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In Italy, following the closure of psychiatric hospitals in 1978 and the release of psychiatric patients into community care, there was a mismatch between common psychiatric patients and the convicted mentally ill who were sentenced to serve in state forensic psychiatric hospitals. The recent closure of such structures following the Prime Minister's Decree of April 1, 2008, fostered the need to create new structures. These are called "REMS," and they are based in the community and led by psychiatrists and healthcare staff who may rely on the collaboration of public security staff. This act completed a course of progressive deinstitutionalization of all psychiatric patients. However, some problems remain, and persons regarded as "partially mentally disabled" at the time of crime perpetration must serve part of their sentence in prison and the rest in the aforementioned structures or in psychiatric rehabilitation communities, depending on their claimed "social dangerousness." Psychiatric services now face the ambiguity of treating persons who are considered dangerous by court orders, while the civil law criteria for involuntary hospitalization is based only on the need of care. The complete closure of forensic hospitals may be considered a decisive step forward in the humanization of society, but there are still some issues to address to make it work better. The implementation of multidisciplinary teams and effective psychotherapy, psychoeducational, and rehabilitation interventions can help., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: The efficacy of a multidisciplinary, intensive and integrated day-hospital treatment was evaluated in a group of overeaters (bulimia nervosa, binge eating disorder, obesity without binging)., Methods: The study sample included 72 subjects consecutively admitted to DH who were evaluated at the first contact with the service, on admission, after 5 weeks of treatment, and at discharge. The primary outcome was the total score at the Eating Disorder Inventory (EDI), and the secondary outcome was change in body mass index (BMI). The effects of the duration of treatment on results were also assessed. The improvement of EDI and BMI was compared between the two groups of bingers and non-bingers., Results: Four patients dropped during the treatment period. In the whole sample, both EDI and BMI improved significantly after 5 weeks (p=0.00) and continued to improve until the end of treatment (p=0.00). The duration of treatment did not have a significant impact on BMI improvement (p=0.07), but significantly affected EDI improvement (p=0.006), although only during the treatment period. No significant differences were observed between obese/overweight bingers and non-bingers in BMI improvement (p=0.41), whereas EDI improvement was higher in bingers (p=0.02)., Conclusions: The relatively good compliance and the efficacy data suggest that in overeating subjects resistant to previous outpatient treatments a more intensive DH treatment may be useful. Our findings show that such a multidisciplinary therapeutic-rehabilitative treatment significantly improves both total EDI score (especially in bingers) and BMI.

Objectives: To study potentially traumatic events (PTE), post-traumatic stress disorder (PTSD), anxiety, depression, somatization and post-migration living difficulties (PMLD) in primary care immigrants., Design: Patients self-rated transculturally validated questionnaires. Those with and without PTSD were compared on all variables. The influence of the number of PTE and of PMLD on PTSD was measured., Results: 391 patients completed the questionnaires. Prevalence of PTSD was 10.2%. PTE and PMLD were frequent in the whole sample but more common in PTSD subjects. Either the number of PTE and of PMLD significantly increased the likelihood to have a PTSD., Conclusions: PTE, PMLD, PTSD and related conditions (anxiety, depression and somatization) are frequent among immigrants in primary care, and either PTE and PMLD significantly influence resulting psychopathology. The implications in clinical practice are discussed.

Aims: We sought to evaluate secondary school teachers' knowledge about psychosis and their level of interest in this topic given the key role they may be able to play in the early detection of psychosis., Methods: A questionnaire survey of 268 secondary school teachers from eight secondary schools within the Azienda Sanitaria Locale Rome/E and Rome/A catchment areas (two of the five city health districts) in Rome. Teachers were asked to complete the Italian version Esperienza e Conoscenza delle Difficoltò Sociali ed Emotive dei Giovani of the Knowledge and Experience of Social Emotional Difficulties among Young people self-report questionnaire that investigates the diagnosis, age of onset, aetiology, prognosis and treatment of psychosis. They were also asked about their experience with pupils with possible psychosis., Results: Most of teachers were able to recognize psychotic symptoms from a case vignette. Approximately 25% of the teachers had experienced a pupil with possible symptoms of psychosis. However, teachers displayed little awareness of psychiatric community services available for young people., Conclusions: Our study shows that teachers may play an important role in early detection and psychosis prevention strategies. The teachers also displayed a keen interest in gaining a deeper knowledge of early psychotic signs and in cooperating closely with a mental health specialist to obtain guidance and support when faced with serious mentally ill pupils., (© 2011 Blackwell Publishing Asia Pty Ltd.)

Aim: To study somatization in a large sample of immigrants attending a first visit to a primary care service. Differences in somatization among four large immigrant groups (Europeans, Asians, South Americans, and Africans) and 16 subgroups based on nationality were assessed., Design: A total of 3105 patients were asked to participate in the study, of whom 3051 completed the 21-item version of the Bradford Somatic Inventory (BSI-21). Patients scoring 14 or higher on the BSI-21 were considered to be somatizers. A multiple logistic regression analysis adjusting for intervening variables tested the relative risk of somatization in and among the groups., Results: Among the 3051 patients who completed the BSI-21, 782 (25.6%) were somatizers. Somatizers were significantly more prevalent among South Americans (30.1%). After adjusting for covariates, Asians and Europeans, but not Africans, showed a significantly lower risk of somatization compared to South Americans. Among national subgroups, somatization occurred more frequently in Peruvians (32.9%). Compared to Peruvians, migrants from Eastern Europe, Morocco, the Philippines, Sri Lanka, and El Salvador demonstrated a significantly lower risk of somatization., Conclusions: Approximately one-fourth of socially disadvantaged immigrants who accessed primary care services used somatization to express their distress. However, the likelihood of somatization varied widely among the different groups, and was significantly higher in South Americans and in some African groups, and lower in some Asian groups.

Aims: The 19-item 'Scale Of Prodromal Symptoms' (SOPS) and its semi-structured interview, the Structured Interview for Prodromal Symptoms (SIPS), have been developed to assess prodromes of psychosis. We assessed psychometric properties of the Italian version of the instrument., Methods: We collected socio-demographic and clinical data of 128 people seeking first-time psychiatric help in a large Roman area, either as outpatients at community facilities or as inpatients in psychiatric wards of two general hospitals. Participants were administered the Italian version of the SOPS and the 24-item Brief Psychiatric Rating Scale (BPRS). Data were analysed through Pearson's correlation and factorial analysis., Results: The English and Italian SOPS versions showed similar psychometric properties and factorial structure. The best-fit model was trifactorial, explaining 90% of total variance, and roughly corresponding to the positive, negative, and general dimensions, with disorganisation spreading over the other dimensions. Compared with the BPRS, the Italian version of the SOPS showed construct validity and convergent validity., Conclusions: The factor-structure of the Italian version of the SOPS is similar to those of the English and Spanish versions, in that the factors emerged are the same (positive, negative, and general symptoms). The scale could be used to assess at-risk people in early intervention services.

The role of post-migration living difficulties (PMLD) on somatization was studied in 101 first generation immigrants visited in primary care. Premigratory traumas and post-traumatic stress disorder (PTSD) were also assessed. About one third of patients somatized. Sociodemographic variables were similar in somatizers and non-somatizers. Premigratory traumas, PTSD and the likelihood to report at least one serious or very serious PMLD were higher in somatizers. Four kinds of PMLD were more frequent in somatizers: worries about unavailability of health assistance, working problems, discrimination and poor social help. Traumas and PTSD influenced the effect of PMLD on somatization. Findings suggest that in specific samples of primary care immigrants severe premigratory traumas increase the sensitivity to PMLD and in turn distress due to PMLD amplifies the tendency to somatize.

Traumatic experiences and somatization are related in studies on complex trauma, though this relation is rarely studied in immigrants. The relationship between somatization and self-reported traumatic experiences and posttraumatic symptoms in patients attending a primary care service for immigrants was studied. The sample consisted of 101 patients attending a primary healthcare service dedicated to immigrants. Participants completed two self-assessment questionnaires specifically designed for use in transcultural research: the Bradford Somatic Inventory and the Harvard Trauma Questionnaire. Both were translated and back-translated into eight languages. Somatization was significantly related to traumatic events and posttraumatic symptoms. In primary care centers for immigrants, physicians should give particular attention to somatization as a possible sign of unreported posttraumatic symptoms.

Objective: The aim of this study was to evaluate whether there were different seasonal variations of births in an Italian population of patients with schizophrenia, with other psychotic disorders, and with personality disorders than in the general population., Methods: Birth dates of 1270 patients admitted to one university psychiatric unit in Rome between 1990 and 2003, with a diagnosis of schizophrenia, other psychotic disorder (OPD) and personality disorder/cluster A (PD) were analyzed according to seasonal variation., Results: A significant excess of births in spring (with a peak in May) and a deficit in autumn (with a trough in October) was found in the sample of male schizophrenics (n = 506). No statistically significant variations were found in either the sample of female schizophrenics (n = 88) or in the combined sample with OPD and PD (n = 676)., Conclusions: The findings serve to strengthen the existing hypotheses that schizophrenia is related to environmental factors acting on the development of the central nervous system intrauterinely.