From Moral Insanity to Psychopathy

Psychopathy is currently a condition that arouses great interest among psychiatrists because of its significant involvement in the forensic field. The authors illustrate the course over time of the concept of psychopathy, starting from the definition of “moral insanity” of Prichard. The historical journey allows to illustrate the different positions that the various European schools of psychiatry have had toward psychopathy, until modern nosographic classification systems such as Diagnostic and Statistical Manual of Mental Disorders (DSM). Special attention is paid to the “core” of psychopathy: the alteration of the moral sense, and through the illustration of moral development is provided a reading of morality in the psychopath and the reasons for its impairment. A clinical and critical examination of psychopathy assessment scales is proposed, with the aim to broaden the horizons of assessment, also to individuals who do not show violent behavior, but with compromised moral sense. Lastly, authors propose an interpretation of the social aspects of psychopathy that goes beyond the assessment of the psychopath confined in jails, with several highlighted aspects of psychopathy that contribute to social success in work, relationships, and career and that can contribute to the success of the psychopath

Delirium in COVID patients: recommendations for assessment and treatment

COVID-19 patients, particularly those admitted to an Intensive Care Unit, are at high risk of Delirium due to the frequently observed concomitant presence of a series of factors which, taken together, constitute an increased risk factor. Factors thought to play a key role include: a direct action of the virus and state of inflammation on the Central Nervous System; secondary effects of organ failure; effect of sedative treatment; prolonged exposure to mechanical ventilation; prolonged immobilisation; environmental factors including social isolation and restricted interaction with relatives and healthcare operators. Bearing in mind the potential impact of delirium on clinical outcome, with an increased risk of death, appropriate prevention and management of this condition, particularly complex in COVID patients due to the frequently observed concomitant presence of numerous predisposing and precipitating factors, is fundamental

Domestic violence: critical issues on Intimate Partner Violence (IPV) primary prevention strategies

Domestic violence is one of the most critical issues worldwide, often reported in newspapers and faced with prejudices and clichés. Violence against women in particular continues to be an obstacle to reaching equality, development, peace and the achievement of respect for women human rights. Primary prevention strategies aim to increase awareness and critical capacity of the phenomenon in the general population. They are therefore not only a clinical challenge, but also a social, cultural and political one. Objective The objective of this literature review is to identify primary prevention programs and interven- tions related to interpersonal violence Methods A literature search was conducted through major databases: MEDLINE/PubMed, PsycINFO/ PsycLIT, Excerpta Medica/EMBASE, Scopus, Web of Science (ISI), Cochrane Library. Nation- al data were collected from, the ISTAT website, the Ministry of Health and the Interior and the Institute of Health. Conclusions The analysis of primary prevention programs highlighted two elements of criticality: insuffi- cient involvement of the perpetrators of the violent behaviour (men) compared to the involve- ment of women, and lack of attention to specific risk and protective factors for each level

Uncertainty in Pandemic Times

The Covid-19 pandemic has burst upon us as a general test for humanity, for which we were woefully unprepared. We all faced the pandemic with little knowledge and no experience. It is the first pandemic of our lives. Over this period, we have seen a range of conflicting statements, positions and behaviours. On occasion, the scientific community and health professionals have failed to speak with a single voice to convey the urgency of the situation, as their views got lost and scattered in rivulets of opposing theories ranging from denying to ringing the alarm. So many elements were in place for the ‘perfect storm’ to get unleashed … and it did. And as the pandemic wreaked its havoc, many health workers have paid a high price for their selfless dedication and professionalism. We have worked in the absence of clear-cut guidelines, in situations where even the cornerstones of medical ethics have faltered. On the other hand, the fruitful aspects of uncertainty also emerged

Six things to know about the homicides of doctors: a review of 30 years from Italy

BackgroundHealthcare workers have a 16 times greater risk of suffering workplace violence than workers in other sectors and around 50% experience workplace violence in the course of their career. The objective of this study is to explore the characteristics and circumstances of work-related killings of doctors.MethodsWork-related homicides of doctors over the period 1988-2019 were identified retrospectively through the Italian national statistical agencies. Variables such as perpetrator, motive and location of the crime were obtained through forensic psychiatric work. After classification, the absolute and percent values of the main characteristics of the homicides were calculated.ResultsOver the period considered, 21 doctors were killed in Italy in connection with their professional activity. In 52% (n=11) of cases, the killer was one of the doctor's patients, in 29% (n=6) of cases it was a patient's relative, in 19% (n=4) an occasional patient (first consultation). The location of the homicide was a community clinic in 48% (n=10) of cases, the street in 19% (n=4) of cases, the doctor's home in 14% (n=3), the hospital in 14% (n=3) and the patient's home in 5% (n=1). In 57% (n=12) of cases the perpetrator was not affected by any mental disorders. The motive for the homicide was revenge in 66.7% (n=14) of cases; in 28.6% (n=6) the revenge was preceded by stalking.ConclusionsDoctors should be aware that the risk of being killed is not limited to hospital settings and that their patients' family members might also pose a threat to them

The New Challenges for Medical Ethics

The evolution of medicine confronts healthcare professionals with new ethical challenges. Elements such as professional secrecy, patient benefit, justice in the distribution of resources are put in crisis by the evolution of medical procedures. Today, doctors must make life-and-death decisions about many patients. As the resources are not enough for all patients, the ‘first-come, first-served’ criterion crumbles under the weight of the overwhelming demand for treatment. Consequently, they can no longer make treatment decisions based only on proportionality and clinical appropriateness criteria. They must take into account the availability of resources and prioritise patients with ‘the longer life expectancy’. This amounts to saying ‘the weakest will die’ … with the doctors’ consent. While the guidelines issued by scientific societies may well protect doctors from lawsuits, the choice of who to treat and who to let die is left to the conscience of the individual doctor; and it is a choice sharply clashing with the Hippocratic oath and with professional and personal ethics. This and others are a real ethical problem

Colloquio psichiatrico e credulità terapeutica nelle istituzioni penitenziarie

The purpose of the present study is demonstrating - through the description of twelve clinical cases - that patients in prison may lie to their therapists and give them false information. A psychiatrist working in a penitentiary institute should remember that a patient may give false information for different reasons: defence of his/her own life, protection of his/her physical integrity, desire to hide a crime committed in jail or to avoid or shorten a condemnation, personal advantage, recreational purpose, masked desire for violence, need to be accepted, need of a physical contact, malingering, deception, social visibility and acceptance. Therefore, it is important to examine the information given by patients and the anthropologic, sociologic and psychologic patterns of penitentiary life in a critical way, in order to achieve a better contextualization of clinical observation.Oggetto del presente studio è di illustrare, attraverso la descrizione di dodici casi clinici esemplificativi, la possibilità che lo psichiatra, nel suo colloquio clinico con pazienti in istituzione carceraria, riceva da questi errate informazioni. È importante, per lo psichiatra che opera in un’istituzione penitenziaria, sapere che il paziente può fornire informazioni di interesse psichiatrico, che non corrispondono al vero per vari motivi, tra cui: la difesa della propria vita, la protezione della sua integrità fisica, il desiderio di nascondere un reato commesso in carcere, uno stratagemma per evitare od abbreviare la durata della pena, l’ottenimento di un beneficio personale, un’opportunità ludica da sfruttare, la verbalizzazione mascherata di desideri di violenza, il bisogno di essere accettato, la ricerca del contatto fisico rassicurante, la simulazione consapevole ed inconsapevole, la dissimulazione per evitare conflitti, la presentazione del proprio doppio. È importante, quindi, che lo psichiatra che opera in carcere esamini ed approfondisca sempre con critica le informazioni che vengono fornite dal paziente e che conosca gli aspetti antropo-socio-psicologici della vita penitenziaria, per meglio contestualizzare le sue osservazioni psichiatriche

Self-Assessed Personality Traits and Adherence to the COVID-19 Lockdown

Introduction: The COVID-19 pandemic, caused by the SARS-CoV-2 coronavirus, has forced all countries affected by it to introduce quarantine and isolation to prevent the spread of the virus, as well as masking and distancing. Not everyone is equally willing to follow the rules related to limit the extent of the coronavirus epidemic. This might be connected with personality traits, especially openness, positive attitude, and optimism. Materials and Methods: An online survey was created and completed by participants in April–May 2020. Self-assessment of personality traits and adherence to lockdown recommendations were assessed. A total of 7404 participants took part in the study, mainly from Poland (83.6%) and Italy (12.7%). Univariate and multivariate regression analysis was performed. Results: The participants were divided into groups depending on the degree of compliance with the lockdown rules. In the multivariate analysis, variables that increased the odds for stricter lockdown compliance were temporary work suspension OR 1.27 (95% CI 1.10–1.48), income level “we can’t handle this situation” OR 1.67 (95%CI 1.20–2.33), and junior high school education OR 1.68 (95% CI 1.13–2.50). Other significant factors included age and place of residence. Each point of self-assessed sociability OR 1.07 (95% CI 1.00–1.13) also increased the likelihood of adhering to lockdown rules. Conclusions: Taking the basic demographic characteristics as well as working and health environment conditions traits into account may be helpful when forecasting epidemiological compliance during a pandemic, as well as in other public health tasks. The key role of self-assessed personality traits was not confirmed in this study. Reliability of the results is limited by significant disproportions in the size of the study groups