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意大利普通精神病学和法医精神病学治疗模式:一个独特的故事。

The Italian general psychiatry and forensic psychiatry treatment model: a unique story.

作者信息

Carabellese Felice F, Parente Lia

机构信息

Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy.

Faculty of Medicine and Psychology, Universita degli Studi di Roma La Sapienza, Rome, Italy.

出版信息

CNS Spectr. 2025 Jan 17;30(1):e1. doi: 10.1017/S1092852924000646.

Abstract

The history of Italian general psychiatry and forensic psychiatry over the last 50 years has been unique in the European and Western healthcare landscape. Western politicians often visit Italy to observe the successful community-based systems that have developed in that country.This article represents a first step toward a necessary attempt, to explore how specific political decisions, such as the Italian one, have produced positive outcomes for patients with psychotic disorders, outcomes not observed in many Western countries, which are instead grappling with negative outcomes such as the complicated management of homelessness and the incarceration of people who would instead require psychiatric care.In its historical context, the 1978 decision to abandon the asylum tradition in favor of socialization for patients living with severe mental disorders represented a difficult choice. This choice led to inevitable critical issues, which today are still not completely dormant.This choice has also, undoubtedly, restored dignity to people living with serious mental illness, even when that person commits a crime.To understand these changes, it is appropriate to mention the regulations that finally led to Law number 180 of 1978, which decreed the closure of psychiatric hospitals (Ospedale Psichiatrico) throughout Italy and continued after 2015 with the closure of high-security psychiatric hospitals (Ospedale Psichiatrico Giudiziario) as well.Culturally, much has changed throughout this time in assistance to the mentally ill in Europe.

摘要

在过去50年里,意大利普通精神病学和法医精神病学的历史在欧洲和西方医疗保健领域中独树一帜。西方政治家经常访问意大利,以观摩该国发展起来的成功的社区式体系。本文是迈向必要尝试的第一步,旨在探究像意大利的决策这样的特定政治决策如何为精神病患者带来了积极成果,而这些成果在许多西方国家并未出现,相反,那些国家正为诸如无家可归者管理复杂以及需要精神科护理的人被监禁等负面后果而苦苦挣扎。在其历史背景下,1978年做出的抛弃收容所传统、转而支持为重度精神障碍患者提供社会化服务的决定是一个艰难的选择。这一选择导致了一些不可避免的关键问题,这些问题至今仍未完全消停。这一选择无疑也恢复了重症精神疾病患者的尊严,即使该患者实施了犯罪行为。为理解这些变化,提及最终促成1978年第180号法律的相关规定是恰当的,该法律规定关闭意大利境内所有精神病院(精神病专科医院),并且在2015年之后还继续关闭了高度设防的精神病医院(司法精神病专科医院)。在文化层面,这段时间里欧洲在精神疾病患者援助方面发生了很大变化。

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