• Direction of the Section of Psychiatry: Administrative Assistant: Ms. Daniela Siri (Monday- Friday, 8.30 a.m. - 2.00 p.m.) (Tel. +39 0532 236409; Fax +39 0532 212240; e-mail: psichiatria@unife.it)

Since the dawn of mankind, one of the main cultural tasks of man has been to ensure his own survival, not only physically, but also psychologically and socially. Various magical institutions tried to protect individuals and groups from the risk of "presence crisis" (Ernesto De Martino) allowing man to  being the master of his own existence.

For shamans and ancient priests, ensuring their existence meant mastering the psychic chaos and removing the paralyzing anguish in dramatic situations. Ancient Greek medicine preserved these roots, recognizing the need for conjugating technique (philotechnia), love for the patient (philanthropia) and knowing how to take care of the soul, the body, the disease and the person, a totally holistic approach. 

Disciplined proximity to the sick person, attention to the psychological and relational components, a continuous comparison with data (as Theophrastus Bombastus -  Paracelsus - taught in Europe, after obtaining in Ferrara part of his vagrant formation) and knowledge of the best scientific evidence are some of the essential characteristics of a medicine and a psychiatry with human foundation.

Although psychiatry was the object of deep transformations and scientific enrichments, at the beginning of a new century it continues to integrate neuro-biological and psycho-pharmacological discoveries and the psychological and interpersonal dimensions, carrying out combined interventions (pharmacotherapy, psychotherapy and rehabilitation) and working in conjunction with other knowledge (general medicine, speciality medicines) in an authentic psycho-somatic perspective.

The Outpatient Service of the Section of Psychiatry began its activity in 1971-72 as a service connected to the Psychiatry Chair and to the Speciality School in Psychiatry, active since the same year. Since then, the Service has maintained an integrative and inter-disciplinary vision but has gradually adapted itself to the new needs arising from the organizational changes  of the Section of Psychiatry and the integration of the unit in the Mental Health Department of Ferrara and in the S. Anna General and University Hospital.

How to reach the Service

The Service is located in the S. Anna Hospital, within the Section of Psychiatry, Unit of Clinical Psychiatry (Tel +39 0532 237129; Fax +39 0532 212240).

Mission

The primary goals of the Service are three-fold:

• psychopathological assesssment;
• treatment of anxiety disorders, depression and somatoform disorders in accordance with the model of integrated therapy (psycho-pharmacological therapy and individual or group psycho-therapy, the latter as focal psychotherapy and/or time-limited psychotherapy);
• liaison with General Medicine to handle complex clinical situations, especially for medically ill patients with psychiatric comorbidity.

Organization

Psychiatrysts and psychologists work in the Service and provide interventions to patients, living inside or outside the region. The service is ideally connected with the Consultation-Liaison Psychiatry Service.  When required, the Service provides those patients followed during their Hospital admission by the C-L Psychiatry Service, the possibility of continuing the post-discharge recommended treatment (psychopharmacology, counselling, psychotherapy).

Documents

Useful information on the prevalence and treatment of disorders such as anxiety,  depression and somatoform disorders is readily available on the World Health Organization website, particularly the Report 2001 on psychiatric disorders in General Medicine or the work of the European Union on the European population’s mental health  (Eurobarometer Survey 2002).  Other useful websites include Psychomedia; BioMed Health & Quality of Life Outcomes; Medical Journal of Australia-Psychiatry) (see Links per further information and journals).

History

Cancer has a high prevalence and high mortality everywhere in the world.  The psycho-oncology area faces the condition of emotional distress caused by cancer, through a multi-disciplinary approach focusing its attention on patients, relatives and care-givers.

Psycho-Oncology is a complex medical and psychological discipline based on the integration of various professionals.

It is the area of the "relationship" and "presence", expressed in oncology and as well as in various other disciplines (e.g. Clinical Psychology, Consultation Psychiatry, Palliative Medicine) through specific programs of care to cancer patients.

Psychiatry has an important role in this field and many Mental Health Departments, both abroad and more recently, in Italy have established services in connection with Oncology Departments and, generally, with various disciplines caring cancer patients (e.g. Gynaecology, Haematolgy. Surgery).

Over the last few years, Psycho-Oncology has shown to be extremely active in research, education and clinical care.

Based on these core values, the Psycho-Oncology Service  of the University of Ferrara was established in 1992 as one of the first in Italy in a general and teaching hospital setting.  Moreover, the Psycho-Oncology service is set in the International Directory of Psycho-Oncology Programs, developed in cooperation with the International Society of Psychosocial Oncology (IPOS).

How to reach the Service

The Service is located in the S.Anna Hospital, within the Section of Psychiatry, Unit of Clinical Psychiatry (Tel +39 0532 237129; Fax +39 0532 212240).

Mission 

The service has the specific mission of increasing the attention of all health-care organizations to the psycho-oncological area and requesting their intervention in the various types of psychological disorders that involves cancer patients and their relatives.

More specifically, the primary objectives of the Psycho-Oncology Service are:

• to properly evaluate and treat psycho-social morbidity secondary to cancer - with the aim of improving cancer patients’ quality of life at every stage of the disease;
• to support families during their relative’s illness, and, if need be, after loss;
• to set up training programmes in order to improve communication skills and recognition of psychological distress secondary to cancer. Such courses are designed for general practitioners, oncologists, nurses and volunteers.

Organization

Psychiatrists, psychologists and a data-manager work for the Psycho-Oncology Service. The unit works in collaboration with the Unit of Clinical Oncology  and other Units (Surgery, Radio-therapy, Haematology, Gynaecology) at the S. Anna General and University Hospital.  All of these units work in synergy to provide the utmost care for the cancer patient.  The activity of the Service is integrated with the the Community Services (i.e., Family Medicine, Child Psychiatry Services, Psychiatry Services of the Mental Health Department, Volunteer Associations) in the development of care projects for cancer patients and their families (Psycho-Oncology Programme 2003 - 2005).

Documents

The Psycho-Oncology programs have become more widespread and common in the past few years.  Essential documents and algorithms on the organization and interventions (i.e., prevention, evaluation and treatment) have been recently issued by the Service. The guidelines developed by the National Comprehensive Cancer Network (NCCN) (Guidelines for Supportive Care - Distress Management) are particularly useful for clinical purposes and are used on a routine basis in the Oncology Outpatient and Inpatient services. Equally important are the Italian Society of Psycho-Oncology (SIPO) guidelines, set in 1998 and presently under revision and translated into English.

Moreover, the Psycho-Oncology Service  organizes various training courses as a part of the educational activities of the Section of Psychiatry.  These programs may be accessed at anytime at the University of Ferrara website in the "Eventi e News" area. The Psycho-Oncology unit, under the direction of the European Community, activated in 2002 a specific site of Psycho-Oncology in the Italian web-journal Psychiatry on-line. The site is available in English. Research articles, clinical experiences, literature abstracts, interviews to representative personalities in psycho-oncology area, and reviews are regularly updated.

Interest in the mental dimension of man is one of the most discussed subjects in medicine, from the mechanical and dualistic tradition of the Knidos school to the monistic one of the Hippocratic school of Cos. Hippocrates defined in his Aphorisms the roles of physicians, patients and events as significant variables to be considered in health and sickness processes:

"Life is short, and the Art long; the occasion fleeting; experience fallacious, and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate".

He also indicated the need to know the person before  knowing the disease:

"It is more important to know what sort of person has a disease than to know what sort of disease a person has".
 

Such aspects, later separated in the the Cartesian paradigm of "res cogitans" and "res extensa", were gradually lost  in a medicine that had initially been based on the organ but became more and more oriented to a mechanization of man and sickness, with an organic and parcelled vision of physical sickness and an "encephalo-iatric" and "cerebro-centric" vision of psychiatry.

In more modern times, since the beginning of the 20th century, two obvious needs became apparent: 1) the need of a global approach towards the person suffering from somatic pathologies; and 2) the need for deeper knowledge of the psychological concomitants of physical functioning in health and disease.

In 1902, in the United States, the first psychiatric department in a general hospital was established.  Similarly, in the twenties Consultation Psychiatry was born as a branch specifically oriented towards the evaluation and treatment of psychological problems of patients suffering from somatic diseases. As a result the groundwork was set to establish and spread theoretical and patient-assistance models, specifically applied to the various medical-surgical branches.

In the fifties and sixties oncology, cardiology, obstetrics, gynaecology and dermatology were the most influential disciplines to this phenomenon. In such disciplines the basic principles of Consultation Psychiatry are applied directly and precisely:

• the need to evaluate the influence of emotional variables from the onset of disease (psycho-somatic pathogenesis) 
• the need to study the effects between both psychological and biological factors (psycho-biology) 
• the need for educational training of physicians; the recognition of psychiatric and psycho-social problems in physically ill patients;
• the need for proper bio-psychos-social treatment 
• the need to develop experimental research in such areas 

Due to the diffusion of such a culture - strictly connected to the development of psycho-somatic medicine - today Consultation-Liasion  Psychiatry has its own role within Psychiatry; with Consultation-Liaison  Psychiatry programs available in the majority of the Hospitals throughout Italy. Very recently (April 2003) the American Board of Psychiatry and Neurology (ABPN) credited this discipline as a speciality of psychiatry: as of June 2003, the Accreditation Council for Graduate Medical Education (ACGME) began referring to the specialty as Psychosomatic Medicine.

In Ferrara, Consultation-Liaison Psychiatry and Psychosomatic Medicine services  were implemented in 1991 at in the S. Anna University Hospital and later, in the Mental Health Department.  

How to reach the Service

The Service is located in the S. Anna Hospital, within the Section of Psychiatry, Unit of Clinical Psychiatry (Tel +39 0532 237129; Fax +39 0532 212240).

Mission

The Consultation-Liaison Psychiatry Service has the mission of improving recognition and treatment of psychiatric disorders of patients suffering from medical illness (psychiatric co-morbidity), in the settings of the General Hospital and Community Medicine. 

The primary objectives are four-fold:

• to ensure the “transitional care” of patients suffering from medical disorders, staying in hospitals or out-patients 
• to establish a close liaison with the General Hospital Acute Psychiatric Unit. This service is responsible for urgent psychiatric interventions in the Emergency Room and in the Medical and Surgical Departments of the University Hospital of S. Anna as defined by an agreement between the University Psychiatric Unit and the Emergency Psychiatry Unit

• to develop programs aimed at integrating the training of doctors and nurses to better recognize and address the most frequent psychiatric problems, second to medical pathologies (e.g. delirium, depression). In addition, promulgating the importance of patients suffering from heavy mental pathologies to General Medicine. 
• to improve communications amongst several health teams, health agencies and services providing patient-care both in the Department and post-discharge.  This includes, but is not limited to the Mental Health Department, GPs, Social Services, Substance and Alcohol Abuse services and other speciality services of the General Hospital

Organization 

The service consists of full-time psychiatrists supported by two psychologists and other physicians in formal psychiatric training.  Information on the hours of operation and its activities is available in the catalogue of Psychiatry Activities in the General and University Hospital S. Anna in Ferrara.

Documents   

Additional information on  Consultation-Liaison Psychiatry may be found on the web-sites of the European Society of Consultation-Liaison Psychiatry  and the Academy of Psychosomatic Medicine site, the official American Organization of Consultation and Liaison Psychiatry. Further information on the important role of this branch of Psychiatry can be found in the recent document, The Psychological care of Medical Patients: A Practical Guide, jointly set in U.K. by the Royal College of Psychiatrists and the Royal College of Physicians.

History 

Much has been dreamt and written on the meaning of the Moon and its relationship with mental health and "lunacy" (the "moon sickness" of medieval tradition, the "lunatics" of Anglo-Saxon tradition and the "lunatic asylums" as care sites for "lunacy"). 

This rich patrimony was also recognized by Ludovico Ariosto, the great poet from Ferrara who imagined that Orlando, made insane by love, could find on the moon his wisdom distilled and preserved in a vessel. 

Another journey I must take you on

leaving the earth beneath us fast below

until we reach the circle of the moon -

the nearest of the planets, as you know,

the only means to cure Orlando soon

is hidden there and that is why we go (Orlando Furioso canto 34, LXVII)

A liquid thin and clear, Astolfo sees

distilled in many vases, large and small

which must (so volatile the fluid is)

be tighty corked (Orlando Furioso canto 34, LXXXII)

And through the breath (“psyche” is the Greek word for breath and "animus" in Latin), wisdom can be inspired and recovered, while awakening from sleep and entering a new life.

As one who wakes from a distressful dream

of gruesome monsters which could never be

however grim and menacing they seem

or of committing some enormity

and though his senses have returned to him

from his amazement cannot yet shake free,

so now Orlando, weakened from illusion,

remained in stupefaction and confusion (Orlando Furioso canto 39, LVII, LVIII)

Along this line of inspiration, the In-patients Psyhciatric Unit for Intensive Rehabiliation Programs (RP) "La Luna" was founded in 1992 to serve as a therapeutic community facility. Initially, the RP had only 10 beds whose purposes were to provide long-term rehabilitative services to patients with schizophrenia discharged from Psychiatric units. The care programs were geared towards training the patient to be self-sufficient in both the workplace and home environments.  Moreover, the patients were involved in social activities aimed at improving their interpersonal relations with others. 

In 1997, in the framework of a global reorganization plan of the Ferrara Mental Health Department, the structure was gradually transformed to accept patients suffering from a wider spectrum of psycho-pathological disorders.  The program was typically for a short period of time ranging from one to three months.  Through these programs the department acquired the characteristics of a real alternative to the conventional psychiatry ward.

How to reach the Unit

The Unit is located in Via Quartieri, 2 (Tel. +39 0532 235402, Fax + 39 0532-235437) and is linked to the Didactic Building of the Graduate Course of Rehabilitation Psychiatry.

Mission  

The structure pursues the following 5 goals:

• to nurture and intensify the relationship between the patient and caring group with the objective of improving the patient’s health and guiding him or her towards self-autonomy;
• to provide intervention in various forms ranging from psycho-diagnostic assessments, psycho-pharmacological treatment, and psycho-educational programs, including expressive therapy;
• to establish a stronger relationship between the psychiatric team and the Physician of General Medicine (GP) with the aim of involving a wider network of individuals in the improvement of patient care;
• to develop and implement project guidelines for psychiatric residents in Italy so that their projects may be sponsored by the RP.

Organization Documents

The RP "La Luna", a "non-hospital" structure with 17 beds, provides patient care 24 hours a day.  The staff consists of 15 nurses, a head nurse and 2 psychiatrists.  Others also include residents of the specialty school of Psychiatry and students in the Degree Course of Psychiatric and Psycho-social Rehabilitation attending the Section of Psychiatry of the Faculty of Medicine and Surgery of the University of Ferrara. Patient admission and discharge is carefully considered in accordance with a personalized program periodically verified by DSM operators, residence operators, patients and other influential figures. Patients typically remain for short to medium periods of time; that is, between 30 and 90 days.  The RFP appears more like a family setting than a hospital one; indeed, throughout the day the patient engages in both relaxing and entertaining activities, catered individually to his/her needs.  Participation in practical and recreational activities is also encouraged to test and improve one's own abilities and to foster a sense of autonomy.   

In recent years, patient needs and satisfaction with psychiatric care have been increasingly studied. This research has generated information useful for improving the quality of care and for implementing therapeutic programs based on evidence-based criteria and on patients’ subjective experiences. A relatively new research area is represented by studies exploring patient opinions on the benefits of treatment provided. This area of research has been studied in the Residential Psychiatric Unit belonging to the Section of Psychiatry.

For more information on clinical services, please see below (in Italian language):

• Acute Inpatient Psychiatry Unit (inside  the University S.Anna Hospital - New site in Cona)
• Inpatient Psychiatry Unit (inside the Hospital of the Delta, Lagosanto, Ferrara)
• Psycho-Oncology Service
• Consultation-Liaison Psychiatry  and Psychosomatic Service

• to educate and train students and doctors within the Faculty (School of Medicine, School of Dentistry, Post-Graduation Schools and Graduate Schools);
• to provide special training in general psychiatry to physicians at the Post-Graduate School of Psychiatry and to students at the Graduate School in Rehabilitation Psychiatry;
• to promote educational events in the framework of Continuous Education in Medicine (CME) in order to train health care professionals in mental health areas;
• to promote evidence-based research in order to deepen and improve the knowledge in various areas of psychiatry, such as prevention, epidemiology, clinical care and treatment;
• to perform and develop clinical care programs for persons suffering from psychological distress and for their families, particularly for cancer patients and their families;
• to promote the psychiatric culture and research performed by the department in various institutional areas, such as Health Agencies, scientific, medical and psychological Societies, Cultural Associations, at local, regional, national and international levels.

The  academic part of the Section of Psychiatry of the University of Ferrara is located inside the  Azienda Ospedaliera Universitaria Arcispedale S. Anna - Old Hospital (Secretary Tel +39 0532 236409; Fax +39 0532 212240)

The clinical units have different locations:

(1) inside the Azienda Ospedaliera Universitaria Arcispedale S. Anna - New Hospital in Cona (Via Aldo Moro, Cona , Tel. +39 0532 236218 - 236470; Fax 0532-236393), with the  Acute Inpatient Psychiatry Unit, the Consultation-Liaison Psychiatry and Psychosomatic Service, and the Psycho-Oncology Service (Tel. +39 0532 293215; Fax +39 0532 293601)

(2) inside the Azienda Ospedaliera Universitaria Arcispedale S. Anna (old Hospital) with its Outpatient clinics and Psycho-Oncology Service

(3) inside the Ospedale del Delta (Lagosanto) with the Hospital Inpatient Psychiatric Unit (Tel + 39 0533-723327; Fax +39 0533-723319).

Academic Psychiatry has been active in Ferrara as part of the School of Medicine since 1971. Although it was initially set inside the Nervous and Mental Diseases Clinic, it later became a self-governing discipline. Also in 1971, the Residency Program in Psychiatry was established (D.P.R. 11/5/1971 n.470 - G.U. 28/7/1971 n.188). In 1998 a Diploma in Psychiatric and Psycho-social Rehabilitation Therapy was implemented.  In 2002, according to a new university reform, it became the Graduation School in Psychiatric Rehabilitation to replace the Diploma program.

The Section of Psychiatry is also registered and recognized on the “Continuous Medical Education (CME)” site at the Health Ministry (provider number 5231) as a structure qualified to organize informative events.

The Psychiatry Section  of the University of Ferrara is therefore a complex structure. Educational, research and clinical-care activities are fundamental expressions of the discipline of psychiatry and are thus the core of the Section.

From  2003 to 2011, the Section of Psychiatry has been the legal site of the Chair (President Prof. Luigi Grassi) of the Italian Society of Psycho-Oncology (SIPO), whose objective is to promote education and research in psychological, psychiatric and social assistance to cancer patients and to their families based on the programmes defined by psycho-oncology over the last twenty years. Further information may be obtained at the official site of SIPO and at the National Secretariat of the Society (see also the Section Links and the Psycho-Oncology Service at the same site). It has been the site of the International Psycho-Oncology Society (IPOS) form 2006 to 2008 (President Prof. Luigi Grassi). Since 2005 it is also the site of the Chair of the Special Section on Psycho-Oncology and Palliative Care (Chair Prof. Luigi Grassi) of the World Psychiatric Association. Since 2011 it is  the chair of the Italan Association of Cognitive Analytic Therapy (ITA-CAT), federated to the International Cognitive Analytic Therapy Association (ICATA).

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