[Italian validation of the Prolonged Grief Disorder Questionnaire (PG-12)]. / Validazione italiana del Questionario Prolonged Grief Disorder (PG-12).

Death or severe invalidity (e.g. vegetative state) of a family member causes deep emotional distress to the caregiver. In most cases elaboration of mourning at the loss unfolds in physiological times and modes, enabling the caregiver to react to the separation and resume their own daily life. In some cases, however, there is an incapacity to react and caregivers remain imprisoned in a condition they are unable to elaborate consisting of memories, regrets and a sense of guilt, that leads to their self isolation and prevents them from leading a full life as prior to the grief-causing event. This condition, not always classifiable as a major depressive disorder, is, according to a recent debate, more adequately described as the "Prolonged Grief Disorder". The Prolonged Grief Disorder is a new diagnostic category, currently under examination in America for inclusion in the DSM V in order to give clinicians a picture that better describes the condition of these caregivers. The PG-12 is a questionnaire that is easy and quick to administer and score which can guide the clinician in the diagnosis of this condition. The present paper presents the methodology followed for the translation into Italian of this instrument and the data that emerged concerning its validity and applicability. 45 caregivers of vegetative state patients were enrolled. The PG-12 Italian version showed good internal consistency (Cronbach alpha = 0.88) and a mono factorial structure.

[Prolonged grief disorder: towards a new diagnostic category]. / Prolonged grief disorder: verso la definizione di una nuova categoria diagnostica.

The grief in response to loss of a significant is a normal, inevitable, experience of life. Nevertheless some people, even after a couple of months, do not succeed in integrating this experience in their daily life and remain stuck in a state of suffering condition that seriously extended in the time is functionally impairing. For long time psychology has focused on bereavement subsequent to the loss and the complications that can derive from the missing elaboration. The condition of prolonged grief has been object of a large debate in the past years, up to the individualization of a specific set of symptoms identified in a new diagnostic category: the Prolonged Grief Disorder (PGD). The PGD is featured as a condition of emotional distress and physical distress by the loss, not for the death, of a significant only, with daily involvement in all function areas. Our work given a short and non exhaustive overview of the cultural and scientific run that has brought to the collection of the evidences to insert the PGD as new diagnostic category in the DSM V and a comparison between the Post-Traumatic Stress Disorder (PTSD) and the Major Depressive Disorder (MDD) for better underlining similes, but above all differences among categories that subtend clinical conditions that can appear sometimes overlaps.

[Vegetative state and over-treatment: what families think of it]. / Stato vegetativo e accanimento terapeutico: cosa ne pensano i familiari.

With the notable advances made in all branches of medicine doctors are now increasingly faced with issues no longer of a purely clinical nature but of an ethical and moral nature. Chronic diseases, terminal conditions, and the vegetative state are just some of the many examples of clinical conditions that impose on health professionals the need to reflect (and make decisions?) on ethical matters. The instruments that medicine places in the hands of the health professional must lead them to reflect not only on the clinical validity of a choice but also on how opportune it is to undertake a given intervention, on the proportionality of the intervention. There is an increasing need to calibrate interventions between 'opportune' and 'excessive'. To do this, technical expertise is not sufficient; other factors come into play that are more personal and difficult to standardize concerning the meaning itself of life and its quality. Alongside the technical-scientific opinions of the medical professional, the voice of family members must also be taken into account. A voice whose tone is deepened by the burden of caring, by the painful situation they are experiencing, by the difficulty of understanding a technical language they are not conversant with. The present study is a preliminary investigation carried out on 32 family caregivers of patients in minimally responsive or vegetative states in either long-term hospital structures or home care. Family caregivers were investigated concerning their understanding of the concept of over-treatment and which aspects of the patient's daily life could, in their opinion, be considered as over-treatment. Findings show that the concept of over-treatment is not well understood by families, even if almost all subjects declared to be contrary to over-treatment. Considering the health interventions in detail, however, family caregivers were of the opinion that all possible medical acts were opportune and necessary, even when they appear to be particularly invasive interventions, such as defibrillation manoeuvres.

[Family reactions to the vegetative state: a follow-up after 5 years]. / Le reazioni dei familiari allo stato vegetativo: un follow up a cinque anni.

Few studies to date have investigated the experience of family members of those who, following acute brain injury, traumatic or otherwise, find themselves in a vegetative state (VS), in particular how families cope, year after year, with care of the patient in hospital, what coping strategies are implemented to cope with everyday life, if the high levels of depression and anxiety, typical of such a difficult situation, modify as time passes, if the place of care chosen for the patient --at home or in a long-term hospital structure--influences the emotional state of the family members. This paper presents the results of a survey conducted on 30 family members of patients in VS, 25 of whom were long-term hospital inpatients and 5 home-based. Results are compared with the findings which emerged from a longitudinal study carried out on 16 family members tested in 2000 and re-evaluated, utilizing the same assessment tools, 5 years later. The results reveal a picture of significant emotional and psychophysical distress, high levels of anxiety and depression and the use mainly of situation-focused coping strategies. Family relations appear little satisfying even if over time they tend to improve. The comparison at 5 years reveals levels of anxiety, depression and emotional burnout superior to the norm and almost unchanged despite the passage of time. The comparison is slightly better for those who take part in mutual help groups under the guidance of a psychologist; these subjects tend to use coping strategies more centered on the expression of their emotions. Group therapy, when its goal is to help care givers share their own personal experience concerning the caring relationship, appears to facilitate the development of new strategies and resources to cope with daily living.

Patients in a persistent vegetative state: caregiver attitudes and reactions.

OBJECTIVES: This exploratory study investigated the problems encountered by caregivers of long-stay hospital patients in a persistent vegetative state. MATERIAL AND METHODS: Sixteen primary caregivers completed questionnaires designed to assess their personality, psychophysical distress, coping strategies and caregiving-related problems. RESULTS: Males showed a higher level of emotional distress and neuroticism than females. All of the caregivers used situation-oriented coping strategies less over time. had apparently unsatisfactory family relationships, and their emotional distress increased with disease duration. The thoughts of the possible death of the patient were associated with anxiety and depressive symptoms. The caregivers' everyday lives were characterized by limited social relationships, and indoor and outdoor interests. CONCLUSION: Our study underlines the importance of psychosocially assessing PVS patient caregivers, who are often alone in coping with a irreversible situation. It also introduces a questionnaire (FSQ2) that seems to be sufficient to assess the caregiving-related problems.