Childhood traumatic experiences in people with obesity with and without eating disorders who are seeking bariatric surgery: the role of attachment relationships and family functioning.

PURPOSE: The present study examines the impact of traumatic childhood experiences in people with obesity seeking bariatric surgery. It considers the presence of eating disorders (ED) in the population with obesity and tests the role of attachment and family relationships as mediators of the relationship between traumatic events and ED. METHOD: 110 participants with severe obesity and 98 participants of a healthy weight (control group) filled out The Childhood Trauma Questionnaire (CTQ-SF), the Attachment Style Questionnaire (ASQ) and the Family Adaptability and Cohesion Evaluation Scale (FACES IV). RESULTS: Comparing the two groups on psychological variables, higher scores in the CTQ Emotional neglect and ASQ insecure attachment scales emerged in the control group than the group with obesity. Considering the presence/absence of an ED only in the group with obesity, and comparing these subgroups, higher scores in traumatic experiences emerged in the individuals with obesity and with ED than the individuals with obesity without ED. Moreover, participants with ED scored higher in ASQ insecure attachment and had lower levels of flexibility in family functioning than the group without ED. Finally, Logistic Regression models showed that insecure anxious attachment and dysfunctional familial relationships affected the relationship between traumatic childhood experiences and the presence of ED in the group with obesity. CONCLUSION: These findings suggest the importance focusing on psychosocial factors linked to obesity, specifically on attachment styles and familial relationships as emotion regulation strategies, since the impact of traumatic childhood events on psychopathology could be ameliorated by an individual's ability to rely on a significant attachment figure. LEVEL OF EVIDENCE: Level II, evidence obtained from well-designed controlled trials without randomization.

[Family style and psychiatric acuity: family functioning assessment of an hospitalized population in a Emergency department]. / Stili familiari e acuzie psichiatrica: valutazione del funzionamento familiare in una popolazione degente presso un Servizio Psichiatrico di Diagnosi e Cura.

OBJECTIVE: The study intends to include the evaluation of family styles while the patients are admitted at a hospital dedicated to the emergency (SPDC). METHODS: The sample of the study involved patients of a SPDC and their families. The clinical assessment has been conducted through the use of ICD-IX, DSM-5 and BPRS. During the stabilization phase, both patients and families have been administered a socio-demographic report and the FACES IV. The FACES Questionnaire assesses the family through eight scales (two scales indicating health-oriented functioning: Balanced Cohesion, Balanced Flexibility; four scales indicating problematic functioning: Disengagement, Hyper-involvement, Rigidity, Disorganization; a scale for Family Communication; a scale for Family Satisfaction). RESULTS: 35,7% has shown to be health-oriented in the sample. Patients have shown a significantly higher problematic perception of their family, compared to their parents, being more involved in the relationship. The patients have a disengaged-disorganized family style, parents have an average-unbalanced style. The age of patients over 30 correlates significantly with a dysfunctional view of their family relationships. CONCLUSIONS: Faced with an event that requires hospitalization, families have a greater tendency toward dysfunctionality, with a more painful perception than their children, partially counterbalanced by a greater functionality of the parents. The temporal element, the age of the patients and the duration of the illness seem significant elements in favor of a greater family problematic.

Is there a correlation between family functioning and functional recovery in patients with acquired brain injury? An exploratory study.

BACKGROUND: Acquired Brain injury (ABI) is a very critical event in a family, as it is a highly distressing and traumatic experience, imposing a very deep reorganization of the whole family. OBJECTIVE: This study aims to evaluate the possible correlation between the family aspects and the patients' functional outcomes after rehabilitation. METHODS: Fifteen patient-caregiver pairs were enrolled in the study. All the patients were assessed by using specific neuropsychological and functional scales, including the Family Adaptability and Cohesion Evaluation Scales, before and after treatment. RESULTS: The results reveal that when the caregiver is the son or the spouse (p = 0,71), the perception of the emotional and physical burden is stronger, while the scores related to the burden were lower in the presence of other kinds of relationship. The family functioning seems to be connected to the burden level for the caregivers. Furthermore, there is a significant correlation between the improvements observed in the patients during their rehabilitative training and the family dynamics. CONCLUSIONS: in our opinion, the family plays a key role in allowing a suitable compliance of the patient to the treatments, and supports the processes of adaptive reorganization.

[The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT'S Project on the discrepancy between routine practice and evidence]. / L'accettabilità delle raccomandazioni NICE per la schizofrenia nei Dipartimenti di Salute Mentale Italiani. Il Progetto SIEP- DIRECT'S sulle discrepanze fra pratiche di routine ed evidenze.

AIMS: This paper aims at presenting the most significant results emerging from the work carried out by the focus groups of the multi-centre Project SIEP-DIRECT'S. The Project is aimed at assessing the existing discrepancies between the evidence-based NICE guidelines for schizophrenia and the usual practices of care given by Italian mental health services. Each focus group was requested to give an evaluation on: (a) appropriateness of the English NICE guidelines in the context of the Italian mental health services; (b) clarity and usefulness of the 103 indicators developed on the basis of the NICE recommendations to measure their level of application within the services. METHODS: In each of the 19 mental health departments or psychiatric services participating in the Project there were organized "multidisciplinary" focus groups and "specialistic" focus groups. The former included, amongst others, professional operators of the mental health services, patients, their relatives, representatives of patient organizations and general practitioners. They examined the recommendations and indicators upon which the participants could express their opinion or judgment based on their knowledge, experience or information in their possession. The latter group, composed only of psychiatrists, examined the recommendations and indicators relative to pharmacological treatments that regarded the specific competences of their professional category. RESULTS: Most NICE recommendations seemed appropriate to the working context of the Italian services. However, some perplexity emerged as regards specific organizational models of the services, such as the specific services for psychotic onsets or the assertive outreach teams, which were believed not to be strictly pertinent to the traditional organization of mental health care in our Country. There were also some criticisms regarding the cognitive-behavioural treatments which the NICE Guidelines recommend as the principle psychotherapeutic option for patients with schizophrenia, since in many Italian services, when the use of psychological interventions are needed, the tendency is to prefer interventions based on psychodynamic theories. The SIEP indicators were generally held to be clear and acceptable. CONCLUSIONS: In the view of the focus groups, the NICE guidelines are on the whole useful and suitable for orientating the services in the choice of more efficacious practices in the treatment of patients with schizophrenia. Moreover, the results obtained legitimate the use of the set of SIEP indicators for the evaluation of good practices and the quality of care offered by Italian services. Finally, the use of focus groups delines to a different context as well as the verification of the comprehensibility and applicability of SIEP indicators.