (2%), dementia (1.33%). Conclusions Findings of the present study are consistent with available literature and could help to identify “high risk” groups to plan future targeted programmes.

2017 - Cardiovascular risk factors, anxiety symptoms and inflammation markers: Evidence of association from a cross-sectional study [Abstract in Rivista]
Rioli, Giulia; Tassi, S.; Mattei, Giorgio; Alboni, Silvia; Mancini, Stefano; Artoni, Cecilia; Galletti, Martina; Giambalvo, Nina; Galli, Giacomo; Marchi, Mattia; Minarini, Alessandro; Montardi, Giulia; Perrone, Daniela; Pollutri, Gabriella; Roncucci, Luca; Saraceni, Serena; Spiga, Giulia; Visentini, Chiara; Galeazzi, Gian Maria; Ferrari, Silvia
abstract

Introduction Anxiety disorders and Cardiovascular (CV) diseases, among the most common disorders in Western World, are often comorbid. A chronic systemic inflammatory state might be a shared underlining pathophysiological mechanism. Aims To investigate the association between anxiety symptoms, CV risks factors and inflammatory markers in an outpatient sample. Methods Cross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C Reactive Protein), LPS (bacterial Lipopolysaccharide). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13. Results Fifty four patients enrolled (27 males, 27 females). Sixteen patients (30.19%) were positive for anxiety symptoms. Thirty-three patients (61.11%) had hypertension, 14 (25.93%) hyperglycaemia and 64.81% were overweight, with frank obesity (BMI≥ 30) in 11 subjects (20.37%). Anxiety symptoms were associated with low hematic HDL values (OR = 0.01; P = 0.01) and high concentration of triglycerides (OR = 0.023; P = 0.02) at the multiple regression model. At the univariate logistic analysis, anxiety was associated with LPS (OR = 1.06; P = 0.04). Conclusions Further evidence over the epidemiological link between common mental disorders and CV diseases was collected, with possible hints on pathophysiology and causative mechanisms related to inflammation. The importance of screening for anxiety and depression in medical populations is confirmed. Suggestions on future availability of screening tools based on inflammatory-related indicators should be the focus of future research.

2017 - Effectiveness and acceptability of psycho-education group intervention for people hospitalized in psychiatric wards and nurses [Articolo su rivista]
Mattei, G.; Raisi, F.; Burattini, M.; Galeazzi, G. M.; Mazzi, F.; Pingani, L.; Reggianini, C.; Rigatelli, M.; Righi, A.; Starace, F.; Vallone, P.; Ferrari, S.
abstract

Objective: To assess effectiveness and acceptability of a Psycho-education Group Intervention (PGI) on a sample of patients admitted to a Psychiatric Inpatient Unit (PIU) and on ward nurses. Methods: Case-control study. PGI was delivered according to the model of Vendittelli and colleagues (2008). Male and female patients aged 18-70 were eligible. Cases attended the PGI, while controls did not. A 5-item ad hoc Likert-scale was used to record ward atmosphere. The Italian version of the Simple Feedback Question Form for people attending Cognitive Behaviour Therapy Group (SFQF-CBTG) was administered to each patient before discharge. The primary outcome was readmission rate after 6 months from discharge, secondary outcomes were ratings of ward atmosphere by nurses and feed-back from people hospitalized. All Statistics were performed with STATA 13.1. Results: Fifty-two patients were enrolled, 17 cases and 35 controls. No significant differences emerged in the primary outcome, though compulsory readmissions were noticeable only among controls. Ratings of ward atmosphere in relation to group activities did not differ. Seventeen SFQF-CBTG were filled in. Most cases reported at discharge to have found the group "helpful", stating that "they would attend it in the future again", and "group topics were not difficult". Conclusions: No evidence emerged in favour or against effectiveness of the PGI for patients and ward nurses, though the intervention was rated as acceptable and feasible.

2017 - How are personality traits and physical activity involved in colorectal carcinogenesis? A cross-sectional study on patients undergoing colonoscopy [Abstract in Rivista]
Marchi, Mattia; Alboni, Silvia; Artoni, Cecilia; Galletti, Martina; Giambalvo, Nina; Mancini, Stefano; Mariani, Francesco; Mattei, Giorgio; Merighi, A.; Montardi, Giulia; Pollutri, Gabriella; Rioli, Giulia; Saraceni, Serena; Spiga, Giulia; Visentini, Chiara; Ferrari, Silvia
abstract

Introduction Inflammatory state of the large bowel is a key factor for the development of colorectal cancer (CRC). It has multifactorial aetiology, including psychological determinants. Physical activity may have a protective function against CRC via anti-inflammatory properties; on the contrary, personality traits correlate with an unhealthy and dangerous lifestyle. Objective To measure the association between personality traits, lifestyle and colonoscopy outcome. Methods Cross sectional study. Patients undergoing colonoscopy aged 40 or more, with a negative history for cancer or inflammatory bowel disease, were enrolled. Data collected: colonoscopy outcome, smoke, alcohol, physical activity, presence/absence of Metabolic Syndrome, personality traits assessed by the Temperament & Character Inventory (TCI). Results In a sample of 53 subjects (females = 24, 45.3%), the mean age was 60.66 ± 9.08. At least one adenoma was found to 23 patients (43.3%). Twenty patients were smokers (37.74%), 36 (67.92%) drank alcohol at least weekly; approximately 60% reported regular physical activity. At the multivariate regression, the outcome was associated to: TCI Self Transcendence domain (ST) (OR = 1.36, P = 0.04) and physical activity (OR = 0.14, P = 0.03). Conclusion People with ST's characteristic personality traits and sedentary life style are more likely to have precancerous colorectal lesions. This confirms the protective role of physical activity, and suggests to further explore the role of personality in cancerogenesis.

2017 - INTERMED-Self Assessment (IMSA): Validity and preliminary applications in research [Abstract in Rivista]
Ferrari, Silvia; Van Reedt Dortland, A. K.; Boenink, A.
abstract

Introduction The INTERMED Self-Assessment questionnaire (IM-SA) was developed as an alternative to the INTERMED Complexity Assessment Grid interview (IM-CAG) to assess biopsychosocial complexity and health care needs in order to optimize care. The aim of this study was to discuss possible applications of IMSA to routine clinical work in a CL psychiatry setting, after presenting IM-SA’s feasibility, reliability, validity and predictive value for health care utilization (HCU) and quality of life (QoL) as emerged by the IMSA Study. Methods The IMSA Study was an international multicentric prospective observational cohort study, involving 850 participants who completed both the IM-SA and IM-CAG. Feasibility by percentages of missing values, reliability by Cronbach's alpha, interrater agreement by intraclass correlation coefficients (ICCs) and convergent validity of IM-SA scores with mental health (SF-36 mental health subscale and HADS) and medical health (CIRS) and discriminant validity of IM-SA scores with QoL (EQ-5D) by Spearmans rank correlations were determined. Predictive validity of IM-SA scores with HCU and QoL was examined by (generalized) linear mixed models. At Modena University Hospital, IMSA was included in several clinical research protocols to support screening procedures. Results Feasibility, face validity and reliability (Cronbach’s alpha 0.80) were satisfactory. ICC between IM-SA and IM-CAG total scores was .78 (95% CI .75–.81). Correlations of the IM-SA with the SF-36, HADS, CIRS and EQ-5D were -.65, .002, .28 and -.59 respectively. The IM-SA predicted HCU and QoL after 3- and 6-month follow-up. Seven subjects suffering from comorbid HIV and depression and 30 subjects undergoing colonoscopy for screening were also tested with IM-SA. Mean baseline score was 17.14 (SD = 8.71) for the depressed HIV subjects, with 2 subjects overcoming the cutoff of 21, suggesting clinical complexity. Mean score was 7.72 (SD = 4.19) for subjects undergoing colonoscopy, none of whom reached a score suggesting clinical complexity. Conclusion The IM-SA may efficiently support healthcare professionals in the assessment of patient’s biopsychosocial complexity aimed at providing integrated, personalized multidisciplinary care. Inclusion of IM-SA as a routine screening tool may be advised in different clinical in- and out-patient contexts.

2017 - Impact of anxiety-depressive symptoms on outpatients’ quality of life: Preliminary results from an Italian observational study [Abstract in Rivista]
Tassi, S.; Rioli, Giulia; Mattei, Giorgio; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

Introduction Several studies have shown an association between the Short-Form 36 (SF36) scores and anxiety-depressive symptoms, suggesting that depression in particular could reduce Quality of Life (QoL) to the same, and even greater, extent than chronic noncommunicable diseases, such as diabetes and hypertension. Aims To explore the relationshipamongQoL and anxiety, depressive and anxiety-depressive symptoms in an outpatient sample. Methods Cross-sectional study. Inclusion criteria: outpatients aged ≥40 years, without history for cancer, attending colonoscopy after positive faecal occult blood test. Collected data: blood pressure, blood glucose, lipid profile. Psychometric test: Hospital Anxiety and Depression Scale (HADS). QoL was assessed with SF36. Statistics performed with STATA13. Results 54 patients enrolled (27 females). Sixteen patients (30.2%) were positive for anxiety symptoms, ten (18.9%) for depressive symptoms and five (9.4%) for anxiety-depressive symptoms. The perceived QoL was precarious in twelve subjects (22.2%): eight (15.9%) had low score (≤ 42) at “Mental Component Summary” (MCS) subscale, three (5.7%) at the “Mental Health” item and one patient (1.9%) at the “Vitality” one. At the multiple regression analysis, depressive (OR = 28.63; P = 0.01) and anxiety-depressive symptoms (OR = 11.16; P = 0.02) were associated with MCS. Conclusions The association emerging from the present study between depressive/anxiety symptoms and the MCS component of SF36 is consistent with available literature. Study design and small sample size do not allow to generalize results, that need further studies to be confirmed.

2017 - Impact of the economic crisis on health-related behaviors in Italy [Articolo su rivista]
Mattei, Giorgio; DE VOGLI, Roberto; Ferrari, Silvia; Pingani, Luca; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population.

2017 - Impact of the economic crisis on mental health. Report of a multidisciplinary Seminar held in Sassuolo (Modena), June 17th, 2016 [Articolo su rivista]
Visentini, Chiara; Mattei, Giorgio; Gobba, Fabriziomaria; Giubbarelli, G; Ferrari, Silvia
abstract

Il paper descrive un'esperienza di collaborazione a fini formativi tra psichiatri e medici del lavoro, nell'ambito di un più ampio progetto integrativo in corso in provincia di Modena.

2017 - Indicators of Complex Care During the Consultation-Liaison Psychiatry Activity at the Transplant Center of the Policlinico Hospital, Modena [Articolo su rivista]
Mattei, Giorgio; Laghi, Alessandro; Balduzzi, Sara; Moscara, Maria; Piemonte, Chiara; Reggianini, Corinna; Rigatelli, Marco; Ferrari, Silvia; Pingani, Luca; Galeazzi, Gian Maria
abstract

OBJECTIVE: The objective of this study was to identify possible biopsychosocial predictors of organizational complexity in patients referred to the consultant psychiatrist for assessment before liver transplantation. METHODS: This was a case-control study. All psychiatric consultations performed before and after liver transplantation from January 1, 2008 to December 31, 2013 were included. Complexity was operationalized as "undergoing two or more psychiatric consultations". Controls were defined as patients who were assessed only once by the consultant. Cases were represented by patients who underwent two or more consultations. Statistical analysis was performed with STATA 13.1, using logistic regressions. RESULTS: In this study, 515 consultations were requested for 309 patients potentially eligible for liver transplantation. Controls were 209 (67.6%); cases were 100 (32.4%). Positive psychiatric history (odds ratio [OR] = 2.44; 95% confidence interval [CI], 1.43-4.16), viral or toxic (alcohol- or drug-related) liver disease (OR = 1.93; 95% CI, 1.09-3.42), use of psychotropic medications at the baseline (OR = 2.15; 95% CI, 1.14-4.07), and female gender (OR = 1.77; 95% CI, 1.01-3.11) were significantly associated with an increased probability of being cases. CONCLUSIONS: Positive psychiatric history, viral or toxic liver disease, use of psychotropic medications at the index referral, and female gender are possible biopsychosocial predictors of complexity in patients eligible for liver transplantation.

2017 - La consulenza psichiatrica nel paziente candidato a trapianto di fegato Implicazioni per la clinica, la formazione e la ricerca [Articolo su rivista]
Mattei, Giorgio; Moscara, Maria; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

Resoconto e riflessioni rispetto all'attività di consulenza psichiatrica nell'ambito dell'iter trapiantologico epatico, relative a questioni cliniche (es. necessità di lavoro in rete per i pazienti a rischio di ricaduta nella dipendenza da alcool), a questioni formative (necessità per operatori di formarsi nella valutazione prognostica e di complessità bio-psico-sociale) e a questioni di ricerca (breve descrizione delle attività svolte ed in corso da parte del servizio di consulenza psichiatrica dell'Università di Modena & Reggio Emilia/Dipartimento di Salute Mentale di Modena).

2017 - N-acetylcysteine in the treatment of psychiatric disorders: current status and future prospects [Articolo su rivista]
Minarini, Alessandro; Ferrari, Silvia; Galletti, Martina; Giambalvo, Nina; Perrone, Daniela; Rioli, Giulia; Galeazzi, Gian Maria
abstract

N-acetylcysteine (NAC) is widely known for its role as a mucolytic and as an antidote to paracetamol overdose. There is increasing interest in the use of NAC in the treatment of several psychiatric disorders. The rationale for the administration of NAC in psychiatric conditions is based on its role as a precursor to the antioxidant glutathione, and its action as a modulating agent of glutamatergic, dopaminergic, neurotropic and inflammatory pathways. Areas covered: This study reviews the available data regarding the use of NAC in different psychiatric disorders including substance use disorders, autism, obsessive-compulsive spectrum disorders, schizophrenia, depression, bipolar disorder. Promising results were found in trials testing the use of NAC, mainly as an add-on treatment, in cannabis use disorder in young people, depression in bipolar disorder, negative symptoms in schizophrenia, and excoriation (skin-picking) disorder. Despite initial optimism, recent findings regarding NAC efficacy in autism have been disappointing. Expert opinion: These preliminary positive results require further confirmation in larger samples and with longer follow-ups. Given its high tolerability and wide availability, NAC represents an important target to investigate in the field of new adjunctive treatments for psychiatric conditions.

2017 - Never too late to be anxious: validation of the Geriatric Anxiety Inventory, Italian version [Articolo su rivista]
Ferrari, Silvia; Signorelli, M. S; Cerrato, F; Pingani, Luca; Massimino, M; Valente, S; Forlani, M; Bonasegla, P; Arcidiacono, E; De Ronchi, D; Rigatelli, Marco; Aguglia, E; Atti, A. R.
abstract

Aim – The aim of this work was to validate the Italian version of GAI (GAI-It) and its short form (GAI-It SF) in an over 65-population. Methods – In 3 recruitment areas across Italy, two raters reciprocally blind to results assessed eligible subjects; a semi-structured diagnostic clinical interview was performed by a psychiatrist. Results – Among the 76 enrolled subjects (mean age 72.7±6.8 years), anxiety symptoms were very common: 69.7% (moderate/severe HADS-Anxiety), 76.3% (moderate/severe STAI-state), 71.0% (moderate/severe STAI-trait), 61.8% (GAI), 55.3% (GAI-SF). Sensitivity, specificity and positive predictive value of GAI confirmed a good reliability of the Italian version, with Cronbach’s Alpha equal to 0.93 for GAI-It and to 0.77 for GAI-It SF, indicating a very good and good construct validity, respectively, of the scales. The Pearson correlation index demonstrated a moderately positive correlation among GAI, GAI-SF and STAI. Conclusions – Our data confirm the validity of GAI-It as a valuable instrument to assess anxiety in an elderly population, for clinical and research purposes.

2017 - Physical exercise for late life depression: effects on cognition and disability [Articolo su rivista]
Neviani, Francesca; Belvederi Murri, Martino; Mussi, Chiara; Triolo, Federico; Toni, Giulio; Simoncini, Elisabetta; Tripi, Ferdinando; Menchetti, Marco; Ferrari, Silvia; Ceresini, Graziano; Cremonini, Alessandro; Bertolotti, Marco; Neri, Giovanni; Squatrito, Salvatore; Amore, Mario; Zanetidou, Stamatula; Neri, Mirco
abstract

Background:: Late-life depression is often associated with cognitive impairments and disability, which may persist even after adequate antidepressant drug treatment. Physical exercise is increasingly recognized as an effective antidepressant agent, and may exert positive effects on these features too. However, few studies examined this issue, especially by comparing different types of exercises. Methods:: We performed secondary analyses on data from the Safety and Efficacy of Exercise for Depression in Seniors study, a trial comparing the antidepressant effectiveness of sertraline (S), sertraline plus thrice-weekly non-progressive exercise (S+NPE), and sertraline plus thrice-weekly progressive aerobic exercise (S+PAE). Exercise was conducted in small groups and monitored by heart rate meters. Patients with late-life depression without severe cognitive impairment were recruited from primary care and assessed at baseline and 24 weeks, using the Montreal Cognitive Assessment (MOCA, total and subdomain scores) and Brief Disability Questionnaire. Analyses were based on Generalized Linear Models. Results:: In total, 121 patients (mean age 75, 71% females) were randomized to the study interventions. Compared with the S group, patients in the S+PAE group displayed greater improvements of MOCA total scores (p=0.006, effect size=0.37), visuospatial/executive functions (p=0.001, effect size=0.13), and disability (p=0.02, effect size=−0.31). Participants in the S+NPE group did not display significant differences with the control group. Conclusions:: Adding aerobic, progressive exercise to antidepressant drug treatment may offer significant advantages over standard treatment for cognitive abilities and disability. These findings suggest that even among older patients exercise may constitute a valid therapeutic measure to improve patients’ outcomes.

2017 - Predictive factors of hospitalization related to the caregiver burden in older adults presenting to the emergency department [Abstract in Rivista]
Mattei, Giorgio; Goldoni, I.; Mariani, Francesco; Casu, Gabriella; Boccaletti, L.; Ferrari, Silvia; Ligabue, Laura; Colantoni, Alessandra
abstract

Background Long-term care for the elderly by their family members represents a serious burden in Italy. The physical and psychological health of informal caregivers is a growing public health issue. Old patients often seek urgent medical attention in the Emergency Department (ED) and hospitalisation is frequent event among the elderly. Aim Aim of the study was (1) to investigate the burden of care among the caregivers of old patients; (2) to examine the influence of the burden experienced by the caregivers on ED and hospital admissions of the elderly. Methods We conducted a descriptive study of patients aged 75 years or older and their caregiver admitted to the ED from 10/1/15 to 6/10/15 (77 patient-caregiver pairs). The caregivers were evaluated using the Caregiver Burden Inventory (CBI). A case manager collected the patient's data. Results CBI score is the highest among patients seeking ED evaluation due to caregiver's concern. The majority of the elderly admitted to the ED whose caregiver shows elevated emotional burden at the CBI do not present with serious or urgent medical condition and are not hospitalised. Emotional burden is the highest among the caregivers of demented subjects who share the same house. Conclusion Our findings indicate that the burden experienced by caregiving family members plays a role in elderly people avoidable ED visits.

2017 - Prevalence of metabolic syndrome and of symptoms of anxiety and depression in patients undergoing colonoscopy [Abstract in Rivista]
Marchi, Mattia; Alboni, Silvia; Fabbrizi, Andrea; Feltri, L.; Galli, Giacomo; Guicciardi, Alessia; Mancini, Stefano; Mattei, Giorgio; Minarini, Alessandro; Perrone, Daniela; Rioli, Giulia; Roncucci, Luca; Sena, Paola; Ferrari, Silvia
abstract

Introduction Metabolic syndrome (MetS) is defined by metabolic and cardio-vascular impairments and is frequently associated with anxiety and depressive disorders. Both MetS and anxiety-depressive syndromes feature similar systemic inflammatory alterations. Inflammation of the large bowel is also a key factor for the development of colorectal cancer (CRC). Objective To measure the prevalence of MetS and symptoms of anxiety and depression among patients undergoing colonoscopy. Methods Cross-sectional study. Patients undergoing colonoscopy aged 40 or more, with negative history for neoplasia or inflammatory bowel disease, were enrolled. Data collected: colonoscopy outcome, presence/absence of MetS (IDF and ATP III criteria), presence/absence of depressive and anxiety symptoms assessed with HADS. Results The sample was made up of 53 patients (female 24, 45.3%). Mean age was 60.66 ± 9.08. At least one adenoma was found to 23 patients (43.3%). Prevalence of MetS ranged from 34% to 36% (ATP III and IDF criteria, respectively). Prevalence of depressive and anxiety symptoms was 20% and 33%, respectively. Conclusion Prevalence of MetS, anxiety and depressive symptoms among patients undergoing colonoscopy was higher than in the general population.

2017 - Quality of life and anxious-depressive symptoms in cancer patients undergoing mindfulness-based interventions: Feasibility and preliminary outcomes on prospective single-centre case-control study (MIND4ME St.) [Abstract in Rivista]
Pontoni, G.; Maur, Michela; Ferrari, Rita; Guida, Antonella; Poletti, S.; Caggia, Federica; Fontana, Annalisa; Gavioli, Francesco; Tarantino, Vittoria; Cascinu, Stefano; Ferrari, Silvia
abstract

Background Mindfulness based interventions (MBIs) have shown efficacy in improving psychological symptoms including depression and anxiety in cancer patients (pts). The study aimed to explore feasibility and reproducibility of MBIs in an Italian Cancer Centre measuring biochemical and psychological parameters. Methods In this pilot prospective case-control study, we recruited newly diagnosed pts receiving adjuvant chemotherapy (CT). A MBIs program was designed consisting of 2.5 hours weekly for 8 weeks and, including meditation, yoga and body scan. Material for 45 minutes (mn) home daily practice was provided. Primary endpoint was to evaluate feasibility. Secondary endpoints were assessment of quality of life (QoL), psychological and biochemical outcomes of stress, tested at baseline (W0), W4, W8, W24, W48. PSS (Perceived Stress Reduction), POMS (profile of mood states scores), EuroQoL (EQ-5D-3L) were administered. Results Ten pts underwent MBIs program arm. We present preliminary results, while data of control arm are being collected. All pts were female, two pts (20%) dropped out. Median age was 56 years. All received adjuvant CT, 5/8 received radiotherapy and hormone therapy. Mean of sessions attending was 6.8 (76%). Median daily practice was 30 mn. EQ-5D item for depression and anxiety showed decreasing trend in mean score from moderate to light (P = 0.15) and significant improvement of auto-perceived QoL was observed comparing W0 and W8 (P = 0.02) Conclusions In a sensitive setting such as start CT, we found high pts compliance to MBIs. Improvement in self-perceived QoL after starting program was found and comparing anxious-depressive symptoms outcomes with control arm is still needed.

2017 - Stay foolish, stay fit: An excursus on strategies to prevent burnout of mental health professionals [Abstract in Rivista]
Ferrari, Silvia; Rioli, Giulia
abstract

Burn-Out (BO) is commonly described as a growing situation of work stress and conceptualized as a combination of emotional exhaustion, depersonalization/cynicism and reduced personal efficacy. Some professionals are exposed to a higher risk, depending on their specific work mansions (most typically the so called helping professions) and on personal and contextual conditions. Evidence from scientific literature has confirmed that being younger and working in the field of mental health are very significant risk factors for BO. Furthermore, BO is an essential target for preventive strategies: prevention of BO, rather than treatment of potential psychopathological consequences, has been proved to be more effective and cost-effective, though unfortunately very often disregarded or left to individual initiatives. Physical activity, diet, and other features of a healthy life-style are core targets of interventions aimed at prevention of BO. Increasing evidence is collected on the effectiveness of mindfulness-based techniques and yoga. Supervision, and more specifically Balint-inspired models of group case discussions. Scientific and professional associationism is also effective as a strategy to avoid isolation. Finally, interventions aimed at improving work organization, targeting logistic aspects (eg. time schedules), infrastructures (eg. parking places) or dynamics and human interactions, are also essential and effective.

2017 - The burden of attempted suicide: The attitude of emergency services workers [Abstract in Rivista]
Cuoghi, Giulia; Venuta, Marco; Mattei, Giorgio; Sacchetti, A.; Ferrari, Silvia
abstract

Introduction The great global burden of suicide requires specific preventive strategies focused on emergency services (ES) workers, providing first aid after attempted suicide. Objectives To investigate the approach of ES workers toward attempted suicides, and to assess work-related stress and teamwork attitude as variables likely to influence suicide risk perception. Methods A total of 265 ES workers (73 medical doctors, 130 nurses, 62 health and social care workers) from 3 hospitals in the area of Modena (Northern Italy) were involved. In a group setting, titles from local newspapers reporting about suicides were read, and ES workers were asked to fill in 3 psychometric scale questionnaires (SUIATT, MBI and SAQ). Results The questionnaires returned were 88 (33%), 47% (n = 42) were filled by women, median age was 40 years. Doctors group had the highest response rate (60%). Burnout levels were intermediate at the Emotional Exhaustion subscale, severe at the Depersonalization subscale and mild at the Professional Efficacy subscale. Eighteen percent recorded a good team perception, 33% had a good perception of their work conditions. SUIATT subscales showed a restrictive attitude toward suicide, regardless of hospital and task. Discussion No associations emerged among SUIATT, MBI and SAQ subscales; male sex alone correlated to the SUIATT factor “rationality/ mental alteration”, suggesting more “tolerance” of suicidal behaviour. Conclusions It is crucial to raise awareness among ES workers on this issue, since those workers considering suicide as “more acceptable” are more likely to recognise its signs.

2017 - The screening for depression and neurocognitive disorders in subjects newly diagnosed with HIV [Abstract in Rivista]
Ferrari, Silvia; Piemonte, Chiara; Feltri, L.; Ottolini, Fedra; Maffei, Simone; Nanni, M. G.; Alboni, Silvia
abstract

Background Inflammatory mediators may be relevant to explain the frequent comorbidity between depression, neurocognitive disorders and HIV. HIV induces activation of inflammatory mediators, mainly cytokines, that have been involved in the onset of depression and response to antidepressant treatment. Aim To identify recurring profiles of inflammatory biomarkers subtending depression, effectiveness of antidepressants and neurocognitive disorders among HIV-infected individuals. Methods All adult newly HIV-diagnosed out-patients attending HIV clinics in three towns of Northern Italy were screened, assessed for depression and studied immunologically and for neurocognitive disorders. Results Twenty-five patients have been enrolled so far: of these, 35% were positive to PHQ-9 screening, of which 6 were positive to the diagnostic assessment for depression. No neurocognitive disorders were found among the patients. As the project will develop, it is expected that frequency of depression, neurocognitive disorders and effective antidepressant treatment will be found to correlate to the profile of immune biomarkers. These findings might help to understand the etiology of depression in HIV, and specifically the role of inflammation and immunological changes.

2016 - Burnout syndrome among psychiatric trainees in 22 countries: Risk increased by long working hours, lack of supervision, and psychiatry not being first career choice [Articolo su rivista]
Jovanovic, N; Podlesek, A.; Volpe, U.; Barrett, E.; Ferrari, Silvia; Rojnic Kuzman, M.; Wuyts, P.; Papp, S.; Nawka, A.; Vaida, A.; Moscoso, A.; Andlauer, O.; Tateno, M.; Lydall, G.; Wong, V.; Rujevic, J.; Platz Clausen, N.; Psaras, R.; Delic, A.; Losevich, M. A.; Flegar, S.; Crã©pin, P.; Shmunk, E.; Kuvshinov, I.; Loibl Weiss, E.; Beezhold, J.
abstract

Background: Postgraduate medical trainees experience high rates of burnout, but evidence regarding psychiatric trainees is missing. We aim to determine burnout rates among psychiatric trainees, and identify individual, educational and work-related factors associated with severe burnout. Methods: In an online survey psychiatric trainees from 22 countries were asked to complete the Maslach Burnout Inventory (MBI-GS) and provide information on individual, educational and work-related parameters. Linear mixed models were used to predict the MBI-GS scores, and a generalized linear mixed model to predict severe burnout. Results: This is the largest study on burnout and training conditions among psychiatric trainees to date. Complete data were obtained from 1980 out of 7625 approached trainees (26%; range 17.8-65.6%). Participants were 31.9 (SD 5.3) years old with 2.8 (SD 1.9) years of training. Severe burnout was found in 726 (36.7%) trainees. The risk was higher for trainees who were younger (P < 0.001), without children (P = 0.010), and had not opted for psychiatry as a first career choice (P = 0.043). After adjustment for socio-demographic characteristics, years in training and country differences in burnout, severe burnout remained associated with long working hours (P < 0.001), lack of supervision (P < 0.001), and not having regular time to rest (P = 0.001). Main findings were replicated in a sensitivity analysis with countries with response rate above 50%. Conclusions: Besides previously described risk factors such as working hours and younger age, this is the first evidence of negative influence of lack of supervision and not opting for psychiatry as a first career choice on trainees' burnout.

2016 - Evaluation der deutschsprachigen Version des "INTERMED-Self-Assessment"- Fragebogens (IM-SA) zur Erfassung von Patienten mit komplexem Versorgungsbedarf [Articolo su rivista]
Boehlen, Friederike Hildegard; Joos, Andreas; Bergmann, Fritz; Stiefel, Friedrich; Eichenlaub, Johannes; Ferrari, Silvia; Boenink, Annette; Van Reedt Dortland, Arianne; Stein, Barbara; Söllner, Wolfgang; Wild, Beate
abstract

Introduction: The INTERMED- interview (IM-CAG=INTERMED complexity assessment grid) is a well validated instrument for the identification of complex patients in need of integrated health care (score ≥21). The IM-SA (INTERMED self-assessment)-questionnaire, derived from the INTERMED- interview, was developed in cooperation with the international INTERMED group in order to facilitate its use in various clinical settings and to foster the patients' perspective on health-care needs. Methods: The German version of the IM-SA was evaluated in a clinical sample (n=136) of psychosomatic outpatients and compared to the IM-CAG. Construct validity was examined by analyzing the correlations of the IM-SA with quality-of-life (SF-36) and anxiety/depression (HADS). Sensitivity and specificity for the identification of complex patients were examined by using ROC (Receiver Operating Characteristic) analysis. Results: The correlations between the total score and the subscales of the IM-SA, compared to the INTERMED, were high (total score r=0.79 (95%-KI: [0.70; 0.85]). Cronbach's α was 0.77, and construct validity was high (SF-36 mental component score: r=-0.57; HADS Depression: r=0.59). The IM-SA total score was significantly lower compared to IM-CAG, mainly because of low IM-SA scores in the somatic domain. According to ROC analysis, the IM-SA-cut-off for identifying complex patients has to be lowered (score ≥17). Discussion: The IM-SA can be used as an instrument to identify complex patients in need of integrated bio-psycho-social care. Conclusion: The IM-SA is a reliable instrument to be used in various clinical settings to identify complex patients and to provide integrated, bio-psycho-social care.

2016 - Liaison psychiatry - is it possible? [Capitolo/Saggio]
Ferrari, Silvia; Dreher, Annegret; Mattei, Giorgio; Diefenbacher, Albert
abstract

Consultation-Liaison Psychiatry (CLP) deals with clinical, research and training activities at the interface between psychiatry and the rest of medicine, most typically medical-psychiatric comorbidities, in the conceptual frame of the bio-psycho-social paradigm. It developed gradually during the 20th century around the world, as dramatic changes in the conceptualization and the clinical management of mental illness were taking place, and operates typically in the General Hospital and in Primary Care. The main clinical competencies of CLP include medical-psychiatric comorbidity (co-existing psychiatric and non-psychiatric disorders affecting reciprocally); medically unexplained physical symptoms, “somatization” and functional disorders; and liaison activities, addressed to medical workers and teams. CLP may effectively impact on prognosis of medical illnesses and consequently on quality of life, disability, use of health care resources. Furthermore, research in the field of CLP and psychosomatic medicine may massively contribute to the understanding of the aetiology of mental illness, by adoption of a translational, interdisciplinary perspective.

2016 - Perceived insecurity, mental health and urbanization: Results from a multicentric study [Articolo su rivista]
Luciano, M; De Rosa, C.; Del Vecchio, V.; Sampogna, G.; Sbordone, D.; Atti, A. R.; Bardicchia, F.; Bertossi, F.; Calò, S.; Cava, L.; Ciafone, M.; De Fazio, P.; Di Iorio, G.; Fantini, E.; Ferrari, Silvia; Ginanneschi, A.; Gotelli, S.; Macina, A.; Mulè, A.; Papanti, D.; Pingani, Luca; Pinna, F.; Piselli, M.; Signorelli, M. S.; Tarricone, I.; Tarsitani, L.; Ventriglio, A.; Carrà, G.; Catapano, F.; Fiorillo, A.
abstract

Aims: This article aims to (1) explore the levels of perceived insecurity in a sample of patients with mood or anxiety disorders and (2) assess whether living in 'big cities' can influence the levels of patients' perceived insecurity and social contacts compared to living in a non-urbanized context. Methods: A total of 24 Italian mental health centers (MHCs) have been invited to participate. Twenty patients consecutively accessing the MHC have been recruited. All patients have been assessed using validated assessment tools. Results: The sample consisted of 426 patients, mostly female, with a mean age of 45 years. Globally, 52.2% of patients had a diagnosis of mood disorders, and 37.8% had anxiety disorders. Half of the sample declared that the main feeling toward life is uncertainty; higher levels of pessimistic views toward life have been detected in patients living in urban areas. A positive association between negative attitudes toward life and higher levels of depressive and anxiety symptoms, poor social functioning and higher levels of perceived psychological distress has been found. Conclusion: Our findings confirm the presence of a common sense of perceived uncertainty among our sample. Such attitude toward life can have a detrimental impact on patients' psychological and physical well-being, contributing to high levels of distress.

2016 - Posturographic destabilization in eating disorders in female patients exposed to body image related phobic stimuli [Articolo su rivista]
Forghieri, M; Monzani, Daniele; Mackinnon, A; Ferrari, Silvia; Gherpelli, Chiara; Galeazzi, Gian Maria
abstract

Human postural control is dependent on the central integration of vestibular, visual and proprioceptive inputs. Psychological states can affect balance control: anxiety, in particular, has been shown to influence balance mediated by visual stimuli. We hypothesized that patients with eating disorders would show postural destabilization when exposed to their image in a mirror and to the image of a fashion model representing their body ideal in comparison to body neutral stimuli. Seventeen females patients attending a day centre for the treatment of eating disorders were administered psychometric measures of body dissatisfaction, anxiety, depression and underwent posturographic measures with their eyes closed, open, watching a neutral stimulus, while exposed to a full length mirror and to an image of a fashion model corresponding to their body image. Results were compared to those obtained by eighteen healthy subjects. Eating disordered patients showed higher levels of body dissatisfaction and higher postural destabilization than controls, but this was limited to the conditions in which they were exposed to their mirror image or a fashion model image. Postural destabilization under these conditions correlated with measures of body dissatisfaction. In eating disordered patients, body related stimuli seem to act as phobic stimuli in the posturographic paradigm used. If confirmed, this has the potential to be developed for diagnostic and therapeutic purposes.

2016 - Psychometric validation of the Italian version of the Reported and Intended Behaviour Scale (RIBS) [Articolo su rivista]
Pingani, Luca; Evans Lacko, S; Luciano, M; Del Vecchio, V; Ferrari, Silvia; Sampogna, G; Croci, I; Del Fatto, T; Rigatelli, Marco; Fiorillo, A.
abstract

Many instruments have been developed and validated to assess the stigma associated with mental disorders and its various domains across different populations. To our knowledge, the Reported and Intended Behaviour Scale (RIBS) is the only validated questionnaire to analyse the presence of reported and intended stigmatising/discriminatory behaviours towards people with mental health problems in the general population. The aims of the study presented herein are to translate and validate the RIBS in Italian language and to adapt it to the Italian socio-cultural background (RIBS-I).

2016 - Role and clinical implications of atypical antipsychotics in anxiety disorders, obsessive-compulsive disorder, trauma-related, and somatic symptom disorders: a systematized review [Articolo su rivista]
Albert, Umberto; Carmassi, Claudia; Cosci, Fiammetta; de Cori, David; Di Nicola, Marco; Ferrari, Silvia; Poloni, Nicola; Tarricone, Ilaria; Fiorillo, Andrea
abstract

Atypical antipsychotics (AAs) may play a role in the treatment of anxiety disorders, obsessive-compulsive disorder (OCD), and trauma-related disorders. No reviews on their differential use in these different disorders have been performed recently. The aim of this systematized review was to obtain data on efficacy and comparative effectiveness of AAs as a treatment of anxiety disorders, OCD, and trauma-related disorders to provide guidance for clinicians on when and which AA to use. We searched on PubMed, Psychnet, and Cochrane Libraries from inception to July 2015. Search results were limited to randomized, placebo-controlled trials of adult patients. Evidence of efficacy was considered the presence of positive results in two or more double-blind placebo-controlled studies. Our systematized search identified 1298 papers, of which 191 were subjected to a full-text review and 56 were included. Quetiapine extended-release showed a role in both acute and maintenance treatment of uncomplicated generalized anxiety disorder, whereas more studies are needed before drawing practical recommendations on the use of olanzapine and risperidone; aripiprazole and risperidone are effective in resistant OCD as augmentation treatments. Risperidone and olanzapine add-on may have a role in resistant or chronic post-traumatic stress disorder patients, although only risperidone addition can be recommended on the basis of the criterion of two or more positive placebo-controlled trials. This systematized review supports the evidence that only a few AAs are effective in only a minority of the off-label conditions in which they are currently used and confirms that AAs are not all the same. Their use should be on the basis of a balance between efficacy and side effects, and the characteristics as well as the preference of the patient.

2016 - Role of metabolic, atherogenic and psychological factors in patients with colorectal adenomas [Abstract in Rivista]
Boarino, Valentina; Merighi, Alberto; Mancini, Stefano; Bertani, Angela; Marocchi, Margherita; Marsico, Maria; Olivetti, Giampiero; Primerano, Anna Maria; Mattei, Giorgio; Ferrari, Silvia; Roncucci, Luca; Villa, Erica
abstract

Some metabolic, atherogenic, and psychological risk factors are related to the growth of colorectal adenomas

2016 - [Critical evaluation of current diagnostic classification systems in psychiatry: the case of DSM-5] [Articolo su rivista]
Luciano, Mario; Sampogna, Gaia; Del Vecchio, Valeria; De Rosa, Corrado; Albert, Umberto; Carrà, Giuseppe; Dell'Osso, Bernardo; Lorenzo, Giorgio Di; Ferrari, Silvia; Martinotti, Giovanni; Nanni, Maria Giulia; Pinna, Federica; Pompili, Maurizio; Volpe, Umberto; Catapano, Francesco; Fiorillo, Andrea
abstract

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.

2015 - Apple or pear? A cross sectional study on the association between body shape and symptoms of anxiety and depression in primary care female patients [Abstract in Rivista]
Rioli, G; Mattei, Giorgio; Ferrari, Silvia; Bursi, S; Rigatelli, Marco; Pingani, Luca; Galeazzi, Gian Maria
abstract

INTRODUCTION - "Apple" body shape (Waist-to-Hip Ratio, WHR>1) is a documented risk factor for cardiovascular diseases, the first cause of morbility and mortality in Western societies. Mental disorders, especially anxiety and depression, are also related to cardiovascular diseases with accumulating evidence that these conditions have in common a dysregulation of inflammatory pathways. Nevertheless, joint assessment of WHR and symptoms of anxiety and depression has not been reported commonly so far. AIM - To explore the association between WHR and symptoms of anxiety and depression in a female primary care sample. METHODS - Cross-sectional design. Evaluation of all consecutive women undergoing a GP consultation in a Northern Italy Practice. Exclusion criteria: age <40 or >80; use of antidepressants or antipsychotics; previous stroke or heart attack; obesity due to hereditary. Psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Statistical analysis was performed using STATA. RESULTS - 125 women were assessed. WHR was inversely associated to HADS-Anxiety subscale score (β=-5.28, p=.02) e HADS-Depression subscale score(β=-4.02, p=.04) in the 40-60 years’ subgroup. In particular, WC was positively related to HADS-A (β=13.39, p=.02) e HADS-D (β=10.38, p=.03) while HC was inversely associated to HADS-A (β=-11.3, p=.01) and HADS-D (β=-8.6, p=.03). No associations were found in older groups. CONCLUSION - 'Pear” body shape (WHR<1), with a peripheral distribution of fat, is inversely associated to symptoms of anxiety and depression in women aged 40 to 60. The post-menopausal transition to the 'apple” model, with a central fat distribution, could explain the lack of correlations in women >60 years.

2015 - Association between anxiety and depressive symptoms with metabolic syndrome in primary care: Results of an Italian cross-sectional study involving outpatients [Abstract in Rivista]
Mattei, G; Rioli, G; Ferrari, Silvia; Galeazzi, Gian Maria; Bursi, S; Padula, Sm; Pingani, Luca; Rigatelli, Marco
abstract

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominal adiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation.

2015 - Association between symptoms of anxiety and depression and BMI in Primary Care patients: a cross sectional study [Abstract in Rivista]
Mattei, Giorgio; Rioli, G; Ferrari, Silvia; Bursi, S; Pingani, Luca; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Background: Metabolic syndrome (MetS) is a heterogeneous entity represented by the coexistence of multiple alterations: abdominaladiposity, impaired glucose tolerance, hypertriglyceridemia, HDL hypocolesterolemia and hypertension. Symptoms of anxiety and depression are frequently comorbid with MetS. Aim of the present study was to measure the association between symptoms of anxiety and depression with the five criteria of MetS in outpatients attending GPs' practices. Method: This is a cross-sectional study, involving male and female patients aged 40–80 attending five GPs' practices within one month in Modena, Northern Italy approved by the local Ethical Committee. All patients were screened for the presence of MetS and depressive/ anxiety symptoms, using the Hospital Anxiety and Depression Scale. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics; previous stroke, heart attack or cardiovascular disease; diagnosed psychotic or mood disorder (according to the DSM-IV-TR); diabetes; pregnancy; hereditary disease linked to obesity. All data were adjusted for socio-demographic confounders. Multiple logistic analysis performed with STATA 13.0. Results: 128 subjects were enrolled in the study (55 men and 73 women), 48 presented with MetS (ATP-III-Revised criteria). MetS was associated with depression only in the female group (OR =6.33, p= 0.01), also when adjusting for age (OR =5.13, p= 0.02). MetS was not associated with anxiety in both males and females, and with depression in men. Among the individual components of MetS, only waist circumference was associated with anxiety in the female group (OR=4.40, p=0.04) also when adjusting for age (OR=4.34, p=0.04). Conclusion: Women aged between 40 and 60, presenting with MetS and attending the primary care services should been regularly screened for the presence of depression. Chronic systemic inflammation could represent the biological link between MetS and psychological symptoms. Further researches are needed to better clarify this possible relation.

2015 - Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice [Articolo su rivista]
Dell'Osso, Bernardo; Albert, Umberto; Atti, Anna Rita; Carmassi, Claudia; Carrà, Giuseppe; Cosci, Fiammetta; Del Vecchio, Valeria; Di Nicola, Marco; Ferrari, Silvia; Goracci, Arianna; Iasevoli, Felice; Luciano, Mario; Martinotti, Giovanni; Nanni, Maria Giulia; Nivoli, Alessandra; Pinna, Federica; Poloni, Nicola; Pompili, Maurizio; Sampogna, Gaia; Tarricone, Ilaria; Tosato, Sarah; Volpe, Umberto; Fiorillo, Andrea
abstract

More than half a century after their discovery, benzodiazepines (BDZs) still represent one of the largest and most widely prescribed groups of psychotropic compounds, not only in clinical psychiatry but also in the entire medical field. Over the last two decades, however, there has been an increased focus on the development of antidepressants and antipsychotics on the part of the pharmaceutical industry, clinicians, and researchers, with a reduced interest in BDZs, in spite of their widespread clinical use. As a consequence, many psychiatric residents, medical students, nurses, and other mental health professionals might receive poor academic teaching and training regarding these agents, and have the false impression that BDZs represent an outdated chapter in clinical psychopharmacology. However, recent advances in the field, including findings concerning epidemiology, addiction risk, and drug interactions, as well as the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with related diagnostic changes, strongly encourage an updated appraisal of the use of BDZs in clinical practice. During a recent thematic event convened with the aim of approaching this topic in a critical manner, a group of young Italian psychiatrists attempted to highlight possible flaws in current teaching pathways, identify the main clinical pros and cons regarding current use of BDZs in clinical practice, and provide an updated overview of their use across specific clinical areas and patient populations. The main results are presented and discussed in this review.

2015 - Consultation-Liaison Psychiatry - from theory to clinical practice: an observational study in a general hospital [Articolo su rivista]
De Giorgio, Giuseppina; Quartesan, Roberto; Sciarma, Tiziana; Giulietti, Martina; Piazzoli, Angela; Scarponi, Laura; Ferrari, Silvia; Ferranti, Laura; Moretti, Patrizia; Piselli, Massimiliano
abstract

To investigate significant association between various clinical and extra-clinical factors brought out the activities of Consultation-Liaison Service.

2015 - From hysteria to somatic symptom disorders: Searching for a common psychopathological ground [Articolo su rivista]
Ferrari, S.; Poloni, N.; Diefenbacher, A.; Barbosa, A.; Cosci, F.
abstract

After decades of manifold contributions aimed at defining hysteria, somatisation and conversion, such syndromes are still neglected and their nosographical definition is debated. The DSM and the ICD have undergone major changes, but their clinical utility with regards to these syndromes is still questionable. On the contrary, the Diagnostic Criteria for Psychosomatic Research represents a useful clinical instrument since it translates psychosocial variables derived from psychosomatic research into operational tools. The present paper offers an overview on the psychopathological description of syndromes such as alexithymia, hypochondriasis, health anxiety, thanatophobia, conversion symptoms, anniversary and reaction which are frequent in clinical practice, but often misdiagnosed due to their absence in the DSM and the ICD. In addition, the influence of culture and cultural changes on the modifications of psychopathological manifestations is described as a further possible source of misdiagnosing and underreporting. New psychopathologies (e.g., multiple chemical sensitivity, orthorexia/vigorexia) that resemble conversion and/or somatisation have been developed, but neither is included in nosography nor taught to clinicians. The aim of the present paper is thus to describe psychopathological manifestations of somatic symptoms and related disorders to help clinicians formulate their diagnosis on the presence of signs and symptoms that can be elicited during a clinical visit, rather than by way of exclusion of other organic or psychiatric disease only.

2015 - Is hyperglycemia associated with anxious-depressive symptoms? An Italian study in primary care setting [Abstract in Rivista]
Rioli, G; Mattei, Giorgio; Galeazzi, Gian Maria; Ferrari, Silvia; Bursi, S; Pingani, Luca; Rigatelli, Marco
abstract

Background: Recent researches exploring the relationship between impaired glucidic tolerance, hyperglycemia or frank type II diabetes mellitus and symptoms of anxiety and depression, mostly conducted on in-patients or highly selected samples and on foreign populations, have reported conflicting results. Nevertheless, these medical and mental conditions are often comorbid in clinical practice. Chronic and systemic inflammation could represent the trait d\'union between these conditions. Primary care represents an interesting setting for exploring this comorbidity, given the high prevalence of psychiatric symptoms displayed by patients. The aims of this research was to measure the association between hyperglycemia and symptoms of anxiety and/or depression in out-patients, and to fill the lack of studies on comorbidity between depression and anxiety disorders and medical conditions in Primary Care services. Method: The present was a cross-sectional study. We evaluated all consecutive patients undergoing a GP consultation in a Northern Italy practice. Exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics medication; psychosis (schizophrenia, schizoaffective, bipolar, organic, or tall as psychotic disorder by DSM IV-TR) or major depression; pregnancy; previous stroke or heart attack; type I diabetes mellitus. The psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Blood Glucose measurements (BM) in the last 6 months were considered in our analysis. Hyperglycemia cutoff: blood glucose N100 mg/dl. The statistical analysis was performed using STATA with multiple linear regressions. Results: 209 subjects were recruited in our study (84 men and 125 women). Of those, 48 (22.9%) were affected by hyperglycemia: 22 were men and 26 women. Hyperglycemia was related to HADS-D score in the men sample (β = .44, p = .01). No association was found between hyperglycemia and HADS-A, either in men or in women. Conclusion: The presence of hyperglycemia, well-known cardiovascular risk factor, may have a clinical value in predicting the presence of depressive symptoms, especially in men. Further studies should examine whether our results are generalizable to other populations and whether they are applicable to clinical depression. Molecular researches could focus on clarifying the pathophysiological reasons for such association, also exploring reasons for sex differences.

2015 - Is low blood pressure always healthy? Evidence of an inverse association between depressive symptoms and arterial blood pressure in a primary care sample [Abstract in Rivista]
Rioli, G; Mattei, Giorgio; Galeazzi, Gian Maria; Ferrari, Silvia; Bursi, S; Pingani, Luca; Rigatelli, Marco
abstract

Background: Common mental health problems, such as anxiety and depression, have been related to the imbalance of the autonomous nervous system, also involved in blood pressure regulation. Low blood pressure readings have mainly been regarded as positive, but recent studies suggest low blood pressure is correlated with depression. The aim of the present research was to investigate the relationship between symptoms of anxiety and depression and blood pressure measures in a primary care sample. Method: We conducted a cross-sectional study that received the approval of the local Ethical Committee. All consecutive patients undergoing a GP consultation in a Northern Italy practice were evaluated, with the following exclusion criteria: age b40 or N80; use of antidepressants or antipsychotics medication; psychosis or major depression; previous stroke or heart attack; type I diabetes mellitus; obesity related to hereditary conditions; pregnancy. The psychometric assessment was done by HADS (Hospital Anxiety and Depression Scale). Arterial blood pressure was measured twice using a stethoscope and a sphygmomanometer at the right upper arm after 5 min of seated rest; the mean measure was considered. High Blood Pressure (BP) cut-offs: systolic BP ≥130 mm Hg and/or diastolic BP ≥ 85 mm Hg, according to IDF 2005 guidelines. The statistical multiple linear regression analysis was performed using STATA. Results: 209 subjects were enrolled in the study (125 women and 89 men). 122 subjects (58.1% of the whole sample) suffered from high blood pressure, and 98 of them (46.7%) followed an antihypertensive pharmacological therapy. A statistically significant inverse correlation between high diastolic BP and symptoms of depression at the HADS-D scale (β= −.28, p= .01) was found in the whole sample. The association was maintained in the male subsample, also after stratification by age, especially in the 40–60 years' group of patients (β=−.53, p =.04). On the contrary, no significant association was found between anxiety and BP measures. Conclusion: This study confirms an inverse association between high diastolic BP and depression at epidemiological level in an outpatients sample; longitudinal studies are needed in order to examine temporal occurrence and to explore the pathophysiology and the molecular mechanism at the basis of this association. Further researches should also investigate whether our results are generalizable to other populations.

2015 - Neuroenhancer use amongst Italian medical students: a survey [Abstract in Rivista]
Pighi, Marcella; Ferrari, Silvia; Pingani, Luca; Pontoni, G; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Introduction. Increasing use of substances by university students to improve cognitive performance ('neuroenhacement') has been reported. This refers not only to over-the-counter supplements, energy drinks, coffee and tobacco, but also to psychostimulants and modafinil. Little is known about this phenomenon in Italy. Aims. To explore prevalence of use of substances as cognitive enhancers by Italian medical students and their attitudes towards prescription-only medication (methylphenidate, amphetamine, atomoxetine, modafinil) used for this purpose. Methods An ad hoc questionnaire was distributed to 433 medical students of the University of Modena and Reggio Emilia. Valid response rate was 83.8% (N=363). Results 271 students (74.7%) reported use of substances to improve cognition in the last 30 days. Coffee (73%, N=265) and tea (33.3%, N=121) were the most used, followed by caffeinated sodas (15.7%, N=57), tobacco (10.2%, N=37) and vitamin B supplements (8.8%, N=32). Prescription-only medicines were used by 2 students (0.6%) and, overall, only 4 students reported lifetime use (1.2%). 295 (83.3% ) students mentioned concerns about safety and side effects as main reasons not to use. Use of cognitive enhancers as a group in the last 30 days slightly correlated with alcohol (r = 0.124; p = 0.023) and cannabis use (r = 0.114; p = 0.036). Conclusions Italian medical students use many substances as cognitive enhancers, but this seems not to apply to psychostimulants and modafinil. Cultural and regulatory differences may underlie this difference with other Countries, which warrants further research.

2015 - Occupational health physicians and the impact of the Great Recession on the health of workers: a qualitative study [Articolo su rivista]
Mattei, Giorgio; Ferrari, Silvia; Giubbarelli, C; Pingani, Luca; Uracci, Gm; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Background: Italy is one of the Eurozone members where the 2008 “Great Recession” struck worst, with a 9% drop in national GDP between 2008 and 2013. The negative effects of the recession on the health of the Italian population were documented on a nation-wide level. However, few local or regional studies are currently available in the scientific literature. Objectives: To assess the impact on workers’ health of the economic recession in the industrial area of Sassuolo (Modena, Northern Italy), and to provide recommendations for targeted interventions. Methods: Two focus groups were conducted, involving 8 occupational health physicians (OHPs) active in the area. Rough descriptions were analyzed using MAXQDA 11, according to the principles of grounded theory. Results: 261 segments were coded, divided into four areas. The first, “changes in contemporary world”, pointed out that the recession may have just made pre-existing problems worse, accelerating reductions in staff and workers’ benefits. The second, “social area”, highlighted a decrease in vertical social capital and the beginning of new trends in emigration. The third, “work area”, covered workers’ fear of losing their jobs if they were ill and a reduction in horizontal social capital, namely difficult relations between co-workers. The fourth, “medical area”, indicated a general worsening of workers’ health in the Sassuolo ceramic district compared to previous years. The OHPs reported an increase in muscular- skeletal complaints, gastritis, tension-type headache, irritable bowel syndrome symptoms, back pain, panic attacks, insomnia, tachycardia, and other medically unexplained symptoms. Anxiety problems seemed to prevail over depressive manifestations. An increase was reported for antidepressants and benzodiazepines consumption. Conclusions: The local impact of the economic crisis on health was mainly negative, consistent with available national data. Mental health professionals could work together with OHPs, e.g., through Balint Group-like meetings, to develop targeted psychosocial and clinical interventions addressing the medical, psychological and social needs of workers, also involving advocacy and fostering workers’ empowerment.

2015 - Psychiatric consultations in pre-orthoptic liver transplantation patients with substance use disorders: focus on timing of cessation and referral and retention by community service [Abstract in Rivista]
Reggianini, Corinna; Moscara, Maria; Ferrari, Silvia; Laghi, A; Mattei, Giorgio; Piemonte, Chiara; Rigatelli, Marco; Galeazzi, Gian Maria
abstract

Introduction: In Italy, 6 months of abstinence from alcohol/substances are required before OLT, evidence for this recommendation remaining controversial. No standard approach linking abstinence duration at the index psychiatric pre-OLT evaluation to referral to Community Services is followed. Aims: To report data of the Modena Consultation-Liaison Psychiatric Service (MCLPS) for pre-OLT patients with Substance Use Disorders (SUDs), and to evaluate patients’ concordance with referrals. Methods: Case-control study. Data source: database of MCLPS. Psychiatric evaluations pre-OLT from 01/01/2008 to 31/12/2013 were extracted. Patients were controls if they had a SUD and abstinent for more than 6 months; cases if they had a SUD with less than 6 months of abstinence. Chi-squared analysis was performed with STATA 13.0. Results: 515 consultations were requested for 309 pre-OLT patients, 36.3% (N=112) of patients had a current or past SUD. Controls were 80 (71.3%), while cases - who had stopped use less than 6 months before the consultation, or were still using- were 20 (17.9%). 52.5% of controls (N=42) and 85.0% of cases (N=17) were referred to community services (Chi 5.71; p=0.02). 70.0% of cases (N=14) and 33.6% of controls (N=27) were seen at least twice (Chi 7.22; p=0.01). 16.7% (N=2) of cases and 23.5 % (N=4) of controls referred to community services reported concordance with Consultant’s recommendation at reassessment, a non-significant difference with cases (Chi 0.00; p=1.00). Conclusions: Consistently with previously research in this field, no difference of concordance with recommendations emerged between patients with SUD with different duration of abstinence.

2015 - Ripensare la pratica psichiatrica: riflessioni sul ruolo della psichiatria nella società moderna [Shall psychiatry change its target? Reflections on the evolving role of psychiatry] [Articolo su rivista]
Pinna, F; Del Vecchio, V; Luciano, M; Sampogna, G; De Rosa, C; Ferrari, Silvia; Pingani, Luca; Tarricone, I; Volpe, U; Carrà, G; Roncone, R; Catapano, F; Fiorillo, A.
abstract

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.

2015 - Somatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry? [Articolo su rivista]
Ferrari, Silvia; Burian, R.; Hahn, E.; Chaudhry, N.; Chaudhry, I. B.; Husain, N.; Ta, T. M. T.; Diefenbacher, A.; Qureshi, A.; Berardi, D.; Braca, M.; Tarricone, I.
abstract

The article describes the reasons why psychiatrists working in the field of consultation-liaison should be trained and aware of the relevance of culture in their everyday work. Moreover, the article aims at advertising the special-interest group on cultural CLP, a network of clinicians and researchers within the European Association of Psychosomatic Medicine that share their interest and activities in this subject.

2015 - Tako-Tsubo cardiomyopathy and psychiatric disorders: Review of comorbidity [Abstract in Rivista]
Rioli, Giulia; Galeazzi, Gian Maria; Ferrari, Silvia; Rigatelli, Marco
abstract

Background: In recent times, the connections between mental health and cardiac outcomes have been under increasing investigation. Tako-Tsubo Cardiomyopathy (TTC) is also called “broken heart syndrome”, since it has been described to occur after emotionally stressful events; it presents as an acute reversible coronary syndrome due to a transient failure of the left ventricle, in the absence of obstructive coronary heart disease. It has a 10-timehigher prevalence in postmenopausal women and may have a strong correlation with biopsycho- social stress. Aim: To review existing studies on TTC in comorbidity with psychiatric disorders. Method: Four PubMed literature searches performed during January 2015 (search terms: tako-tsubo AND psy*; tako-tsubo AND anxiety; tako-tsubo AND depression; tako-tsubo AND mania) provided 9 references: 4 case reports, 2 reviews, 2 prospective studies and 1 case–control study. Results: Not only chronic psychological stress (present in 2/3 of these patients, on average), but also a high co-occurrence of anxiety and depression (from 50 to 70% of patients with this cardiopathy), panic attacks (diagnosed in almost 20% of women with tako-tsubo), subthreshold and full-blown PTSD (co-morbid in almost 40% of patients according to a 2-year prospective study) were associated with TTC. It has been suggested that changes in circulating levels of catecholamines combined to heart's abnormal response to these hormones could be at the pathophysiological basis for such associations. Conclusion: The present literature review confirms a high cooccurrence of comorbid conditions with increased sympathetic activity (in particular anxiety, depression and panic disorder), which could be risk factors for TTC. More studies, especially longitudinal ones, are needed to better clarify the causative pathways of this usually reversible, but potentially lethal, syndrome, especially among post-menopausal women.

2015 - The HD project" - biomarkers of depression in HIV newly diagnosed patients [Abstract in Rivista]
Ferrari, Silvia; Menozzi, Marianna; Alboni, Silvia; Miselli, Manuela; Rigatelli, Marco; Ghidoni, Andrea
abstract

Background: Inflammatory mediators may be relevant to explain the frequent comorbidity between depression, neurocognitive disorders and HIV. HIV induces activation of inflammatory mediators, mainly cytokines, that have been involved in the onset of depression and response to antidepressant treatment. Aim: To identify recurring profiles of inflammatory biomarkers subtending depression, effectiveness of antidepressants and neurocognitive disorders among HIV-infected individuals. Method: All adult newly HIV-diagnosed out-patients attending HIV clinics in three towns of Northern Italy will be screened, assessed for depression and studied immunologically and for neurocognitive disorders. The study-specific set of immune biomarkers will consist of: IL-1β and α, IL-6, IL-23, IL-18, IFN-γ, TNFα, MCP1, IL-8, BDNF, FGF-8, CNTF; IL1Ra, IL18Rα type II, IL18Rβ short, IL18BP. Results: 17 patients have been enrolled so far: of these, 6 (35%) were positive to PHQ-9 screening. Three of the 6 PHQ-9-positive patients were positive to the diagnostic assessment for depression. No neurocognitive disorders were found among the 17 patients. As the project will develop, it is expected that frequency of depression, neurocognitive disorders and effective antidepressant treatment will be found to correlate to the profile of immune biomarkers. These findings might help to understand the etiology of depression in HIV, and specifically the role of inflammation and immunological changes.

2015 - The impact on mental health of the economic recession in the district of Sassuolo (Modena): opinions of local occupational physicians. [Abstract in Rivista]
Mattei, Giorgio; Urraci, Gm; Ferrari, Silvia; Galeazzi, Gian Maria; Rigatelli, Marco
abstract

INTRODUCTION The recent economic recession and the subsequent strategy of austerity have deceased the amount of resources devoted to health care. They may also have contributed to the deterioration of the population health. AIM To assess the impact on mental health of the economic recession in the district of Sassuolo (Modena), by collecting and analyzing opinions of local Occupational Physicians. METHODS Qualitative survey, by focus groups, conducted in Sassuolo (Modena), industrial center of ceramics, involving 8 Occupational Physicians active in the area. Rough descriptions analyzed independently by GU and GM using MAXQDA, with the independent supervision of a third researcher (SF), according to the principles of the General Grounded Theory. The second focus group was intendened as respondent validation of the first, yet it gathered further data, up to theortical saturation. RESULTS Two focus groups, about one hour long, attended by 8 Occupational Physicians, 7 during the first focus group, 4 during the second (of these, 3 attending both focus groups). The coding process yielded 261 segments, divided into four main areas: "changes in contemporary world" (16 coded segments), "social area" (82 coded segments), "medical area" (94 coded segments), "working area" (69 coded segments). CONCLUSIONS The impact of the economic crisis on health produced mainly negative consequences, locally, consistently with national data. Psychiatrists should work together with Occupational Physicians to develop targeted interventions, addressing social, political and medical needs. A more structured liaison between Psychiatry and Occupational Medicine is an interesting and useful tool for future action and advocacy.

2015 - The “revolving door phenomenon” in an acute psychiatric ward: a 5-year retrospective analysis. [Abstract in Rivista]
Di Lorenzo R, 2. 3. 6.; Sagona, M; Landi, Giulia; Martire, Lisa; Piemonte, Chiara; Ferrari, Silvia
abstract

Introduction The term 'revolving door (RD) phenomenon” was coined to define recurrent hospitalizations of chronically ill patients after closure of psychiatric hospitals and implementation of community treatments. Objectives Continued readmissions require a large portion of Mental Health Departments’ resources. Aims To analyze the RD phenomenon in an acute psychiatric ward during a 5-year period. Methods We retrospectively selected all patients with 3 or more hospitalizations per year from 01/01/ 2009 to 31/12/2013 in SPDC-Modena Centro. From their medical records we collected selected variables, potential predictors of RD phenomenon. Data were statistically analyzed. Results In the 5-year period, a sample of 105 patients (47 females, 58 males) with an average age of 40.25 years (± 13.47 SD), 5.68 % of all inpatients (n = 1850), realized 778 hospitalizations, 23.94 % of all admissions (n=3250). The most frequent reason for admission was 'worsening of psychiatric symptomatology" (55.27%). The most frequent diagnoses at discharge were 'Schizophrenia” (41.26%) and 'Personality Disorders” (25.32%). Most of RD patients (87%) were Italian, only 15 % were employed and 50 % lived with family. The mean duration of RD hospitalizations (12.23 days ± 18.37 SD) was statistically significantly different from all others in the 5-year period (10.39 days ± 11.09 SD, p=0.0008, t test) as was the frequency of compulsory admissions (RD hospitalizations 18% vs. 26% all others, chi2, p<0.001). Conclusions Our RD patients represented a small percent of all inpatients but required many and long hospitalizations, probably due to severe and disabling illness.

2015 - Young and burnt? Italian contribution to the international BurnOut Syndrome Study (BOSS) among residents in psychiatry [Articolo su rivista]
Ferrari, Silvia; Cuoghi, Giulia; Mattei, Giorgio; Carra, Elena; Volpe, U; Jovanovic, N; Beezhold, J; Rigatelli, Marco; Galeazzi, Gian Maria; Pingani, Luca
abstract

The Burnout Syndrome (BS) is a common condition among health care professionals, yet data concerning its prevalence and associated factors among psychiatric residents are lacking. Objectives: To report the results of the Italian contribution to "BOSS", an international multicentre research project aiming at estimating the burden of BS among residents in psychiatry, and at identifying factors contributing to its development and prevention. Methods: Cross-sectional study. The BOSS online questionnaire, which collected socio-demographic data and five psychometric tools (MBI-GS, AWLS, PHQ-9, SIBQ, BFI), was administered electronically to 180 Italian residents in psychiatry. Simple and multiple linear regressions were performed to analyse data. Results: 108 questionnaires provided data for the study (response rate: 60%). Mean age: 30.5 +/- 3.7 years. Eighty percent of the sample were female. A moderate level of BS emerged, related to work conditions, absence of major depression, satisfaction with pay or less academic activity. Only 0.9% (N=1) of the sample showed PHQ-9 scores suggestive of major depression, while lifetime suicidal ideation was admitted by 16% of residents. For the three dimensions of the MBIGS, Italian sample scores were consistent with previously published results concerning pooled data in a FrenchCroatian sample, reporting moderate levels of BS. Higher workload, symptoms of depression and lower satisfaction predicted higher levels of Emotional Exhaustion and Cynicism. Conclusions: Italian residents in psychiatry showed overall moderate levels of BS, related to workload and work organization. Other alerts of psychic distress were found among participants, namely symptoms of depression, suicidal ideation and use of psychotropic medications.

2014 - Consultation-liaison psychiatry and the “Women Wellness Project”: analysis of the association between cardiovascular risk factors and psychiatric comorbidity [Abstract in Rivista]
Mattei, Giorgio; Simoni, Elena; Borghi, Ambra; Bursi, S; Capitani, C; Coppi, Francesca; Ferrari, Silvia; Gorlato, Giulia; Pingani, Luca; Rigatelli, Marco; Rossi, Rosario
abstract

INTRODUCTION The Consultation-Liaison Psychiatry Service of the Modena General Hospital collaborates regularly with the Cardiology Clinic, within the Woman Wellness Project (WWP). Aim of this collaboration is detection and prevention of post-menopausal correlated diseases, including psychiatric syndromes. AIM To investigate the association between cardiovascular risk factors (BMI, blood pressure, hyperglycemia, hypertrygliceridemia) and psychiatric symptoms in peri-post menopausal. METHODS Ecological study. Data between January 2008 and December 2012 were collected. Correlations, logistic regessions and categorial regressions were performed with STATA. RESULTS 675 outpatients attended the WWP. 90 (13.3%) were referred to the psychiatrist; 9 refused the examination. Of the remaining 57.7% had a positive psychiatric history and 22.03% already receaved a psychiatric therapy. 40.6% had at least two medical diseases, mainly: overweight (54.2%), hypertension (40.7%) and dyslipidemia (49.1%). After psychiatric consultation emerged that: 11.9% had anxiety symptoms, 27.1% had depressive symptoms and 47.5% presented both anxiety and depressive symptoms. Only 7 patients (11.9%) had a negative psychiatric examination. The regression analysis pointed out no significant association between the cardiometabolic risk-factors and the psychiatric symptomatology. Differently, the outcome at the end of the psychiatric consultation was associated with BMI (r = -.26; p = .05) and heart rate (r = .33; p = .01). CONCLUSIONS Heart rate and BMI emerge as factors associated with the psychiatric symptomatology presented by the patient. This finding is consistent with previous researches. The absence of significant associations at the regression analysis could be explained by the small sample considered in the present study.

2014 - Correlation of articular involvement, skin disfigurement, and unemployment with depressive symptoms in patients with systemic sclerosis: a hospital sample [Articolo su rivista]
Tedeschini, Enrico; Pingani, Luca; Simoni, Elena; Ferrari, D; Giubbarelli, C; Giuggioli, D; Lumetti, F; Rigatelli, Marco; Ferri, Clodoveo; Ferrari, Silvia
abstract

Background: Systemic sclerosis (SSc) is a connective tissue disease associated with increased functional impairment, body image distress due to skin lesions, and psychosocial comorbidity, particularly depression. Prevalence of depressive symptoms in SSc patients ranges from 36% to 65% and it contributes to the worsening of any aspect of the disease. The aim of this study was to investigate the prevalence and clinical and non-clinical correlates of depressive symptoms in a sample of outpatients with SSc. Methods: Seventy-eight consecutive SSc outpatients were recruited from February 2005 to July 2007. Sociodemographic and SSc-related clinical data were collected, including a modified Rodnan Skin Score, the Valentini Disease Activity Index and psycho-metric assessment of disability and pain. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Two questions on perception of support from relatives and impact of disfigurements were also directly addressed to subjects. Results: The BDI mean score was 10.5 ( 8.3), with 36 subjects (46.2%) scoring above clinical significance. Unemployment, increased disability, pain, disease activity and articular involvement were significantly associated with more depressive symptoms. Older age, unemployment and more depressive symptoms were also related with complaints of disfigurements due to skin involvement. Conclusions: Depression is an influential prognostic factor in SSc. The present study contributes to the knowledge of the relationship between depression and clinical features routinely collected in rheumatology settings in order to develop a standardized assessment of psychosocial distress in routine rheumatologic procedures.

2014 - Disturbi psichiatrici in corso di patologie mediche [Capitolo/Saggio]
Giubbarelli, Cinzia; Baraldi, Sara; Rigatelli, Marco; Ferrari, Silvia
abstract

Il capitolo descrive le diverse modalità rilevanti per la clinica con cui la patologia psichiatria può complicare o essere complicata da altre patologie mediche, con particolare riferimento alle forme depressive, al delirium ed alle difficoltà di gestione farmacologica

2014 - Esiste una correlazione fra BMI e SAD nei pazienti dei medici di medicina generale? [Articolo su rivista]
Mattei, Giorgio; Padula, MARIA STELLA; Rioli, Giulia; Sacchetti, Andrea; Bursi, Serena; Simoni, Elena; Arginelli, Lodovico; Bursi, Roberto; Epifani, Antonio; Francesca Rosato, Maria; Ferrari, Silvia
abstract

2014 - Factors associated to complexity of patients evaluated for inclusion in orthotopic liver transplantation: a retrospective study. [Abstract in Rivista]
Piemonte, Chiara; Reggianini, Corinna; Carra, Elena; Ferrari, Silvia
abstract

INTRODUCTION In this retrospective study, the main clinical features of patients waiting for orthotopic liver transplantation (pre-OLTx) assessed at the Consultation-Liaison Psychiatric Service (CLPS) of the Modena General University Hospital were collected and analyzed, with the aim to assist early detection of complex patients. METHODS Relevant information about OLTx patients were extracted from the electronic database of the CLPS. Repeated referral for the same patient was considered as indicator con complexity. RESULTS During five years between 1st of January 2008 and 31st of December 2013, a total of 6011 first psychiatric assessment were performed by the CLPS. Of these, 366 (6.09%) were pre-OLTx assessments. Ninety subject (27.6% of total pre-OLTx assessments) were referred for psychiatric assessment more than once, and precisely: 62.2% twice, 27.8% three times and the remaining 10% more than three times. Main reasons for repeated referral of patients were depression (33 patients, 36,7%) and second evaluation pre-OLTx (35 patients, 38,9%). Repeatedly referred patients had the following features: the majority (56, 62.2%) were male, 61,1% (55) had a lifetime positive psychiatric history, 33.3% (30) were already on psychotropics, but 85.6% (77) were not under regular charge of psychiatric services. Among the 90 patients, a psychiatric disorder was diagnosed in 40 (44.4%) subjects, and the most common was depression/adjustment disorder (37.5%). A psychotropic medication was advised to 42 (46.7%) patients, most commonly antidepressants (42.9%) and benzodiazepines (35.7%). Patients were most commonly back-referred to their GP, but 20 (22.2%) were referred to community mental health care centers or to the CLPS itself. CONCLUSIONS A high number of presumably complex management patients were identified among the group of pre-OLTx, requiring better understanding of factors associated to complexity and need of integrated management.

2014 - First episode psychosis among migrants in Italy (PEP-Ita Study): preliminary results from Modena. [Abstract in Rivista]
Ferrari, Silvia
abstract

Purpose. Literature shows that migrants have a higher incidence of psychotic disorders; post-migratory social adversities and discrimination are considered the main environmental risk factors. A recent study of the Bologna Transcultural Psychiatric Team (BoTPT) suggested that psychotic disorders in migrants may have a peculiar psychopathological configuration, characterized by the prevalence of somatic symptoms over positive and negative symptoms. The aim of the present study is to explore the correlation between environmental risk factors and psychopathology in a sample of migrants with a first-episode psychosis. Methods. Through the PEP-Ita (Primo Episodio Psicotico – Italia) study, an Italian multicentric research project exploring risk factors for first-episode psychosis in a population of first-generation migrants, we recruited 79 patients aged 18-64 between January 2012 and December 2013. Social adversities and perceived discrimination were recorded through the Migration History Questionnaire (MHQ), the Discrimination Interview and the Social Environment Assessment Tool (SEAT). The Association for Methodology and Documentation in Psychiatry (AMDP) system was used to assess the psychopathology: symptoms were pooled into eight psychopathological syndromes (positive, negative, depressive, manic, psychoorganic, obsessive-compulsive, hostility and somatic). T-student test was used to study the correlation between the scores of the eight syndromes and the environmental risk factors. Results. Among the 79 patients currently recruited in the study, 27 have so far agreed and managed to answer our questionnaires. Those patients who recently perceived discrimination in at least three domains of life reported higher scores in the somatic syndromes (2.5±0.7 vs 0.3±0.8, p=0.056), and so did those who perceived an economic deterioration (2.5±1.7 vs 0.4±0.9, p=0.01) and poor quality of work position (2.1±2.9 vs 0.2±0.6, p=0.043) after the migration process. Those who went through economic troubles had higher scores of positive (22±6.5 vs 12.7±7.6, p=0.025) and somatic (3.2±3.3 vs 0.4±1.3, p=0.003) syndromes, while those who reported family adversities after resettlement showed higher scores of hostility syndrome (10.6±3.7 vs 5.9±4.3, p=0.016). Discussion. Despite the small size of the current sample we found that, in migrant patients presenting a first-episode psychosis, the perception of discrimination impacted on the somatic dimension of disease, which in a recent study of ours showed to be the main psychopathological dimension of psychotic disorders in migrants. Also the perception of socioeconomic, work and family-related adversities shaped some of the psychopathological dimensions (positive, hostility) underlying psychotic disorders in migrants.

2014 - First visits of a local mountain psychiatric service. [Abstract in Rivista]
Ferrari, Silvia; Miselli, Manuela
abstract

INTRODUCTION We analyzed the first visits carried out by a local mountain psychiatric service in 9 months from January to September 2013. OBJECTIVES and AIMS Analyze the mode of access to the service, and the continuation of the course of treatment. METHODS Different variables were considered: sex, how to access, the level of urgency, the prescription drug, the previous psychiatric history, duration of taking charge and sending to other facilities of the Mental Health Department. RESULTS The total number of patients was 176, of which 64% were female; scheduled visits were the most (146), the remaining (30) were urgent. The majority (110) were sent from their GPs, among these, more than half (63) are still in load. Half had a positive psychiatric history, and most (92) had a positive psychiatric drug history. It was set to a drug therapy to the majority of patients visited (147), especially anxiolytics (112) and secondarily antidepressants (109). A small part was hospitalized (3) or sent to Psychogeriatrics (11) or Pathological Addictions or Clinical Psychology; about one-third (57) were discharged. CONCLUSIONS According to the literature the women access more frequently than men. From the data it can be inferred that submissions by GPs have become more appropriate in t

2014 - First-episode psychosis and migration in Italy (PEP-Ita migration): a study in the Italian mental health services [Articolo su rivista]
Tarricone, Ilaria; Braca, Mauro; Allegri, Fabio; Barrasso, Giuseppe; Bellomo, Antonello; Berlincioni, Vanna; Carpiniello, Bernardo; Ceregato, Alessio; Conforti Donati, Marco; Defilippi, Samuele; Del Vecchio, Valeria; De Rosa, Corrado; Ferrannini, Luigi; Ferrari, Silvia; Furio, Maria Antonietta; Gramaglia, Carla; La Cascia, Caterina; Luciano, Mario; Mulè, Alice; Nardini, Marcello; Podavini, Francesca; Primavera, Diego; Reggianini, Corinna; Rigatelli, Marco; Todarello, Orlando; Turella, Elena; Ventriglio, Antonio; Zeppegno, Patrizia; Fiorillo, Andrea; Berardi, Domenico
abstract

Background: It has been frequently reported a higher incidence of psychotic disorders in immigrants than in native populations. There is, however, a lack of knowledge about risk factors which may explain this phenomenon. A better understanding of the causes of psychosis among first-generation migrants is highly needed, particularly in Italy, a country with a recent massive migration. Methods/Design: The “Italian study on first-episode psychosis and migration (PEP-Ita)” is a prospective observational study over a two-year period (1 January 2012–31 December 2013) which will be carried out in 11 Italian mental health centres. All participating centres will collect data about all new cases of migrants with first-episode psychosis. The general purpose (“core”) of the PEP-Ita study is to explore the socio-demographic and clinical characteristics, and the pathways to care of a population of first-episode psychosis migrants in Italy. Secondary aims of the study will be: 1) to understand risk and protective factors for the development of psychotic disorders in migrants; 2) to evaluate the correlations between psychopathology of psychotic disorders in migrants and socio-demographic characteristics, migration history, life experiences; 3) to evaluate the clinical and social outcomes of first-episode psychoses in migrants. Discussion: The results of the PEP-Ita study will allow a better understanding of risk factors for psychosis in first-generation migrants in Italy. Moreover, our results will contribute to the development of prevention programmes for psychosis and to the improvement of early intervention treatments for the migrant population in Italy.

2014 - Gli interventi psicosociali con i familiari: dalla teoria alla pratica clinica [Articolo su rivista]
Gibertoni, G; Seidenari, C; Guicciardi, Alessia; Carra, Elena; Brogli, Alice; Stefanetti, S; Pingani, Luca; Ferrari, Silvia
abstract

L'articolo descrive un'esperienza di lavoro psicoeducazionale con familiari di pazienti gravi in carico ad un Centro di Salute Mentale.

2014 - I disturbi da sintomi somatici [Capitolo/Saggio]
Ottolini, Fedra; Giubbarelli, Cinzia; Piemonte, Chiara; Rigatelli, Marco; Ferrari, Silvia
abstract

Il capitolo descrive la nuova versione DSM del capitolo relativo ai pregressi disturbi somatoformi, specificandone le difficoltà diagnostiche

2014 - Modalità di presentazione del disagio psichico nei migranti: accessi in pronto soccorso e comportamenti suicidairi. [Abstract in Atti di Convegno]
Pizzirani, Margherita; Reggianini, Corinna; Bettelli, Margherita; Santunione, Anna Laura; Ferrari, Silvia; Rigatelli, Marco; Silingardi, Enrico; Galliani, Ivan
abstract

Dall'analisi degli accessi al PS dei due ospedali di Modena di italiani e stranieri e il numero di suicidi, gli AA fanno alcune considerazioni sulla difficoltà di individuare un percorso di presa in carico psichiatrica per i pazienti migranti che nel 59% dei casi presentano disturbi apsecifici, suggestivi di somatizzazione.

2014 - Pathways to mental health care in Italy: results from a multicenter study [Articolo su rivista]
U., Volpe; A., Fiorillo; M., Luciano; V., Del Vecchio; C., Palumbo; S., Calò; S., Piras; M., Signorelli; D., Filippo; M., Piselli; P., De Fazio; S., Gotelli; F., Bardicchia; G., Cerveri; Ferrari, Silvia; A., Mulè; M., Ribolsi; G., Sampogna; C., De Rosa; N., Sartorius
abstract

Background and aims: In Italy, the reform of the mental health system in 1978 should have drastically changed the provision of care and pathways of patients seeking to obtain it. The aim of this article is to examine the current pathways to psychiatric care in Italy. Methods: We used a method developed in the World Health Organization international collaborative studies to investigate pathways to care in 15 Italian mental health centers. We recruited 420 patients with a psychiatric illness and explored the care pathways they took to reach to psychiatric services and the delays from the onset of illness to reaching psychiatric care. Results: The majority of patients (33.8%) had direct access to mental health care, whereas the others arrived to a specialist in psychiatry through general hospitals (20.3%), general practitioners (33.0%) or private practitioners (9.8%). The main diagnosis for referral was neurotic disorder (36.6%), followed by affective disorder (35.4%) and psychotic disorder (11.5%). The delay from onset of illness to psychiatric care was greater for patients with psychotic disorders than for those with affective and neurotic disorders. The most frequently prescribed treatments were pharmacotherapy (56%), psychological support (8%), and psychotherapy (7.0%); 15% of the patients received no treatment. Conclusions: Our multicenter study shows that although general practitioners and hospital doctors are still the main referral point for mental health care, a greater proportion of patients are first seen in private settings or directly reach mental health centers, compared to previous surveys conducted in Italy. However, a stronger collaboration of psychiatrists with general practitioners and psychologists is still needed.

2014 - Positive Narrative Group Psychotherapy: the use of traditional fairy tales to enhance psychological well-being and growth [Articolo su rivista]
Ruini, Chiara; Masoni, Licia; Ottolini, Fedra; Ferrari, Silvia
abstract

Background: Oral narrative strategies have rarely been applied in the positive psychology domain. Traditional folk and fairy tales are concerned with several concepts that are now scientifically investigated by research on positive psychology, such as resilience, self-realization, personal growth and meaning in life. The aim of this pilot study was to apply a new narrative approach based on fairy tales (Märchen, tales of magic, rise tales) told, discussed, and written in a group context for the purpose of promoting psychological well-being and growth. Methods: A group intervention consisting of 7 sessions was delivered to 21 women who reported adjustment disorder. The group was conducted by a folklorist and a clinical psychologist. Each session consisted of an introduction to a number of themes recurring in fairy tales as well as references to the social uses of narratives, followed by a discussion with the participants. In two concluding workshops, participants were asked to work as a group to write their own original fairy tale. Assessment pre- and post-intervention was performed with the Ryff Psychological Well-being Scale, the Kellner Symptom Questionnaire and 2 subscales of the Posttraumatic Growth Inventory (Appreciation of Life and personal strengths). Results: Participants reported increased personal growth, self-acceptance, and an enhanced sense of appreciation of life and personal strengths, together with decreased levels of anxiety. Conclusions: This pilot investigation suggests the feasibility and positive effect of a group intervention based on narrative strategies for promoting well-being and growth in stressed women. Considering its promising results, clinical implications and possible further applications are discussed.

2014 - Progress with the INTERMED Self-Assessment (IMSA) Study: from European to international. [Abstract in Rivista]
Frankel, S; Bourgeois, J; Ghidoni, Andrea; Piemonte, Chiara; Paderni, S; Ferrari, Silvia
abstract

Background: “Complex” patients have one or more chronic medical illnesses and psychiatric/substance use comorbidity. They account for 50% of all health service use. The INTERMED method (INTERMED Complexity Assessment Grid – IMCAG) and its self-assessment version (IMSA) were developed to identify patients with multiple care risks/needs and negative health outcomes in order to support their integrated care. A multicentric research project is ongoing within the INTERMED working group of the EAPM, to test the IMSA's predictive validity, reliability and feasibility in research and clinical practice. Collaboration with the “360 Positive Care” HIV Clinic at the University of California, San Francisco was started, for inclusion as a research site. Objective: To provide an update on the progress of the IMSA study (IMSAS) about stage of involvement of research sites and preliminary results. Method: Features of recruiting sites, including ongoing preparation to enter the IMSAS (particularly the training on the use of IMCAG), stage of enrollment and problems encountered will be outlined. Also in view of its probable inclusion, the San Francisco research site will be discussed in some detail. Preliminary data on the subjects already assessed will be presented. Results: Research data on 454 patients enrolled at the sites of Modena, Amsterdam, Sion, Lausanne and Freiburg are already available, with 6-month follow-up data for 289 subjects (63.7%), as well as data from patients consenting to more informative clinical analyses. Preliminary analysis of 100% of the patients completing follow-up in Modena confirmed that the IMSA score positively correlates with indicators of complexity at follow-up. Additional resources have been developed at the San Francisco site for work with this patient population including a textbook authored by the presenters of this workshop describing a similar method for addressing problematic, high complexity cases (the MPCP method). Conclusions: According to our preliminary findings, the identification and management of clinical complexity associated with co-morbid systemic medical-psychiatric disorders, appears instrumental for providing effective and cost-effective care. The use of the INTERMED Complexity Assessment Grid ( IMCAG) and its self-assessment version (IMSA) appears both reliable and feasible for use in research and clinical practice.

2014 - Psichiatria di liaison [Capitolo/Saggio]
Simoni, Elena; Ferrari, Silvia; Rigatelli, Marco
abstract

Il capitolo descrive la storia, le funzioni, le modalità operative attuali della psichiatria di consultazione e collegamento, branca della psichiatria dedicata in particolare alla gestione della comorbilità medico-psichiatrica ed alla patologia psicosomatica

2014 - Short-term effects of the 2008 Great Recession on the health of the Italian population: an ecological study [Articolo su rivista]
Mattei, Giorgio; Ferrari, Silvia; Pingani, Luca; Rigatelli, Marco
abstract

Purpose To report on the effects on health that the 2008 Great Recession is producing in Italy, by comparing the consistency of Italian data with general observations reported in the scientific literature, and by pointing out consequences on the rates of all-cause mortality, cardiovascular mortality, male suicidal behaviours, daytime alcohol drinking and traffic fatalities. Methods This is an ecological study in which MEDLINE, PsycINFO and PubMed were searched for the literature with combinations of the following keywords: economic recession, financial crisis, unemployment, health, suicide and mental health. Data from two Italian government agencies (Italian Institute of Statistics, ISTAT, and Italian Agency of Drugs, AIFA) in the years from 2000 to 2010 were obtained and analysed, by producing models of multiple linear regressions. Results After the recession onset, all-cause mortality remained stable, and was not associated with the economic fluctuations. Differently, cardiovascular mortality was associated with the rate of unemployment, and showed a significant increase in 2010. Alcohol consumption increased in 2009, the year with the worst real GDP decrease (-5.1 %). Though the total rate of suicide was not associated with the economic situation, male completed and attempted suicides due to financial crisis were significantly associated with the rate of unemployment and the real GDP. The increasing diffusion of antidepressants was not associated with a lowering of the rate of suicide. Conclusions The data on the Italian situation here discussed are sufficiently reliable to conclude that a link exists between the ongoing economic recession and health and mental health of Italians. Further research is needed to understand more in detail and with stronger reliability such link, to support primary and secondary preventive interventions and orient the development of effective sociopolitical interventions.

2014 - Taglia e cuci: la chirurgia estetica tra identità e vanità [Capitolo/Saggio]
Pighi, Marcella; Moretti, Valentina; Ferrari, Silvia; Simoni, Elena
abstract

Il capitolo descrive il complesso rapporto tra psicopatologia e richiesta di interventi di chirurgia estetica

2014 - Vertigo "In the Pink": The Impact of Female Gender on Psychiatric-Psychosomatic Comorbidity in Benign Paroxysmal Positional Vertigo Patients [Articolo su rivista]
Ferrari, Silvia; Monzani, Daniele; Baraldi, S; Simoni, E; Prati, G; Forghieri, M; Rigatelli, Marco; Genovese, Elisabetta; Pingani, Luca
abstract

BACKGROUND: Comorbidity between vestibular and psychiatric disorders in predisposed individuals is underestimated, untreated, and may result in chronicization and poor quality of life. There are few studies concerning the type and the prevalence of psychiatric-psychosomatic distress in patients with benign paroxysmal positional vertigo (BPPV). OBJECTIVE: The aim of this study was to evaluate psychiatric-psychosomatic comorbidities, in particular anxiety, depression, somatization symptoms, and alexithymia, in a group of BPPV patients compared with healthy subjects, and according to gender. METHODS: Case-control study comparing 92 BPPV patients recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010, and 141 healthy controls. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI), and Toronto Alexithymia Scale (TAS-20) were used to perform psychometric assessment. RESULTS: BPPV patients scored higher than controls, with statistical significance, at BDI, BSI somatization, anxiety, and phobic anxiety subscales, and STAI state anxiety; a larger proportion of BPPV patients suffered from clinically significant BDI depressive symptomatology; DCPR disease phobia, functional somatic symptoms secondary to a psychiatric disorder, and demoralization were more common among BPPV subjects. High levels of symptomatology were still found among BPPV female patients, but not among males, even after controlling for symptom severity. CONCLUSIONS: Affective symptomatology, such as depression, demoralization, phobia and anxiety, and somatization, were significantly prevalent in BPPV patients, and female gender may be a predisposing factor.

2014 - Why medical students choose psychiatry - a 20 country cross-sectional survey [Articolo su rivista]
Farooq, Kitty; Lydall, Gregory J; Malik, Amit; Ndetei, David M; Bhugra, Dinesh; Isosccip, Group; Ferrari, Silvia
abstract

Recruitment to psychiatry is insufficient to meet projected mental health service needs world-wide. We report on the career plans of final year medical students from 20 countries, investigating factors identified from the literature which influence psychiatric career choice. Methods: Cross sectional electronic or paper survey. Subjects were final year medical students at 46 medical schools in participating countries. We assessed students' career intentions, motivations, medical school teaching and exposure to psychiatry. We assessed students' attitudes and personality factors. The main outcome measure was likelihood of specializing in psychiatry. Multilevel logistic regression was used to examine the joint effect of factors upon the main outcome. Results: 2198 of 9135 (24%) of students responded (range 4 to 91%) across the countries. Internationally 4.5% of students definitely considered psychiatry as a career (range 1 to 12%). 19% of students (range 0 to 33%) were "quite likely", and 25% were "definitely not" considering psychiatry. Female gender, experience of mental/physical illness, media portrayal of doctors, and positive attitudes to psychiatry, but not personality factors, were associated with choosing psychiatry. Quality of psychiatric placement (correlation coefficient = 0.22, p &lt; 0.001) and number of placements (correlation coefficient = 0.21, p &lt; 0.001) were associated with higher ATP scores. During medical school, experience of psychiatric enrichment activities (special studies modules and university psychiatry clubs), experience of acutely unwell patients and perceived clinical responsibility were all associated with choice of psychiatry. Multilevel logistic regression revealed six factors associated with students choosing psychiatry: importance of own vocation, odds ratio (OR) 3.01, 95% Cl 1.61 to 5.91, p &lt; 0.001); interest in psychiatry before medical school, OR 10.8 (5.38 to 21.8, p &lt; 0.001); undertaking a psychiatry special study module, OR 1.45 (1.05 to 2.01, p = 0.03) or elective OR 4.28 (2.87-6.38, p &lt; 0.001); membership of a university psychiatry club, OR 3.25 (2.87 to 6.38, p &lt; 0.001); and exposure to didactic teaching, OR 0.54 (0.40 to 0.72, p &lt; 0.001). Conclusions: We report factors relevant to medical student selection and psychiatry teaching which affect career choice. Addressing these factors may improve recruitment to psychiatry internationally.

2013 - A LITERARY WORKSHOP FOR INCREASING ASSERTIVENESS IN PATIENTS WITH EATING DISORDERS: A RANDOMIZED CONTROLLED TRIAL [Articolo su rivista]
Pingani, Luca; Fulvio, Arnone; Maria Laura, Chierici; Elena De, Bernardis; Sara, Donelli; DEL GIOVANE, Cinzia; Vera, Vinci; Giuliano, Turrini; Rigatelli, Marco; Ferrari, Silvia
abstract

Objectives: To assess the effectiveness of a literary workshop activity for increasing linguistic skills and assertiveness in patients with eating disorders (ED).Methods: Twenty-four patients consequently admitted to the ED In-patient Unit at the Private Clinic “Villa Maria Luigia” (Parma, Northern Italy) were enrolled in the study. Of these, 8 were randomly assigned to treatment and 16 to care as usual (being the difference between treatment and care as usual only represented by the literary workshop activity). The literary workshop consisted in 15 weekly 60-minute group sessions. Linguistic and expressive skills were provided and tested during the sessions. The Rathus Assertiveness Schedule and the Verbal Fluency Test (phonemic and semantic) were administered to all patients at the beginning and at the end of hospitalization. Results: A significant improvement of semantic skills, phonetic skills and assertiveness (p<.01) was registered in the treatment group. A positive correlation was also found between variations of linguistic skills and assertiveness in the treatment group, but not in the control group. Conclusions: Effectiveness of a literary workshop activity within a rehabilitation program for patients suffering from ED was suggested: improved communication and language skills might have a positive and significant impact on patients' levels of assertiveness

2013 - Before and after acceding to A&E departments by migrants: data from a 1-year observation [Abstract in Rivista]
Gazzoletti, E; Reggianini, Corinna; Ferrari, Silvia
abstract

Analisi degli accessi in PS di migranti valutati dal servizio consulenze psichiatriche di Modena

2013 - Cibo ed emozioni: falsi miti o strumento clinico? [Abstract in Rivista]
Cameli, Michela; Ferrari, Silvia; N., Colombini; Rigatelli, Marco
abstract

Stefania ha 29 anni. Orfana di padre, che soffriva di anoressia nervosa ed è deceduto prematuramente per infarto del miocardio, vive con la madre, che è invece affetta da una grave patologia renale in terapia dialitica 3 volte alla settimana. Si definisce una “bimba grassottella e serena” fino alla prima adolescenza: inizia allora ad acquisire uno stile alimentare restrittivo, con importante dimagramento che rende necessari svariati ricoveri in ambiente psichiatrico. Viene posta diagnosi di anoressia nervosa. In Day Hospital, dove è giunta per un intervento riabilitativo di reinserimento socio-lavorativo, presenta sin dall’inizio uno stile alimentare irregolare e disordinato, estremamente restrittivo da un punto di vista quantitativo ma non qualitativo: tende a saltare i pasti, salvo poi prediligere il consumo di cibi grassi durante le occasioni sociali. Sono evidenti rituali ossessivi di organizzazione dei pasti, su cui è imperniata tutta la sua vita. Estremamente seduttiva nelle relazioni con medici e pazienti, non abbandona neanche dopo mesi le sue abitudini alimentari, non riesce a raggiungere il peso auspicato e non elabora progetti lavorativi di nessun tipo. Anna ha invece 30 anni. Alta, magrissima, bella ragazza alla moda, lavora come commessa ma sogna di diventare una cantante famosa. La sua storia clinica è caratterizzata dal presentarsi e ripresentarsi di sintomi somatici vari, per i quali si sottopone a svariati accertamenti e terapie, tra cui: eritema nodoso; dermatite simil-psoriasica al cuoio capelluto ed acne; disturbi della fonazione; irregolarità mestruali con addominalgie; ed in particolare disturbi intestinali con alvo prevalentemente e marcatamente diarroico. In relazione a quest’ultima sintomatologia, molto invalidante, ed anche con riferimento alla presunta origine allergica dei sintomi cutanei, si sottopone a svariati regimi dietetici, che segue in modo rigido per un certo periodo e che poi abbandona, tornando ad uno stile alimentare irregolare e caotico, che la fa sentire in colpa proprio perché irregolare. Situazione familiare di grande invischiamento, madre ipercontrollante e svalutante, padre assente e inaffidabile. Figlia unica. Il cibo ha un’enorme importanza fisica e simbolica per l’essere umano. Indispensabile per la sopravvivenza, diventa un elemento anche metaforico di benessere ed equilibrio bio-psico-sociale. I due casi clinici presentati forniranno l’opportunità di riflettere sulle potenziali funzioni di prevenzione e terapia che interventi basati sull’alimentazione (psicoeducazione, riabilitazione tramite attività culinaria…) possono avere rispetto al disagio psichico.

2013 - Clinica medica per lo psichiatra [Monografia/Trattato scientifico]
A., Fiorillo; C., De Rosa; Ferrari, Silvia
abstract

Questo volume si propone come uno strumento di lavoro quotidiano per lo psichiatra del nuovo millennio, che non può più permettersi di considerarsi meno medico degli altri medici e che deve sviluppare e mantenere competenze multidisciplinari, pur in equilibrio con le sue competenze specifiche. L’iniziativa editoriale, promossa, sviluppata e curata dal Coordinamento nazionale dei Giovani Psichiatri della Società Italiana di Psichiatria, mira a produrre una guida pratica, essenziale, di facile consultazione, attendibile ed aggiornata, a cui lo psichiatra possa far riferimento nella sua quotidianità lavorativa.

2013 - Disturbi del comportamento alimentare in pazienti uomini trattati presso un servizio di Day Hospital in Psichiatria [Abstract in Rivista]
M., Moscara; Bolondi, Marisa; Cuoghi, Giulia; Cameli, Michela; Miselli, Manuela; Visentini, Chiara; Ferrari, Silvia; Rigatelli, Marco
abstract

DCA in soggetti maschi

2013 - Eating disorders in male patients: medical and psychiatric co-morbidity [Abstract in Rivista]
Moscara, Maria; Bolondi, Marisa; Cuoghi, Giulia; Cameli, Michela; Miselli, Manuela; Visentini, Chiara; Ferrari, Silvia; Rigatelli, Marco; Mattei, Giorgio
abstract

ntroduction Men make up approximately 10% of the diagnoses of specified Eating Disorders (ED), with Bulimia Nervosa more common in men than Anorexia. However, Eating Disorder Not Otherwise Specified (EDNOS) are more prevalent in men than Anorexia and Bulimia combined. Rates of concurrent depression and personality disorders are also high in men with EDNOS, as well as rates of medical co-morbidity. Objectives To describe a sample of male patients attending a Psychiatric Day Hospital. Aims To understand possible links between the diagnosis of ED and medical and psychiatric co-morbidity among male subjects. Methods Clinical data about male patients attending the Psychiatric Day Hospital of Modena from 05/01/2009 to 13/06/2012 were collected and analyzed. Psychiatric diagnoses were defined according to DSM IV criteria, medical comorbidities according to ICD10 criteria. Results Male patients with ED were on the whole 11 (7.9% of total patients). Nine of them (81.8%) were diagnosed with EDNOS; 7 had medical co-morbidity, namely gastrointestinal (36.4%), respiratory (9.1%), renal (9.1%), rheumatologic (18.2%), cardiac (9.1%) and hypertension (16.6%); 9 had psychiatric co-morbidity, namely personality disorders (46.2%), major depression (30.8%), substance abuse (15.4%) and anxiety disorders (7.7%). Only 1 male patient (9.1%) was suffering from the ED, with no medical or psychiatric co-morbidity. Conclusions Male patients suffering from ED are increasing and knowledge on their clinical features are less clear than for female subjects, resulting in a more difficult and less effective clinical management. Despite the small sample size, this study attempts to increase the understanding of this clinical population.

2013 - Futuro e formazione psicosomatica [Abstract in Rivista]
Ferrari, Silvia
abstract

cosa ci prospetta la psichiatria del futuro e a cosa dobbiamo prepararci

2013 - International Study of Student Career Choice in Psychiatry (ISoSCCiP): results from Modena, Italy [Articolo su rivista]
Ferrari, Silvia; Reggianini, Corinna; Mattei, Giorgio; Rigatelli, Marco; Pingani, Luca; Bhugra, D.
abstract

Italy was one of the 16 countries to take part in the International Study of Student Career Choice in Psychiatry (ISoSCCiP). This paper reports and comments on the IsoSCCiP data on Italian medical students. Italian fi nal year medical students from the University of Modena and Reggio Emilia were asked to fi ll in an on-line questionnaire during the fi rst semester of two consecutive academic years (2009 – 2010, 2010 – 2011). Step-wise logistic regressions were performed. Of the 231 students invited, 106 returned completed questionnaires (response rate 46.7%). Women constituted 66%, and mean age was 25.14 (SD 1.15). Psychiatry was the second most common choice of possible career by students (5.7%, n 6). Choosing psychiatry was predicted by having volunteered for further clinical/research activities in psychiatry (p 0.01), believing that ‘ the problems presented by psychiatric patients are often particularly interesting and challenging ’ (p 0.01), and by accounts of personal/family experience with physical illness (p 0.01). Both personal factors and factors related to training may be involved in the choice of psychiatry among Italian medical students. Cultural and organizational specifi cities of Italian mental healthcare may be involved, particularly the strong tradition of social psychiatry.

2013 - Internet as a tool to estimate psychiatrists’ opinions on consultation activity in the Emergency Room: a mix-method survey [Articolo su rivista]
Mattei, Giorgio; Tedeschini, Enrico; Pingani, Luca; Rigatelli, Marco; Ferrari, Silvia
abstract

OBJECTIVES This study aims at exploring the attitudes of psychiatrists towards their work as consultants in the Emergency Room (ER). Considerations and suggestions concerning the use of Internet-based surveys for research purposes are also offered. METHODS A quali-quantitative Internet survey was sent to 288 psychiatrists. The 11-item questionnaire was made up of 8 half-structured questions, 2 multiple-choice questions and 1 open question. Surveymonkey was used to collect responses. Data collection went on for two weeks, from June 1st until June 15th 2011. Psychiatric consultation activity in the ER deals with assessing and managing patients with mental health problems in the specific context of urgency/emergency. RESULTS Out of the 288 invitations sent by e-mail, 132 questionnaires were returned (response rate: 45.8%); of these, 58 provided useful data for the research since they were answered by psychiatrists who usually practice as consultants in the ER. Fifty-three percent of the responders were women. Mean age was 43.6 years ± 7.4. Forty percent of the consultants said they are called in the ER “more than once a week”, mainly due to “acute clinical failures” (31%), “behavioural emergencies” (22%), “acute clinical onsets” (17%) and “self-harm behaviours” (13.8%). Social emergencies were indicated as a rare cause of consultation (1.7%), yet they were considered particularly challenging by the 36.2% of psychiatrists. A large amount of psychiatric assessments in the ER (69%) led “to prescribe a therapy and send the patient to the mental health community centre”. Some critical aspects were pointed out, such as: “lack of suitable setting” (50.9%) for meeting the patient, a “trend to delegate to the psychiatrist” (45.5%) by the ER personnel, “poor autonomy of the personnel working in the ER” (38.2%), and “poor perceived safety” (30.9%) by the consultant. Yet, it is noticeable that the vast majority of psychiatrists (75.9%) reported that they enjoy their activity as consultants in the ER. CONCLUSIONS The study points out that the majority (75.9%) of psychiatrists like their job as consultants in the ER, even if referrals are not always appropriate and settings sometimes fail to be suitable. Some relevant critical aspects were also addressed that should provide suggestions for improvement of effectiveness, organization and integration within the general hospital, to reduce waste of resources. Internet is useful and feasible as a research tool, due to low costs and easy logistics, particularly when studying younger subjects, though limited external validity might be a problem only partially addressed by adopting mixed-method strategies of research.

2013 - Into the dragon’s belly: the experience of a psychotherapist among the victims of the 2012 Emilia earthquake [Articolo su rivista]
Bertacchini, Eleonora; Masoni, Licia; Ferrari, Silvia
abstract

The telling of the experience of being psychotherapist on the spot in the first days after the Emilia earthquake of 2012

2013 - Miglioramento delle abilità linguistiche e dell'assertività nei disturbi del comportamento alimentare: studio randomizzato controllato di un'attività di laboratorio letterario [Improving linguistic skills and assertiveness in eating disorders: A randomized controlled trial on a literary workshop activity] [Articolo su rivista]
Pingani, Luca; Arnone, F; Chierici, Ml; De Bernardis, E; Donelli, S; Del Giovane, C; Vinci, V; Turrini, G; Rigatelli, Marco; Ferrari, Silvia
abstract

Objectives: To assess the effectiveness of a literary workshop activity for increasing linguistic skills and assertiveness in patients with eating disorders (ED). Methods: Twenty-four patients consequently admitted to the ED in-patient unit at the private clinic "Villa Maria Luigia" (Parma, Northern Italy) were enrolled in the study. Of these, 8 were randomly assigned to treatment and 16 to care as usual (the only difference between treatment and care as usual was the literary workshop activity). The literary workshop consisted in 15 weekly 60-minute group sessions. Linguistic and expressive skills were provided and tested during the sessions. The Rathus Assertiveness Schedule and the Verbal Fluency Test (phonemic and semantic) were administered to all patients at the beginning and end of hospitalization. Results: A significant improvement of semantic skills, phonetic skills and assertiveness (p < 0.01) was registered in the treatment group. A positive correlation was also found between variations of linguistic skills and assertiveness in the treatment group, but not in the control group. Conclusions: The results of this study suggest that a literary workshop activity within a rehabilitation program for patients suffering from ED can aid in improving communication and language skills that might have a positive and significant impact on levels of assertiveness.

2013 - Percezione dell’insicurezza urbana e paura del crimine tra pazienti con disturbi ansiosi e depressione lieve [Abstract in Rivista]
Spattini, Ludovica; Landi, Giulia; Visentini, Chiara; C., De Rosa; A., Fiorillo; Ferrari, Silvia
abstract

resoconto dei dati di Modena

2013 - The use of IM in research: the IM-SA study [Abstract in Rivista]
S., Paderni; Corradini, G. M.; Ghidoni, Andrea; Piemonte, Chiara; A., Gentile; Ferrari, Silvia
abstract

Dati di Modena della multicentrica europea

2013 - Who cares for it? How to provide psychosocial interventions in the community [Articolo su rivista]
Pingani, Luca; Fiorillo, A; Luciano, M; Catellani, S; Vinci, V; Ferrari, Silvia; Rigatelli, Marco
abstract

Background: Since the Mental Health Reform Law 1978/180, in Italy mental hospitals have been progressively closed and a community-centred psychiatric care oriented to rehabilitation began. After almost 35 years, the de-institutionalization process is now complete. However, psychosocial interventions in the community are provided only rarely, although a specific mental health professional, the psychiatric rehabilitation technician, has been established in Italy. Material: Training courses and the education of psychosocial rehabilitation technicians have been analysed and the university degree has been described. Moreover, the practical and theoretical skills needed at the end of the training course have been discussed. Discussion: Psychiatric rehabilitation technicians are trained to perform multidisciplinary rehabilitative and educational interventions for people with severe mental disorders and their carers. They represent an innovative professional workforce in mental health care, not yet established outside Italy, whose role and activities are essential in a communitybased mental health system model. Conclusion: The skills needed for properly performing psychosocial interventions are not available in other mental health professionals and it is not possible that these interventions, which require in-depth training, are performed by professionals with a different background. It is advisable that psychiatric rehabilitation technicians become an integral and permanent component of an efficient community psychiatric staff.

2012 - CL-psychiatry in primary care - the Modena model [Abstract in Rivista]
Ferrari, Silvia; N., Colombini; M., Andreoli; Rigatelli, Marco
abstract

Abstracts of the 20th European Congress of Psychiatry

2012 - Consulenze, certificazioni e problematiche di genere [Relazione in Atti di Convegno]
Ferrari, Silvia; Moretti, Valentina; Pighi, Marcella; A. R., Atti; Martire, Lisa; Tedeschini, Enrico; Rigatelli, Marco
abstract

psichiatria di consultazione, certificazioni, sesso femminile

2012 - Consultation-liaison psychiatry and the "Woman Wellness Project": a model of integrated services for female mental health [Abstract in Rivista]
Simoni, Elena; Baraldi, Sara; Tedeschini, Enrico; Bartolacelli, Ylenia; Giubertoni, Elisa; G., Origliani; Modena, Maria Grazia; Ferrari, Silvia
abstract

wellness, integrated care, females

2012 - Der Hausbesuch in der Pflege des psychiatrischen Patienten [Relazione in Atti di Convegno]
E., Ferri; Ferrari, Silvia; J., Wildner; I., Cacciapuoti; Ferri, Paola
abstract

Vorwort 1978 trat in Italien das Gesetz Nr. 180 in Kraft, dessen Grundprinzipien den Ersatz der psychiatrischen Einrichtungen durch Spezialabteilungen in-nerhalb der allgemeinen Krankenhäuser, die Integration der psychiatrischen Gesundheitsversorgung in den staatlichen Gesundheitsdienst und die terri-toriale psychiatrische Gesundheitsversorgung sind. Es wurde ein Rehabilita-tionskonzept entwickelt, dessen Fundament auf der Überzeugung beruht, dass der psychisch Kranke seine verlorenen Fähigkeiten und seine familiären und soziale Rollen wiedererlangt Dies erlaubt ihm sich wieder in das ge-meinschaftliche Leben einzufinden. Hintergrund Zahlreiche Studien haben belegt, dass eine lokal orientierte Versorgung mit einer Verbesserungen des Gesundheitszustandes, der Patientenzufrieden-heit und der Kontinuität in der Versorgung und gleichzeitig mit einer Kos-tenminimierung einhergehen. In diesem ganzen Zusammenhang spielt der pflegerische Hausbesuch bei der Genesung des Patienten eine strategi-sche Rolle, indem er ihm erlaubt in der eigenen Wohnung, mit wirklicher Verbundenheit, in gewohnter Umgebung verankert zu bleiben und zwi-schenmenschliche Beziehungen auszubauen. Die Forschungsarbeit von Simpson et al. hat bestätigt, dass ein Programm der häuslichen Versor-gung für Patienten mit ernsten psychischen Störungen, verglichen mit sta-tionärer Betreuung, den Krankenhausaufenthalt stark reduziert hat (80%). Nach Luc Pelletier ermöglicht die professionelle Teamarbeit den Klienten koordinierte Leistungen zu erhalten, die ihnen erlauben in ihrem geschätz-ten, familiären, häuslichen Umfeld aktiv und angemessen weiterzuleben. Ziele Die Ziele dieser Studie waren: - Analyse der Aktivitäten bei den Hausbesuchen der Gesundheits- und KrankenpflegerInnen der territorialen Zentren für psychische Gesund-heit (CSM) und die Erforschung des Erlebten; - Erprobung eines organisatorischen Modells zur Einführung des pflegeri-schen Hausbesuchs. Methode und Material Studiendesign: Als Studiendesign wurde eibe retrospektive Beobachtungsstudie über die durchgeführten Hausbesuche (diagnostische Auswahlkriterien, Gliederung der Leistungen) und eine qualitative Untersuchung des Erlebens der Mitar-beiter gewählt. Anhand eines Pilotprojektes wurde ein organisatorisches Modell erprobt, das die Bedürfnisse und die Prioritäten des Patienten be-wusster machen soll, mit dem Ziel der Einführung des pflegerischen Hausbe-suchs bei psychiatrischen Patienten. Art der Datensammlung und Durchführung: In der retrospektiven Studie stammten die untersuchten Daten aus dem Informationssystem der CSM der Provinz Modena im Zeitraum vom 1. Januar 2007 bis 31. Dezember 2010. Die qualitative Studie erfolgte durch ein semi-strukturiertes Interview mit den Gesundheits- und KrankenpflegerInnen der CSM. Zur Durchführung des Pilotprojekts (im Zweijahreszeitraum 2009-2011) benutzten wir die Skala, Camberwell Assessment of Need“ zur Bedürfnisermittlung, zur Einbeziehung des Patienten in das Pflegeprojekt und zur Effizienzbewertung der Hausbesuche. Es wurden 80 an Psychosen erkrankte Patienten in die Studie aufgenommen. Die Ergebnisse waren die Verbesserung der Lebensqualität der Patienten hinsichtlich einer Reduzie-rung von Zahl und Länge der stationären Aufenthalte, der Zwangseinwei-sungen und der Therapieabbrüche. Ergebnisse und Schlussfolgerung: Es gab eine signifikante Heterogenität in den Zielen und Art der Durchfüh-rung der Hausbesuche zwischen den CSM, wahrscheinlich aufgrund der unterschiedlichen Arbeitsweisen der Teams. Hinsichtlich der Hausbesuche berichteten die Gesundheits- und KrankenpflegerInnen in der qualitativen Studie von folgenden kritischen Elementen: - das Alleingelassensein der Gesundheits- und KrankenpflegerIn beim Management der Hausbesuche - die Komplexität der Pflege im häuslichen Bereich - das starke Eintauchen in das Krankheitsbild des Patienten - die ungenügende theoretische und praktische

2012 - From Modena to Norwich: a medical student journey through systems of psychiatry [Abstract in Rivista]
L., Spattini; Ferrari, Silvia; J., Beezhold
abstract

training, psychiatry

2012 - How does economic recession in Italy affect the health of Italian people? [Abstract in Rivista]
Mattei, Giorgio; Ferrari, Silvia; Rigatelli, Marco
abstract

Abstracts of the 20th European Congress of Psychiatry

2012 - How would you have chosen to study psychiatry? Traditional didactic vs. interactive education - a journey from Modena to Norwich [Abstract in Rivista]
L., Spattini; Ferrari, Silvia; J., Beezhold
abstract

training,psychiatry

2012 - Integrazione tra psichiatria adulti e psicogeriatria: non è un paese per vecchi? [Abstract in Rivista]
Neri, Mirco; Neviani, Francesca; M., Mannina; Ferrari, Silvia
abstract

come e perchè sia possibile il dialogo tra psichiatri e geriatri nella gestione clinica di situazioni di confine

2012 - MUPS in the general hospital: outcomes of psychiatric consultations over 10 years of activity [Abstract in Rivista]
Ferrari, Silvia; Martire, L; Rigatelli, Marco
abstract

Not available

2012 - Mental illness and mass media: review of the literature since 1950 up to date [Abstract in Rivista]
Pingani, Luca; Vinci, V; Colavito, Mg; Rigatelli, Marco; Ferrari, Silvia
abstract

Introduction and aims: Mass media have become the main source of information on mental illness. In recent years, numerous studies documented a relationship between a stigmatizing presentation of psychiatric disorders and negative perception of mental illness by general population. This paper aims at analyzing how mental illness is described in scientific articles published by journals and magazines and delineating the average portrait of a psychiatric patient offered by media to the general population. Methods: Scientific articles published from 1957 until August 2010 were reviewed, collecting positive and negative expressions commonly associated to mental illness; a qualitative assessment method of these was then applied. Results: Negative descriptions of mental illness resulted by far more common than positive ones; generally, the tone and the negative attitude that describes mental illness are in the titles and in short articles, often sensational and dramatic, put on the front page, referring to stories of crime and danger. The titles are often inconsistent with the contents of the article. Moreover, there is a discriminatory and derogative language or a language of derision or pity. If there are positive descriptions, they are associated with the involvement of mental health experts, the active role of the psychiatric patient in the mass media or the effect produced by anti-stigma campaigns towards journalists. Conclusions: Although negative and stigmatizing depictions predominate, there are still opportunities for improving media reporting of mental illness, which should be taken up in future media strategies.

2012 - Migrants presenting with suicidal behaviours at the A&E department in Modena [Abstract in Rivista]
Ferrari, Silvia; Martire, L; Pizzirani, M; Reggianini, C; Rigatelli, Marco; Santunione, Anna Laura
abstract

Not available

2012 - Opinions of general hospital ward staff on a consultation-liaison psychiatry service [Abstract in Rivista]
Ferrari, Silvia; Catellani, S; Pingani, Luca; Rigatelli, Marco; Simoni, E.
abstract

Objective: Consultation-Liaison Psychiatry is the application area of psychiatry dealing with psychosocially distressed patients in nonpsychiatric health care settings and providing integration of the psychosomatic and bio-psycho-social theories with clinical practice. The overcoming of sectorialization in contemporary medical care through the establishment of effective collaboration is its main theoretical framework. This study collects evaluations of doctors and charge nurses working in non-psychiatric wards of the Modena General Hospital, about the Psychiatric and Psychosomatic Consultation Service (PPCS). Method: 330 health professionals (medical doctors and charge nurses) were contacted by e-mail or in person, and required to compile an anonymous questionnaire over a two-week period, in June 2009. Results: 109/330 (33.03%) responded to the questionnaire, of these the vast majority (n=95, 87.20%) were medical doctors. The majority of respondents (84.39%) estimated a range of frequency of psychiatric referrals between 1 and 24% of their patients. The most frequent reasons for referrals were suspected depression (60.55%) or anxiety (53.21%). The PPCS intervention was rated as “very useful" particularly for psychopharmacotherapeutic advice (84.40%), to improve communication with patients and relatives (73.39 and 39.45% res-pectively) and to facilitate after-discharge care (33.94%). Half of the sample also recognized an improvement of their own knowledge and skills in the management of mentally ill patients. Conclusion: TheModena PPCS is perceived as effective and useful by its users. It is relevant to assess opinions of consultees and ward staff on Consultation and Liaison activities, to better focus clinical and training interventions as well as to improve organisational procedures.

2012 - Predictors of dropout from in-patient treatment of eating disorders: an italian experience [Articolo su rivista]
Pingani, Luca; Catellani, S; Arnone, F; De Bernardis, E; Ziosi, G; Turrini, G; Rigatelli, Marco; Ferrari, Silvia
abstract

Introduction. The aim of the study was to examine possible risk factors for dropout from in-patient treatment for eating disorders (ED). Materials and methods. The present study consisted in a retrospective analysis of clinical and non-clinical available information about 186 patients suffering from ED consecutively admitted into the Villa Maria Luigia Private Hospital (Parma, Italy) in the a three-year period between (01/01/2006- and 31/12/2009). Socio-demographics, clinical history and current features, and results to the following psychometric instruments were analysed: Eating Disorder Questionnaire (EDQDA), Predisposing, On-set and Maintaining risk factors list for Eating Disorders, Eating Disorders Inventory-II, Body Uneasiness Test and SCL-90. Results. Of the 186 patients, 46 (24.7%) voluntarily left the treatment program prematurely. Predictive factors included poor educational and professional achievements, parents’ divorcing, parents’ history of substance abuse and difficulties in interpersonal relationships. Discussion. Dropout is a multifactorial phenomenon with deep clinical consequences: the recognition of possible risk factors may support the choice of specific therapeutic strategies to improve the treatment of ED and its outcomes.

2012 - Preliminary data on INTERMED self-assessment (IMSA) predictive validity [Abstract in Rivista]
Ghidoni, Andrea; F. J., Huyse; F., Stiefel; Zdrojewski, C; B., Wild; Ferrari, Silvia
abstract

complexity assessment

2012 - Prevenzione dei disturbi mentali attraverso il collegamento con l’ospedale generale [Abstract in Rivista]
Ferrari, Silvia; Martire, Lisa; Ghidoni, Andrea; Rigatelli, Marco
abstract

Descrizione di come l'attività di liaison nell'ospedale generale possa prevenire la comorbilità medico-psichiatrica

2012 - Psychiatric comorbidity in benign paroxymal positional vertigo patients: a case-controlled study [Abstract in Rivista]
Baraldi, Sara; Simoni, Elena; Prati, G; Pingani, Luca; Monzani, Daniele; Ferrari, Silvia
abstract

Introduction: Vestibular disorders can trigger the onset of psychiatric disorders in predisposed individuals: these comorbidities are often underestimated, untreated and may consequently result in chronicization and poor quality of life. There are still few studies concerning the type and the prevalence of psychiatric disorders in patients with benign paroxysmal positional vertigo (BPPV). Aim: To evaluate psychiatric comorbidities, in particular anxiety, depression, somatisation disorder and alexithymia in a group of BPPV, patients compared to healthy subjects. Methods: Case-control study. We compared for psychiatric morbidity 92 BPPV patients and 141 controls (not suffering from BPPV) recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010. Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI) and Toronto Alexithymia Scale (TAS-20) were used to assess psychiatric symptoms. Results: BDI and STAI scores, BSI subscales for somatization, anxiety and phobic anxiety, DPCR subscales for disease phobia, functional somatic symptoms secondary to a psychiatric disorder and demoralization were significantly different between patients and controls. Conversely, significant differences between the two groups were not found for alexithymia scores. Conclusions: Affective disorders, such as depression, demoralization, phobia and anxiety, and somatisation appeared to be significantly prevalent in BPPV patients. Contrary to expectations, alexithymia was not found to be more common in these subjects. Further studies are needed, in order to identify psychiatric sufferings at early stages in this population.

2012 - Psychiatry between politics and ethics: opinions of final-year medical students [Abstract in Rivista]
Mattei, Giorgio; Ferrari, Silvia; Rigatelli, Marco
abstract

Abstracts of the 20th European Congress of Psychiatry

2012 - Quality of training program for early-career psychiatrists in Italy: focus on forensic psichiatry and psychotherapy [Abstract in Rivista]
A. R., Atti; M., Forlani; M., Morri; A., Fiorillo; U., Volpe; C., De Rosa; Ferrari, Silvia
abstract

training for italian residents in psychiatry

2012 - Scoop or stigma? La psicopatologia sui quotidiani dal 1950 a oggi [Abstract in Rivista]
Pingani, Luca; Ferrari, Silvia; Vinci, Vera; S., Catellani; G., Ziosi; Rigatelli, Marco
abstract

Psicopatologia descritta da quotidiani negli ultimi anni in Italia

2012 - Stigma and discrimination toward mental illness: translation and validation of the Italian version of the Attribution Questionnaire-27 (AQ-27-I). [Articolo su rivista]
Pingani, L.; Forghieri, M.; Ferrari, Silvia; Ben Zeev, D.; Artoni, P.; Mazzi, F.; Palmieri, G.; Rigatelli, Marco; Corrigan, P. W.
abstract

The aim of this study was to translate the Attribution Questionnaire-27 (AQ-27) to the Italian language (AQ-27-I), and to examine the reliability and validity of this new Italian version.|The questionnaire was translated using the standard translation/back-translation method. Cronbach's alpha and intraclass coefficients were used to estimate instrument reliability. Confirmatory factor analysis was conducted to corroborate the original English version factor structure in the new measure, and to establish validity. Path analyses were meant to validate relationships found in the English version among Italian-speaking participants.|The AQ-27-I demonstrated acceptable internal consistency, with a Cronbach's alpha of 0.82 for the total scale and ranging between 0.52 and 0.91 for the subscales. The test-retest reliability was also satisfactory, with intraclass correlation coefficients of 0.72 for the total scale and ranging between 0.51 and 0.89 for the subscales. Fit indices of the model supported the factor structure and paths.|The AQ-27-I is a reliable measure to assess stigmatizing attitudes in Italian.

2012 - Suicidal migrants in Modena [Abstract in Rivista]
Reggianini, Corinna; Martire, Lisa; Ferrari, Silvia; Pizzirani, Margherita; Santunione, Anna Laura; Rigatelli, Marco
abstract

Self-harm behaviours, including attempted and complete suicide, have been reported to be common among migrants. Data from our analysis confirm general epidemiologic features of suicide, with complete suicide by hanging more typical among adult males and self-harm behaviours by drug ingestion more typical among youg adult females.

2012 - The Psychiatric-Psychosomatic Consultation Service (PPCS) of Modena: eleven years of experience between clinical, training and research activities [Abstract in Rivista]
Ferrari, Silvia; Martire, L; Rigatelli, Marco
abstract

Not available

2012 - Violence against women and mental health [Articolo su rivista]
Amorosi, M.; Atti, A. R.; Botter, V.; Calo, P.; Clemente, P.; De Ronchi, D.; Ferrari, S.; Iacopini, P.; Lorettu, L.; Orru, G.; Roncone, R.; Zuccolin, M.; Martino, C.
abstract

2011 - Anche i medici sono cittadini [Articolo su rivista]
Ferrari, Silvia; Mattei, Giorgio
abstract

il ruolo politico del medico

2011 - Assessment of quality of life in over-80 patients undergoing cardio-surgery: Is it feasible? [Abstract in Rivista]
G., Pontoni; Ferrari, Silvia; D., Gabbieri; I., Pedulli; D., Gambetti; I., Ghidoni; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - Attendance at a Primary Care Clinic: pattern of use over time and related psychiatric morbidity [Abstract in Rivista]
Ferrari, Silvia; Ascari, A; Andreoli, M; Peggi, M; Rigatelli, Marco
abstract

Not available

2011 - Common mental disorders in migrants in primary care services: an emerging issue for CLP [Abstract in Rivista]
Tarricone, I; Ferrari, Silvia; Marseglia, M; De Gregorio, M; Braca, M; Morri, M; Carchia, G; Menchetti, M; Rigatelli, Marco; Berardi, D.
abstract

Not available

2011 - Economic recession in Italy: a review of short-term effects on health [Abstract in Rivista]
Mattei, G; Ferrari, Silvia; Rigatelli, Marco
abstract

Not available

2011 - Feasibility of assessing quality of life in over-80 patients undergoing cardio-surgery [Abstract in Rivista]
Ferrari, Silvia; Pontoni, G; Gabbieri, D; Gambetti, D; Ghidoni, I; Rigatelli, Marco
abstract

Not available

2011 - Frequent attenders at a primary care clinic: Occasional or regular abusers? [Abstract in Rivista]
A., Ascari; Ferrari, Silvia; M., Andreoli; M., Peggi; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - Home visit in mental health care: the “italian way” [Abstract in Rivista]
Ferrari, Silvia; L., Malavolta; M. R., Laghezzi Ortolani; S., Mimmi; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - How to collaborate with other specialties [Capitolo/Saggio]
Ferrari, Silvia; J., Blum; P., Kelly
abstract

examples of the challenging relationship between psychiatrists and other medical specialties are provided and discusses

2011 - Intermed self-assessment: developing an instrument to evaluate biopsychosocial complexity [Abstract in Rivista]
C., Piemonte; A., Disavoia; Ferrari, Silvia; E., Simoni; F., Huyse; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - La psichiatria di consultazione e collegamento nell’ospedale generale: l’esperienza perugina [Articolo su rivista]
Piselli, M; DE GIORGIO, G; Santilli, C; Sciarma, T; Scarponi, L; Rella, A; Blasi, T; LA FERLA, T; Ferrari, Silvia; Quartesan, R.
abstract

Objective - This study describes the Consultation-Liaison Service of the Perugia University and investigates the significant associations between a many variables of the assessed population. Results - During the time from July 2008 to June 2009, 722 consultations were performed at the general hospital in Perugia. First examinations were 605. Most consultations involved European patients (95,2%) of female gender (56.3%); mean age was 55.77 (SD ± 21.27). Emergencies were 22.5%; one fifth of patients were not informed of having been referred to our service and half of interventions were requested by departments of internal medicine. The primary reasons for the referral were depression (18.6%), unexplained physical symptoms (12.3%) and anxiety (10.4%); most patients were already taking psychotropic medication before our intervention (58.8%).The significant associations are the following: associations between gender and social status (p < 0.01), social condition (p < 0.01), work (p < 0.01) and advice about the need of the consultation (p < 0.05). The area (medical, surgical and specialized area) are related with the advice (p < 0.05), the reason (p < 0.01) and the type of the consultation (p < 0.01), the diagnostic explanations (p < 0.01), the liaison investigations (p < 0.01) and, at last, with the longrange plan after discharge (p < 0.01).

2011 - Migrant pathways to community mental health centres in Italy. [Articolo su rivista]
I., Tarricone; E., Stivanello; Ferrari, Silvia; N., Colombini; E., Bolla; M., Braca; C., Giubbarelli; C., Costantini; S., Cazzamalli; S., Mimmi; D., Tedesco; M., Menchetti; Rigatelli, Marco; E., Maso; M., Balestrieri; S., Vender; D., Berardi
abstract

BACKGROUND: Many studies indicate that migrants in western countries have limited access to and low utilization of community mental health centres (CMHCs) despite the high prevalence of mental disorders. AIMS: We aimed to compare migrant pathways to care across four CMHCs located in different Italian provinces and to identify pathway to care predictors. METHODS: Migrants attending the four CMHCs between 1 July 1999 and 31 December 2007 were included in the study. Data were gathered retrospectively from clinical data sets and chart review. RESULTS: Five hundred and eleven (511) migrants attended the four CMHCs, 61% were referred by GPs or other health services and 39% followed non-medical pathways to care (self-referral or through social and voluntary organizations), with important site variations. Younger age and being married were predictors of medical pathways to care; lacking a residence permit and having a diagnosis of substance abuse were related to non-medical pathways. CONCLUSIONS: Pathways to CMHCs are complex and influenced by many factors. Non-medical pathways to care seem to be frequent among migrants in Italy. More attention should be paid to developing psychiatric consultation liaison models that also encompass the social services and voluntary organizations.

2011 - Predictors of dropout from inpatient treatment for eating disorders [Abstract in Rivista]
S., Catellani; F., Arnone; E., De Bernardis; Ferrari, Silvia; L., Pingani; G., Ziosi; G., Turrini; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - Project “social point”: Partnership of sociality activities of mental health service recipients [Abstract in Rivista]
V., Poggi; R., Ambrosino; M., Ciambellini; Ferrari, Silvia; E., Melati; L., Pingani; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - Quality of life assessment after cardiac surgery in octogenarians: is it really feasible? [Abstract in Rivista]
G., Pontoni; Ferrari, Silvia; D., Gabbieri; M., Pedulli; D., Gambetti; I., Ghidoni; Rigatelli, Marco
abstract

quality of life,heart surgery,elderly

2011 - Severe mental illness is an HIV indicator disease [Abstract in Rivista]
M., Ferrara; G., Solignani; Ferrari, Silvia; Rigatelli, Marco; Guaraldi, Giovanni
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - Una riflessione sul ruolo politico del medico [Articolo su rivista]
Mattei, G; Ferrari, Silvia
abstract

Il medico ha (anche) un ruolo politico, solo in quanto professionista, a prescindere da impegni e convinzioni individuali? L’articolo riflette su questa suggestione, con particolare riferimento alla prospettiva della psichiatria.

2011 - Validation of a web-radio station (“Radio Tab”) run by users of the Reggio Emilia mental health service: A pilot study [Abstract in Rivista]
E., Mazzoni; Ferrari, Silvia; L., Pingani; G., Zanni; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - Vulnerability and diagnosis of psychosis among migrant patients in Modena [Abstract in Rivista]
C., Giubbarelli; Ferrari, Silvia; C., Reggianini; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2011 - “SVAROSKI”: A computerised method of assessment of rehabilitation outcomes [Abstract in Rivista]
A., Gandolfi; F., Arnone; M. L., Chierici; E., De Bernardis; M., De Bernardis; Ferrari, Silvia; A., Mori; L., Pingani; G., Turrini; Rigatelli, Marco
abstract

Abstracts of the 19th European Congress of Psychiatry

2010 - ARE PSYCHOPATHOLOGICAL SYMPTOMS IN PATIENTS WITH DEMENTIA RELATED TO STRESS PERCEPTION IN THE CAREGIVER? [Abstract in Rivista]
Pingani, L; Cataldo, I; De Bernardis, M; Ughetti, Ml; Fulvio, A; De Bernardis, E; Ferrari, Silvia; Turrini, G; Rigatelli, Marco
abstract

Not available

2010 - Burn-out syndrome among Italian psychiatry residents: Results for Italy from the BOSS international study [Abstract in Rivista]
Ferrari, Silvia; Pingani, Luca; Cuoghi, Giulia; Jovanovic, N; Beezhold, J; Rigatelli, Marco
abstract

Background and aims: Acknowledged risk factorsfor burnout syndrome include being a mental healthworker, younger age (in the sense of less professionalexperience) and status as a residents. The aim of theBOSS International Study was to put all these and otherrisk factors together and study their associations, aspredictors of this undesirable condition. 20 countriesworldwide were involved. Results from the Italianparticipants are displayed and discussed here.Methods: An invitation to join in the study was sentto 193 residents in psychiatry from the whole nationalterritory of Italy, including a link to the BOSS onlinequestionnaire (Italian version); this collects data ondemographics, education, working circumstances, andfrom five psychometric instruments (Maslach BurnoutInventory – MBI-GS, Areas of Worklife Survey, PHQ-9,Big Five Inventory - 10, Suicide Ideation and BehaviourQuestionnaire).Results: A total of 113 residents completed the survey(58.5% response rate, 22/78% M/F, mean age 30.3-3.7). Mean scores at the three MBI components were2.9 (exhaustion), 1.9 (cynicism) and 4.8 (professionalefficacy), accounting for low levels of burnout amongthe respondents. 14% of respondents confessed theywere on daily medication, mainly antidepressants (42%)and self-prescribed (50%). Out of all respondents, 34.8%met criteria for PHQ-9 minor depression, and 8.9%. formajor depression. Only PHQ9-depression was found tobe a statistically significant predictor of burnout.Conclusions: Despite the low level of burnout amongItalian residents in psychiatry, other findings in theBOSS survey suggested the need for improved supportand tutoring of young psychiatrists-to-be. This presents asignificant challenge for training organisations.

2010 - Consulenze in pronto soccorso e nei reparti ospedalieri [Capitolo/Saggio]
G., Cerveri; A. R., Atti; Ferrari, Silvia
abstract

Il capitolo descrive sinteticamente le competenze richieste per l'esecuzione di una consulenza psichiatrica in un reparto ospedaliero o al pronto soccorso.

2010 - Evaluation of HIV positive recipients of orthotopic liver transplant (OLT): an observational study in the modena consultation liaison psychiatric service [Abstract in Rivista]
Borsari, Lucia; M., Ferrara; V., Barbanti Silva; Pingani, Luca; S., Cocchi; Guaraldi, Giovanni; Gerunda, Giorgio Enrico; Rigatelli, Marco; Ferrari, Silvia
abstract

18th European Congress of Psychiatry

2010 - Evaluation of psychological impact of facial lipoatrophy in HIV: the “assessment of face & body change and distress” questionnaire [Abstract in Rivista]
M., Ferrara; R., Murri; E., Bertaccini; G., Orlando; M., Vandelli; M., De Paola; R., Bucciardini; Rigatelli, Marco; R., Esposito; Guaraldi, Giovanni; Ferrari, Silvia
abstract

18th European Congress of Psychiatry

2010 - Gestione dello stress per gli operatori nei servizi psichiatrici [Capitolo/Saggio]
U., Volpe; Ferrari, Silvia; M., Garzarella
abstract

Il capitolo continene alcune indicazioni pratiche su come riconoscere e difendersi dallo stress lavorativo e dal burnout a cui è esposto il giovane professionista della salute mentale.

2010 - INTERMED from training to clinical implementation. The complex patient in different care settings [Abstract in Rivista]
Ferrari, Silvia; A., Disavoia; Zannoni, Enrica; Ferri, Paola; F. C., Stiefel; C., Zdrojewski; F. J., Huyse; Rigatelli, Marco
abstract

complexity assessement

2010 - Intermed from training to clinical implementation: the complex patient in different care settings [Abstract in Rivista]
Disavoia, Alessandra; Zannoni, Enrica; Ferrari, Silvia; Ferri, Paola; F. J., Huyse; Rigatelli, Marco
abstract

The aim of this work was to assess preliminary the effectiveness of a training program on the clinical use of INTERMED.Methods: after a group training on the use of INTERMED carried out between April and September 2009, the method was applied to 30 female patients aged between 20 and 65, subsequently referring to three clinical settings: a GP clinic; a psychiatry day-care clinic; a CLP out-patient clinic. Demographic and clinical data were collected, together with administration of HADS and WHOQol-bref.Results: the mean INTERMED score was 20.8, borderline as to definition of complex cases. Patients from the GP clinic and in the CLP setting scored lower than patients from the psychiatric day-clinic (27.8), suggesting that the presence of severe psychiatric disturbances might contribute to increasing the level of case-complexity. Concordance with results at HADS and WHOQoL was high.Conclusions: these preliminary positive results will hopefully open the way to a wider diffusion of this tool in clinical practice in the area of Modena.

2010 - Italian validation of AMDP-system: prelyminary results [Abstract in Rivista]
F., Mazzi; S., Grandi; Ferrari, Silvia; L., Pingani; Rigatelli, Marco
abstract

18th European Congress of Psychiatry

2010 - La presa in carico sul territorio dei pazienti con disturbi mentali gravi: competenze di base [Capitolo/Saggio]
A., Fiorillo; D., Filippo; Ferrari, Silvia; U., Volpe
abstract

Il capitolo descrive sinteticamente i principali costituenti della presa in carico psichiatrica territoriale del paziente affetto da disturbi mentali gravi

2010 - Mental health services utilisation of migrants in Modena [Abstract in Rivista]
C., Giubbarelli; Ferrari, Silvia; S., Mimmi; Rigatelli, Marco
abstract

18th European Congress of Psychiatry

2010 - Migrant and mental health services in Modena [Abstract in Rivista]
C., Giubbarelli; Ferrari, Silvia; Reggianini, Corinna; Rigatelli, Marco
abstract

mental health, migrants

2010 - Psychiatric consultation in an Italian hospital [Abstract in Rivista]
M., Piselli; G., De Giorgio; C., Santilli; T., Sciarma; L., Scarponi; A., Rella; T., Blasi; T., La Ferla; Ferrari, Silvia; R., Quartesan
abstract

Psychiatric consultation in an Italian hospital

2010 - Psychiatry and culture: Quantifying the contamination [Abstract in Rivista]
Ferrari, Silvia; Menozzi, Marianna; Piemonte, Chiara; Pontoni, G.; Masoni, L.; Rigatelli, Marco
abstract

Background and aims: Psychiatry has strong andcircular connections with culture and society, which arereflected in a continuous and progressive phenomenonof “contamination” of common language and colloquialexpressions. The analysis of this phenomenon mightprovide with significant elements for training and clinicalactivities. The aim of this work was to collect and analyzeexpressions in colloquial language originally derivedfrom psychiatric technical terminology.Methods: A hundred and ten fifth-year medical students(M/F% = 42/58; mean age = 23.5 ± 3.1) attending theirsemester in psychiatry were asked to list and discuss624 EACLPP Abstracts / Journal of Psychosomatic Research 68 (2010) 605–679as many words, phrases and expressions as possiblereferring to psychiatry and mental health. A semiqualitativeanalysis of the expressions collected wascarried out.Results: A list of 150 expressions was drawn andthen classified in the following 5 categories: technicalpsychiatric terms; medical-neurological terms; referencesto psychoanalysis; terms referring to abnormalityand need for care; not pertinent terms. Psychiatricexpressions, though usually exploited with pertinence,are used alternatively to define individual or others’states or conditions, with different intentions in the twocases, either as means for emphasis or ridiculisation.Conclusion: Due to fears and prejudices evoked bypsychiatric themes, an attempt on exorcising andtaking distance leads to the use of psychiatric terms aspotentially offensive and despising. This work suggeststhe need to work – especially in training settings – onfilling the gap between common and medical languagesand to analyze critically the contaminations as suggestiveof very relevant cultural issues

2010 - Psychopathological distress, body image perception and social phobia in patients with hearing aids and cochlear implants [Abstract in Rivista]
F., Eleuteri; M., Forghieri; Ferrari, Silvia; A., Marrara; Monzani, Daniele; Rigatelli, Marco
abstract

18th European Congress of Psychiatry

2010 - Ricerca e giovani psichiatri, tra impegno, difficoltà e passione [Articolo su rivista]
Ferrari, Silvia
abstract

Si fornisce una descrizione ed un'analisi critica della situazione dei giovani ricercatori in psichiatria in Italia, approfondendo le difficoltà ma anche le grandi possibilità di questo lavoro nel contesto contemporaneo.

2010 - Social disfunction and body disperception in patients with cochlear implants [Abstract in Rivista]
Forghieri, Matilde; F., Eleuteri; Ferrari, Silvia; A., Marrara; Monzani, Daniele; Rigatelli, Marco
abstract

Social disfunction and body disperception in patients with cochlear implants

2010 - THE EFFECTS OF A LITERARY WORKSHOP FOR INCREASE ASSERTIVITY IN PATIENTS WITH EATING DISORDERS: A RANDOMIZED CONTROLLED TRIAL [Abstract in Rivista]
Pingani, L; Arnone, F; Chierici, Ml; De Bernardis, E; Donelli, S; Ferrari, Silvia; Zucchi, G; Turrini, G; Rigatelli, Marco
abstract

Not available

2010 - Teamwork in psychiatry [Abstract in Rivista]
M., Miselli; M., Pighi; Ferrari, Silvia; V., Barbanti Silva; S., Mimmi; Rigatelli, Marco
abstract

18th European Congress of Psychiatry

2010 - The bio-psycho-social trauma of migration: a case report [Abstract in Rivista]
Ferrari, Silvia; F., La Porta; S., Brancolini
abstract

The bio-psycho-social trauma of migration: a case report

2010 - The international resident/trainee Burnout Study: BOSS international [Abstract in Rivista]
J., Beezhold; N., Jovanovic; O., Aulander; A., Podlesek; S., Papp; Ferrari, Silvia; A., Mihai
abstract

The international resident/trainee Burnout Study: BOSS international

2010 - The psychiatric team: a space to work and live in [Abstract in Rivista]
Ferrari, Silvia; BARBANTI SILVA, Veronica; Pighi, Marcella; S., Mimmi; Rigatelli, Marco
abstract

The psychiatric team: a space to work and live in

2010 - Training on how to use the INTERMED: the experience at Modena Medical School [Abstract in Rivista]
Ferrari, Silvia; Zannoni, Enrica; A. R., Bombi; A., Bonati; T., Delli Carri; A., Disavoia; V., Mazzali; E., Simoni; Ferri, Paola; F. C., Stiefel; C., Zdrojewski; F. J., Huyse; Rigatelli, Marco
abstract

complexity assessment

2010 - Training on how to use the INTERMED: the experience at Modena Medical School [Abstract in Rivista]
Zannoni, Enrica; A., Bombi; A., Bonatti; T., Delli Carri; Disavoia, Alessandra; Ferrari, Silvia; V., Mazzali; Simoni, Elena; Ferri, Paola; F. J., Huyse; Rigatelli, Marco
abstract

Background: INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs and risks of patients. It consists in a structured interview leading to definition of 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. Aim: To describe the training process on the use of INTERMED and to assess its effectiveness.Methods: A training group of 9 subjects (4 student nurses, 3 residents in psychiatry, 1 consultant psychiatrist and 1 psychiatric nurse) had two-hour meetings twice a month between April and September 2009. After introductory sessions on theoretical aspects and inter-trainee simulations on interviewing and scoring techniques, students were assigned the task of producing video-recorded clinical material, which was used to comment on interviewing skills and practice on scoring. Individual and consensus scores were collected at the beginning and at the end of the training and compared statistically by means of Cohen’s kappa. Results: Motivation and involvement of students in the training was high (participation was on a voluntary basis during extra-work hours), as well as satisfaction, particularly among the student nurses. Agreement between individual and consensus scores was high already at the beginning of the training (Cohen’s kappa mean value of 0.80) and slightly improved during the course. Conclusions: The training process gave positive results both on the quantitative and the qualitative sides of evaluation. A six-month 25-hour training period is a reasonable time for learning how to master the instrument, although it needs to be followed by the clinical practice. These preliminary positive results will hopefully open the way to a wider diffusion of this tool in clinical practice in the area of Modena.

2010 - Update in psycho-geriatric activity at a CL psychiatry service in the general hospital [Abstract in Rivista]
Ferrari, Silvia; Forghieri, M; Pingani, L; Rigatelli, Marco
abstract

Not available

2010 - “Am I just paranoid?!”: a study about psychiatric contaminations on colloquial language [Abstract in Rivista]
Ferrari, Silvia; M., Menozzi; C., Piemonte; G., Pontoni; L., Masoni; Rigatelli, Marco
abstract

18th European Congress of Psychiatry

2010 - “No country for old men”: consultation-liaison psychiatry activities in a geriatric population [Abstract in Rivista]
Ferrari, Silvia; M., Forghieri; L., Pingani; Rigatelli, Marco
abstract

18th European Congress of Psychiatry

2009 - A proposal of screening for psychiatric disorders in a rheumatologic ward. [Abstract in Rivista]
C., Giubbarelli; D., Ferrari; E., Tedeschini; F., Lumetti; E., Simoni; Ferrari, Silvia; Ferri, Clodoveo; Rigatelli, Marco
abstract

XII ANNUAL MEETING OF THE EUROPEAN ASSOCIATION FORCONSULTATION-LIAISON PSYCHIATRY AND PSYCHOSOMATICS (EACLPP)

2009 - Antidepressants for the treatment of fibromyalgia. [Abstract in Rivista]
Ferrari, D; Giubbarelli, C; Giunti, M; Tedeschini, E; Ferrari, Silvia; Rigatelli, Marco; Ferri, Clodoveo
abstract

Not available

2009 - Cannabis abuse at first episode psychosis (FEP): Data from mental health centres in modena and Bologna, Italy [Abstract in Rivista]
I., Tarricone; E., Rossi; D., Pecile; A., Castellani; A., Paparelli; V., Bandieri; Ferrari, Silvia; L., Pingani; R., Di Lorenzo; Rigatelli, Marco; D., Berardi
abstract

17th EPA Congress

2009 - Consultation liaison psychiatry in otoneurology [Abstract in Rivista]
Forghieri, Matilde; Ferrari, Silvia; Monzani, Daniele; Rigatelli, Marco
abstract

Background and aims: Balance disorder is oneof the most common health problems (Perez etal., 2003). A huge amount of scientific literaturedescribes the coexistence of a significant linkbetween vestibular and psychiatric disorders(Monzani et al, 2006) and its neurobiologicbackground (Balanban et al., 2001). We aim todescribe the relationship between otoneurologyand psychiatry.Methods: We considered two conditions: 1-where anxiety has a predominant role inoriginating vestibular symptoms such as phobicpostural vertigo (Brandt, 1996), space andmotion discomfort, dizziness andlightheadedness in panic attacks (Furman andJacob, 2001); 2-when pre-existing vestibulardysfunction is worsened by anxiety symptoms,increasing vestibulo-oculo-motor reflex gain(Yardley et al, 1995) and reducing adaptationmechanisms in visuo-vestibular conflicts(Viaud-Delmon et al., 2000).Results: A critical review of scientific dataexploring how vestibular and psychiatricdisorders clinically interact will be presented,together with preliminary results concerning ourstudies on: psychopathological profile andalexithimia in patients suffering from positionalparossistic vertigo, anger in hearing impairedpatients, posturography and eating disorder,coping strategies in hyperacusic patients , bodyimage perception in patients using acousticprothesis.Conclusions: Scientific literature was examinedand potential applications explored concerningthe connection between otoneurology andpsychiatry.

2009 - Consultation-liaison psychiatry in primary care: an experience in Modena, Italy [Abstract in Rivista]
Tedeschini, Enrico; N., Colombini; Simoni, Elena; Ferrari, Silvia; Rigatelli, Marco
abstract

Consultation-liaison psychiatry in primary care: an experience in Modena, Italy

2009 - Cross-cultural psychiatry, liaison psychiatry and other major challenges for modern psychiatrists [Abstract in Rivista]
Ferrari, Silvia; V., Barbanti Silva; M., Forghieri; Rigatelli, Marco
abstract

17th EPA Congress

2009 - Depression in rehumatic patients [Abstract in Rivista]
Tedeschini, Enrico; D., Ferrari; M., Giunti; Ferrari, Silvia; Ferri, Clodoveo; Rigatelli, Marco
abstract

Depression in rehumatic patients

2009 - Ideal and reality of team-working in psychiatry. [Abstract in Rivista]
Ferrari, Silvia; Pighi, M; Silva, Vb; Mimmi, S; Rigatelli, Marco
abstract

Not available

2009 - Medical-psychiatric comorbidity [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia; Pingani, Luca
abstract

Medical-psychiatric comorbidity

2009 - Metabolic syndrome and psychiatric comorbidity the modena protocol [Abstract in Rivista]
Po, S; Cameli, M; Ferrari, Silvia; Pingani, L; Chiurlia, E; Iaccarino, D; Modena, Maria Grazia; Rigatelli, Marco
abstract

Not available

2009 - Metabolic syndrome and psychiatric comorbidity: the Modena protocol [Abstract in Rivista]
S., Po; Cameli, Michela; Forghieri, Matilde; C., Giubbarelli; Pingani, Luca; Ferrari, Silvia; Chiurlia, Emilio; Iaccarino, Daniele; Modena, Maria Grazia
abstract

Metabolic syndrome and psychiatric comorbidity: the Modena protocol

2009 - Migrants and pathway to psychiatric care in Italy: results from a multi-cities survey [Abstract in Rivista]
I., Tarricone; P., Rucci; M., Braca; V., Castorini; A., Castellani; Ferrari, Silvia; E., Bolla; D., Berardi
abstract

Migrants and pathway to psychiatric care in Italy: results from a multi-cities survey

2009 - Percorsi di ricerca in psichiatria in Italia [Capitolo/Saggio]
Ferrari, Silvia; Caraci, F; Salvi, V.
abstract

Negli ultimi decenni, la ricerca in psichiatria ha certamente contribuito a rafforzare l’immagine della psichiatria come scienza medica che si richiama all’ordine del metodo scientifico, anche se la complessità dei disturbi psichiatrici richiede un approccio non riduzionista ed esclusivamente bio-medico, ma un approccio più complesso, di tipo bio-psico-sociale (1), che tenga conto anche dei fattori ambientali nella patogenesi, nell’evoluzione e nel trattamento di questi disturbi nella pratica clinica.Gli indirizzi di ricerca in psichiatria sono molti e complessi, alcuni con radici antiche ma in continuo sviluppo, altri - più recenti - la cui origine è connessa all’enorme sviluppo avvenuto negli ultimi anni delle neuroscienze.In questo capitolo non tratteremo in maniera sistematica tutti i possibili approcci alla ricerca in psichiatria presenti in Italia, poiché una tale opera non corrisponderebbe agli scopi del presente volume, ma cercheremo di descrivere il possibile percorso che un giovane psichiatra può compiere in Italia nell’area della ricerca in rapporto ai mezzi attualmente disponibili ed in considerazione delle nuove possibili evoluzioni della psichiatria. Inoltre, presenteremo alcune importanti opportunità di ricerca in Italia e all’estero per i giovani psichiatri.

2009 - Psychiatric comorbidity in end-stage liver disease patients with and without HIV infection [Abstract in Rivista]
BARBANTI SILVA, Veronica; Ferrari, Silvia; Pingani, Luca; Rigatelli, Marco
abstract

Psychiatric comorbidity in end-stage liver disease patients with and without HIV infection

2009 - Psychiatric consultation activities to migrant patients in the general hospital [Abstract in Rivista]
Ferrari, Silvia; Giubbarelli, C; Rigatelli, Marco
abstract

Not available

2009 - Psychotic symptoms and general health in a socially disadvantaged migrant community in Bologna [Articolo su rivista]
Tarricone, I; Salvatori, F; Braca, M; Ferrari, Silvia; Malmusi, D; Atti, Ar; Berardi, D.
abstract

Background and aims. Several evidences showed that social exclusion and reduced access to primary care and mental health services can lead to urgent health problems among immigrants and can explain their increasing admittance to psychiatric in-patient units and high prevalence of psychotic disturbances. The present cross-sectional study aimed to evaluate general health status, distress and prevalence of psychotic symptoms among Romanian immigrants living in very poor conditions at a neglected hotel in Bologna. In Bologna as in Italy, Romanians are one of the largest immigrant communities. Methods. The Psychosis Screening Questionnaire and General Health Questionnaire-12 were administered to all Romanian immigrants residing at the hotel during two index days, with the help of a Romanian cultural mediator. Socio-demographic, migration and health characteristics were also collected. Results. 68 subjects were evaluated. More than 80% left Romania for economic reasons. 57% of immigrants surpassed the 4-point GHQ-12 threshold of potential mental disorders cases; 21% scored positively at the PSQ. The following factors were found to predict positive PSQ: being affected by chronic illness (OR=9.2, 95%CI=2.1–39.9); taking chronic drug therapy (OR=10.4; 95%CI=1.6–64.7); the development of new health problems after migrating (OR=8.8, 95%CI=2.0–38.3). Immigrants with positive PSQ showed higher mean GHQ-12 scores (5.9±3.5, vs. 3.8±2.75; p=0.02). Conclusions. This community of immigrants living in deprived conditions showed a very high prevalence of distress and psychotic symptoms, related with chronic health problems. More attention should be paid to physical and mental health of social disadvantaged immigrants.

2009 - Recent changes in psychiatric care setting: educational and practical implications for young psychiatrists [Abstract in Rivista]
A., Fiorillo; U., Volpe; J., Beezhold; N., Pastour; J., Fousson; C., Hanon; I., Tarricone; Ferrari, Silvia; N., Jovanovic; M., Rokjnic Kuzman
abstract

Recent changes in psychiatric care setting: educational and practical implications for young psychiatrists

2009 - Stress e burnout: alcuni consigli pratici per i giovani psichiatri [Capitolo/Saggio]
Volpe, U; Ferrari, Silvia; BARBANTI SILVA, V; Fiorillo, A.
abstract

Nel corso delle ultime decadi, le condizioni di lavoro, l’ambiente lavorativo, le tipologie lavorative, nonché gli specifici modelli di riferimento del contesto lavorativo, ed anche sanitario, hanno subito delle radicali modifiche: in particolare, nel mondo globalizzato della new economy, il lavoro non viene più concettualizzato come un processo lineare, continuativo e stabile, che comporta un graduale accumulo di conoscenze ed esperienze lavorative. Piuttosto, nel ventunesimo secolo, il lavoratore tende sempre più a subire il progressivo superamento delle strutture organizzative gerarchiche, in favore di quelle “piatte” e policentriche, con gerarchie poco definite, con ruoli e responsabilità altrettanto scarsamente definiti (1). Tale processo è, probabilmente, reso ancor più complesso dalle recenti modificazioni economico-finanziarie verificatesi a livello internazionale, che forniscono al lavoratore ancora minori certezze rispetto al proprio setting lavorativo, in termini sia temporali (ad esempio, la prevalenza di tipologie contrattuali a tempo determinato, l’aumento della mobilità fisica dei lavoratori) che economici (ad esempio, minori prospettive di stabilità lavorativa longitudinale, riduzione relativa dei compensi).

2009 - Validation of the Italian version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) [Articolo su rivista]
Palmieri, Gaspare; C., Evans; V., Hansen; G., Brancaleoni; Ferrari, Silvia; P., Porcelli; F., Reitano; Rigatelli, Marco
abstract

The CORE-OM (Clinical Outcomes in Routine Evaluation- Outcome Measure) was translated into Italian and tested in non-clinical (n=263) and clinical (n=647) samples. The translation showed good acceptability, internal consistency and convergent validity in both samples. There were large and statistically significant differences between clinical and non-clinical datasets on all scores. The reliable change criteria were similar to those for the UK referential data. Some of the clinically significant change criteria, particularly for the men, were moderately different from the UK cutting points. The Italian version of the CORE-OM showed respectable psychometric parameters. However, it seemed plausible that non-clinical and clinical distributions of self-report scores on psychopathology and functioning measures may differ by language and culture.

2009 - What does it take to become a psychiatrist? Results from a survey on quality of training [Abstract in Rivista]
BARBANTI SILVA, Veronica; Forghieri, Matilde; Ferrari, Silvia; U., Volpe; A., Fiorillo
abstract

What does it take to become a psychiatrist? Results from a survey on quality of training

2008 - A psychiatrist at the primary care clinic [Abstract in Rivista]
Ferrari, Silvia; M., Andreoli
abstract

A psychiatrist at the primary care clinic

2008 - Cl service in modena: The Italian experience [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia; L., Pingani
abstract

Not available

2008 - Comorbid depression in rheumatic patients [Abstract in Rivista]
Ferrari, D.; Tedeschini, E; Giunti, M; Ferrari, Silvia; Rigatelli, Marco; Ferri, Clodoveo
abstract

Not available

2008 - EACLPP conference in Bologna [Articolo su rivista]
Berardi, D; Bortolotti, B; Tarricone, I; Rigatelli, Marco; Ferrari, Silvia; Pingani, Luca
abstract

A description of main features and peculiarities of the 2007 annual meeting of the european association for consultation liaison psychiatry and psychosomatic which was held in Bologna, Italy.

2008 - Frequent attenders in primary care: impact of medical, psychiatric and psychosomatic diagnoses [Articolo su rivista]
Ferrari, Silvia; Galeazzi, Gian Maria; Mackinnon, Andrew; Rigatelli, Marco
abstract

Background: Anxiety, mild depression and somatization are common in Primary Care (PC). Several studies have suggested that they may play a role in causing an excessive use of health care services, especially when combined to medical morbidity. The present case-control study explored how psychiatric and psychosomatic diagnoses and perceived quality of life are associated to the phenomenon of frequent attendance.Methods: The 50 most frequent attenders (FAs) in a one-year period at a PC clinic in Italy were compared to 50 randomly selected average frequency attenders at the same clinic. Socio-demographic and medical data were collected from PC files. The SCID-brief version for research and the Structured Interview for Diagnostic Criteria for use in Psychosomatic Research (DCPR) were administered to both patient groups. Quality of life was also assessed.Results: FA status was associated with being female, older, less well educated, and living with their spouse and/or children. Medical-psychiatric comorbidity was more frequent in the FA group than in the control group. The median number of psychosomatic-DCPR syndromes per patient was 4 among FAs compared to only 1 in controls. Functional somatic symptoms secondary to a psychiatric disorder, type A behaviour, irritable mood, and demoralization were significantly associated with being an FA. Perceived quality of life was significantly lower among FAs, although this was no longer significant after adjusting for socio-demographic variables. Conclusions: The present study confirms the association between medical-psychiatric comorbidity and frequent utilization of PC resources. It suggests a role for DCPR criteria in revealing sub-threshold psychiatric comorbidity predicting a pattern of frequent attendance.

2008 - Mental health services and primary care in Castelfranco Emilia (Italy): comparing two different methods of integration [Abstract in Rivista]
Colombini, N; Tedeschini, E; Simoni, E; Ferrari, Silvia; Zurlini, A; Montaguti, A; Rigatelli, Marco
abstract

Not available

2008 - Psychosomatic psychiatry: a comment from Italy [Articolo su rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

Reasons in favour and against the proposal of the suggestions for a new name for consultation liaison psychiatry are offered and discussed.

2008 - Suicide intervention skills in health professionals: A multidisciplinary comparison [Articolo su rivista]
Palmieri, G.; Forghieri, M.; Ferrari, S.; Pingani, L.; Colombini, N.; Rigatelli, M.
abstract

Aim of the study: Training in the recognition and management of suicidal risk is of crucial importance for prevention. The aim of our study was to compare competence in assessing and managing suicidal patients in different groups of Italian health professionals. Materials and methods: Two hundred and thirty two professionals completed the Suicide Intervention Response Inventory (SIRI-2) and a questionnaire on perceptions of risk and protective factors in suicidal patients. Results and conclusions: Exposure to suicidal patients was found to be widespread in all groups, but specific training in suicide assessment and intervention was conspicuously rare. Psychiatrists outscored all other groups. Taken together, our findings suggest the necessity of further training in suicide intervention for Italian health professionals, and especially for emergency service personnel and general practitioners.

2008 - Suicide intervention skills in health professionals: a multidisciplinary comparison [Articolo su rivista]
Palmieri, Gaspare; Forghieri, Matilde; Ferrari, Silvia; Pingani, Luca; Coppola, P.; Colombini, N.; Rigatelli, Marco; Neimeyer, R. A.
abstract

Training in the recognition and management of suicidal risk is of crucial importance for prevention. The aim of our study was to compare competence in assessing and managing suicidal patients in different groups of Italian professionals. Two hundredand thirty two professionals (38 psychiatrists, 50 general practitioners, 34 psychiatric nurses, 60 doctors and nurses working in accident and emergency services, and50 medical students) completed the Suicide Intervention Response Inventory (SIRI-2) (Neimeyer & Bonelle, 1997) and a questionnaire on perceptions of risk and protective factors in suicidal patients. Exposure to suicidal patients was found to be widespread in all groups, but specific training in suicide assessment and intervention was conspicuously rare. Psychiatrists outscored all other groups andpsychiatric nurses scored significantly higher than general practitioners in identifying appropriate responses to suicidal patients. Taken together, our findings suggest thenecessity of further training in suicide intervention for Italian health professionals, and especially for emergency service personnel and general practitioners.

2008 - Understanding somatisation through Cross-Cultural Liaison psychiatry [Abstract in Rivista]
Ferrari, Silvia; Malmusi, D; Giubbarelli, C; Pingani, L; Rigatelli, Marco
abstract

Not available

2007 - Delirium and other emergencies [Capitolo/Saggio]
Gill, P; Rigatelli, Marco; Ferrari, Silvia
abstract

Not available

2007 - Difendere la dignità futura: il testamento cognitivo [Articolo su rivista]
Ferrari, Silvia
abstract

discussione sulle analogie e specificità del testamento cognitivo e biologico in pazienti con demenza

2007 - Disturbi psichiatrici in corso di patologie mediche [Capitolo/Saggio]
Rigatelli, Marco; Ferrari, Silvia; S., Po
abstract

Malattie mediche e psichiatriche non solo in alcuni pazienti coesistono, ma molto spesso contribuiscono a determinarsi o ad aggravarsi vicendevolmente o si manifestano le une con i sintomi delle altre.Le patologie psichiatriche associate a disturbi medici spesso non vengono riconosciute o vengono interpretate come una reazione normale dell’individuo: tendenza che si associa ad effetti negativi sia nei confronti delle condizioni dei pazienti che in termini di costi sanitari.

2007 - I disturbi somatoformi [Capitolo/Saggio]
Rigatelli, Marco; Ferrari, Silvia; C., Giubbarelli
abstract

La categoria dei disturbi somatoformi rappresenta un tentativo, messo in atto dal DSM III e non condiviso da tutti gli autori, di fornire una sistematizzazione descrittiva ed a-teoretica del complesso fenomeno della somatizzazione.I disturbi somatoformi comprendono forme cliniche accomunate dalla presentazione di sintomi fisici in assenza di reperti organici o meccanismi fisiopatologici noti.I disturbi somatoformi sono il risultato di processi eterogenei e complessi che vedono l’azione di diversi fattori biologici, psicologici e socio-culturali.I disturbi somatoformi, frequenti nella popolazione generale, si associano ad alto utilizzo dei servizi sanitari e hanno significative ricadute sul piano socio-economico.

2007 - Integration between mental health and primary care service: Does it really improve quality of psychiatric care? [Abstract in Rivista]
Colombini, N; Tedeschini, E; Ferrari, Silvia; Rigatelli, Marco
abstract

Not available

2007 - Is the psychosocial condition of patients who undergo OLTx ITER affected by the etiology of liver disease? [Abstract in Rivista]
Barbanti, Sv; Ferrara, M; Pingani, L; Ferrari, Silvia; Rigatelli, Marco
abstract

Not available

2007 - Psichiatria di liaison [Capitolo/Saggio]
Rigatelli, Marco; Ferrari, Silvia
abstract

La psichiatria di liaison è l’area di applicazione della psichiatria che si occupa dei pazienti con disagio psichico presso i contesti di cura non specialistici psichiatrici (ospedale generale, medicina generale…)La psichiatria di liaison si propone come interfaccia tra la psichiatria e le altre discipline mediche, con un intento trasversale di realizzazione clinica del paradigma bio-psico-socialeI tre target clinici della psichiatria di liaison sono la comorbidità medico-psichiatrica, la patologia psicosomatica e le attività di liaison rivolte alle altre équipes medico-chirurgicheLa psichiatria di liaison presenta aspetti comuni rispetto alla medicina psicosomatica, ma anche specificità cliniche, formative e di ricerca, da salvaguardare e potenziare

2007 - Psychiatric disorders and cardiovascular diseases: State of the art. [Abstract in Rivista]
Po, S; Pingani, L; Ferrari, Silvia; Rigatelli, Marco
abstract

Not available

2007 - Psychotic symptoms and general health in a social disadvantaged Romanian community in Bologna [Abstract in Rivista]
I., Tarricone; M., Morri; Ferrari, Silvia; E., Pedrini; D., Malmusi; C., Giubbarelli; F., Poggi; D., Berardi
abstract

Psychotic symptoms and general health in a social disadvantaged Romanian community in Bologna

2007 - Somatic symptoms of distress in the general population: A comparison of natives and immigrants with a focus on social factors. [Abstract in Rivista]
Malmusi, D; Ferrari, Silvia; Giubbarelli, C; Tarricone, I; Rigatelli, Marco
abstract

Not available

2007 - Testing ters and madrs on 567 pre-OLTx patients [Abstract in Rivista]
V., Barbanti Silva; M., Ferrara; Ferrari, Silvia; Rigatelli, Marco
abstract

15th AEP Congress

2007 - What do they think of us? Opinions of general hospital ward staff ona CLP service [Abstract in Rivista]
V., Barbanti Silva; Ferrari, Silvia; Rigatelli, Marco
abstract

15th AEP Congress

2006 - Applicazione di TERS E MADRS ad oltre 400 pazienti in screening pre-OLTx. [Articolo su rivista]
BARBANTI SILVA, Veronica; Forghieri, Matilde; Ferrari, Silvia; Mazzi, F; Rigatelli, Marco
abstract

Applicazione di TERS E MADRS ad oltre 400 pazienti in screening pre-OLTx

2006 - Chronic hepatitis C and psychosocial distress [Abstract in Rivista]
Barbanti, Sv; Tesini, Em; Ferrari, Silvia; Pigozzi, F; Pingani, L; Vandelli, Carmen; Rigatelli, Marco
abstract

Not available

2006 - Delirium in the neoplastic patient: Data on eight years of psychiatric consultation activity [Abstract in Rivista]
Disavoia, A; Ferrari, Silvia; Forghieri, M; Rigatelli, Marco
abstract

Delirium in the neoplastic patient: data on eight years of psychiatric consultation activity

2006 - Depressione e cardiopatia: il punto di vista del medico di medicina generale [Articolo su rivista]
Colombini, N; Ferrari, Silvia; Gabrielli, F; Rigatelli, Marco
abstract

Not available

2006 - General hospital psychiatry in Italy: an update [Articolo su rivista]
Ferrari, Silvia; Rigatelli, Marco
abstract

The turning point in the history of consultation–liaison psychiatry (CLP) in Italy was undoubtedly the passing of the famous Reform Law 180 in 1978, with its dramatic consequences on both the clinical and health organizational levels of psychiatry. This has brought psychiatry back to medicine and to the general hospital CL Cazzullo, M Comazzi, GP Guaraldi, M Rigatelli and A Verdecchia, General hospital psychiatry in Italy: on the hospitalization of psychiatric patients and consultation–liaison psychiatry after Law 180/1978, Gen Hosp Psychiatry 6 (1984), pp. 261–265. Abstract | View Record in Scopus | Cited By in Scopus (8)[1] and [2].The development of CLP in Italy since then has been slow and variable across the country. During the 1980s, a few specific and integrated CLP services were established in university-based hospitals (e.g., Milan, Modena, and Padua), which led the way for the implementation of other centers in the country (e.g., Naples and Ferrara). These were some of the centers that were involved as research sites in ECLW studies . During the 1990s, Italian CLP then gradually started to move out of the general hospital toward community primary care, with the establishment of specific CLP services for GPs (e.g., Verona, Bologna, and Reggio Emilia) and the development of relevant research projects .As such services increased, a shift occurred from on-demand urgent psychiatric referrals to planned, excellent integrated activities. This has been a major achievement; some of these services include Ferrara for psycho-oncology, Modena and Udine for transplant units, Bari for gastroenterology, and Milan and Genova for psychogeriatrics. Integrated and formalized clinical experiences such as these have stimulated research activities in the same fields—locally, nationally, and internationally .

2006 - Health-related quality of life in recent and long standing chronic HCV infection. [Abstract in Atti di Convegno]
Tesini, E. M. C.; BARBANTI SILVA, V.; Pigozzi, F.; Ferrari, Silvia; DEL GIOVANE, C.; Marino, M.; Rigatelli, Marco; PONZ DE LEON, Maurizio; Vandelli, Carmen
abstract

Not available

2006 - Il rilassamento psico-tonico in psicosomatica [Capitolo/Saggio]
Casolari, L; Ferrari, Silvia; Bonatti, R; Rigatelli, Marco
abstract

Not available

2006 - Is frequent attendance at a GP clinic a persistent feature? [Abstract in Rivista]
Ferrari, Silvia; Rigatelli, Marco
abstract

Frequent attenders (FAs) account for a large proportion of contacts with general practitioners (GPs); their levels of physical and psychosocial morbidity are high. A debate exists on whether frequent attendance is a persistent feature or a temporary trait in the consultation pattern of patients. The aim of the study was to follow up the consultation pattern of a group of FAs and to compare features of persistent and occasional FAs.

2006 - La valutazione routinaria degli esiti della psicoterapia: traduzione e validazione preliminare del sistema CORE [Articolo su rivista]
Palmieri, G; Evans, C; Freni, S; Baroni, A; Chicherio, M; Ferrari, Silvia; Palmieri, L; Rigatelli, Marco; Reitano, F.
abstract

In questo articolo viene presentato il sistema CORE (Clinical Outcomes for Routine Evaluation), costituito da una serie di strumenti per la valutazione degli esiti in psicoterapia e in particolare il CORE-OM (Outcome Measure) un questionario composto da 34 item che indaga diverse aree (benessere soggettivo, problemi e sintomi, funzionalità, rischio), largamente utilizzato nel Regno Unito per valutare l’esito delle psicoterapie nel Servizio Pubblico. Presentiamo qui la traduzione italiana del CORE-OM. È in corso un progetto nazionale multicentrico di validazione dello strumento su un vasto campione clinico in collaborazione con la SIPSOT (Società Italiana di Psicologia Ospedaliera e Territoriale), i cui risultati saranno resi noti il prossimo anno.

2006 - Psychiatric consultation activities at the emergency department [Abstract in Rivista]
Po, S; Giubbarelli, C; Disavoia, A; Ferrari, Silvia; Rigatelli, Marco
abstract

2006 EACLPP Meeting

2006 - Tentativo di suicidio e rischio suicidiario. Analisi del fenomeno presso il Policlinico di Modena nel quadriennio 2000-2003 [Articolo su rivista]
Palmieri, Gaspare; Po, S; Ferrari, Silvia; Rigatelli, Marco
abstract

suicidio dal punto di vista del servizio di psichiatria di consultazione di modena

2006 - Testing TERS and MADRS on 400 pre-OLTx patients [Abstract in Rivista]
BARBANTI SILVA, Veronica; Ferrari, Silvia; Forghieri, Matilde; Rigatelli, Marco
abstract

Testing TERS and MADRS on 400 pre-OLTx patients

2006 - The evaluation of competence in the assessment of the suicidal patient among different health professionals [Abstract in Rivista]
Ferrari, Silvia; G., Palmieri; M., Forghieri; N., Colombini; Rigatelli, Marco
abstract

Not available

2006 - What do they think of us? Opinions of general hospital ward staff on a CLP service [Abstract in Rivista]
Barbanti, Sv; Ferrari, Silvia; Rigatelli, Marco
abstract

Not available

2005 - Delirium in the cancer patient: eight years of psychiatric consultations [Abstract in Rivista]
Ferrari, Silvia; Disavoia, A.; Rigatelli, Marco
abstract

EACLPP Meeting

2005 - Elderly inpatients from the perspective of modena consultation-liaison psychiatry service [Abstract in Rivista]
Ferrari, Silvia; Gazzani, C; Vivoli, R; Rigatelli, Marco
abstract

Not available

2005 - Il Servizio di Consulenza psichiatrica-psicosomatica di Modena [Articolo su rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

Non disponibile

2005 - Il problema diagnostico dei disturbi somatoformi [Relazione in Atti di Convegno]
Rigatelli, Marco; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

la diagnosi di somatizzazione è complessa e resa ancor più tale dall'attuale nosografia psichiatrica

2005 - Il trattamento della comorbilità psichiatrica nella patologia neurologica cronica. [Relazione in Atti di Convegno]
Ferrari, Silvia; G., Janiri; Rigatelli, Marco
abstract

il ruolo dello psichiatra di consultazione nelle principali patologie neurologiche

2005 - Is old age a risk factor for psychiatric referral in the general hospital [Abstract in Rivista]
Gazzani, C; Ferrari, Silvia; Rigatelli, Marco
abstract

Not available

2005 - La nuova medicina psicosomatica [Articolo su rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

Not available

2005 - Psychiatric disorders and depression in multiple sclerosis outpatients: Impact of disability and interferon beta therapy [Articolo su rivista]
Galeazzi, Gian Maria; Ferrari, Silvia; Giaroli, Giovanni; Mackinnon, Andrew; Merelli, Elisa; Motti, L; Rigatelli, Marco
abstract

Associations between psychopathology and gender, duration of MS, disability and therapy with beta-interferons were studied in multiple sclerosis (MS) outpatients. A controlled descriptive epidemiological study was carried out in two Italian outpatient MS centres on 50 outpatients with clinically definite relapsing-remitting MS presenting for regular follow-up and 50 healthy controls matched for sex, age and educational level. Subjects were assessed with the Structured Clinical Interview for DSM-IV (SCID I), the Beck Depression Inventory (BDI) and the State Trait Anxiety Inventory (STAI). MS patients reported a higher prevalence of psychiatric disorders (odds ratio 3.17), with 46\% (n=23) suffering from major depressive disorder. The risk of suffering from any non-mood psychiatric disorder was also higher in MS patients than in controls (odds ratio 2.67). Risk factors for depression were female sex and severity of disability, but not therapy with interferon beta or longer duration of illness. Disability level, but not therapy with beta-interferons, is a risk factor for depression in MS outpatients. Regular screening for depression in this population is appropriate.

2005 - Somatization in a transcultural perspective: a survey in primary care [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia; Malmusi, D; Giubbarelli, C.
abstract

Not available

2005 - Syncope, pre-syncope, pseudo-syncope: the psychiatric causes [Abstract in Rivista]
Ferrari, Silvia; Po, S; Rigatelli, Marco
abstract

Not available

2005 - The biopsychosocial screening of transplant patients by means of the INTERMED [Abstract in Rivista]
G., Ludwig; L., Michaud; S., Bernay; S., Amann; J., Skacel; E., Lobo; Ferrari, Silvia; P., De Jonge; F., Stiefel; W., Soellner
abstract

The biopsychosocial screening of transplant patients by means of the INTERMED

2004 - Diagnostic problems about somatoform disorders [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

Diagnostic problems about somatoform disorders

2004 - Frequent attenders of primary care: getting to know them [Abstract in Rivista]
Ferrari, Silvia; Galeazzi, Gian Maria; Rigatelli, Marco
abstract

Frequent attenders of primary care: getting to know them

2004 - Gradimento da parte dei medici non psichiatri del servizio di consulenza psichiatrica-psicosomatica del Policlinico di Modena [Abstract in Rivista]
Barbanti Silva, V; Ferrari, Silvia; Rigatelli, Marco
abstract

Not available

2004 - Il problema diagnostico dei disturbi somatoformi [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

Stress, persona e malattia

2004 - Il trattamento della comorbilità psichiatrica nella patologia neurologica cronica [Abstract in Rivista]
Ferrari, Silvia; Rigatelli, Marco
abstract

Not available

2004 - Interrater reliability, prevalence, and relation to ICD-10 diagnoses of the Diagnostic Criteria for Psychosomatic Research in consultation-liaison psychiatry patients. [Articolo su rivista]
Galeazzi, Gian Maria; Ferrari, Silvia; Andrew, Mackinnon; Rigatelli, Marco
abstract

The Diagnostic Criteria for Psychosomatic Research (DCPR) have been proposed by an international group of psychosomatic investigators as an operationalized tool for the assessment of psychological distress in medical patients. The aims of the present study were to evaluate interrater reliability, the distribution of DCPR syndromes, and their relationship with ICD-10 diagnostic categories. One hundred consecutive patients who were referred for psychiatric consultation in a university general hospital consented to assessment for DCPR syndromes as elicited in a joint interview conducted by two researchers. The results showed excellent interrater agreement, with kappa values for the 11 DCPR syndromes ranging from 0.69 to 0.97. More patients met criteria for one or more of the DCPR (87\%) than for an ICD-10 diagnosis (75\%). Four DCPR syndromes were particularly prevalent: demoralization, alexithymia, illness denial, and type A behavior. DCPR criteria appear to be a useful, reliable, and promising approach in the assessment and description of psychological distress in medical patients. They may serve as a focus of intervention studies in this population.

2004 - Managing deliberate self-harm in the general hospital [Abstract in Rivista]
Rigatelli, Marco; Palmieri, Gaspare; Ferrari, Silvia
abstract

Managing deliberate self-harm in the general hospital

2004 - The Modena Consultation-Liaison Psychiatry service, Italy [Articolo su rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

The article provides a description of the Modena Service for consultation-liaison psychiatry (C-L P), with hints on its history, activity and research interests. The Modena C-L P service was founded in 1989 and, since then, has delivered up to about 1200 first psychiatric assessments each year. The main research interests were related to medical-psychiatric comorbidity and psychosomatics, and organisational standards of care in the general hospital and in primary care.

2004 - The patient admitted to a medical ward with comorbid depression and self-harm behaviour risk [Abstract in Rivista]
Rigatelli, Marco; Palmieri, Gaspare; Ferrari, Silvia
abstract

The patient admitted to a medical ward with comorbid depression and self-harm behaviour risk

2004 - The patient with Personality Disorder in the General Hospital: the intervention of the Psychiatric Consultation Service [Relazione in Atti di Convegno]
Rigatelli, Marco; Barbanti Silva, V; Ferrari, Silvia
abstract

Not available

2004 - The relationship between psychosomatic medicine and consultation-liaison psychiatry: an ongoing problem [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

The relationship between psychosomatic medicine and consultation-liaison psychiatry: an ongoing problem

2003 - Medico, psichiatra e paziente terminale: cosa cambia? [Relazione in Atti di Convegno]
Rigatelli, Marco; Ferrari, Silvia
abstract

atteggiamento e specificità dello psichiatra di consulenza rispetto alle tematiche di fine vita

2003 - Tre tipi particolari di urgenze in psichiatria di consultazione [Relazione in Atti di Convegno]
Rigatelli, Marco; Ferrari, Silvia; Bertoncelli, B; Massari, I.
abstract

attività di PdC in ospedale generale nell'urgenza

2002 - C-L psychiatry and psychosomatic medicine are separated disciplines? [Articolo su rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

Several issues enhance the differences that have gradually developed between Consultation-Liaison Psychiatry (CLP) and Psychosomatic Medicine (PM). PM has a strong and solid tradition inthe research field, as is well demonstrated by numbers of highly significant works in internationalliterature; it also does well in the area of education and teaching, either under- or postgraduate. But itis in the field of clinical activities and organisation of services that a blank is left: neither the‘‘psychosomatist’’ nor the specialisation do exist in most countries. CLP instead has only recentlywalked its first steps in the field of research, with some specific projects such as those brought aboutby the European Consultation-Liaison Workgroup (ECLW), though a further statement of identity isneeded; it is also gaining growing importance with teaching and training activities, addressed notonly to students but also to a variety of professional figures, with varying strategies: the liaison is initself a very powerful and direct, everyday educational tool, even in its less structured form. It is thenin the field of clinical activities and organisation that CLP has historically developed most, and‘‘psychosomatic problems’’ represent only a small proportion of the CL psychiatrist’s competencies.Some brief considerations are collected in this paper over the complex relationship between CLP andPM, which is far from being clear and definitive.

2002 - La psichiatria di consultazione e collegamento nell’ospedale generale. [Capitolo/Saggio]
Rigatelli, Marco; Ferrari, Silvia; Gala, C; Grassi, L.
abstract

Not available

2002 - Psicosomatica e psichiatria di consultazione e collegamento [Capitolo/Saggio]
Rigatelli, Marco; Casolari, L; Ferrari, Silvia
abstract

Non disponibile

2001 - A follow-up study of psychiatric consultations in the general hospital: what happens to patients after discharge [Articolo su rivista]
Rigatelli, Marco; L., Casolari; I., Massari; Ferrari, Silvia
abstract

Background An appropriate follow-up is considered essential in the consultation-liaison psychiatry setting, but it is often neglected. This study evaluated the effectiveness of the psychiatric consultation process in the general hospital, by investigating what occurred to patients 3 to 5 months after discharge. Methods We used a three-part questionnaire: (1) the results of the consultation process; (2) a telephone interview with patients; and (3) a telephone interview with the patients’ primary care physicians, to whom the patients were referred after discharge from hospital. We contacted all consecutive, unselected patients referred to psychiatric consultation from January to July 1999. Complete data were available for 119 patients from an initial group of 318. Results The consultation process was well accepted by patients and useful to general hospital physicians to complete the final diagnosis of the patient when discharged from hospital. In most cases (78.9%), the psychiatric letter was attached to the discharge letter. The second part of the questionnaire indicated that most patients were satisfied with the consultation process. They thought it helped focus their problems and 60% asserted that they felt better after following their psychiatrists’ instructions or therapy. The primary care physicians agreed with the diagnostic results of the psychiatric consultation, mainly followed the psychiatrists’ advice, and generally expressed positive comments about the consultation-liaison service. Conclusions Compliance of hospital physicians, patients, and primary care physicians was good. Follow-up studies on outcome of psychiatric consultations are few and further analysis is strongly recommended.

2001 - I pazienti che hanno tentato il suicidio nell'ospedale generale: il ruolo della consulenza psichiatrica [Relazione in Atti di Convegno]
Ferrari, Silvia
abstract

epidemiologia e modalità operative di gestione clinica di quest'importante problematica

2001 - La Psichiatria di Consultazione nell'Ospedale Generale [Articolo su rivista]
Rigatelli, Marco; Ferrari, Silvia; Galeazzi, Gian Maria
abstract

Not available

2001 - L’organizzazione di un servizio di psichiatria di consultazione e collegamento [Relazione in Atti di Convegno]
Rigatelli, Marco; Ferrari, Silvia
abstract

L’organizzazione di un servizio di psichiatria di consultazione e collegamento.

2000 - A new C-L P complexity: Abortion after 1st trimester of pregnancy [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia; Palmieri, G.
abstract

Not available

2000 - Possibilità e responsabilità di un servizio di psichiatria e di consultazione nei confronti del burn-out degli operatori sanitari [Capitolo/Saggio]
Rigatelli, Marco; Massari, I; Ferrari, Silvia
abstract

Not available

2000 - Teaching and training in the psychiatric-psychosomatic consultation- liaison setting [Articolo su rivista]
Rigatelli, Marco; Ferrari, Silvia; Uguzzoni, Ugo; Natali, Alba
abstract

Background: The consultation-liaison (C-L) psychiatrist isin an opportune position to undertake the tasks of education,training and assessment of performance as regardsfuture physicians, psychiatrists, specialists in otherbranches and nurses. This paper describes the educationand training programme in the Psychiatric-PsychosomaticC-L Service of Modena University Hospital. Descriptionof the Programme: This programme consists ofthe following main activities: (1) daily group-case supervision,performed by the full-time psychiatrist togetherwith the psychiatry residents of the C-L staff; (2) abimonthly quality management meeting, which is part ofa European project of measurement and improvement ofquality of service; (3) weekly lectures on selected topics;(4) monthly tutorials in research techniques; (5) bimonthlypresentations of literature reviews; (6) weekly clinicalcase conferences, which are the nucleus of the curriculumand which focus on the following main topics: ‘the patients’, ‘the intervention’ and ‘the group’, and (7) liaisonmeetings requested by non-psychiatric departments.Conclusions: A common denominator seenthroughout the teaching and training activities of such aprogramme is the attitude of openness and effort towardintegration which should be the C-L psychiatrist’s distinguishingmark, in the context of the general hospital.

2000 - Training medicine and psychiatry residents in the academic C-L setting [Abstract in Rivista]
Rigatelli, Marco; Ferrari, Silvia
abstract

Not available

1999 - Le consulenze psichiatriche ripetute al Policlinico di Modena ed al SSM di Reggio Emilia: due esperienze a confronto. [Relazione in Atti di Convegno]
Rigatelli, Marco; Ferrari, Silvia; M., Moscara; F., Asioli
abstract

aspetti comuni e specifici di due attività di psichiatria di consultazione, intra- ed extra-ospedaliera

1999 - Psichiatria di consultazione e dipartimenti di salute mentale [Relazione in Atti di Convegno]
Rigatelli, Marco; Ferrari, Silvia
abstract

aspetti comuni ed opportunità nell'ottica del lavoro territoriale