Search Results (11)

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and continuity of care. Nevertheless, risk governance gaps persist for high-complexity patients, imposing a disproportionate legal and clinical burden on mental health professionals. This group includes individuals who refuse treatment despite meeting criteria for compulsory admission, patients at elevated risk with substantial management complexity, and offenders with a current or suspected psychiatric disorder. Methods: We conducted a comparative legal and policy review across seven jurisdictions (Italy, England and Wales (UK), France, Germany, Spain, the United States, and Canada) to map frameworks for involuntary treatment, forensic services, CTOs (or equivalents), and community-based risk management. We also extracted procedural safeguards, duration and renewal limits, and interfaces with forensic services. Results: CTOs are available in five of the seven jurisdictions (England and Wales, France, Spain, the United States, and Canada) but are absent in Italy and Germany. We propose a three-pillar framework: (1) enforceable outpatient measures, including CTOs; (2) Forensic Psychiatry Units within Local Health Authorities; and (3) oversight boards with judicial, clinical, and social representatives. These components aim to redistribute responsibility, ensure continuity of care, and provide proportional oversight within a least restrictive, graduated system. Conclusions: When narrowly targeted, time limited, and paired with robust safeguards and service-quality standards, CTOs can support adherence and continuity for patients who repeatedly disengage from care. For Italy, integrating this instrument within the three-pillar framework and under independent oversight could strengthen patient rights and public safety, reduce revolving-door admissions, and improve outcomes. Full article

Background: Italy’s forensic psychiatric system has undergone major reforms over recent decades, shifting from custodial institutions to a right-based, community-oriented model. While internationally praised for its commitment to dignity, recovery, and social reintegration, this framework presupposes a degree of clinical recoverability that is not always achievable. Individuals with chronic, treatment-resistant disorders—particularly those who remain socially dangerous—pose complex challenges that strain the system. Methods: We report a thirty-year longitudinal case of G.D.M.: a man initially diagnosed with schizophrenia and later with chronic delusional disorder. Clinical data, forensic assessments, institutional records, and community-based rehabilitation reports were reviewed to reconstruct his clinical, criminological, and forensic trajectory. Results: The patient committed a femicide in early adulthood and, decades later, engaged in stalking behavior toward the victim’s family. Despite prolonged institutionalization, pharmacological treatment, multiple forensic evaluations, and rehabilitation programs, his psychopathology remained substantially unchanged. He persisted with fixed delusional ideation, exhibited minimal insight, and maintained a high level of social dangerousness. Conclusions: This case exemplifies structural gaps in Italy’s forensic psychiatric system, particularly the absence of stratified security levels, long-stay therapeutic facilities, and post-custodial continuity of care for individuals who do not recover. It also highlights the increasing burden placed on the Dipartimenti di Salute Mentale (DSM, Italian Mental Health Departments), which must manage both general psychiatric and high-complexity forensic cases, often without adequate resources or training. Targeted reforms—including secure long-term care pathways, systematic outcome monitoring, and clearer forensic mandates—are needed to ensure proportionate, ethical, and effective management of such cases. Full article

In recent years, Italy has experienced a significant increase in violence against healthcare workers, mirroring a global trend. Manifesting as verbal, physical, psychological, and material aggression, this phenomenon endangers both personnel safety and the foundational principles of the National Health Service (SSN) as outlined in Article 32 of the Italian Constitution. The escalation—most acute in emergency departments, psychiatric units, inpatient wards, and community services—affects a broad spectrum of professionals, compromising care quality and institutional integrity. Data from the FNOMCeO-CENSIS Report 2023–2024 reveal over 18,000 reported incidents in 2024, with verbal assaults disproportionately affecting female nursing staff. The COVID-19 pandemic further exacerbated systemic vulnerabilities, heightening user dissatisfaction and psychological strain among healthcare providers. In response, legislative actions—such as Law No. 113/2020 and Decree-Law No. 137/2024—aim to strengthen prevention, monitoring, and penal measures. This article examines legal, institutional, and organizational responses, including on-the-ground and hospital-based strategies to mitigate violence. Adopting a multidisciplinary perspective, it analyzes recent policy developments, regional dynamics, and victim-perpetrator profiles, arguing that safeguarding healthcare environments is both a public security priority and an ethical imperative essential to preserving the dignity of care work and the resilience of the health system. Full article

Background/Objectives: The Mood Disorder Questionnaire (MDQ) is a widely used tool for the early detection of Bipolar Disorder (BD), yet its diagnostic accuracy remains debated. In particular, the MDQ often yields false positives in individuals with anxiety, stress-related, or personality disorders, raising questions about its clinical utility. This study aimed primarily to evaluate the sensitivity, specificity, and predictive values of the MDQ in identifying BD within a large, community-based sample using structured clinical interviews. Additionally, we explored the construct of DYMERS (Dysregulation of Mood, Energy, and Social Rhythms Syndrome), a proposed condition characterized by mood instability, hyperactivation traits, and rhythm dysregulation among MDQ-positive individuals without a formal psychiatric diagnosis. Methods: A total of 4999 adults were surveyed across six Italian regions using a stratified random sampling method. Psychiatric diagnoses were established using DSM-IV-TR criteria via the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS). The MDQ was administered face to face in its validated Italian version, with a positivity cut-off of ≥7. The MDQ exhibited low sensitivity and high specificity (0.962; 95% CI: 0.961–0.963). Results: Among 2337 analyzable cases, the MDQ showed high specificity (96.2%) but low sensitivity (42.9%) for BD, indicating limited effectiveness as a screening tool. In clinical terms, this implies that while MDQ-positive individuals are unlikely to be false positives, a substantial proportion of true BD cases are not identified. Notably, a significant subgroup of MDQ-positive individuals without psychiatric diagnoses displayed features consistent with DYMERS. Conclusions: Our findings confirm the limited screening value of the MDQ for BD in community samples. However, MDQ positivity may help identify a broader spectrum of mood and rhythm dysregulation not captured by current diagnostic systems. Future research should focus on validating DYMERS as a clinical entity and on developing targeted diagnostic instruments capable of capturing this emerging dimension of psychopathology. Full article

Suicidality poses a significant public health threat and stands as a leading cause of death and disability. Aside from committed suicides, a substantial portion of suicidal behaviors comprises suicide attempts and suicidal ideation. These events may be characterized by a non-fatal outcome, shedding light on the possibility of recurrence. The objectives of the present study were to assess hospitalization rate trends related to any suicidal event and to elucidate the risk factors associated with recurrent suicidal behaviors. In this population-based study, an observational descriptive analysis was conducted on all hospital discharge forms (HDRs, Italian SDO) registered for the residents of the Veneto Region from 2012 to 2021. Cases of attempted suicide (AS) and suicidal ideation (SI) were defined according to ICD coding. Age-standardized hospitalization rates were computed with the direct method. Join Point Regression was used to assess the significance of variations in trends. Factor risks for the reiteration of suicidal behaviors were assessed by multivariate logistic regression. Higher prevalence of SI occurred among individuals under 40 years of age and those affected by psychiatric disorders. Conversely, among individuals aged 60 and above, AS was more common. SI turned out to be associated with a higher likelihood of reiteration compared to AS. Individuals suffering from personality disorders and those with a history of AS as index case exhibited increased risk for the reiteration of AS. Females, younger individuals, and individuals experiencing SI as first episode were instead identified as more likely to repeat this form of suicidal behavior. Contemporary economic and environmental crises, a recent pandemic, and numerous conflicts represent significant additional menaces to mental well-being. Our analysis highlights a concerning positive trend in suicide attempts and ideations, underscoring the imperative for Public Health Systems to implement targeted preventive strategies and mental health promotion campaigns. In the absence of structured suicide registries, we demonstrated that HDRs can serve as an invaluable foundation for preventionists to address the phenomenon and strategically plan interventions. Full article

Background: The ever-increasing spread of Internet-based systems for common mental disorders has generated the need for brief online screening methods. This study aims to test the psychometric properties of the Web Screening Questionnaire (WSQ) to examine its suitability for screening for common mental health problems among a community sample of Italian adults. Methods: A total of 1282 subjects (F = 819; mean age = 42.05) answered the WSQ. Its discriminant characteristics were examined with other validated selected scales for measuring mental health widely used in the Italian population using sensitivity, specificity, and area under the curve (AUC), as well as positive (PPV) and negative predictive values (NPV). Results: Most of the WSQ subscales exhibited moderate to high specificity values. Specifically, the scales of ‘agoraphobia’ (0.947; 95%CI [0.934, 0.960]), ‘anxiety’ (0.959; 95%CI [0.946, 0.970]), and ‘panic disorder’ (0.973; 95%CI [0.964, 0.981]) showed the highest values whilst the ‘obsessive-compulsive’ dimension had the lowest value at 0.838, 95%CI [0.815, 0.861]. With exceptions observed for ‘depression’ (0.716; 95%CI [642, 798]) and ‘alcohol abuse’ (0.760; 95%CI [560, 920]), instead, the WSQ demonstrated critical sensitivity values (<0.6) in all dimensions. Conclusions: The WSQ was appropriate for discriminating between people with and without a psychiatric condition, as it helps to confirm the absence of disorders. However, further diagnostic procedures are required, in case of a positive WSQ screening result. Full article

This retrospective observational study on hospital staff requesting an “application visit” (from 2017 to 2022) at the Occupational Medicine department aimed at comparing a “pre-COVID group” (2017–2019) with a “COVID group” (2020–2022) regarding (a) sociodemographic data (i.e., age, sex, occupation, years of employment at the hospital), (b) rate and type of psychiatric diagnoses in both groups and rate of psychiatric diagnoses per subject, and (c) rate of drug/psychotherapeutic prescriptions. Two hundred and five healthcare workers (F = 73.7%; mean age = 50.7 ± 10.33) were visited. Compared with the pre-COVID group, healthcare workers evaluated during COVID-19 were significantly younger and reported fewer years of employment at the hospital. Although rates of primary psychiatric diagnoses were similar in both samples, an increased number of psychopathologies per subject and associated treatment prescriptions in the COVID group was observed. In the COVID group, 61% had one psychiatric diagnosis, and 28% had 2+ psychiatric diagnoses, compared with 83.8% and 6.7% of pre-COVID. Furthermore, 56.2%/1.9% in pre-COVID and 73%/6% in the COVID group were prescribed drugs/psychotherapy, respectively. The findings of the present study highlighted an increase in both younger workers’ requests and psychiatric comorbidities during the pandemic, representing a burden on the Italian healthcare system. It is thus relevant to address the mental health challenges of healthcare workers accordingly. Full article

During the COVID-19 pandemic, an increase in the incidence of psychiatric disorders in the general population and an increase in the severity of symptoms in psychiatric patients have been reported. Anxiety and depression symptoms are the most commonly observed during large-scale dramatic events such as pandemics and wars, especially when these implicate an extended lockdown. The early detection of higher risk clinical and non-clinical individuals would help prevent the new onset and/or deterioration of these symptoms. This in turn would lead to the implementation of public policies aimed at protecting vulnerable populations during these dramatic contingencies, therefore optimising the effectiveness of interventions and saving the resources of national healthcare systems. We used a supervised machine learning method to identify the predictors of the severity of psychiatric symptoms during the Italian lockdown due to the COVID-19 pandemic. Via a case study, we applied this methodology to a small sample of healthy individuals, obsessive-compulsive disorder patients, and adjustment disorder patients. Our preliminary results show that our models were able to predict depression, anxiety, and obsessive-compulsive symptoms during the lockdown with up to 92% accuracy based on demographic and clinical characteristics collected before the pandemic. The presented methodology may be used to predict the psychiatric prognosis of individuals under a large-scale lockdown and thus supporting the related clinical decisions. Full article

(1) Background: The Italian Constitutional Court’s decision n. 99/2019 abolished the distinction between physical and psychological health care in the Italian prison system. However, this and other changes to the penitentiary system present challenges to prison staff, which may vary based on their roles and backgrounds; (2) Purpose: To create a process of dialogue and collaboration that include different points of view, needs, and proposals regarding mental health in prisons, this study collects and integrates the perspectives of 91 prison staff who work in various capacities in eight prisons in northeast Italy. (3) Methods: Each participant was involved in either a focus group or a semi-structured interview, and thematic analysis was used to process the resulting transcripts; (3) Results: Through this process, 10 themes were derived that highlight the difficulties of working with prisoners with psychiatric disorders or psychological distress, including lack of human and economic resources, lack of positive communication between prisoners and society and a sense of professional incompetency; (4) Conclusions: Based on these themes, the need for increased points of view, dialogue, and collaboration between prison professionals and between prison and society is discussed, and the current feasibility of treating psychiatric disorders in prison is considered. Full article

Demoralization is a commonly observed syndrome in medically ill patients. The risk of demoralization may increase in patients after a kidney transplant (KTRs) because of the stressful nature of renal transplantation, psychosocial challenges, and adjustment needs. No study is available on demoralization amongst KTRs. The purpose of our study was to evaluate the validity of the Italian version of the Demoralization Scale (DS-IT) and the prevalence of demoralization in KTRs. Also, we aimed at exploring the association of the DS-IT with International Classification of Diseases (ICD) psychiatric diagnoses, post-traumatic growth (PTG), psychological and physical symptoms, and daily-life problems. A total of 134 KTRs were administered the MINI International Neuropsychiatric Interview 6.0. and the Diagnostic Criteria for Psychosomatic Research–Demoralization (DCPR/D) Interview. The DS-IT, the Edmonton Symptom Assessment System (ESAS), the Canadian Problem Checklist (CPC), were used to measure demoralization, physical and psychological symptoms, and daily-life problems; also, positive psychological experience of kidney transplantation was assessed with the PTG Inventory. Routine biochemistry and sociodemographic data were collected. Exploratory factor analysis demonstrated a four-dimensional factor structure of the DS-IT, explaining 55% of the variance (loss of meaning and purpose, disheartenment, dysphoria, and sense of failure). DS-IT Cronbach alpha coefficients indicated good or acceptable level of internal consistency. The area under the Receiving Operating Characteristics (ROC) curve for DS-IT (against the DCPR/D interview as a gold standard) was 0.92. The DS-IT optimal cut-off points were ≥20 (sensitivity 0.87, specificity 0.82). By examining the level of demoralization, 14.2%, 46.3%, 24.6%, and 14.6% of our sample were classified as having no, low, moderate, and high demoralization, respectively, with differences according to the ICD psychiatric diagnoses (p < 0.001). DS-IT Total and subscales scores were positively correlated with scores of ESAS symptoms and CPC score. A correlation between DS-IT loss of meaning and purpose subscale and PTGI appreciation of life subscale (p < 0.05) was found. This study shows, for the first time, a satisfactory level of reliability of the DS-IT and a high prevalence of severe demoralization in KTRs. Full article

This article traces the rise and fall of psychiatric evaluation in criminal trials from the School of Criminal Anthropology of the late nineteenth century to the current Italian justice system. Influenced by positivism and by specific theories on human evolution, Cesare Lombroso considered criminal action as the result of organic causes excluding any kind of legal autonomy and responsibility of the accused. The Positive School of Penal Law he founded with Enrico Ferri and Raffaele Garofalo profoundly inspired the Rocco Code, on which the current Italian Penal Code is still based, albeit with revisions and repeals. Drafted in 1930 during the fascist government (1922–1943), the latter has also suffered from racial ideology. In order to assess potential mental illnesses that would exclude the responsibility of the accused, to determine their level of dangerousness and to establish the corresponding security measures introduced by the Rocco Code, Italian criminal justice consolidated the link between penal law and psychiatric instruments. Such faith in psychiatric evaluation, however, has been particularly questioned by the increasing frequency of judicial processes involving members of different cultural communities in Italy since the 1970s. Thus, the predominantly pathological aspects evaluated by forensic psychiatrists have often proved to be conceptually and methodologically inadequate to take fully into account the differences between cultures, as well as the different social and cultural conditions affecting the defendant’s behaviour. This paper argues that cultural anthropology is particularly suited as an instrument capable of disclosing the cultural implications of the legal process and encourages the use of cultural expertise as an important tool for the inclusiveness and understanding of diversity. Full article