[Integrated therapy in panic attack disorders]. / Terapia integrata nel disturbo da attacchi di panico.

For the past years or so, studies on panic attack disorders (PAD) have accounted for a large proportion of psychiatric research. In spite of the attempts to clarify the etiopathogenesis of PAD, its characteristic psychopathological aspects and the evolutionary stages of its development, its nosographic status is still controversial (despite its inclusion in DSM III-R) and the same is true of the therapeutical approach. Using these observation as their starting point, the authors have divided the present paper into four parts. In the first they attempt to classify PAD in nosographical terms, whereas the second reviews all pharmacological therapies put forward over the past ten years. The third part consists of a short summary of the most widely used psychotherapeutic approaches, and in the last the authors suggest a model of integrated PAD therapy which is still being clinically experimented. The practice of associating pharmacological therapy with a psychotherapeutic approach has certainly been widely used for some time, but the authors underline that the two methods are only fully integrated in the presence of a therapeutic project resulting in a treatment protocol with controls during the course and at the end of treatment. In this context, the psychodiagnostic stage before therapy is particularly important since it provides as precise as possible a picture of the subject's basic personality and psychopathological state. These factors can lead to a wide varation in the choice of drug therapy, and even jeopardise therapeutic success. On the other hand, an exclusively psychotherapeutic approach to PAD does not rule out the onset of recurrent episodes during treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[An examination of the correlations between the general population and the users of the Biella Mental Health Service]. / Esame di alcune correlazioni tra la popolazione generale e l'utenza afferente al Servizio di Salute Mentale di Biella.

This paper correlates certain general population variables with that of the users of the Biella Mental Health Service. Age, sex, civic status and schooling are considered. Analysis of the data points to certain risk zones. The significance of these correlations is considered.

[The training of family members in treatment with suggestive and autogenic psychotherapies. The advantages and limits]. / L'addestramento dei familiari nel trattamento con psicoterapie suggestive e autogene. Vantaggi e limiti.

The first part of the paper examines the reasons for involving the patient's family in suggestion and autogenous therapy, giving details of the advantages and limitations of this involvement and listing the pathologies in which it is employed. Finally, the use of autogenous techniques as an aid in the diagnosis of the patient's individual and relational situation as well as the prognosis for a cure is briefly described.

[The involvement of family members in treatment with suggestive and autogenic psychotherapies. An analysis of a case]. / L'associazione dei familiari nel trattamento con psicoterapie suggestive e autogene. Analisi di un caso.

The first part of the present work reports the case of a young man given suggestion and autogenous therapy. The second part presents some remarks on the technique employed. In particular the advantages derived from recourse to a variety of suggestion techniques followed by the patient's use of autogenous training at home are examined. Finally the advantages to be derived from involving the patient's family in the induction therapy and the autogenous treatment are reported.

[Emergency home psychiatric care and the role of the general physician. Evaluations and hypotheses]. / L'urgenza psichiatrica domiciliare ed il ruolo del medico generico. Valutazioni ed ipotesi.

Some aspects of the activity of the Mental Health Service of Biella are described, particularly those regarding home care. Then, on the basis of a description of a clinical case, the functions and role that it is considered can be fulfilled by the general physician in cooperation with the psychiatrist during emergency hope care when the patient is not already known to the psychiatric service are outlined.

[The activity of psychiatric consultancy within a general hospital. The relationship and institutional implications]. / L'attività di consulenza psichiatrica all'interno dell'ospedale generale. Implicazioni relazionali ed istituzionali.

The consultancy activity performed by Biella Ward of the local general hospital in 1979-1987 is described. After presenting data regarding the quantity and nature of consultancy requests, the medico-hospital cultural background relating to mental suffering is analysed. The hospital often tends to address only the patient's bidimensional aspects, excluding his internal being. Because of a mutual, tacit contact between physician and patient, the moment of admission is seen as a "somatic repair service". The psychological crisis usually arises in the form of the breakdown of the contract when the possible uncertainty of diagnosis and the prolongation of clinical examination affects the personality. In the specific case of Biella Psychiatry, the forced closure of the Psychiatric Diagnosis and Care Service about six years ago helped push the Psychiatrist towards a "liaison" role.

[An epidemiological study of psychiatric emergencies at the Biella Department of Emergencies and Admissions in the 5 years of 1983-1987]. / Indagine epidemiologica sull'urgenza psichiatrica presso il DEA di Biella nel quinquennio 1983-87.

The psychiatric intervention procedure at the Emergency and Registration Department (ERD) of Biella Hospital is examined. After a short introduction in which some general data are provided regarding Health Unit no. 47 of Biella and Unit no. 48 of Cossato, the data collected by the ERD psychiatric register are analysed. Data on ERD arrival modalities are reviewed and the type of diagnosis attributed by the psychiatrist to patients examined at the ERD is examined. The various types of responses given by the psychiatrist after consultancy are then presented. The time bands in which the request for psychiatric intervention mainly fall are then noted. The paper closes with remarks on the effectiveness over time of psychiatric intervention at the ERD.

[Relation of the psychotherapist to the general practitioner]. / I rapporti dello psicoterapeuta con il medico generico.

The paper is divided into two parts. The first briefly examines the way patients react to distress and to the therapist. Common therapist attitudes to patients are then examined. The network of support the depressed patient should be surrounded by is then described as is the directive role to be played by the therapist. The second part presents cases of depression personally treated in collaboration with the patient's GP and family. The paper ends with a brief assessment of the attempt to combine the prescription of drugs, instruction to the doctor and the use of short advisory and autogenous psychotherapy session.

[Activity of psychiatric consultation in the D.E.A. of the hospital of Biella in the 4-year period 1-15-83/1-15-87]. / Attività di consulenza psichiatrica presso il D.E.A. dell'ospedale di Biella nel quadriennio 15-1-83/15-1-87.

The paper analyses the work of the psychiatrist in Biella Hospital D.E.A. between 15-1-83 and 15-1-87. The general outlines of the study are described under Material and Method. This is followed by a description of the way patients arrive at the D.E.A. during which it is pointed out that both the general practitioner and the local psychiatric service are generally excluded from the emergency circuit. The reasons for the emergency, the diagnosis arrived at and the types of treatment proposed by the psychiatrist are then reviewed. One section is dedicated to recurrences with particular emphasis on the so-called major users of the psychiatric emergency service.

[Problems of therapeutic training in conducting short-term psychotherapy]. / Problemi della formazione terapeutica nella conduzione di psicoterapie brevi.

On the basis of personal experience several problems facing the psychotherapist in the practice of short-term therapy are reviewed. The paper begins with a brief review of the training given with reference to the time element and the language used in psychotherapy. The chapter entitled "Hard and Soft Elements in Therapy" shows how much influence so-called external or contextual factors have on therapy. This is followed by two short chapters on the involvement of the patient's family or other partners or a health worker in the treatment given.

[Psychiatric emergencies]. / L'urgenza in psichiatria.

The present work is divided into four parts, the first part is a brief "Discourse on Emergency" that attempts to clarify the elements that distinguish psychiatric from medical emergency. The second part reviews the "Clinical pictures in which psychiatric emergency is not common". Psychopathological emergencies are briefly reviewed and mention is made of psychiatric emergencies deriving from non-psychiatric pathologies. The third part gives "Advice on the right approach to adopt in response to calls". Some integrated approaches are suggested. The fourth part presents several models of "Short-term psychotherapy in psychiatric emergency". Two cases of emergency treatment using multiple approach techniques are reported.

[Physician-patient relations in autogenic training and hypnotherapy]. / Aspetti della relazione in terapia autogena e ipnoterapia.

The paper is divided into two parts. The first deals with aspects of the doctor-patient relationship. It begins with a brief examination of the importance of training as a means of establishing an appropriate relationship and goes on to analyse certain aspects of that relationship. The most significant differences between analytical treatment and short-term therapy are then outlined. In particular, the influence that the imposition of a rigorous limit on the duration of treatment has on both the relationship and the course of the patient's condition is examined. The second part presents cases of treatment by autogenous training and hypnotherapy. Details are given of the use of the autogenous principle in therapy with recourse to a variety of autogenous techniques and the way the therapist can direct the treatment through hypnotherapy. The value of involving the patient's family in the treatment is also pointed out.

[Models of brief psychotherapy]. / Modelli di psicoterapie brevi.

The report is divided into four parts. The first compares psychoanalysis with short-term psychotherapy models. In particular, the problem of the patient's dependence on the therapist is analysed. The second part described the features of Erikson type short-term psychotherapy with remarks on autogenous therapy and some paradoxical aspects of autogenicity. The third part summarizes the lines along which short-term therapy is conducted including recourse to the autogenous element and prescription. The report concludes with the hypothesis that these techniques could be used in the Mental Health Services with the possibility of training in short-term therapy.

[Legal and social responsibilities of the psychiatrist within the public health service]. / Le responsabilità penali e civili dello psichiatra nell'ambito del servizio pubblico.

The present work is divided into four sections: The first deals with the general criteria for the assessment of responsibility. Aspects of negligence, imprudence and lack of professional skills in psychiatric practice are tackled with particular reference to diagnosis, the prescription of drugs and psychotherapy. The second part deals with the psychiatrist's responsibility in relation to the body in which he operates with particular emphasis on the problems of team work, the responsibilities deriving from the malfunction of the health service, the division of legal and social responsibilities between the psychiatrist and the organisation. The third part tackles certain problems related to the application of Law 180/78, developed in arts. 33-34-35 of Law 833/78. Controversial aspects of obligatory treatment measures (TSO) in situations when mental pathology is either dominant or not are examined. In relation to TSO for mental pathology, the possibility of implementing the measure outside the hospital environment is examined as is the behaviour of the psychiatrist in the face of irregular obligatory hospitalisation. The fourth section draws our attention to: particular aspects of the legal and social responsibilities of the head of a psychiatric diagnosis and treatment service. In particular the problems deriving from the transformation of a TSO into voluntary hospitalisation or its continuation are analysed as are the risks deriving from the patient's release.

[Analysis of the activities of the Biella Mental Health Service during the 3-year period 1980-1982]. / Analisi dell'attività del Servizio di Salute Mentale di Biella nel triennio 1980-1982.

An account is presented of the work of the Biella local health unit in the province of Vercelli, Piedmont. Attention is drawn to the difficulties met with in applying the latest enactments concerning psychiatry. Delay in application of the health reforms is having an adverse effect on the operation of the new psychiatric care structures. Psychiatry is finding it difficult to become an integral part of the other health services. This is clear from the requests for consultation made to department psychiatrists at Biella Hospital. There has been an increase in applications for admission and compulsory treatment in the three-year period under review. In particular, there is the difficulty of taking on a small number of patients from the previous structures. By contrast, there has been a change for the better in the relationship between the community and the outpatient service. This relationship is becoming stable and is beginning to acquire a psychotherapeutic structure.