Lara Del Col

Psychological and behavioral disease during developmental age: the importance of the alliance with parents

The aim of the study is to analyze the clinician’s alliance with parents during the diagnostic process in relation to therapeutic compliance and clinical evolution of individuals aged 0–11 years. The sample was formed by 84 individuals aged 0 to 11 years (18 < 6 years, 66 aged 6 to 11 years; 62 males and 22 females) who came to the Neuropsychiatric Unit for Children and Adolescents for a consultation regarding psychorelational and behavioral problems. Neuropsychiatric consultation took place in five diagnostic interviews with child and parents, separately. The last session was devoted to communication of psychiatric diagnosis (according to ICD 10) and therapeutic suggestions, if any. The clinician’s relationship with parents and patients’ participation were evaluated in terms of collaboration and quality of interaction, on the basis of pre-established criteria. Data about patients’ therapeutic compliance and clinical outcome were collected during a follow-up visit eight months after the last session. Results suggest that the better the alliance between parents and clinician, the higher the therapeutic compliance and the likelihood of a positive outcome for patients. Our data suggest that good communication with parents benefits child patients, both in terms of response to the parents’ need to report their children’s worrying behavior and as a response to the discomfort expressed by children when they come in for consultation.

Psicodramma analitico di gruppo con adolescenti: analisi testuale dei contenuti emersi

Questo lavoro verte sull’analisi testuale delle trascrizioni di un ciclo di psicodramma analitico con un gruppo di adolescenti affetti da patologie neuropsichiatriche, omogeneo per eta, livello di disfunzionamento psicosociale e presa in carico. E stata effettuata un’analisi qualitativa attraverso ATLAS.ti focalizzandosi su quanto verbalizzato dai soggetti, sui significati e sulle transazioni intra-seduta a livello microanalitico. Tale analisi e stata improntata ad un’ottica bottom-up, con l’obiettivo di costruire una griglia di analisi adattabile e utilizzabile per lavori futuri. Si e partiti dagli obiettivi terapeutici dell’intervento per stabilire macrofamiglie che hanno permesso un’accurata analisi del testo per mezzo dell’attribuzione di codici che riassumevano in se i significati verbalizzati durante le 12 sedute. Dai dati e emersa la presenza di contenuti rilevanti nel processo terapeutico, che si connettono sia ad aspetti primariamente legati al disagio psichico dei soggetti sia ad aspetti connessi alla specifica fase evolutiva che tali ragazzi stanno attraversando. Gli autori sostengono la dimensione esplorativa del loro lavoro, evidenziando che la griglia di macrofamiglie e codici ottenuta possa essere in futuro utilizzata per l’analisi di altri contributi.

Community Services for Psychiatric Adolescents: When Planning a Residential or Semi-residential Treatment

Background: Adolescence psychopathology often represents a challenge in regards of the way it is treated, due to the shortage of public mental health resources like Wellbeing Centers and daily Services, that differ from hospitals. From our experience in a daily Semi-residential Service for Children and Adolescents, part of the Public Neuropsychiatry Unit in Padua Italy, we carried out a retrospective analysis in order to identify which factors could be the best indicators for the referral of a young person to a residential or a semi-residential placement. Scope: We aimed to identify which variables, detectable at an early stage of treatment, may be Original Research Article Gatta et al.; INDJ, 7(1): 1-19, 2016; Article no.INDJ.23329 2 good predictors for the referral of the young person, either to a daily semi-residential facility, or to recommend a more intensive treatment in a residential unit. Methods: The sample consists of 102 adolescents referred to the daily Semi-residential Service. It was later on divided into two groups: one group stayed in the Semi-residential Service and the second group pursued a referral in a residential child care institution. All patients were assessed using the Youth Self Report Form YSR (11-18) and the Global Assessment of Functioning Scale (GAF) with a test – retest methodology. For each patient the following data were collected: personal and family details, schooling, diagnosis, therapeutic objectives, adolescent‘s level of cooperation, their families’, and type of intervention submitted. All data were analyzed and compared to find out the most predictive factors towards the best placement for the patient. Results: It emerged that residential child care institution was recommended for adolescents with the following features: aged under 14, living with single parent, affected by externalizing problems, displaying a poor therapeutic compliance and with non cooperative families. Conclusions: This study showed the importance to identify which predictive factors are related to a better outcome in patients who used alternative services to hospitalization, considering these factors also necessary in terms of a better therapeutic intervention.

Adolescenza e psicodramma analitico: analisi testuale ed effetti a breve termine sui sintomi psichiatrici

Questo lavoro si propone di compiere un’analisi qualitativa e quantitativa di un progetto di psicodramma analitico a tempo limitato con un gruppo omogeneo di adolescenti affetti da patologie neuropsichiatriche. L’impianto metodologico ha previsto l’analisi del testo sulle trascrizioni delle sedute mediante il software ATLAS.ti e, parallelamente, l’analisi statistica dei punteggi del gruppo al test SCL-90, confrontati con quelli di un gruppo di controllo omogeneo sottoposto a terapia individuale breve ad orientamento psicodinamico. Gli obiettivi sono stati la creazione e la successiva validazione di una griglia di codici che potesse fungere da griglia di analisi qualitativa, potenzialmente applicabile ad interventi similari, e la valutazione dell’efficacia terapeutica passante attraverso piu dimensioni: da considerazioni di processo focalizzate sui contenuti e le transazioni intra-seduta a livello microanalitico, alla verifica di indicatori clinici di outcome legati ad eventuali variazioni sintomatologiche.

Adolescents with Mental Disorders: The Efficacy of a Multiprofessional Approach

Approaches to mental health problems can historically be grouped into three theoreticalmethodological systems, i.e. the psychological, the bio-pharmacological and the socioenvironmental. Operators often tend ideologically to support one of these approaches, thereby emphasizing a distinction that originates from an old-fashioned separation between body and mind, and between individual and setting. The therapist with a biological education thus often brings the issue down to choosing the appropriate drug to eliminate the symptom; the therapist with a background in psychology is only interested in giving patients the most fitting interpretation of their symptoms to enable the latter to deal with them; and the educational therapist tends to search for social breakdowns (seen as the reason for the patient’s pathological behavior) and suggest more adequate relational models. The different types of therapist remain locked in their own world and often mistrust the other possible approaches, running the risk of misunderstanding the patient’s needs and providing only partial or ineffective intervention as a result. Many studies have focused on and compared the benefits of different treatment settings for different mental disorders (psychoses, eating disorders, mood disorders, behavioral problems, ADHD, etc), and reviewed the various treatment methods that have proved helpful in managing young patients (Bachmann et al., 2008a, 2008b; Connor et al., 2006; MTA, 2004; Velligan et al., 2009). Although different settings and a multimodal treatment approach (including individual psychotherapy, pharmacology and family-based interventions) are described and recommended, evidence-based findings on the effects of the various treatment methods are still limited (Herpertz-Dahlmann & Salbach-Andrae, 2009; Masi et al., 2008; Nutzel, Schmid, Goldbeck & Fegert, 2005; Steiner & Remsing, 2007).