Education in Psychopathology in Europe: Results from a Survey in 32 Countries

The Power of Images and the Logics of Discovery in Psychiatric Care

This paper, aligned with contemporary thinking in terms of patient-centered care and co-creation of patient care, highlights the limitations of the reductionist approaches to psychiatry, offering an alternative, "emergent" perspective and approach. Assuming that psychopathological phenomena are essentially relational, what kind of epistemological framework and 'logic of discovery' should be adopted? I review two standard methods I call 'ticking boxes' and 'drafting arrows'. Within the ticking boxes framework, the clinician's main goal is to discover whether a patient showing psychopathological phenomena meets pre-given diagnostic criteria. The process of discovery can be compared to two people assembling a puzzle where the patient has the pieces and the interviewer has the image of the completed design. Drafting arrows consists in constructing pathogenetic diagrams that display linear causative relationships between variables connected by an arrow to other nodes. These explanatory narratives include psychodynamic (motivational) and biological (causal) diagrams. I argue for a third approach called 'linking dots', a method of discovery based on the emergent properties of psychopathological phenomena. I build on and develop the approach to images and discovery devised by art historian Aby Warburg in his atlas of images Bilderatlas Mnemosyne. The visual constellations created by Warburg in the panels of the Bilderatlas can be understood as a method to reveal the layers of memory and the web of relationships manifested in them, inviting the viewer to participate in the production of meanings, forging ever new connections between the images. It is the viewer's acts of perception that draw relationships between singularities. I suggest that this method is of enormous significance in the context of today's socio-cultural transformation processes and related forms of psychopathological conditions, which can no longer be comprehended using the categories of existing knowledge systems.

Suicide-Related Knowledge among Italian Early Career Psychiatrists and Trainees: Results from a Cross-Sectional Survey

The training of mental health professionals is an important component of suicide-prevention programs. A cross-sectional survey was conducted in different Italian regions to evaluate knowledge of, and attitudes toward, suicide as well as the experience of a patient's suicide or a suicide attempt in early career psychiatrists (ECPs) and trainees (N = 338). The Suicide Knowledge and Skills Questionnaire and the Impact of a Patient's Suicide on Professional and Personal Lives scale were administered. Furthermore, symptoms of intrusion, avoidance, and arousal were examined through the Impact of Event Scale in ECPs and trainees who had experienced the suicide of a patient or a suicide attempt. Participants with training were more confident in the clinical management of suicide-risk patients. The group with experience of a patient's suicide reported more suicide skills except for support and supervision. Finally, the participants who reported a patient's suicide presented a more conservative patient selection, difficulties in relationships, loss of self-esteem, dreams linked to suicide, intrusive thoughts of suicide, guilt, and anger. Our results show that knowledge of, and attitudes toward, suicide are essential in the management of suicide-risk patients.

Prejudices in the psychopathologist: Karl Jaspers' heritage

Contributions of Karl Jaspers to the discipline of psychopathology are numerous. One of his most important insights deals with the method of interviewing in psychopathology. Specifically, how an interviewer (i.e. psychopathologist) approaches and explores mental phenomena that present themselves in the person being interviewed. By cultivating a phenomenological attitude, clinicians also acquire and renew self-criticism (Selbskritik), an essential aspect of a true psychopathologist. A fundamental part of the critical attitude in descriptive psychopathology is the re-examination of prejudices present in psychopathological interviewing. This review outlines and discusses six types of prejudices, as abstracted by Karl Jaspers, and illustrates them with clinical examples. (i) Philosophical prejudice deals with deductive and inductive reasoning; (ii) theoretical prejudice addresses the modeling of understanding of mental phenomena by analogy with natural sciences; (iii) somatic prejudice addresses biological reductionism in psychopathology; (iv) psychological prejudice focuses on approaches that consist of psychological interpretations that transgress the boundaries of psychological intelligibility; (v) pictorial prejudice deals with conceptualizations of psychic life as an analogy with certain visual depictions; (vi) medical prejudice is connected with strivings towards quantity, objectivity and diagnostic precision in psychopathology. To have the ability to represent the inner life of a person, we must dispense with prejudices in the clinical encounter with our patients. With the demands of modern-day life, and requests for quick clinical assessments, the idea of examining our prejudices and performing phenomenological interviews is more important than ever.

Factors influencing lithium versus valproate prescription preference in the maintenance treatment of bipolar patients: a report from the Italian Early Career Psychiatrists (SOPSI-GG)

BACKGROUND

Objective of the present manuscript is to investigate, among Italian early career psychiatrists (ECPs), prescriber and patient-related factors associated with lithium or valproate preference to treat patients affected by Bipolar Disorder (BD).

METHODS

An on-line survey was carried out among 252 ECPs, investigating their prescription patterns in relation to lithium and the differences with prescription of valproate. Collected data were compared according to lithium or valproate prescription preference in the long-term treatment of BD by χ² tests for qualitative variables.

RESULTS

Over two thirds of ECPs preferred lithium over valproate for the maintenance treatment of BD. Less than half of the sample used lithium as first-line agent for mania or major depression, and less than one third for mixed episodes. Factors associated with lithium preference as first-line maintenance treatment include perception of having a good knowledge of lithium (p < 0.001) and complete satisfaction with education on lithium (p < 0.001). One of the main factors to prefer valproate was the concern about long-term side effects of lithium (p < 0.001).

CONCLUSIONS

Type of education, source of information, clinical experience and safety concerns influence the choice of lithium versus valproate in the long-term treatment of BD. Present findings may guide educational training of ECPs.KEY POINTSLithium has been less prescribed in the last years for long-term treatment of Bipolar Disorder.Educational and clinical factors seem to influence the attitude to prescribe lithium.Only half of the Italian early career psychiatrists declare to have at least an adequate knowledge of lithium.Residency program in psychiatry should consider the implementation of education on lithium.

Perceived insecurity, mental health and urbanization: Results from a multicentric study

AIMS

This article aims to (1) explore the levels of perceived insecurity in a sample of patients with mood or anxiety disorders and (2) assess whether living in 'big cities' can influence the levels of patients' perceived insecurity and social contacts compared to living in a non-urbanized context.

METHODS

A total of 24 Italian mental health centers (MHCs) have been invited to participate. Twenty patients consecutively accessing the MHC have been recruited. All patients have been assessed using validated assessment tools.

RESULTS

The sample consisted of 426 patients, mostly female, with a mean age of 45 years. Globally, 52.2% of patients had a diagnosis of mood disorders, and 37.8% had anxiety disorders. Half of the sample declared that the main feeling toward life is uncertainty; higher levels of pessimistic views toward life have been detected in patients living in urban areas. A positive association between negative attitudes toward life and higher levels of depressive and anxiety symptoms, poor social functioning and higher levels of perceived psychological distress has been found.

CONCLUSION

Our findings confirm the presence of a common sense of perceived uncertainty among our sample. Such attitude toward life can have a detrimental impact on patients' psychological and physical well-being, contributing to high levels of distress.