Paola Carozza

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Psychiatrist, Director of Mental Health Department and Addiction Services of Ferrara (Italy) and former Director Psychiatric Rehabilitation Unit and Mental Health Department and Addiction Services of Ravenna (Italy). Former Professor of Social Psychiatry at the School of Specialization in Psychiatry at the University D ' Annunzio, Chieti and Co-Director of Master “Evidence – based and recovery- oriented Psychosocial Treatments”, University of Ferrara. Former member of the Executive WAPR Italia (World Psychiatric Rehabilitation Association). Currently, member of the Italian Association of Psychosocial Rehabilitation and member of WAPR International Board.Consultant and trainer in psychosocial EBPs and expert in oriented-recovery mental health public services organizations, presenter in many national and international conferences and author of several texts of theory and practice of psychiatric rehabilitation, intended for students, professionals, users and familiars and adopted by numerous Italian universities.

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Papers by Paola Carozza

ADOCARE A preparatory action related to

Lesbian, gay, bi, transgender and questioning youth WHO World Health Organisation  Adolescents: ... more Lesbian, gay, bi, transgender and questioning youth WHO World Health Organisation  Adolescents: young people between 12-24 years old  Acceptability: "judgments by laypersons, clients, and others of whether treatment procedures are appropriate, fair, and reasonable for the problem of the client" (Kazdin, 1981, p. 262)  Accessibility: the direct service and organizational mechanisms that facilitate a person's ability to enter into, navigate, and exit the appropriate services and supports as needed (Inniss et al., 2009)  Availability: having acceptable services and supports in sufficient range and capacity to meet the needs of the target populations (Inniss, Nesman, Mowery, Callejas, & Hernandez, 2009)  Balanced care: a comprehensive mental health system including different types of mental health facilities so that each person is able to receive the type of care that matches with his preferences and needs (Thornicroft & Tansella, 2013b; Thornicroft & Tansella, 2004).  Cyberbullying: being cruel to others by sending or posting harmful material or engaging in other forms of social aggression using the internet or other digital technologies (Willard, 2007, p. 265).  End-user: young adolescents who use(d) mental health services, their relatives, people who know or are in close contact to young adolescents with mental health problems, young people in general, representatives of patient organisations, etc.  Experts: academics, researchers, child and adolescent psychiatrists, etc. who are expert within the field of adolescent mental health care.  Good practice: a practice that has been proven to work well and produce good results, and is therefore recommended as a model. It is a successful experience, which has been tested and validated, in the broad sense, which has been repeated and deserves to be shared so that a greater number of people can adopt it (United Nations, 2014).  Integrated care setting: a MHC service that not only provides medical and psychological treatment, but that supports adolescents to reintegrate as good as possible into society. Such a service takes into account other needs, such as the need for education, the need to find good housing or a good job, the need to build trustful relationships with others, etc., and collaborates with other organisations within a broader network the address these different needs.  Policy maker: governmental representatives, directors of care services, ombudsmen for children, etc. operating within the field of adolescent mental health.  Policy plans: a detailed scheme for action on mental health which includes setting priorities for strategies, and establishing timelines and resource requirements (WHO, 2005b, p. 17).  Policy legislation: specific legal provisions that are primarily related to mental health (WHO, 2005b, p. 18).  Professional: child and adolescent psychiatrists, psychotherapists, mental health nurses, directors of care services, etc. working as a clinician within the field of adolescent mental health care.  Psychosocial interventions: a variety of interventions, including counselling/psychotherapy, social support, education, provision of information or training.  Quality indicator: a measurable element of practice performance for which there is evidence or consensus that it can be used to assess the quality of care, and hence change in the quality of care provided (Legido-Quigley et al., 2008).

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Sex differences in schizophrenia-spectrum diagnoses: results from a 30-year health record registry

Archives of Women's Mental Health

This study investigated sociodemographic and clinical differences between the sexes in individual... more This study investigated sociodemographic and clinical differences between the sexes in individuals affected by schizophrenia-spectrum disorders (SSD) who accessed outpatient mental health services. Within a retrospective cohort of 45,361 outpatients receiving care in Ferrara (Italy) from 1991 to 2021, those with a SSD diagnosis were compared between the sexes for sociodemographic and clinical characteristics before and after the index date (when the ICD-9: 295.*diagnosis was first recorded) to assess early trajectory, age and type of diagnosis, and severity of illness indicated by medication use, hospitalization, and duration of psychiatric care. Predictors of discharge were also investigated. Among 2439 patients, 1191 were women (48.8%). Compared to men, women were significantly older at first visit (43.7 vs. 36.8 years) and at index date (47.8 vs. 40.6) with peak frequency at age 48 (vs. 30). The most frequent last diagnosis recorded before the index date was delusional disorder (...

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A public early intervention approach to first‐episode psychosis: Treated incidence over 7 years in the <scp>Emilia‐Romagna</scp> region

Early Intervention in Psychiatry, May 23, 2023

Establishment of a Public Mental Health Database for Research Purposes in the Ferrara Province: Development and Preliminary Evaluation Study

JMIR Medical Informatics

Background The immediate use of data exported from electronic health records (EHRs) for research ... more Background The immediate use of data exported from electronic health records (EHRs) for research is often limited by the necessity to transform data elements into an actual data set. Objective This paper describes the methodology for establishing a data set that originated from an EHR registry that included clinical, health service, and sociodemographic information. Methods The Extract, Transform, Load process was applied to raw data collected at the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy, from 1925 to February 18, 2021, to build the new, anonymized Ferrara-Psychiatry (FEPSY) database. Information collected before the first EHR was implemented (ie, in 1991) was excluded. An unsupervised cluster analysis was performed to identify patient subgroups to support the proof of concept. Results The FEPSY database included 3,861,432 records on 46,222 patients. Since 1991, each year, a median of 1404 (IQR 1117.5-1757.7) patients had newly accessed...

Illness Management and Recovery (IMR): Implementation in an Italian Department of Mental Health and Pathological Addictions

Journal of Psychosocial Rehabilitation and Mental Health

Illness Management and Recovery (IMR) is a manualized psychosocial intervention developed to guid... more Illness Management and Recovery (IMR) is a manualized psychosocial intervention developed to guide patients towards their recovery. This study presents the implementation of IMR within the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy. IMR was provided from April 2017 to July 2021 by trained professionals, who recruited psychiatric outpatients with different diagnoses, in a stable phase of the illness and motivated to engage in the program. The modules and sessions were tailored according to the specificity of the patients (e.g., diagnoses, age) and the services providing it. The characteristics of the patients and the services who adopted IMR were extracted from electronic health records, and by a summary form filled out by providers. The IMR scale (IMRS) was completed at the end of the intervention. A total of 126 patients completed the IMR intervention: they were mainly men (61.1%), with a mean age of 40.1 (12.9) years old, significantly het...

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La formazione del personale nei Dipartimenti di Salute Mentale

PSICOTERAPIA E SCIENZE UMANE

Oggi la crescente domanda di Servizi di Salute Mentale capaci di dare prestazioni di alto livello... more Oggi la crescente domanda di Servizi di Salute Mentale capaci di dare prestazioni di alto livello qualitativo sul piano assistenziale, coniugato con sostenibili ricadute su quello economico, richiede nuove conoscenze, nuove abilità e nuove attitudini, anche in virtù dell'emergere di altrettanto nuove questioni che pongono sfide molto alte. È necessario un ripensamento radicale sui contenuti dei programmi formativi e sulle modalità con le quali essi vengono offerti, alla luce delle acqui-sizioni più aggiornate basate sull'evidenza scientifica e sul paradigma biopsicosociale, favorendo le formazioni dell'intero Dipartimento di Salute Mentale affinché, in qualsiasi nodo della rete dipartimentale si imbatta, un cittadino riceva la stessa qualità di trattamento e la stessa metodologia di intervento.

La formazione del personale nei Dipartimenti di Salute Mentale

Psicoterapia e scienze umane, Feb 1, 2023

ICF, salute mentale e dipendenze. Strumenti per la riabilitazione orientata alla recovery

Carocci editore Spa, 2020

ICF-DIPENDENZE. Un set di strumenti per programmare e valutare la riabilitazione nelle dipendenze patologiche

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Recovery in Italy: An Update

International Journal of Mental Health, 2016

Abstract: Since the 1990s, a general reflection has gradually evolved in Italy on the effects of ... more Abstract: Since the 1990s, a general reflection has gradually evolved in Italy on the effects of the transformation of psychiatry from being mainly institutional to more community-oriented. Increasingly substantial epidemiological studies and processes of outcome evaluations have focused not only on the clinical aspects, but also on the social and functional level (quality of life, care needs, users’ satisfaction for the treatments received). With a certain delay compared to the Anglo-Saxon countries, in recent years, several elements of the concept of recovery have also increasingly emerged in Italy: hope, expectations, self-esteem, self-efficacy, awareness, personal autonomy, and dignity. The present article describes the most relevant experiences conducted in Italy in the latest years developing a recovery-oriented approach in psychiatry, in different areas: methodology, peer support, education, services transformation, and research. In particular, the Italian Study on Recovery (SIR) is described, a research conducted in the “real world” of service-users of Italian mental health services and their family members. Its quantitative part consists of the validation of the Italian translation of the Recovery Assessment Scale (RAS) and its efficacy in identifying persons in recovery (after University of California–Los Angeles [UCLA] criteria). The qualitative research spotlights the experiences and values of services users in recovery and their families. Conclusions focus on the importance of reshaping psychiatric services based on the principles of recovery and on how this transformation should be guided.

Lo stigma associato alla malattia mentale: tipologie, conseguenze e strategie per contrastarlo

RIVISTA SPERIMENTALE DI FRENIATRIA

Il presente articolo si propone di approfondire il fenomeno dello stigma nel contesto della salut... more Il presente articolo si propone di approfondire il fenomeno dello stigma nel contesto della salute mentale. In particolare, dopo una introduzione dedicata alle radici storiche del termine "stigma", vengono analizzate le sue diverse tipologie alla luce della più recente letteratura: public stigma, structural stigma, selfstigma, felt or perceived stigma, experienced stigma, label avoidance, courtesy stigma e spiritual stigma. Fra le diverse declinazioni che il fenomeno discriminante può assumere, viene fornita una ampia descrizione di quella iatrogena: la discriminazione perpetrata dai professionisti sanitari nei confronti delle persone con disagio psichico. Proprio su questa tipologia di stigma viene proposta una revisione narrativa e non sistematica della letteratura al fine di permettere al lettore di avere una panoramica esaustiva per l'inquadramento di questa particolare forma di stigma. L'ultima parte dell'articolo è dedicata alle principali strategie, sost...

Implementing Psychiatric Rehabilitation in the Mental Health System Services: From Theory to Practice

Person Centered Approach to Recovery in Medicine, 2018

Psychiatric rehabilitation services incorporate principles of recovery and wellness, community su... more Psychiatric rehabilitation services incorporate principles of recovery and wellness, community support, person-centred care and active involvement of individuals and families in the behavioural health system and services. Based on the definition from the Psychiatric Rehabilitation Association (PRA, formerly USPRA), psychiatric rehabilitation: …promotes recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives. Psychiatric rehabilitation services are collaborative, person-directed and individualized. These services are an essential element of the health care and human services spectrum, and should be evidence-based. They focus on helping individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning, and social environments of their choice.

First‐episode psychosis in the Ferrara Mental Health Department: Incidence and clinical course within the first 2 years

Early Intervention in Psychiatry

Between China and Italy: A case report of first-episode schizophrenia in the Covid-19 era

Psychiatry Research

Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy

Psycho-Oncology

OBJECTIVE To examine cancer-related mortality in patients with severe mental disorders (SMI) in t... more OBJECTIVE To examine cancer-related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008-2017 and compare it with the regional population. METHODS We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD-9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10-year period (2008-2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period. RESULTS Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%-29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site-specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender. CONCLUSIONS Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho-oncology.

L'approccio multidimensionale al recovery nella grave malattia mentale: oltre la dimensione della cronicità

RIVISTA SPERIMENTALE DI FRENIATRIA

La diagnosi e la valutazione del funzionamento nel trattamento riabilitativo

Rivista Sperimentale Di Freniatria, 2011

Come in molti Paesi occidentali, anche in Italia la maggior parte degli sforzi nel campo della ri... more Come in molti Paesi occidentali, anche in Italia la maggior parte degli sforzi nel campo della ricerca e della pratica psichiatrica e stata finora orientata alla formulazione sempre piu dettagliata delle diagnosi psichiatriche, alla ricerca di farmaci sempre piu efficaci e con sempre minori effetti collaterali, o all’analisi di raffinati interventi psicoterapici. Minore attenzione e stata rivolta agli strumenti e ai metodi per valutare livelli di disabilita psichiatrica e gli effetti devastanti che la malattia mentale produce sugli individui che ne sono colpiti. In questa direzione, l’affermarsi della riabilitazione psichiatrica, enfatizzando il trattamento delle conseguenze della patologia piuttosto che la patologia in se, ha contribuito non poco alla comprensione dell’impatto del disturbo psichiatrico sulla vita di tante persone, condizionata non solo da menomazioni, ma anche da limitazioni funzionali, disabilita e handicap. All’interno di tale paradigma, si colloca la prassi della valutazione del funzionamento del paziente e della formulazione di una diagnosi di competenza sociale.