The "squiggle game" is, above all, a method for relating and encouraging mutual exchange between ... more The "squiggle game" is, above all, a method for relating and encouraging mutual exchange between the analyst and the patient (no matter if child, adolescent, or adult), enabling him to experience holding and freely explore different communication possibilities. After having explored the "technique" as it has been developed by Winnicott, this study also exposes some theoretical considerations, and some variations in the basic technique, brought together by the crucial role played by reciprocity: "Me a little and you a little." The paper is a clinical case with a Chinese adolescent.
La psicoanalisi si trova oggi di fronte a un pluralismo di modelli, teorie e tecniche sconosciuto... more La psicoanalisi si trova oggi di fronte a un pluralismo di modelli, teorie e tecniche sconosciuto in passato; parte della letteratura analitica individua un possibile terreno comune nel controtransfert. Il presente lavoro propone una panoramica storico-descrittiva dello sviluppo del concetto di controtransfert, focalizzando l’attenzione su un filone ben preciso di tale sviluppo, ovvero quello che va dal contributo originario portato da Freud fino a quelli degli analisti della scuola inglese delle relazioni oggettuali che diedero, e continuano a dare, un apporto fondamentale nella diffusione della discussione, necessaria allo sviluppo scientifico, riguardo al controtransfert nei suoi aspetti teorico-clinici.
The medical intervention concerning protection and care of both physical and mental health begins... more The medical intervention concerning protection and care of both physical and mental health begins with the meeting between the clinician and the patient and with the observation of the personal conditions of the individual with the problem, or put forward himself/herself as a problem. After having shortly outlined the theoretical and methodological evolution of the strictly connected concepts of “illness” and “semeiotics”, from the protohistoric age to nowadays, focus is placed on the reasons triggering the need of a greater epistemological awareness in the use of the semeiotics by the specialist. The usefulness of replacing a “semeiotic of deviation” with a “semeiotic of differences” is also explained, which entails a process of comparison between the semeiotic of the doctor and the patient’s one.
The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between ... more The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between the analyst and the patient (no matter if child, adolescent, or adult), enabling him to experience holding and freely explore different communication possibilities. After having explored the “technique” as it has been developed by Winnicott, this study also exposes some theoretical considerations, and some variations in the basic technique, brought together by the crucial role played by reciprocity: “Me a little and you a little.” The paper is a clinical case with a Chinese adolescent. Le jeu du squiggle est avant tout une méthode favorisant la relation et l'échange mutuel entre l'analyste et le patient (qu'il s'agisse d'un enfant, d'un adolescent ou d'un adulte) et permettant à ce dernier de faire ;'expérience du holding et d'explorer librement différentes modalités de communication. Après avoir examiné la “technique” développée par Winnicott, l'a...
I bambini gravemente malati vivono emozioni difficili, che dovrebbero poter raccontare e vedere a... more I bambini gravemente malati vivono emozioni difficili, che dovrebbero poter raccontare e vedere ascoltate qualora ne abbiano bisogno, con la liberta di poter stare a contatto con la sofferenza senza essere "costretti a stare bene" o spinti a un "di-vertirsi" inteso come fuga dall’esperienza. La qualita di una cura si misura anche su quanto la sofferenza del bambino puo avere spazio nel rapporto con gli adulti. Il miglior modo in cui un bambino puo "parlare" di se e tramite la creativita spontanea. Compito degli adulti e costruire uno spazio potenziale e riconoscere le comunicazioni del bambino, tollerando gli affetti piu intensi, la cui perdita rappresenterebbe un ulteriore peso di una malattia in cui gli adulti non sanno farsi usare dal piccolo. Indicatore piu valido di questo atteggiamento e la capacita di non seguire vie controfobiche rispetto alla sofferenza, ma di condividere momenti di tristezza come espressione di un contatto con il vero Se del bambino e quindi come testimonianze di maturita emozionale.
The Italian Society of Psycho-oncology (SIPO) set up a panel consisting of 39 experts in the fiel... more The Italian Society of Psycho-oncology (SIPO) set up a panel consisting of 39 experts in the field of the evaluation of quality of life. Panel members were psychologists, psychiatrists, neurologists, oncologists, algologists, experts in palliative care, biostatisticians and clinical epidemiologists. They prepared guidelines in two sessions. in April and September, 1991. During the first session, the panel members discussed the answers to a multiple choice questionnaire sent by the coordinator, and in the second they expressed their agreement with the final draft of the text summarizing their discussions. The objective of the panel was to determine where and how quality of life should be assessed in cancer research. The importance of its inclusion in future oncology research and the use of the questionnaire as an effective survey instrument were established. The following questions were to be answered:
The current CoViD-19 pandemic threatens both physical and psychological well-being. According to ... more The current CoViD-19 pandemic threatens both physical and psychological well-being. According to the bio-psycho-social model, Units of Clinical Psychology of the Hospitals in Lombardy (Italy) reacted to this risk, offering diversified interventions, described in the present contribution. The medical staff operated on the front line during the emergency: psychologists addressed their needs through individual clinical work, sessions of decompression and debriefing. At the same time, Units of Clinical Psychology supported the hospitalized positive patients by conducting psychological consultations, either on the ward or through devices. Moreover, some hospitals activated helplines to address the needs of the population and family members, who were particularly vulnerable during the relative's illness and after the mourning.
Treatment and care of terminal cancer patients are conducted in different ways, according to the ... more Treatment and care of terminal cancer patients are conducted in different ways, according to the cultural, social, political and economical situations of the countries which have progressively adopted and developed them. In Italy there are no specialized structures such as "hospices" or the "palliative care units" like in the Anglo-Saxon world: the care of terminal cancer patients is carried out either in a general hospital or at their own home. In Milan and elsewhere there are home care teams in which doctors, nurses, social workers and volunteers, all work in connection with hospital structures. In this way, patients can receive specialized care for physical, psychological and social problems at home too. To evaluate costs and effectiveness of this program, a comparison was made between the home care and the conventional treatment carried out in general hospitals. Two groups of thirty terminal cancer patients have been studied: the first group was composed of hospital patients in Desio and the second one included patients cared for by the home care service organized by the Floriani Foundation and the Italian League against Cancer (Milan Section). We evaluated intensity and duration of pain, hours of sleep and hours of standing, sitting and lying, presence of side-effects, performance status and therapies. Data were also collected on the quality of life (Spitzer QLI), social and economical needs of the patients, type and quality of care, degree of awareness of the diagnosis by the patient and the family. This data were collected by the nurse who looked after the patient. Care costs were also quantified. The comparison between the two groups significantly favours the home care group as shown by the performance status after 2 weeks of care, the "health scale" and the Total index of the Spitzer QLI and in general the greater satisfaction of the care received. Home care produces results equivalent to those achieved in hospitals as far as clinical parameters are concerned. An approximate quantification of the costs shows that an average cost for a day's home care was about Lit. 52,500 as compared with Lit. 360,000 for a day's hospitalization.
From the data in the literature it can be seen that 40% of the surgical population has insufficie... more From the data in the literature it can be seen that 40% of the surgical population has insufficient postoperative analgesia. Many reasons have been given for this: pain control delegated to the doctor on duty and/or the nursing staff; administration of drugs 'on demand', if the patient asks for them, or the nurses feel it to be necessary; fear of causing side effects such as respiratory insufficiency; or provoking addiction by giving narcotics. The aim of this paper is to evaluate the intensity of pain, the side effects, the degree of activity, anxiety, feeling of weakness and the mood of patients surgically treated for oncological diseases of the thorax and upper abdomen, comparing two different antalgic approaches. Thirty-five patients were studied. Pain was treated on demand with a narcotic, or an anti-inflammatory drug, or not treated at all; 20 patients were treated with analgesics given at predetermined hours, following the regime: methadone 10 mg intramuscularly (i.m.) every 12 h from the first to the third day following surgery and sodium diclofenac 75 mg (i.m.) every 12 h from the fourth to the seventh day. Results showed that patients treated with analgesics given intramuscularly at fixed hours have a significantly better pain control during the whole week of treatment (P less than 0.001), on average sleep more (P less than 0.001), spend more time standing or sitting and fewer hours lying down (P less than 0.001), have a higher performance status and feel less weak (P less than 0.05) than the group of patients treated with drugs 'on demand', or not treated at all.
By means of a cross-sectional study, 115 terminal cancer patients (53 males, 62 females) who were... more By means of a cross-sectional study, 115 terminal cancer patients (53 males, 62 females) who were no longer responsive to anticancer treatment, were investigated. The sample included all patients who had been undergoing palliative care (PC) during a single week (at the out-patient clinic, in hospital or at home). From the start of PC, the quality of the patients' lives was assessed by a weekly self-descriptive record comprising 32 items at four levels of intensity. The responses given on the questionnaire during the sample week were compared to those given by the same patients at the beginning of PC (T0). From T0 to time during treatment, figures show a significant increase in the percentage of patients who reported drowsiness, and a significant decrease in pain, weakness, functional impairment and psychological distress. The global judgment of not feeling well was reduced from 49% of the patients at TO to 31% during the period of treatment (p less than 0.01). This result shows that, although the disease progressively develops, PC can enhance the quality of the lives of patients during the terminal stages of illness. The subjective judgment of not feeling well was much more closely correlated with physical, functional and psychological symptoms. Of the physical symptoms, pain has the closest correlation with feeling bad. However, pain has a low number of statistically significant correlations with respect to the other items, in marked contrast to the high number of correlations regarding psychological and functional items.(ABSTRACT TRUNCATED AT 250 WORDS)
Objectives: The original manufacturers recommended dose of enzyme replacement therapy (ERT) for G... more Objectives: The original manufacturers recommended dose of enzyme replacement therapy (ERT) for Gaucher disease of 120 units/kg body weight/month is safe and effective. In Israel 30 units/kg/month with comparable safety and efficacy is used. Preliminary observations have raised concern that drug withdrawal/dose reduction after high dose is associated with a relatively rapid deterioration in disease parameters, findings not observed on lower doses. We speculated that this differential might be due to down-regulation of endogenous expression of the GBA gene induced by higher concentration of exogenous enzyme.
Objectives: The original manufacturers recommended dose of enzyme replacement therapy (ERT) for G... more Objectives: The original manufacturers recommended dose of enzyme replacement therapy (ERT) for Gaucher disease of 120 units/kg body weight/month is safe and effective. In Israel 30 units/kg/month with comparable safety and efficacy is used. Preliminary observations have raised concern that drug withdrawal/dose reduction after high dose is associated with a relatively rapid deterioration in disease parameters, findings not observed on lower doses. We speculated that this differential might be due to down-regulation of endogenous expression of the GBA gene induced by higher concentration of exogenous enzyme.
Sixty-six patients, surgically treated for head and neck cancer and free of disease, were intervi... more Sixty-six patients, surgically treated for head and neck cancer and free of disease, were interviewed at the outpatient clinic from 6 months to 8 years after surgery. The patients were divided by the physician into two groups, according to the patients' degree of disfigurement, i.e., minor (24 patients, 36%, minor disfigurement group = MDG) or extensive (42 patients, 64%, extensive disfigurement group = EDG). Subsequently, the patients were interviewed with close-ended questions. The following subjective aspects were assessed: self-image; relationship with the partner, family, and friends; and the overall impact of the therapy. The results of the study showed a significantly higher impact in the EDG versus the MDG as regards a changed self-image (57% vs 25%, P < 0.05), a worsened relationship with the partner (27% vs O%, P < 0.05), a reduced sexuality (74% vs 39%, P < 0.01), and an increased social isolation (36% vs 12%, P < 0.05). On the whole, 18% of the subjects stated that the disadvantages of therapy outweighed the advantages, and 30% felt that the difficulties encountered were "too harsh." In such cases, the opportunity of setting up a rehabilitation program offering psychosocial support should be considered.
The "squiggle game" is, above all, a method for relating and encouraging mutual exchange between ... more The "squiggle game" is, above all, a method for relating and encouraging mutual exchange between the analyst and the patient (no matter if child, adolescent, or adult), enabling him to experience holding and freely explore different communication possibilities. After having explored the "technique" as it has been developed by Winnicott, this study also exposes some theoretical considerations, and some variations in the basic technique, brought together by the crucial role played by reciprocity: "Me a little and you a little." The paper is a clinical case with a Chinese adolescent.
La psicoanalisi si trova oggi di fronte a un pluralismo di modelli, teorie e tecniche sconosciuto... more La psicoanalisi si trova oggi di fronte a un pluralismo di modelli, teorie e tecniche sconosciuto in passato; parte della letteratura analitica individua un possibile terreno comune nel controtransfert. Il presente lavoro propone una panoramica storico-descrittiva dello sviluppo del concetto di controtransfert, focalizzando l’attenzione su un filone ben preciso di tale sviluppo, ovvero quello che va dal contributo originario portato da Freud fino a quelli degli analisti della scuola inglese delle relazioni oggettuali che diedero, e continuano a dare, un apporto fondamentale nella diffusione della discussione, necessaria allo sviluppo scientifico, riguardo al controtransfert nei suoi aspetti teorico-clinici.
The medical intervention concerning protection and care of both physical and mental health begins... more The medical intervention concerning protection and care of both physical and mental health begins with the meeting between the clinician and the patient and with the observation of the personal conditions of the individual with the problem, or put forward himself/herself as a problem. After having shortly outlined the theoretical and methodological evolution of the strictly connected concepts of “illness” and “semeiotics”, from the protohistoric age to nowadays, focus is placed on the reasons triggering the need of a greater epistemological awareness in the use of the semeiotics by the specialist. The usefulness of replacing a “semeiotic of deviation” with a “semeiotic of differences” is also explained, which entails a process of comparison between the semeiotic of the doctor and the patient’s one.
The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between ... more The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between the analyst and the patient (no matter if child, adolescent, or adult), enabling him to experience holding and freely explore different communication possibilities. After having explored the “technique” as it has been developed by Winnicott, this study also exposes some theoretical considerations, and some variations in the basic technique, brought together by the crucial role played by reciprocity: “Me a little and you a little.” The paper is a clinical case with a Chinese adolescent. Le jeu du squiggle est avant tout une méthode favorisant la relation et l'échange mutuel entre l'analyste et le patient (qu'il s'agisse d'un enfant, d'un adolescent ou d'un adulte) et permettant à ce dernier de faire ;'expérience du holding et d'explorer librement différentes modalités de communication. Après avoir examiné la “technique” développée par Winnicott, l'a...
I bambini gravemente malati vivono emozioni difficili, che dovrebbero poter raccontare e vedere a... more I bambini gravemente malati vivono emozioni difficili, che dovrebbero poter raccontare e vedere ascoltate qualora ne abbiano bisogno, con la liberta di poter stare a contatto con la sofferenza senza essere "costretti a stare bene" o spinti a un "di-vertirsi" inteso come fuga dall’esperienza. La qualita di una cura si misura anche su quanto la sofferenza del bambino puo avere spazio nel rapporto con gli adulti. Il miglior modo in cui un bambino puo "parlare" di se e tramite la creativita spontanea. Compito degli adulti e costruire uno spazio potenziale e riconoscere le comunicazioni del bambino, tollerando gli affetti piu intensi, la cui perdita rappresenterebbe un ulteriore peso di una malattia in cui gli adulti non sanno farsi usare dal piccolo. Indicatore piu valido di questo atteggiamento e la capacita di non seguire vie controfobiche rispetto alla sofferenza, ma di condividere momenti di tristezza come espressione di un contatto con il vero Se del bambino e quindi come testimonianze di maturita emozionale.
The Italian Society of Psycho-oncology (SIPO) set up a panel consisting of 39 experts in the fiel... more The Italian Society of Psycho-oncology (SIPO) set up a panel consisting of 39 experts in the field of the evaluation of quality of life. Panel members were psychologists, psychiatrists, neurologists, oncologists, algologists, experts in palliative care, biostatisticians and clinical epidemiologists. They prepared guidelines in two sessions. in April and September, 1991. During the first session, the panel members discussed the answers to a multiple choice questionnaire sent by the coordinator, and in the second they expressed their agreement with the final draft of the text summarizing their discussions. The objective of the panel was to determine where and how quality of life should be assessed in cancer research. The importance of its inclusion in future oncology research and the use of the questionnaire as an effective survey instrument were established. The following questions were to be answered:
The current CoViD-19 pandemic threatens both physical and psychological well-being. According to ... more The current CoViD-19 pandemic threatens both physical and psychological well-being. According to the bio-psycho-social model, Units of Clinical Psychology of the Hospitals in Lombardy (Italy) reacted to this risk, offering diversified interventions, described in the present contribution. The medical staff operated on the front line during the emergency: psychologists addressed their needs through individual clinical work, sessions of decompression and debriefing. At the same time, Units of Clinical Psychology supported the hospitalized positive patients by conducting psychological consultations, either on the ward or through devices. Moreover, some hospitals activated helplines to address the needs of the population and family members, who were particularly vulnerable during the relative's illness and after the mourning.
Treatment and care of terminal cancer patients are conducted in different ways, according to the ... more Treatment and care of terminal cancer patients are conducted in different ways, according to the cultural, social, political and economical situations of the countries which have progressively adopted and developed them. In Italy there are no specialized structures such as &quot;hospices&quot; or the &quot;palliative care units&quot; like in the Anglo-Saxon world: the care of terminal cancer patients is carried out either in a general hospital or at their own home. In Milan and elsewhere there are home care teams in which doctors, nurses, social workers and volunteers, all work in connection with hospital structures. In this way, patients can receive specialized care for physical, psychological and social problems at home too. To evaluate costs and effectiveness of this program, a comparison was made between the home care and the conventional treatment carried out in general hospitals. Two groups of thirty terminal cancer patients have been studied: the first group was composed of hospital patients in Desio and the second one included patients cared for by the home care service organized by the Floriani Foundation and the Italian League against Cancer (Milan Section). We evaluated intensity and duration of pain, hours of sleep and hours of standing, sitting and lying, presence of side-effects, performance status and therapies. Data were also collected on the quality of life (Spitzer QLI), social and economical needs of the patients, type and quality of care, degree of awareness of the diagnosis by the patient and the family. This data were collected by the nurse who looked after the patient. Care costs were also quantified. The comparison between the two groups significantly favours the home care group as shown by the performance status after 2 weeks of care, the &quot;health scale&quot; and the Total index of the Spitzer QLI and in general the greater satisfaction of the care received. Home care produces results equivalent to those achieved in hospitals as far as clinical parameters are concerned. An approximate quantification of the costs shows that an average cost for a day&#39;s home care was about Lit. 52,500 as compared with Lit. 360,000 for a day&#39;s hospitalization.
From the data in the literature it can be seen that 40% of the surgical population has insufficie... more From the data in the literature it can be seen that 40% of the surgical population has insufficient postoperative analgesia. Many reasons have been given for this: pain control delegated to the doctor on duty and/or the nursing staff; administration of drugs &#39;on demand&#39;, if the patient asks for them, or the nurses feel it to be necessary; fear of causing side effects such as respiratory insufficiency; or provoking addiction by giving narcotics. The aim of this paper is to evaluate the intensity of pain, the side effects, the degree of activity, anxiety, feeling of weakness and the mood of patients surgically treated for oncological diseases of the thorax and upper abdomen, comparing two different antalgic approaches. Thirty-five patients were studied. Pain was treated on demand with a narcotic, or an anti-inflammatory drug, or not treated at all; 20 patients were treated with analgesics given at predetermined hours, following the regime: methadone 10 mg intramuscularly (i.m.) every 12 h from the first to the third day following surgery and sodium diclofenac 75 mg (i.m.) every 12 h from the fourth to the seventh day. Results showed that patients treated with analgesics given intramuscularly at fixed hours have a significantly better pain control during the whole week of treatment (P less than 0.001), on average sleep more (P less than 0.001), spend more time standing or sitting and fewer hours lying down (P less than 0.001), have a higher performance status and feel less weak (P less than 0.05) than the group of patients treated with drugs &#39;on demand&#39;, or not treated at all.
By means of a cross-sectional study, 115 terminal cancer patients (53 males, 62 females) who were... more By means of a cross-sectional study, 115 terminal cancer patients (53 males, 62 females) who were no longer responsive to anticancer treatment, were investigated. The sample included all patients who had been undergoing palliative care (PC) during a single week (at the out-patient clinic, in hospital or at home). From the start of PC, the quality of the patients&#39; lives was assessed by a weekly self-descriptive record comprising 32 items at four levels of intensity. The responses given on the questionnaire during the sample week were compared to those given by the same patients at the beginning of PC (T0). From T0 to time during treatment, figures show a significant increase in the percentage of patients who reported drowsiness, and a significant decrease in pain, weakness, functional impairment and psychological distress. The global judgment of not feeling well was reduced from 49% of the patients at TO to 31% during the period of treatment (p less than 0.01). This result shows that, although the disease progressively develops, PC can enhance the quality of the lives of patients during the terminal stages of illness. The subjective judgment of not feeling well was much more closely correlated with physical, functional and psychological symptoms. Of the physical symptoms, pain has the closest correlation with feeling bad. However, pain has a low number of statistically significant correlations with respect to the other items, in marked contrast to the high number of correlations regarding psychological and functional items.(ABSTRACT TRUNCATED AT 250 WORDS)
Objectives: The original manufacturers recommended dose of enzyme replacement therapy (ERT) for G... more Objectives: The original manufacturers recommended dose of enzyme replacement therapy (ERT) for Gaucher disease of 120 units/kg body weight/month is safe and effective. In Israel 30 units/kg/month with comparable safety and efficacy is used. Preliminary observations have raised concern that drug withdrawal/dose reduction after high dose is associated with a relatively rapid deterioration in disease parameters, findings not observed on lower doses. We speculated that this differential might be due to down-regulation of endogenous expression of the GBA gene induced by higher concentration of exogenous enzyme.
Objectives: The original manufacturers recommended dose of enzyme replacement therapy (ERT) for G... more Objectives: The original manufacturers recommended dose of enzyme replacement therapy (ERT) for Gaucher disease of 120 units/kg body weight/month is safe and effective. In Israel 30 units/kg/month with comparable safety and efficacy is used. Preliminary observations have raised concern that drug withdrawal/dose reduction after high dose is associated with a relatively rapid deterioration in disease parameters, findings not observed on lower doses. We speculated that this differential might be due to down-regulation of endogenous expression of the GBA gene induced by higher concentration of exogenous enzyme.
Sixty-six patients, surgically treated for head and neck cancer and free of disease, were intervi... more Sixty-six patients, surgically treated for head and neck cancer and free of disease, were interviewed at the outpatient clinic from 6 months to 8 years after surgery. The patients were divided by the physician into two groups, according to the patients' degree of disfigurement, i.e., minor (24 patients, 36%, minor disfigurement group = MDG) or extensive (42 patients, 64%, extensive disfigurement group = EDG). Subsequently, the patients were interviewed with close-ended questions. The following subjective aspects were assessed: self-image; relationship with the partner, family, and friends; and the overall impact of the therapy. The results of the study showed a significantly higher impact in the EDG versus the MDG as regards a changed self-image (57% vs 25%, P < 0.05), a worsened relationship with the partner (27% vs O%, P < 0.05), a reduced sexuality (74% vs 39%, P < 0.01), and an increased social isolation (36% vs 12%, P < 0.05). On the whole, 18% of the subjects stated that the disadvantages of therapy outweighed the advantages, and 30% felt that the difficulties encountered were "too harsh." In such cases, the opportunity of setting up a rehabilitation program offering psychosocial support should be considered.
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