I nuovi "casi difficili" in psichiatria

Translated title of the contribution: The new "difficult cases" in psychiatry

Massimo Biondi, Angelo Picardi

Research output: Contribution to journalReview articlepeer-review


In psychiatry, as in the other medical disciplines, there are cases that are 'difficult' due to their clinical characteristics. However, recently some cases seem to emerge that are 'difficult' because of management, responsibility, and safety issues, rather than psychopathological issues. Some of these particularly characterise Italian psychiatry, and mostly involve the clinicians working in public facilities. In several instances, they involve aggressive behaviours towards self or others that cannot be forecast or prevented despite healthcare workers' efforts, which is still a poorly recognised issue as far as responsibility is concerned. The 1978 healthcare reform has put Italy in a vanguard position regarding the public mental health care system, which has made giant steps since the times when psychiatric hospitals were in place. Nevertheless, some recent social, epidemiological, and psychopathological changes have caused new problems and difficulties in psychiatric care. Such changes include the growing complexity of large urban areas, increased immigration, a considerable rise in substance use, changes in the boundaries of responsibility of the physician, and the introduction of complex regulations on safety, data management, consent to treatment, and decisional competence of persons with mental illness. As a result, psychiatric healthcare workers are currently facing several new management and organisational difficulties, as well as issues about patient and staff safety, with increased ethical, deontological, and legal responsibilities. It is our hope that this paper will stimulate a constructive debate aimed at improving work conditions for psychiatric healthcare staff members who work hard every day to improve their patients' outcomes.

Translated title of the contributionThe new "difficult cases" in psychiatry
Original languageItalian
Pages (from-to)223-232
Number of pages10
JournalRivista di Psichiatria
Issue number5
Publication statusPublished - Sep 1 2018

ASJC Scopus subject areas

  • Psychiatry and Mental health


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