Assestment and Treatment on young adults in the Public Service A clinical case


BACKGROUND: The importance of early diagnosis, the identification of subjects atrisk and the speed of treatments are pillars shared by the scientific community for the interception of mental pathologies, particularly in the population of adolescents andyoung adults. Intervening at the first signs and symptoms of the disease is one of theessential factors for the effectiveness of the treatment and its course 1. The increasing number of requests, even in the face of the pandemic, have made it necessary to accesstimely and quality mental health services 2. Since 2020, a Clinical Reception practicefor young adults (18-25) has been carried out in a Roman CSM, characterized by amultidisciplinary team made up of psychiatrist, psychologist and sometimes nurses. Access is direct and free, the young person is seen quickly, and all together for usually around 4 meetings. The purpose of the interviews are to collect accurate medicalhistory of the patient and his family, the formulation of an entrance diagnosis and theevaluation through psychometric scales both self-administered and filled out by theoperators.

MATERIALS AND METHODS: The scales administered during the Reception phaseare 5: the PQ-16 to investigate psychotic risk, the Beck Depression Inventory (BDI)and the Beck Anxiety Inventory (BAI) for the evaluation of depression and anxiety,and the social functioning (GFSS) and role (GFRS); they are administered to a T0during reception, at T1 and T2 after 6 months and 1 year. At the end of the cycle ofinterviews, a therapeutic project is proposed as specific as possible to the case. They range from Integrated Treatments in which therapeutic – rehabilitative activities arecarried out, to Combined Treatments (psychiatric and psychological visits), to single Psychiatric or Psychological Treatments. The latter consist of individualpsychotherapy interventions with a dynamic, systemic or cognitive behavioral approach.

OBJECTIVES: E. is a young woman of 20 when she comes into the practice on herspontaneous initiative in 2020; she is suffering from a Borderline Personality Disorder. In the Reception phase, she presents a deflated mood, intense ideas of death, cutting,social withdrawal, emotional ambivalence, distrust and opposition to the therapeutic relationship. At the first textological evaluation, severe levels of depression (BDI: 40)and anxiety (BAI: 32) emerge, a high psychotic risk especially in the distress scale (PQ: 18), social and role functioning are both severely compromised (GFSS: 2 andGFRS: 4). We initially propose a combined psychiatric and psychological treatment, and the progressive insertion into two rehabilitation activities for young adults. We then observe the subsequent psychopathological and functioning progress andoutcomes.

RESULTS: After one year of treatment, the scales show an important reduction indepression (BDI: 19) clinically confirmed by minimal planning and personal safety, a reduction in the frequency and intensity of ideas of death, disappearance of self-injurious behaviors, improvement in sleep and the reduction of anhedonia and abulia. Greater confidence emerges towards the caregivers and with it, the reduction ofdestructiveness in the therapeutic relationship. Operation shows moderate impairmenton both variables (GFSS: 6 and GFRS: 6). The level of anxiety remains almostunchanged and within the range of severity, and the level of psychotic risk remainshigh even though it has been reduced (PQ distress: 13). In interpersonal relationshipsE. moves in a less ambivalent way, she is not sexually promiscuous, family relationships are more aware. In light of the outcomes achieved so far, we believe it ispossible to deepen the psychotherapeutic path with the inclusion in a structured group psychotherapy setting.



1 McGorry P.D. Early intervention in psychosis : obvious, effective, overdue, in The Journalof Mental and Nervous Disease „ 203,5,205, pp.310-318

2 McGorry P.D. et al. Designing and scaling up integrated youth mental health care. WorldPsychiatry 2022;21:61–76

3 Fagioli M. Istinto di morte e conoscenza 1972, L’Asino d’oro ed. 2017

4 Fagioli M. La Psichiatria come Psicoterapia in “Il sogno della farfalla“ n 4. 2013, ed. L’Asino d’oro 2021