Hepatic encephalophaty: management and diagnostic therapeutic assistance path of Ligurian Local Health Company 3 (ASL3).

Hepatic encephalophaty (HE) is a neuropsychiatric syndrome with a prevalence in the cirrhotic population ranging from 20 to 80%. HE is a cause of inappropriate hospitalization, caregiver burdening and increased social costs. There is need to create dedicated care pathways to better manage patients and support family caregivers. The data used for the preparation of this diagnostic therapeutic assistance path (DTAP) are based on a detailed analysis of the scientific literature published before June 30, 2022 (PubMed, Web of Science, Scopus, Google Scholar). Furthermore, in the process of developing this work, we consulted in particular the guidelines/ position papers of International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN), Italian Association for the Study of the Liver (AISF), European Association for the Study of the Liver (EASL), American Association for the Study of Liver Diseases (AASLD), Italian Society on Alcohol (Società Italiana di Alcologia [SIA]) and other relevant papers. DTAP was created based on the most recent recommendations of the international scientific literature. The present DTAP highlight the need for a multidisciplinary activity integrated with territorial medicine in close connection with caregivers. This guarantees improved therapeutic adherence, hospital readmission reduction, improved quality of life for patients and caregivers and a significant reduction in costs.

[Addiction disorders: a new management.] / Patologie delle dipendenze: un nuovo management?

Psychiatry and addiction disorders are closely linked, but the current epidemiological and clinical evidence impose us to effectively define the "dependence medicine" (DM) discipline, and to review its management. The need for change is also suggested indirectly by the new DSM-5 which proposes a partial overcoming of the term 'addiction' by introducing the definitions Substances Use Disorders (SUDs), Alcohol Use Disorders (AUDs), and disorders related to behavioral alterations (behavioral disorders): eating disorders, gambling, etc. These disorders can generate organic diseases, psychic, family and social problems. The onset of psycho-pathological diseases, in young poly-dependents, occurs in a high percentage of cases of SUDs and/or AUDs (40-70%); the constant increase of young poly-dependents requires us to avoid psychiatrization as a first approach. For these reasons we suggest a change of management in this field, underlining how the DM combines elements of public health, prevention, internal medicine, clinical pharmacology, neurology 'and even psychiatry'.