Publications by authors named "Francesco Franza"

18 Publications

  • Page 1 of 1

Results of the COVID-19 mental health international for the general population (COMET-G) study.

Eur Neuropsychopharmacol 2021 Oct 15;54:21-40. Epub 2021 Oct 15.

Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia. Electronic address:

Introduction: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study.

Material And Methods: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

Statistical Analysis: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables.

Results: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed.

Conclusions: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them.
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http://dx.doi.org/10.1016/j.euroneuro.2021.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609892PMC
October 2021

The Effect of the Pandemic on the Care of Patients with Mental Disorders: Measure of "Compassion Fatigue" and "Burn-Out" in the Operator.

Psychiatr Danub 2021 Sep;33(Suppl 9):114-118

Psychiatric Rehabilitation Center "Don Tonino Bello"- Assoc. M.I.T.A.G. - Onlus, Via Venezia, 1, 72019 San Vito dei Normanni, Brindisi, Italy,

Background: The Covid-19 Pandemic has had a significant impact on psychophysical well-being and the ability to work productively in contexts concerning people's physical and mental care. The helping professions involved have seen an increase in stress levels, a sense of helplessness, fear, pain and social isolation. They are anchored to the hope of being able to return to their normality.

Method: In this study, 87 mental health operators were evaluated, divided into nurses, psychiatric rehabilitation technicians, educators, social workers, psychologists and doctors, working in two psychiatric care rehabilitation communities in Puglia and Campania in southern Italy.

Results: The results obtained with the administration of the scales ProQOL, BHS, Save-9, BDI-II, BEES reported a remarkable impact in nursing and medical professions due to the pandemic. A 11%. burn-out was reported by nurses.

Conclusions: The collected data are comparable to the previous work (Franza et al. 2015, 2020); however, there is no evidence of a high level of burnout in the helping professions involved in this study.
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September 2021

The Emotional Impact of the Operator in the Care of Patients With Mental Disorders during the Pandemic: Measure of Interventions on Compassion Fatigue and Burn-Out.

Psychiatr Danub 2021 Sep;33(Suppl 9):108-113

Mental Health Department, ASL TA, Via Piemonte, 51, 72022 Latiano, Italy,

Background: The continuation of the health emergency due to the management of COVID-19 is having a profound effect on all aspects of society, including mental health and physical health. This observational study examined practitioners of psychiatric rehabilitation and therapeutic communities, focusing on the emotional aspects of patient care, in particular the fatigue of compassion, empathy and lack of hope, aspects that could be directly linked to the burnout of health professionals, as found in other similar studies.

Method: In this study, self-administered scale data was collected in 87 healthcare professionals recruited from 3 different psychiatric rehabilitation communities. In particular, we assessed the fatigue of compassion, vicarious trauma, burnout and hope (hopeless), empathy and depressive symptoms in the two months of May and June 2021.

Results: The results obtained after the administration of the following rating scales, ProQOL, BHS, SAVE-9, BDI-II and BEES, showed an overall increase in scores in all professional figures, a significant fatigue of compassion, while the percentage burnout is not present in several groups. The presence of high levels of hope, satisfaction of compassion is indicative of a moderate level of empathy in some professional figures; these high levels can protect workers from the risk of developing work-related stress and depressive symptoms.

Conclusions: The data obtained with this study are not similar to those of previous studies, although they may indicate the importance of factors such as hope, empathy in the care of the patient with psychic disorders in rehabilitation communities, underlining the need for interventions aimed at the emotional management of the care relationship as a tool to improve care and prevent burnout even during times of high stress, such as managing a pandemic.
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September 2021

Loneliness and Hopelesness: Their Role in the Depressive Cases during the COVID Pandemia.

Psychiatr Danub 2021 Sep;33(Suppl 9):14-17

Psychiatric Rehabilitation Center, Casa di Cura "Villa dei Pini", 83100 Avellino, Italy,

The COVID-19 pandemic has created new problems and presented new challenges for its management. Hope, or rather its absence, social isolation and loneliness are considered risk factors for the development of anxious and depressive symptoms. Health authorities have had to address issues regarding the mental health risks that the pandemic has created. There is numerous scientific evidences of the increase in affective disorders in the last two years. Associated with these disorders, particular characteristics of personality temperament, such as affective temperament, can determine an increased risk especially in some patient populations, such as the elderly, with significant negative consequences on the quality of life and on the onset of mental and organic diseases. The hope of the end of the pandemic has been placed on mass vaccination. After an initial enthusiasm there was a growing concern about its side effects. An adequate information policy is necessary to put an end to concerns about vaccines and thus lead to an increase in hope for the future and an end to social isolation.
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September 2021

The Role of Fatigue of Compassion, Burnout and Hopelessness in Healthcare: Experience in the Time of COVID-19 Outbreak.

Psychiatr Danub 2020 Sep;32(Suppl 1):10-14

Psychiatric Rehabilitation Center "Villa dei Pini", Avellino, Italy,

Background: In the times of serious health alarm, as it is happening in the COVID-19 pandemic, burden of healthcare is likely to explode. The current pandemic is having a profound effect on all aspects of society, including mental health and physical health. In a previous study we showed interaction between compassion fatigue, burnout and workload.

Methods: In our study, we have evaluated stress levels in 102 healthcare workers recruited in different rehabilitation departments (psychiatric and multidisciplinary). In particular, we evaluated the fatigue of compassion, vicarious trauma, burnout and hope (hopelessness) in the first two months of lookdown due to the COVID-19.

Results: The results obtained after the administration of the following evaluation scales: sCFs, CBI, Pro QOL, HBS, showed an overall increase in the scores in all professional figures. Significant compassion fatigue and burnout percentage is present in several groups. The highest levels of hopelessness in some professional figures, while higher educational levels can protect workers from the risk of developing high levels of work stress.

Conclusions: The data obtained with this study are similar to those of our previous study, although they may indicate that during the period of the coronavirus pandemic the scores of the several scales used are higher.
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September 2020

A New Rating Scale (SAVE-9) to Demonstrate the Stress and Anxiety in the Healthcare Workers During the COVID-19 Viral Epidemic.

Psychiatr Danub 2020 Sep;32(Suppl 1):5-9

Psychiatric Studies Center (Cen.Stu.Psi.), Piazza Portici, 11 - 25050 Provaglio d'Iseo (BS), Italy,

The COVID-19 epidemic has been a major global public health problem during past months in Italy and in several other Countries and on the date of publication of this article, is still a serious public health problem. The health staff, engaged in the care of the sick and in the prevention of the spread of the infection have been subjected to a further increase in psychological difficulties and work-related stress, related to the workload for the continuous influx of sick and intense and close working shifts for the viral emergency. The SAVE-9 (Stress and Anxiety to Viral Epidemics - 9 items) scale has been developed as a tool for assessing work anxiety and stress in response to the viral epidemic of health professionals working to prevent the spread of the virus and to treat infected people.
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September 2020

The emotional and psychological burden of the "burnout" in families of psychiatric patients.

Authors:
Francesco Franza

Psychiatr Danub 2019 Sep;31(Suppl 3):438-442

Neuropsychiatric Centre "Villa dei Pini", Via Pennini 86/a, 83100 Avellino, Italy,

People, who assist patients with chronic health problems for work, voluntary or for family reasons, may be affected by burnout. This is defined as an excessive reaction to stress caused by one's environment that may be characterized by feelings of emotional and physical exhaustion, coupled with a sense of frustration and failure. A person who assists a suffering person, beyond the professional role, is indicated generally by the term "caregiver". The definition of Burnout in families is fairly recent, because the psychology of trauma has ignored a large segment of traumatized and disabled subjects (family and other assistants of "suffering people") unwittingly, for a long time. The burnout of secondary stress is due to one's empathic ability, actions trough disengagement, and a sense of satisfaction from helping to relieve suffering. Figley (1995) claims that being a member of a family or other type of intimate or bonded interpersonal relationship, one feels the others' pain. Closely associated with the suffering of the family caregiver is the concept of compassion fatigue, defined as a state of exhaustion and disfunction-biologically, psychologically, and socially - as a result of prolonged exposure to compassion stress and all that it evokes. In families, this can be the cause of serious conflicts and problems, quarrels, verbal and physical aggression, and broken relationships. The intervention on families requires practice and effectiveness approaches performed by experienced professionals. Some approaches focus more specifically, such as those that adopt a cognitive/behavioural technique with direct exposure, implosion methods, various drug treatments and family group psychotherapy. One of the most common models of intervention is based on the principle that the observation unit for the understanding of the disorder is not the single individual but the relationship between individuals.
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September 2019

Mental Illness and Prejudices in Psychiatric Professionals. Data from the Social Stigma Questionnaire for Psychiatric Professionals: A Multicentre Study.

Psychiatr Danub 2018 Nov;30(Suppl 7):479-484

DSM ASL NA 3 SUD, "Centro Diurno" of Mental Health 57, via Marconi 66, 80059 Torre del Greco (NA), Italy,

The prejudices about mental illness and the related social stigma are still present in the population. People suffer from both the disease and the marginalization behaviors implemented by the "so-called healthy" towards them and their relatives. Even psychiatric professionals can get sick and suffer for the same reason. The authors of this multicentric study have focused their attention on the presence or absence of groups of psychiatric pathologies among the "insiders". The most frequent pathologies encountered were the mood and anxiety disorders, in a percentage similar to that of the general population. To continue the research on the stigma begun in a previous study, the authors asked themselves if there could be prejudices and/or stigma among psychiatric professionals towards sick colleagues, how they relate in the workplace and how they react to the behavior of colleagues. The stigma questionnaire has been used on psychiatric professionals, and 130 Italian colleagues were tested in the provinces of Avellino, Brindisi and Trento. The data were compared with those of the research on the stigma "Thinking of Psychiatric Disorders as" Normal "Illness" (Tavormina et al. 2016) and it emerged that among the attending professionals there are no statistically significant behaviors of marginalization, exclusion or stigma against sick colleagues, even if there is a certain discomfort in working together. Above all, it emerged that 80% of the interviewees, who have had work experience with sick colleagues, have replied that the latter can treat those who are also sick of their own disease, thus showing esteem and confidence in their work, in analogy with the Jungian thesis of the "wounded Healer" in the myth of the centaur Chiron.
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November 2018

Relationship between Cognitive Remediation and Evaluation Tools in Clinical Routine.

Psychiatr Danub 2018 Nov;30(Suppl 7):405-408

Rehabilitation Center "Neamente", Via Nazionale, 88 - 83013 Mercogliano (AV), Italy, www.neamente.com.

Many clinicians do not have adequate knowledge and interest in assessing cognitive deficits in psychiatric patients. However, these deficits are crucial and key symptoms, which can lead to impairment of quality of life, worsening of symptoms of disorders and difficulties in social, family and work relationships. Another limitation to the assessment of cognitive deficits is the poor maneuverability and practicality of the main cognitive assessment tools. Because there are no appropriate pharmacological approaches, new techniques have been developed to improve cognitive abilities in these patients. The most important techniques concern cognitive remediation (CR). In this article we summarize the main techniques of cognitive remediation.
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November 2018

Assessing the critical issues of atypical antipsychotics in schizophrenic inpatients.

Psychiatr Danub 2017 Sep;29(Suppl 3):405-408

Neuropsychiatric Centre "Villa dei Pini", Avellino, Italy,

Antipsychotics are effective in reducing positive and disorganization symptoms of schizophrenia. Although SGAs initially all were believed to be more efficacious and tolerable than FGAs, several data show that the SGAs are no more effective than FGAs. In clinical practice, frequent switching of antipsychotic medications is widespread for lack of efficacy, adverse side effects, and partial or not-compliance response. This study suggested that most clinically stable inpatients with schizophrenia maintain their remission states after being switched to another atypical antipsychotic; but that at the end (after 20 years) of the observation period of our study, 11.54% of the patients assumed again typical antipsychotics (haloperidol).
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September 2017

Clinical Utilisation and Usefullness of the Rating Scale of Mixed States, ("Gt-Msrs"): a Multicenter Study.

Psychiatr Danub 2017 Sep;29(Suppl 3):365-367

Piazza Portici, 11, 25050 Provaglio d'Iseo (BS), Italy,

The rating scale "G.T. MSRS" has been designed to improve the clinical effectiveness of the clinician psychiatrists, by enabling them to make an early "general" diagnosis of mixed states. The knowledge of the clinical features of the mixed states and of the symptoms of the "mixity" of mood disorders is crucial: to mis-diagnose or mis-treat patients with these symptoms may increase the suicide risk and make worse the evolution of mood disorders going to the dysphoric state. This study is the second validation study of the "G.T. MSRS" rating scale, in order to demonstrate its usefullness.
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September 2017

Neurocognitive management of the primary negative symptoms of schizophrenia: a role of atypical antipsychotics.

Psychiatr Danub 2016 Sep;28(Suppl-1):145-148

Neuropsychiatric Centre "Villa dei Pini", Via Pennini, 86/a, 83100 Avellino, Italy,

Patients with schizophrenia have profound and disabling cognitive deficits while negative symptoms represent a separate symptom domain, with respect to depression, neurocognition, and social cognition. Particularly, primary negative symptoms of schizophrenia represent a diagnostic and therapeutic challenge, In this study we try to evaluate the cognitive symptoms in 51 primary negative schizophrenic inpatients by the administration of simple, fast and understandable scales (MMSE, DSST, EpiTrack, PANSS cognitive factor). We also evaluate the correlation with some SGAs (aripiprazole, quetiapine, olanzapine, paliperidone). Our results support the evidence of the use of simple, rapid and acceptable scales for cognitive evaluation in clinical practice. Overall data indicate no statistically significant variations of the negative symptomatology in all the examined sample, although a reduction of the statistical averages in each group is observed (paliperidone and olanzapine, particularly).
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September 2016

Thinking of psychiatric disorders as "normal" illness. Data from a questionnaire on social stigma: a multicenter study.

Psychiatr Danub 2016 Sep;28(Suppl-1):125-131

DSM ASL NA 3 SUD, "Centro Diurno" of Mental Health, 57, - via Marconi 66 - 80059 Torre del Greco (NA), Italy,

Prejudice and stigma about mental illness is still present in society. Patients suffer both from the disease, and from the marginalization behavior exhibited by others towards them and their families. Psychiatric professionals may also become ill and suffer for the same reason. The authors of this international multicenter study have set themselves the question of whether there may be prejudice and/or stigma among psychiatric professionals towards their suffering colleagues, among patients towards nursing staff affected by the same disease and between patients themselves. Using two standardized questionnaires which have been tested, but have not been used before they have studied 207 mental health professionals and 407 patients, of Italian, Belgian, Hungarian and Croatian nationalities. The results show that there are in fact prejudices among Mental Health Professionals about colleagues suffering from mental illness because they responded that such persons cannot treat well patients with their own pathology. However Mental Health Professionals do not demonstrate behaviors which are not frankly marginalizing or stigmatizing towards colleagues suffering from mental illness. On the other hand, among patients the prevailing view was that psychiatric professionals who suffer from mental illness, can better understand the sick, because they are also suffering. This is in analogy with the Jungian theory of the "wounded healer" in the myth of the centaur Chiron. Patients did not demonstate rejection or marginalization behavior towards other sick patients. Finally both the professionals and the patients tend to be cautious in relating to healthy persons and tend not to disclose their suffering for fear of being misjudged or marginalized.
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September 2016

Risk and efficacy in cognitive functions in Bipolar Disorder II with atypical antipsychotic augmentation.

Authors:
Francesco Franza

Psychiatr Danub 2016 Sep;28(Suppl-1):13-17

Mental Health Department "Villa dei Pini", Via Nazionale, 88 - 83013 - Mercogliano (AV), Italy,

BD-II has been consistently associated with cognitive dysfunction across a broad range of cognitive domains. Atypical antipsychotic drugs, or SGAs are effective antipsychotics in these diseases, often in combination with antidepressants and mood stabilizers. Data on the possible effect of antipsychotics on neuro-cognition are rare and conflicting. The main objective of our study was to assess the effectiveness and possible risks to cognitive function in a group of inpatients affected by BD-II. Forty-five inpatients with Bipolar II Disorder (DSM-5) were included in a two-year observational study. They were treated with sodium valproate as a mood stabiliser, atypical antipsychotics and SSRIs. The utilized SGA augmentation were quetiapine (n=13); aripiprazole (n=10); olanzapine (n=11); asenapine (n=11). All inpatients were administered some psychopathological scales and evaluated for neuropsychological variables (for example, attention, verbal memory domains, etc.). After two years of treatment with SGAs, there has been no significant reduction of previous levels. In particularly, quetiapine and asenapine groups showed a better performance in learning task, short-term task and recognition tasks, in accordance with previous studies. Our small observational study shown that atypical antipsychotics cause an improvement in symptoms in BD, and particularly BD II. In particular, they do not induce significant alterations in overall cognitive performance generally. On the contrary, some SGAs, such as quetiapine and asenapine, seem to demonstrate a not statistically significant mild improvement in cognition.
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September 2016

Psychiatric caregiver stress: clinical implications of compassion fatigue.

Psychiatr Danub 2015 Sep;27 Suppl 1:S321-7

Neuropsychiatric Centre "Villa dei Pini", Via Pennini, 86/a, Avellino, Italy,

The capacity to work productively is a key component of health and emotional well-being. People who work in health care can be exposed to the fatigue of care. Compassion fatigue has been described as an occupational hazard specific to clinical work related severe emotional distress. In our study, we have evaluated compassion fatigue in a mental health group (47 psychiatric staff) and its relationship with inpatients (237 inpatients) affected by some psychiatric disorders. At baseline, the more significant data indicate a high percentage of Job Burnout and Compassion Fatigue in psychiatric nurses (respectively, 39.28%, 28.57%). Significant Compassion Fatigue percentage is present also in psychologist group (36.36%). Finally, in psychiatrists, the exposure to patients increased vicarious trauma (28.57%), but not job burnout. After a year of participation in Balint Groups, the psychiatric staff presented an overall reduction in total mean score in any administered scale (CBI: p<0.0000045; sCFs: (Vicarious Trauma: p<0.0288; Job Burnout: p<0.000001)). Thus, compassion fatigue causes concern among mental health professionals, and Balint Groups may represent a therapeutic strategy to help health professionals to face difficulties in challenging work environments.
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September 2015

Management of primary negative symptoms in schizophrenia: an one-year observational study.

Psychiatr Danub 2015 Sep;27 Suppl 1:S245-9

Neuropsychiatric Centre "Villa dei Pini", Via Pennini, 86/a, Avellino, Italy,

Negative symptoms represent a separate symptom domain, with respect to depression, neurocognition, and social cognition and have a strong direct and indirect impact on real-life functioning. Furthermore, negative symptoms that do not improve following antipsychotic treatment are an important diagnostic and therapeutic challenge. We conducted a 12-month-study open-observational study to evaluate the efficacy of some atypical antipsychotics on negative symptoms, according to the following recommendations of Consensus Development Conference Attendees. In our study, we evaluated in an open-label study the efficacy of some second-generation antipsychotics (clozapine, quetiapine, olanzapine, aripiprazole, paliperidone) in 42 patients with schizophrenia or schizoaffective disorder (DSM-5 criteria) with 'persistent negative symptoms'. We used different rating scales (PANSS, CDSs, BNSS, BPRS), but mainly we focused on the new Brief Negative Symptoms Scale (BNSS) for negative symptoms. Our total data indicate an overall statistically significant reduction in all scales, although not clinically relevant.
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September 2015

Neurobiology of love.

Psychiatr Danub 2014 Nov;26 Suppl 1:266-8

Neuropsychiatric Center Villa dei Pini Avellino, Via Nazionale 88, 83013 Mercogliano (AV), Italy,

Romantic love is a "universal... or near universal" human phenomenon. Recently, love, romantic love, also became a theme of interest for scientists. The current research is seeking an explanation to clarify the brain mechanisms that are responsible for love behavior and feelings. Until recently, the study of love has been mainly the field of psychology. The biology of love originates in the primitive parts of brain that eolved long before the cerebral cortex. Discoveries in neuroscience have led to the identification of specific areas, facilities, brain circuits that are involved in the genesis of love. However, love remained a research field mainly for psychologists, despite the massive increase in neuroscientific research. In the last few decades, there has been a significant increase in the number of studies on the neuronal corelates of love, through the use of neuroimaging techniques (fMRI, PET) and in the studies that have investigated the action of the neurotransmitter and neuroendocrine systems.
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November 2014

Metabolic alterations associated with first and second generation antipsychotics: an twenty-years open study.

Psychiatr Danub 2014 Nov;26 Suppl 1:184-7

Neuropsychiatric Center Villa dei Pini Avellino, Via Nazionale, 88, 83013 - Mercogliano (AV), Italy,

Introduction: The initial enthusiasm for atypical antipsychotics, with a lower incidence of extra pyramidal symptoms, was tempered by the association with metabolic disorders. The presence of metabolic alterations significantly influences morbidity and patients' quality life. We performed this open-study to determine the relationship between antipsychotic efficacy and side effects, especially the impact of various antipsychotics on metabolic parameters after 20-year treatment with atypical (SGA) and typical antipsychotics (FGA).

Method: 62 psychiatric schizophrenic inpatients treated with typical (haloperidol) and atypical (clozapine, risperidone, olanzapine, quetiapine, aripiprazole) antipsychotics were studied over 20 years. Some biological parameters such as blood arterial pressure, lipidic and glucidic profile, liver enzymes, complete blood count, electrocardiogram and body weight (and body mass index) were collected.

Results: The results have demonstrated a not homogeneous statistically significant variation of the lipidic and glicidic profile but we have also found a reduction of the recorded values at endpoint vs baseline in aripiprazole and haloperidol groups vs clozapine, olanzapine, and quetiapine groups.

Conclusions: We want to point out that to endpoint of the period of observation (20 years) the patients with typical antipsychotics haloperidol reported satisfactory and a better glycemic and lipidic profiles than previous pharmacological treatments with antipsychotics of second generation. Optimal monitoring should include assessments of fasting glucose, lipids, cholesterol, and blood pressure.
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November 2014
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