Journal of Psychosomatic Research
Volume 60, Issue 2 , Pages 217-218, February 2006

General hospital psychiatry in Italy: an update

  • Silvia Ferrari

      Affiliations

    • Corresponding Author InformationCorresponding author. Clinica Psichiatrica, Policlinico di Modena, Via del Pozzo, Modena 71-41100, Italy. Tel.: +39 348 6915254 (Mobile); fax: +39 059 4224307.
    • ,
  • Marco Rigatelli

Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy

Received 8 December 2005; accepted 13 December 2005.

Article Outline

 

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Introduction 

The turning point in the history of consultation–liaison psychiatry (CLP) in Italy was undoubtedly the passing of the famous Reform Law 180 in 1978, with its dramatic consequences on both the clinical and health organizational levels of psychiatry. This has brought psychiatry back to medicine and to the general hospital [1], [2].

The development of CLP in Italy since then has been slow and variable across the country. During the 1980s, a few specific and integrated CLP services were established in university-based hospitals (e.g., Milan, Modena, and Padua), which led the way for the implementation of other centers in the country (e.g., Naples and Ferrara). These were some of the centers that were involved as research sites in ECLW studies [3]. During the 1990s, Italian CLP then gradually started to move out of the general hospital toward community primary care, with the establishment of specific CLP services for GPs (e.g., Verona, Bologna, and Reggio Emilia) and the development of relevant research projects [4], [5].

As such services increased, a shift occurred from on-demand urgent psychiatric referrals to planned, excellent integrated activities. This has been a major achievement; some of these services include Ferrara for psycho-oncology, Modena and Udine for transplant units, Bari for gastroenterology, and Milan and Genova for psychogeriatrics. Integrated and formalized clinical experiences such as these have stimulated research activities in the same fields—locally, nationally, and internationally [6], [7], [8], [9], [10].

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The Italian CLP Society 

The growing interest in CLP in Italy and the stimulus for further expansion in the field have been triggered, in recent years, by the Italian Society for Consultation–Liaison Psychiatry, the SIPC (Società Italiana di Psichiatria di Consultazione; www.sipc.it). The society is affiliated to the Italian Society of Psychiatry. The activities organized by the society are listed in Table 1. Marco Rigatelli is currently the society's president.

Table 1. Activities promoted by the SIPC
• SIPC affiliation to the Italian Society of Psychiatry and the EACLPP
• Website: www.sipc.it; marked as “link of interest” by the websites of the EACLPP, APM, SIP, and SIMP
• Research activities [3], [4]
• Editorial activities [books and scientific journals (Psichiatria di Consultazione, CIC Editore; La Psichiatria nella Pratica Medica, CIC Editore; Ricerche in Psichiatria, CIC Editore]
• Young Researcher SIPC Awards (1999; 2003) for an original article on CLP by young researchers
• Two multicenter investigations on CLP in Italy
• SIPC regional section meetings (Sicily, Campania, Liguria, Puglia, Piemonte, Lazio, Emilia Romagna)
• Work groups for the development of guidelines on clinically relevant issues (delirium, suicidal behaviors, organ transplantation, etc.)
• Interdisciplinary formats: psychiatry and cardiology; psychiatry and geriatrics; psychiatry and rheumatology
• Organization of symposia on CLP at national general psychiatry congresses

National meetings of the society (SIPC) are held every 3 years: the most recent congress took place in Milan at the end of November 2004 and was attended by more than 300 psychiatrists from all over the country. Between the national meetings, a large number of minor events are organized by members of the society and regional sections of the SIPC (regional meetings were held in Sicily, Sardinia, Puglia, Emilia Romagna, and Liguria). Excitement is already growing about the next major event on the agenda: the next national congress of the society will take place in Milan in Autumn 2007 and will be a very special meeting because the annual meeting of the European Association for Consultation and Liaison Psychiatry and Psychosomatics will take place within it. The event will be a very significant occasion for Italian CLP to demonstrate its development and place it within the European arena.

In view of the recognition in the United States of the subspecialty of psychosomatic medicine (PM), a growing interest has been witnessed worldwide over the complex interactions between CLP and PM: In Europe and Italy, the word psychosomatic was never successfully expelled and the Modena CLP Service, for example, since its foundation in 1989, has had the formal denomination of “service for psychiatric consultation and psychosomatics” [11]. Moreover, many of the Italian psychiatrists working in the field of CLP and very actively contributing to the expansion of the SIPC have also been recently involved in a newborn group for research in psychosomatics (GRP), conceived with the aim of revitalizing research in the field of psychosomatics in a very interactive, clinically-based way.

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Weak points 

The main limitations and weak points of Italian CLP remain:

1.Scarce interest from public administrations in terms of formal recognition and subsequent funding. Because they are based on the integration of clinical competencies between psychiatrists and other general hospital doctors, CLP activities may be reasonably funded by both psychiatry and other departments of general hospitals that request daily psychiatric consultations. Although formal, integrated plans of cooperation between wards and CL services exist, this dual funding seems quite unrealistic in Italy at the moment.

2.Heterogeneity of experiences and activities: many excellent ideas and projects have been conceived and set into practice, but they still tend to be singular experiences because of the enthusiasm of few. Italian CL psychiatrists should also quickly learn how to constantly monitor and document their activities for public relation and marketing use: the general impression is that we do a lot but no one knows about it and no one has the exact quantification of how much we do.

3.The need to improve standards of clinical practice, clinical management, training, and, most importantly, research quality levels. With regard to these limitations, the main way we plan to change things for the better in the future is through the activities of the society itself. The various geographical, professional, and clinical interests of its members should generate the necessary momentum and coordination of our CL activities.

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References 

  1. Cazzullo CL, Comazzi M, Guaraldi GP, Rigatelli M, Verdecchia A. General hospital psychiatry in Italy: on the hospitalization of psychiatric patients and consultation–liaison psychiatry after Law 180/1978. Gen Hosp Psychiatry. 1984;6:261–265
  2. Rigatelli M. General hospital psychiatry: the Italian experience. World Psychiatry. 2003;2:97–98
  3. Gala C, Rigatelli M, de Bertolini C, Gabrielli F, Grassi L. A multicenter investigation of consultation–liaison psychiatry in Italy. Gen Hosp Psychiatry. 1999;21:310–317
  4. Berardi D, Menchetti M, Cevenini N, Scaini S, Versari M, De Ronchi D. Increased recognition of depression in primary care. Comparison between primary-care physician and ICD-10 diagnosis of depression. Psychother Psychosom. 2005;74:225–230
  5. Rossi A, Morgan V, Amaddeo F, Sandri M, Tansella M, Jablensky A. Psychiatric out-patients seen once only in South Verona and Western Australia: a comparative case-register study. Aust N Z J Psychiatry. 2005;39:414–422
  6. Grassi L, Gritti P, Rigatelli M, Gala C. Psychosocial problems secondary to cancer: an Italian multicentre survey of consultation–liaison psychiatry in oncology. Eur J Cancer. 2000;36:579–585
  7. Mangelli L, Fava GA, Grandi S, Grassi L, Ottolini F, Porcelli P, et al. Assessing demoralization and depression in the setting of medical disease. J Clin Psychiatry. 2005;66:391–394
  8. Porcelli P, De Carne M, Fava GA. Assessing somatization in functional gastrointestinal disorders: integration of different criteria. Psychother Psychosom. 2000;69:198–204
  9. Fava GA, Porcelli P. Multisomatoform disorder. Arch Gen Psychiatry. 1998;55:756–757
  10. Balestrieri M, Marcon G, Samani F, Marini M, Sessa E, Gelatti U, et al. Mental disorders associated with benzodiazepine use among older primary care attenders. A regional survey. Soc Psychiatry Psychiatr Epidemiol. 2005;40:308–315
  11. Rigatelli M, Ferrari S. The Modena (Italy) Consultation–Liaison Psychiatry Service. Br J Psychiatry. 2004;184:268–269

PII: S0022-3999(05)00508-8

doi:10.1016/j.jpsychores.2005.12.002

Journal of Psychosomatic Research
Volume 60, Issue 2 , Pages 217-218, February 2006

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