Ministero della sanità e ordini di sviluppo Sociali di alcolismo

Come smettere di essere dipendenti dai vizi: la soluzione definitiva

Colm in Mogilev

To browse Academia. Skip to main content. You're using an out-of-date version of Internet Explorer. Log In Sign Up. Ministero della salute Fede Lap. ISSN 22 17 n. I temi trattati, numero per numero, con taglio monografico, affronteranno i campi e le competenze più importanti, ove sia da ricercare e conseguire la definizione di standard comuni di lavoro. La novità è nel metodo, inclusivo e olistico, che addensa e unifica i diversi contributi provenienti da organi distinti e consente quindi una verifica unica del criterio, adattabile volta per volta alla communis res.

Alla pubblicazione è affiancata anche una versione telematica integrale sfo- gliabile in rete ed edita sul portale internet del Ministero www. IX Foreword pag. XIII Sintesi dei contributi pag. XVII Abstract pag. XXII Premessa pag. XXVII 1. Epidemiologia, eziopatogenesi e caratteristiche cliniche pag.

Stili di vita nella popolazione generale: pag. Appropriatezza clinica nella gestione dei disturbi pag. Appropriatezza strutturale e operativa nella gestione pag. Conclusioni e raccomandazioni pag. È stato recentemente segnalato un aumento dei casi a esordio precoce. Le persone con anoressia nervosa, in particolare, hanno una mortalità tra le 5 e le 10 volte maggiore di quella delle persone sane della stessa età e sesso.

È importante che la gente sappia che per la terapia di questi disturbi sono oggi di- sponibili vari trattamenti, la cui efficacia è stata documentata da studi clinici con- trollati.

Sul versante psichiatrico-psicologico, le psicoterapie terapia basata sulla famiglia nei giovani con anoressia nervosa; te- rapia cognitivo-comportamentale e terapia interpersonale nella bulimia nervosa e nel BED hanno un ruolo essenziale. È essenziale promuovere la diagnosi precoce di questi disturbi, attraverso la sensi- bilizzazione dei medici di medicina generale e dei pediatri di libera scelta, la crea- zione di sportelli di consulenza e la sensibilizzazione di pazienti, famiglie e insegnanti.

Andrebbero inoltre promossi interventi preventivi nelle aree a rischio elevato, come i settori dello sport, della moda e della danza. Lo stile del Quaderno è stato reso semplice e chiaro, evidenziando anche grafica- mente i messaggi principali.

In the general population of women aged over 18 years, the estimated lifetime prevalence is 0. The incidence is estimated to be at least 8 new cases perwomen per year for anorexia nervosa and at least 12 new cases perwomen per year for bulimia nervosa.

An increase in early onset cases was recently reported. This increase can Ministero della sanità e ordini di sviluppo Sociali di alcolismo part be attributed to the lowering in the age of menarche observed in recent years, but could also be due to a lowering of the age at which adolescents are exposed to socio- cultural pressures concerning thinness, by means of media such as the Internet.

Ear- lier onset can mean a greater risk of permanent damage secondary to malnutrition, particularly Ministero della sanità e ordini di sviluppo Sociali di alcolismo those tissues that have not reached full maturation, such as bones and the central nervous system. More specifically, mortality amongst people with anorexia nervosa is 5 to 10 times higher than in healthy people of the same age and gender. The aetiopathogenesis of eating disorders involves a number of genetic and envi- ronmental factors.

Amongst the sociocultural factors, it is thought that an important role is played by the thinness ideal that has developed over the past 50 years in the western world: women are encouraged to be thin, because thin peo- ple are considered to be more intelligent, more competent and more successful, which explains why some women develop a self-evaluation that is excessively based on their weight and body shape.

Epidemiological data suggest an association between frequent dieting and the Ministero della sanità e ordini di sviluppo Sociali di alcolismo of an eating disorder. Most individuals with eating disorders do not receive adequate diagnosis and treat- ment. Most cases are only referred to clinical observation after a long history of ill- ness, when it is more difficult to achieve full recovery.

It is important for people to know that various therapies whose efficacy has been confirmed in clinical trials are now available for the treatment of these disorders.

These treatments require coop- eration between professionals with different competences psychiatrists, psychologists, nutritionists, general practitioners, internal medicine experts, endocrinologists, pae- diatricians and child neuropsychiatrists. Nutritional intervention includes assisted eating as part of a psychonutritional rehabilitation program and oral nutritional supplements.

Most patients should start the treatment programme at the least intensive level of care and move up to the more intensive treatments if there is no improvement, ac- cording to a step-by-step model. It is essential to promote the early diagnosis of these disorders, by improving the awareness of general practitioners and primary care paediatri- cians, the creation of counseling spots and sensitization of patients, families and teachers.

Another important action would be to promote prevention initiatives in high-risk areas such as sport, fashion and dancing. The aim of this Quaderno della Salute is to provide a summary of the current knowledge on eating disorders that Ministero della sanità e ordini di sviluppo Sociali di alcolismo be used not only by professionals working in the area, but also by patients and their families and any other subjects interested in the matter.

It also aims to provide the essential elements for health programming that guarantees those who suffer from these disorders assistance that is both qualified and homogeneously accessible nationwide. The style adopted for the Quaderno is clear and straightforward, using graphs and charts to highlight some of the key messages.

Special attention is dedicated to the topic of prevention, specifically those public health initiatives that are able to reduce the incidence of eating disorders, through cooperation between medical professionals, schools, food industries, the media and the fashion industry.

Lastly, the document provides a detailed description of the various levels of treatment now available for eating disorders, which may represent a benchmark for the or- ganisation of services in all Regions of Italy. I sincerely hope that the information it contains may contribute to overcoming prejudices and stereotypes and encourage the development of concrete initiatives in an area of grow- ing importance for public health.

Essi com- elementi di vulnerabilità. È necessario sità di aumentare tale controllo. Le istituzioni nella popolazione generale. Essi com- rente in toto o relativamente a singoli nutrienti e prendono alcune interviste cliniche strutturate o la nutrizione artificiale in pazienti gravemente semistrutturate, vari questionari autosommini- malnutriti, previo consenso informato del paziente strati e alcuni strumenti per la valutazione dei o del suo delegato.

Il trattamento in regime ambulatoriale intensivo La formazione degli Ministero della sanità e ordini di sviluppo Sociali di alcolismo a livello dei corsi è indicato per pazienti che hanno difficoltà a mo- di laurea, delle scuole di specializzazione mediche dificare le loro abitudini alimentari con la terapia e del corso di formazione specifica in medicina ambulatoriale standard.

In anorexia nervosa and bulimia nervosa, the age of onset is usually between 15 and 19 years, while in BED it is distributed in a wide range from childhood to old age. Several factors, both genetic and environmental, 1. Epidemiology, etiopathogenesis are involved in the etiology of eating disorders. Among sociocultural factors, of Ministero della sanità e ordini di sviluppo Sociali di alcolismo countries.

They include anorexia ner- an important role has been played by the ideal of vosa, bulimia nervosa, binge-eating disorder BED thinness which has developed during the last 50 and eating disorders not otherwise specified. Most of these complications shape is experienced.

BED shares with bulimia nervosa the episodes of 2. Relationships between eating disorders binge eating, but not the compensatory behav- Ministero della sanità e ordini di sviluppo Sociali di alcolismo obesity iours aimed to prevent weight gain, so that the individuals can develop obesity.

Eating disorders Obesity is a chronic pathology due to an unbal- not otherwise specified have clinical features sim- ance between caloric intake and energetic con- ilar to anorexia nervosa and bulimia nervosa, but sumption. It is associated with an increased risk do not meet all the criteria required for those di- for several diseases, including type 2 diabetes mel- agnoses. It may chosocial consequences, as documented by the precede the onset of an eating disorder sometimes Minnesota Study, conducted between and being a risk factor for that development or be to explore the best modalities of care for the consequence of episodes of binge eating.

Eat- the victims of famine in Europe and Asia during ing disorders and obesity, when they coexist, tend the Second World War. Many symptoms of mal- to interact negatively with each other and make nutrition reported by the volunteers of the Min- treatment more difficult.

Clinicians should be aware that a Ministero della sanità e ordini di sviluppo Sociali di alcolismo assess- The pre-operative diagnosis of BED is a negative ment of personality and psychosocial functioning predictor of the outcome of gastric banding and in underweight people with eating disorders can by-pass, but not such as to exclude the use of be implemented only after the normalization of these interventions.

There is a need to explore body weight. People with eating disorders should problems related to the psychological sphere in be educated on malnutrition symptoms and obese patients with or without BED who request helped to interpret them in a way which can lead bariatric surgery and to follow-up these people to the achievement of a healthy body weight.

When obesity and eating disorders coexist, a treat- 4. Lifestyles in the general population: ment is required by a multidisciplinary team in- relevance to eating disorders cluding specialists who are able to address both conditions, possibly being part of a network which The combination of an obesogenic environment offers different levels of care.

Undernutrition and eating disorders of food with a cultural context strongly influ- enced by the industry of diet and fashion which Malnutrition is a condition of functional, struc- idealizes thinness and disdains the excess of tural and development alteration of the organism weight can favour the development of eating dis- due to an unbalance between the need, intake orders.

Undernutrition may The industry of diet is strongly involved in the be due to an insufficient intake of food, chronic development of social contempt against people diseases involving chronic inflammation, or acute with obesity and, indirectly, in favouring the de- diseases or traumas involving acute inflammation. However, many people, hoping to meet ance of the body. This may explain why some women inter- fashion and dance. The institutions dealing with It is essential to promote public health pro- public health have the responsibility to implement grammes aimed to improve eating habits and interventions such as the control of diet industry lifestyles in the general population.

Public health advertisement and the promotion of healthy eat- initiatives aiming to reduce Ministero della sanità e ordini di sviluppo Sociali di alcolismo incidence of eating ing and physical activity behaviours. Clinical appropriateness media and the industry of fashion.

Prevention of eating disorders The diagnostic criteria for anorexia nervosa, bu- limia nervosa and BED have been recently up- School programmes of prevention of eating dis- dated in the fifth edition of the Diagnostic and orders have been extensively developed and stud- Statistical Manual of Mental Disorders DSM-5ied through controlled trials in many Western produced by the American Psychiatric Association.

First generation programmes adopted In this new edition, amenorrhea is no more in- a psychoeducational didactic approach, provid- cluded in the diagnostic criteria for anorexia ner- ing information on nutrition, body image, eating vosa, and the frequency of episodes of binge eating disorders and their harmful effects. Second gen- and compensatory behaviours required for the di- eration programmes addressed more directly some agnosis of bulimia nervosa has been reduced from risk factors for eating disorders identified by re- two to one per week.

BED appears for the first search. Third generation programmes used an in- time in the section on eating disorders in the teractive and experiential approach, and strategies previous edition of the manual, it was included aimed to modify dysfunctional attitudes and un- among conditions proposed for further studies. Structural and operative appropriateness symptoms, personality and cognitive functioning.

Among psychotherapeutic interventions, dential — focusing on severe states of malnu- the efficacy is documented of family based therapy trition, phases of instability and decompensa- for adolescents with anorexia nervosa, and of cog- tion in somatic and psychiatric comorbidities, nitive-behavioural and interpersonal therapy for and the start of a stable correction of lifestyle bulimia nervosa and BED.

The treatment pro- especially concerning eating and physical ac- gramme should always include, especially for tivity. In this latter respect, ing and early diagnosis, evaluation of physical the only medication approved in Italy is fluoxetine risk, referral to specialist centers, treatment of for bulimia Ministero della sanità e ordini di sviluppo Sociali di alcolismo.

It in- ical complications and Ministero della sanità e ordini di sviluppo Sociali di alcolismo malnutrition, or in cludes the implementation of evidence-based psy- psychiatric wards, for the management of suicide chotherapies, but often is not restricted to this. Ministero della sanità e ordini di sviluppo Sociali di alcolismo risk or psychiatric comorbidity.

Secondo al- corpo, che possono arrecare danni alla salute fisica cuni dati epidemiologici, la loro incidenza è au- e compromettere in misura significativa il fun- mentata notevolmente nel corso degli ultimi zionamento psicosociale. Il dato certo è che tut- menti specificati. Esso intende, inoltre, fornire elementi su internisti. Con il termine prevalenza puntiforme si intende la percentuale di una popolazione affetta da Sesso una malattia in un determinato momento. Un esordio cliniche ed evolutive.

Mag- scenza non hanno ancora raggiunto una piena ma- giore negli uomini sembra anche essere la fre- turazione, come le ossa e il sistema nervoso centrale. Mentre studi Alcune osservazioni cliniche recenti hanno segna- precedenti al indicavano una disparità nella lato un aumento dei casi a esordio precoce.

Le ricerche sui ciali, includenti i pari e la famiglia.