bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of mental disorder and related treatments in a local jail: a 20-month consecutive case study
Authors: Carrà Giuseppe , Giacobone Caterina , Pozzi Florinda , Alecci Pasquale , Barale Francesco
Published: October 2011

Aims – To define the prevalence of mental disorder within an Italian local jail and to describe main psychiatric treatments provided. Methods – Cross-sectional study of consecutive male prisoners referred, over a twenty-month period, for a clinical psychiatric assessment, among population (N=990) of Casa circondariale “Torre del Gallo”, Pavia (I); clinical DSM-IV diagnostic assessment and retrospective analysis of provided psychiatric treatments (i.e. psychiatric visits and pharmacological prescriptions). Results – 191 men (19.3%) had one or more current mental disorders (excluding substance misuse), including 13 (1.3%) psychosis; 53 (5.4%) mood disorder; 24 (2.4%) anxiety disorder; 26 (2.6%) adjustment disorder; 40 (4.1%) personality disorder; 32 (3.2%) personality disorder plus mood disorder; 3 (0.3%) mental retardation. Substance- (N=89, 47%) and HIV-related (N=19, 10%) disorders comorbidity is recognised. Psychiatric visits are mainly provided to psychosis and personality disorder plus mood disorder subgroups. Off-label antipsychotics prescriptions are frequent. Conclusions – The prevalence of mental disorder in this population is higher than US and EU averages, and for particular diagnostic subgroups it could be underestimated. Psychiatric management in prison should be reorganized according to national and European health guidelines.
Schizophrenia: still Kraepelin's Dementia Praecox?
Authors: Häfner Heinz
Published: October 2011

Asking whether E. Kraepelin's early dementia praecox and disease concepts (1896) are still valid today, we condensed his early theory into four theses:1) schizophrenia is a disease entity, distinguishable from affective psychosis. 2) It is caused by a specific neuropathology. 3) It usually manifests itself in adolescence or early adulthood. 4) Underlying schizo- phrenia is a progressive disease process that leads to defects and dementia.

Having tested whether Kraepelin's dementia praecox and modern schizophrenia are actually comparable, we studied 1) how schizophrenia and depression are linked or separable in terms of symptoms, risk factors and illness course from onset until five years after first treatment contact. The analyses are based on a population-based sample of 130 first admissions because of schiz- ophrenia, 130 age- and sex-matched first admissions because of unipolar depressive disorder and 130 “healthy” population con- trols from the study area. 2) Results will be presented that, though not very specific, confirm Kraepelin's farsighted hypothesis of a neuropathological basis of the disorder. In this context it will be discussed whether the brain changes are developmental or degenerative in origin. 3) The distribution of age of onset extends far into old age. In a sample of 1109 consecutive first admis- sions because of nonaffective psychosis from the total age range it was shown that age-dependent developmental factors mod- ify certain components of symptomatology linearly and significantly. The main risk factors, too, significantly change with age. 4) Long-term course was examined in three studies of epidemiologically recruited first-episode samples: Study 1 included five cross sections over 5 years, Study 2 was a prospective pre-post-comparison over 12 years supplemented by a retrospective assessment of the illness course (IRAOS) and Study 3 encompassed 10 cross sections over fifteen years. Finally, the disease concept of schizophrenia, as it presents itself in the light of current knowledge, will be outlined and compared with Kraepelin's earlier and later view of the disorder.

Declaration of Interest

the paper is based on a lecture (Lettura magistrale) presented at the SIEP Sesto Congresso Nazionale, “Gli Esiti della Schizofrenia - Trattamenti, Pratica nei Servizi, Valutazione” in Sirmione, November 6-8, 2003. Unfortunately, the illustrations shown there and some 20 % of the relevant references could not be included in this printed ver- sion for lack of space. This paper was written within the framework of the German Research Network on Schizophrenia and was funded by the German Federal Ministry for Education and Research BMBF (grant 01GI 0236). The ABC study was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) as part of the Special Research Branch (Sonderforschungsbereich) 258 at the Central Institute of Mental Health until December 1998. From January 1999 to Sept. 2002 it was continued to be funded by the DFG.
An observational study of effectiveness in community residential facilities
Authors: Lora Antonio , Contartese Antonio , Franco Maurizio , Crocina Lo Maglio Maria , Molteni Emanuela , Pallavicini Alessandra , Rasi Elena , Rossini Maristella , Violanti Elisabetta , Lanzara Dino
Published: October 2011

Aims — Evaluation of community residential facilities effectiveness in the Department of Mental Health of Desio (Milan). Method — Outcomes in symptoms, disability, family burden and quality of life were evaluated during one year through a longitudinal study, using a pre—test and post test design without control group. Results — Residential care is effective in reducing disability and symptoms, while it is not effective towards family burden. Quality of life is improved in some domains, but not in others (e.g. social and family relationships). Conclusions — Outcome assessment is feasible in residential facilities, following a multiaxial and multifactorial model. We need to clarify the goals of residential care, focussing on active components of the residential treatment.

Declaration of Interest

the research project was funded by Department of Health of Regione Lombardia (DGR n. 37596 del 24.7.1998).
Analysis of patterns of mental health care with three different approaches (cross-sectional, longitudinal and dynamic)
Authors: Küstner B. Moreno , González F. Torres , Del Castillo J.D. Luna
Published: October 2011

RIASSUNTO

Scopo– Questo articolo si propone di fornire una panoramica dei diversi metodi di analisi delle informazioni relative alFutilizzazione dei servizi secondo approcci differenti.Metodi– E' stata predisposta un review sistematica degli studi suipatterndi cura. L'analisi suipatterndi cura è stata divisa secondo tre differenti approcci:cross-sectional, longitudinale e dinamico.Risultati– Negli studicross-sectional, le informazioni sull'utilizzazione sono basate sui numero totale dei contatti con i servizi di salute mentale, in un certo periodo. Nel secondo approccio, chiamato longitudinale, l'analisi di sopravvivenza è applicata considerando l'intervallo di tempo tra ciascun contatto. Il terzo tipo di contatto, chiamato qui approccio «dinamico», comporta l'applicazione di modelli matematici basati sulle catene markoviane per analizzare la probabilità di cambiamento da un tipo di contatto all'altro.Conclusioni– Si sottolinea la necessita di studi ulteriori predisposti per analizzare i dati dei registri psichiatrici dei casi con modelli standardizzati per l'analisi dell'utilizzazione dei servizi psichiatrici.
Symptoms and social functioning features in chronic schizophrenia are aggregate in a tripartite structure
Authors: Di Michele Vittorio , Bolino Francesca , Di Zio Gabriella , Pincini Paola
Published: October 2011

RIASSUNTO

Scopo– Verificare l'esistenza di correlazioni fra sintomatologia schizofrenica e variabili multidimensionali del funzionamento sociale e se tali correlazioni possano condurre ad una precisazione classificativa orientata sull'esito attraverso una metodica empirica.Disegno– Quaranta pazienti affetti da schizofrenia cronica con diagnosi accertata clinicamente e attraverso criteri diagnostici sono stati arruolati.Setting–Ipazienti erano in carico ad un Centro di Salute Mentale ed erano in fase stabilizzata di malattia definita con criteri operativi.Principali misure utilizzate– Per la valutazione psicopatologica è stata utilizzata laPositive And Negative Syndrome Scalee laClinical Global Impression.Il funzionamento sociale è stato valutato con laLife Skills Profilee la Scala di Valutazione del Funzionamento Globale.Risultati– Esiste una correlazione fra variabili sintomatologiche e psicosociali che suggerisce un costrutto unitario. A tali variabili soggiaciono 2 fattori principali in grado di spiegare il 79% della varianza che consentono di differenziare il campione in tre gruppi sulla base della Cluster analysis. Sia i sintomi positivi che negativi risultano embricati con alcune aspetti del funzionamento sociale, ma non con tutti.Conclusioni– I sintomi e le variabili psicosociali dei pazienti si aggregano in una struttura omogenea tripartitica. Tale dato suggerisce l'esistenza, nell'ambito di un concetto unitario, di una differenziazione sindromica derivabile con criteri empirici e orientata prognosticamente.
Neuropsychological and neuropsychiatric perspectives on maternal cradling preferences
Authors: Sieratzki Jechil S. , Woll Bencie
Published: October 2011

Objective – To assess competing explanations for the universal preference of mothers to cradle infants on their left side and to propose a relation to hemispheric asymmetry for social attachment and communication behaviour. Methods – A review of observational, experimental, physiological, psychological, neuro-physiological, and neuro-psychological studies, including new findings on the cradling behaviour of mothers with auditory or visual impairments. Results – A significant left-cradling bias is observed in both right- and left-handed mothers which cannot adequately be explained by arguments based on handedness or closer contact to the soothing sound of the maternal heartbeat. Observations of primate behaviour have led to the suggestion that the left-cradling bias may be related to a left visual field (right hemisphere) advantage for monitoring an infant's facial expressions of distress. However, more than just monitoring, cradling subserves the mother's connection with the infant. For that reason, we have suggested that left cradling might be related to a right hemisphere specialisation for emotional communication, i.e. the speech melody, smiles, signals, and stroking which mothers use to interact with their infants. Studies of mother-infant interaction show that the sound of the mother's voice is more soothing when cradling on the left, more stimulating when cradling on the right. Cradling laterality may thus be related to emotional state and behavioural intent. There is also evidence to suggest that left cradling is linked to a special role of the right hemisphere in social attachment behaviour. This function may be disturbed in mothers with postnatal depression who show abnormal right hemisphere activity. Conclusion – Cradling embodies the symbiotic relationship between mother and infant; various lines of evidence support the suggestion that the universal preference of mothers to cradle infants on their left side is related to a right hemisphere dominance for social attachment and communication behaviour.
The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study
Authors: Priebe Stefan , McCabe Rosemarie , Bullenkamp Jens , Hansson Lars , Rössler Wulf , Torres-Gonzales Francisco , Wiersma Durk
Published: October 2011

Three issues characterise the background to the MECCA study: A) Throughout Europe, most patients with severe forms of psychotic disorders are cared for in the community. The challenge now is to make processes in community mental health care more effective. B) There are widespread calls to implement regular outcome measurement in routine settings. This, however, is more likely to happen, if it provides a direct benefit to clinicians and patients. C) Whilst user involvement is relatively ?" easy to achieve on a political level, new mechanisms may have to be established to make the views of patients feed into individual treatment decisions. The MECCA study is a cluster randomised controlled trial following the same protocol in community mental health teams in six European countries. In the experimental group, patients' subjective quality of life, treatment satisfaction and wishes for different or additional help are assessed in key worker-patient meetings every two months and intended to inform the therapeutic dialogue and treatment decisions. The trial tests the hypothesis that the intervention – as compared to current best standard practice – will lead to a better outcome in terms of quality of life and other criteria in patients with psychotic disorders over a one year period. This more favourable outcome is assumed to be mediated through different treatment input based on more appropriate joint decisions or a more positive therapeutic relationship in line with a partnership model of care or both. Moreover, the study will hopefully reveal new insights into how therapeutic processes in community mental health care work and how they can be optimised.
Estimating the causal effects of treatment
Authors: Dunn Graham
Published: October 2011

Objective – To provide a relatively non-technical review of recent statistical research on the analysis and interpretation of the results of randomised controlled trials in which there are possibly all three of the following types of protocol violation: non-adherence to allocated treatment, contamination (that is, patients receiving treatments other than the one to which they were allocated) and attrition (missing outcome data). Methods – The estimation methods involve the use of potential outcomes (counterfactuals) in the definition of a causal effect of treatment and in drawing valid inferences concerning its size. Results – The methods are explained through the use of simple arithmetical expressions involving the counts from three-way contingency tables (Outcome by Treatment Received by Random Allocation). Illustration is provided through the use of a hypothetical data set. Conclusions – Recent advances in statistical methodology enable one to estimate treatment effects from the results of randomised trials in which the treatment actually received is not necessarily the one to which the patient was allocated. These methods allow one to make adjustments to allow for both non-compliance and loss to follow-up. Even for such a 'broken' randomised trial, inference concerning causal effects is safer than that from data arising from an observational study that never involved random allocation in the first place.
Suicide in Verbano-Cusio-Ossola province: decade 1990-2000
Authors: Torre Eugenio , Zeppegno Patrizia , Usai Carmen , Rudoni Marco , Ammirata Gianluca , De Donatis Olivia , Manzetti Elena , Marangon Debora , Migliaretti Giuseppe
Published: October 2011

RIASSUNTO

Scopo– Scopo del presente lavoro è quello di effettuare uno studio epidemiologico sul suicidio nella provincia del Verbano-Cusio-Ossola, tra il gennaio 1990 e il dicembre 2000.Disegno– Il lavoro si basa sull'acquisizione di dati attraverso l'analisi dei modelli 45, che registrano tutti i casi di morte violenta e di suicidio, archiviati presso la Procura della Repubblica di Verbania.Setting– La provincia del Verbano-Cusio-Ossola si estende per 2255 Km2 e conta 161248 abitanti. La Procura di Verbania copre l'intero territorio della provincia considerata.Principali misure utilizzate– Le informazioni rilevate sul campione sono state presentate in termini di analisi descrittive, stima dei tassi standardizzati della provincia del Verbano-CusioOssola. Allo scopo di valutare differenze rispetto alia media del Nord Italia, vengono utilizzati i Rapporti Standardizzati di Mortalita (RSM) ed i relativi intervalli di confidenza (IC 95%).Risultati– Negli undid anni considerati sono stati notificati aH'autorita giudiziaria 297 casi di suicidio con un tasso medio annuo di 16.74/100000 abitanti. La frequenza del suicidio nel corso degli anni presi in esame mostra un andamento disomogeneo, con significative differenze tra i due sessi. L'analisi dei RSM evidenzia la maggiore incidenza del suicidio nella provincia analizzata rispetto alia popolazione generale del nord Italia nello stesso periodo, differenza dovuta, in misura maggiore, all'elevato tasso femminile. L'analisi dei diversi parametri sociodemografici della popolazione in esame conferma i dati della letteratura intemazionale: il suicidio à più diffuso in età avanzata, tra le persone vedove e pensionate.Conclusioni– Il presente lavoro intende fornire una descrizione del fenomeno suicidio, inserendolo in un contesto geografico e culturale specifico, nell'intento di metterne in luce gli aspetti problematici in un'ottica diagnostico-clinica, che possa servire da stimolo ad un lavoro preventivo su più larga scala.
HoNOS-Rome: an expanded, customized, and longitudinally oriented version of the HoNOS
Authors: Morosini Pierluigi , Gigantesco Antonella , Mazzarda Angelica , Gibaldi Loredana
Published: October 2011

Aims– To clarify the acceptability, reliability and factorial validity of a new Italian version of the HoNOS called HoNOS-Rome. Its main innovations are both in design and in contents.Methods– Face validity was assessed by surveying 3 focus groups. Reliability was assessed in 8 different pairs of raters on a sample of 24 patients; construct validity was analysed by factor analysis using a sample of 187 patients at 6 day centres. Acceptability was investigated by means an anonymous questionnaire filled by professionals that were using the instrument.Results– Time of completion was low (range 4–12 minutes), the tool proved very acceptable and the reliability was good (weighted kappa ≥ 0.71 for all items). Factor analysis was consistent with the division of HoNOS–Rome into four sensible factors accounting for 52% of the total variance.Conclusions– The findings indicate that HoNOS–Rome has a satisfactory degree of acceptability, construct validity and reliability, and may promote the routine evaluation of outcomes in mental health services.

Declaration of Interest: the authors declare that the study was supported by grant no. 96/Q/T41 of the Italian National Mental Health Project – Istituto Superiore di Sanità – Sub-project: Development and validation of tools for outcome evaluation of mental health services, Italy (Professor P. Morosini).
Patient cues and medical interviewing in general practice: examples of the application of sequential analysis
Authors: Zimmermann Christa , Piccolo Lidia Del , Mazzi Maria Angela
Published: October 2011

Aims – To illustrate how sequence analysis may be applied to the medical interview to: 1. explore how physicians without formal training in communication skills elicit and respond to patient cues and expression of expectations and opinions; and 2. test the hypothesis that physicians' closed ended questions determine the use of subsequent closed ended questions. Methods – 238 consultations in primary care, coded with the Verona Medical Interview Classification System, were analysed. Lag 1 analysis was applied to study which physician behaviour precedes and follows patient cues. Pattern recognition analysis for five lag sequences was performed to test the occurrence of predefined specific code chains, where a closed and an open ended question were followed either by two closed-ended questions or by two patient facilitating interventions Results – Patients' cue offers were most likely after facilitative interventions, but not after open-ended questions; physicians were most likely to respond to these expressions with facilitation. Physicians' tendency to use closed ended questions increased after previous closed questions and decreased after an open-ended question. Conclusions – Lag sequential analysis and pattern recognition analysis are useful methods to study exploratory and theory driven hypotheses and allow an initial approach to validate the supposed appropriateness of specific physician interventions.

Declaration of Interest: none.
Eating disorders and their correlates in high school adolescents of Northern Italy
Authors: Toselli Anna Linda , Villani Simona , Ferro Antonio Maria , Verri Anna , Cucurullo Laura , Marinoni Alessandra
Published: October 2011

Objective – The study investigated eating disordered behaviours and life-habits correlated in a large sample of Northern Italian adolescents of both sexes. Methods – The study had a cross-sectional design. 2595 students (2,146 responders; mean age 17.2±1.7 years) attending high schools in Savona (Italy) in April and May 2001 were sampled. To assess eating attitudes, the Inventory for the Screening of Eating Disorders (ISED) was self-administered. Inquiries regarding possible risk factors for eating disorders were also made: socio-economic status, body weight, smoking and alcohol drinking habits, illegal drugs use. Results – Females scored significantly higher than males at ISED (13.4±7.7 vs. 7.6±5.8). 28.5% of females had a total ISED score above the cut-off point (18/19). Unhealthy eating behaviours were strongly associated with higher BMI, body image disturbance and illegal drugs use in both sexes; age had significant role only in males. No significant association between disordered eating behaviours and socio-economic status, smoking habit and alcohol consumption were found. Conclusions – Symptoms of eating disorders are quite spread in the Northern Italian female adolescents and associate with illegal drugs use. These data, with not negligible frequency of unhealthy eating behaviours and attitudes in males too, suggest that primary and secondary preventive interventions for teen-agers should be got ready.

Declaration of Interest: 1) the study received the financial support by Regione Liguria and ASL 2 of Savona; 2) the study didn't receive any forms of financing by pharmaceutical company support and any honoraria for consultancies or interventions was received by each author in the last two years; 3) any other involvements that might be considered a conflict of interest in connection with the submitted article. The authors state that if and when the manuscript accepted for publication, they automatically agree to transfer the copyright to the publisher
Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Caltagirone 1987–1990
Authors: Interlandi Gaetano , Sotera Maria Grazia
Published: October 2011

Riassunto

Sono descritte, con la stessa metodologia impiegata in altre 4 aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-aerea, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Caltagirone. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (763/100000 residenti adulti) e un giorno (223/100000 residenti adulti) hanno valori inferiori ai RPC europei. I tassi di incidenza (281/100000 residenti adulti) indicano un afflusso di nuovi casi appartenenti a tutte le categorie diagnostiche. II RPC di Caltagirone monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale: residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 4,4 a 1. II tasso di lungoassistiti è di 122/100000 residenti adulti, con una tendenza ad un accumulo per quelli che vivono nel territorio, mentre vi è un calo di quelli che sono in Comunità. II costo del Dipartimento, che è andato riducendosi dal 1987 al 1990, è in buona parte da addebitare alle giornate di assistenza in Comunità.

Parole chiave

servizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.

The principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Caltagirone are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the year prevalence (763'100000 adult inhabitants) and day prevalence (248'100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (248'100000 adult inhabitants) shows that new patients belong to all diagnostic categories. The PCR records data of the activities made in multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, care in outpatient clinics, domiciliary care, etc. The ratio between non-hospitalized and hospitalized users is 4.3 to 1. The rate of long-term patients is 122'100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the sheltered apartments is decreasing. The costs of the Service (which have decrease from 1987 to 1990) have to be attributed mainly to the costs of the treatment in sheltered apartments.
Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Legnano 1987-1990
Authors: Mastroeni Antonino , Colombo Maria Grazia
Published: October 2011

Riassunto

Sono descritte, con la stessa metodologia impiegata in altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi dell'Unità Operativa di Psichiatria di Legnano. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (530/100000 residenti adulti) e un giorno (226/100000 residenti adulti) hanno valori inferiori ai RCP europei. I tassi di incidenza (152/100000 residenti adulti) sono diminuiti nel corso dei 4 anni considerati, mostrando la difficoltà dei servizi ad accogliere nuovi utenti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è, mediamente, di 3,8 a 1. II tasso dei lungoassistiti è di 195/100000 residenti adulti, con un accumulo di quelli che vivono nel territorio, ma non di quelli che sono in Comunita. II costo dei servizi psichiatrici di Legnano è diminuito nella componente ospedaliera e semiresidenziale, mentre è aumentato in quella territoriale.

Parole chiave

servizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.

The principles, structure. Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Legnano are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the mean year prevalence (530/100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (152/100000 adult inhabitants) have diminished, showing a difficulty of the psychiatric services in accepting new patients. The ratio between non-hospidalized and hospidalized users is 3.8 to 1. The rate of long-term patients is 195/100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the community is increasing over the years, whereas the similar rate of patients living in the scheltered apartments is stable. The costs of the hospital-based and the semiresidential agencies decreased, while the cost of the community agencies increased.
Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Portogruaro 1987-1990
Authors: De Salvia Domenico , Rocco Diego
Published: October 2011

Riassunto

Sono descritte, con la stessa metodologia impiegata in quattro altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Portogruaro. II monitoraggio della domanda su 4 anni evidenzia tassi di prevalenza un anno (1045/100000 residenti adulti), di prevalenza un giorno (332/100000 residenti adulti) e di incidenza (250/100000 residenti adulti) inferiori a quelli dei RPC europei. II RPC di Portogruaro monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale (residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, socioambientale, domiciliare, ecc), secondo il principio della continuità dell'assistenza fornita ai pazienti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è nel 1990 di 5,5 a 1. II tasso di lungoassistiti è di 161/100000 adulti. La spesa globale del Dipartimento è lievemente diminuita dal 1987 al 1990.

Parole chiave

servizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.

The principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Portogruaro are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows one-year prevalence rates (1045/100000 adult inhabitants), one-day prevalence rates (332/100000 adult inhabitants) and incidence rates (250/100000 adult inhabitants) lower than those of other european PCRs. Portogruaro PCR records data of the activities made in a comprehensive psychiatric service, which has multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, in outpatient clinics, domiciliary, etc. The 1990 ratio between non-hospitalized and hospitalized users is 5.5 to 1. The rate of long-term patients is 161/100000 adult inhabitants. The costs of the Community Psychiatric Service slightly decreased during 1987-90 period.
La morbilità psichiatrica nella medicina di base: aspetti concettuali e diagnostici
Authors: Piccinelli Marco , Ferraris Aloisia
Published: October 2011

Riassunto

Gli Autori affrontano alcuni aspetti concettuali e metodologici legati allo studio della morbilità psichiatrica nella medicina di base. Vengono discussi i concetti di «malattia» in generale e di «caso psichiatrico» in particolare, con le ripercussioni che tali definizioni possono avere sull'attività di ricerca. Sono presentati i risultati di alcuni studi che hanno utilizzato i modelli statistici basati sulla latent trait theory per indagare i disturbi emotivi di comune riscontro tra i pazienti del medico di base. È stato cosi possibile evidenziare che tali disturbi tendono a distribuirsi lungo un continuum in assenza di punti di interruzione o di rarità. I problemi diagnostici tuttora presenti nella medicina di base sono considerati alia luce delle difficoltà nell'applicazione delle tradizionali categorie diagnostiche e delle prospettive aperte dai recenti sistemi multiassiali di classificazione.

Parole chiave

medicina di base, disturbi emotivi, diagnosi.

The Authors examine some conceptual and methodological issues involved in the study of psychiatric morbidity in primary care settings. The concept of «disease» in general and that of «psychiatric case» in particular are discussed together with the implications that such definitions may have in research activity. Some studies are reviewed which have employed statistical models based on latent trait theoryto investigate the emotional disorders commonly found among subjects who consult the general practitioner. It becomes apparent that these disorders tend to distribute along a continuum with no rarity points or interruptions. Diagnostic problems still present in primary care settings are considered paying attention to the difficulties in the application of traditional diagnostic categories and to the new perspectives disclosed by recent multiaxial systems of classification.
Classificazione, diagnosi ed ICD-10. III - Le sindromi affettive
Authors: Nicolaou Stylianos , de Girolamo Giovanni
Published: October 2011

Riassunto

Scopo - Presentare un breve profilo storico sui termini nosografici e sui principali modelli di classificazione dei disturbi affettivi descrivendo le caratteristiche più importanti della loro classificazione secondo l'ICD-10, le principali novita introdotte in essa rispetto all'ICD-9 ed infine alcune similarità e differenze tra la classificazione ICD-10 ed il DSM-III-R. Risultati - DalFanalisi della struttura della classificazione di questi disturbi nelFICD-10 emerge con chiarezza la difficoltà di arrivare ad una sistemazione nosografica esauriente sulla base delle conoscenze attuali. L'ICD-10, comunque, ha segnato un significativo progresso rispetto all'ICD-9, ed ha, al tempo stesso incorporato molti degli orientamenti riscontrabili nel DSM-III-R. Conclusioni - L'ICD-10 ha proposto un modello di classificazione che cerca di operare una sintesi tra tradizioni e scuole diverse, e di valorizzare nel contempo, per quanto possibile, i risultati emersi dalle ricerche di queste ultime 2 decadi.
The economic perspective in the care and treatment of patients with diagnosis of schizophrenia
Authors: Percudani Mauro , Knapp Martin
Published: October 2011

RIASSUNTO

Scopo- Considerare le principali problematiche connesse all'assistenza ed al trattamento dei pazienti con diagnosi di schizofrenia alia luce della piu recente letteratura sugli aspetti economici di questa patologia.Metodo- È stata effettuata una analisi della letteratura relativa ai costi sociali della schizofrenia, all'analisi economica di diversi modelli di assistenza, alia valutazione dei costi dei trattamenti antipsicotici.Risultati- La schizofrenia è una patologia che genera ingenti costi sociali. I costi sanitari legati all'assistenza alia schizofrenia assorbono una percentuale significativa delle risorse dei sistemi sanitari dei principali paesi industrializzati. I costi indiretti, dovuti principalmente al mancato inserimento al lavoro dei pazienti, risultano superiori ai costi diretti di trattamento. Nei paesi ove l'assistenza centrata sul territorio è stata supportata da un reale sforzo organizzativo per la creazione di servizi territoriali e residenziali, è emerso che essa è meno costosa dell'assistenza centrata sull'ospedale psichiatrico e genera un miglior esito per pazienti e familiari. L'introduzione di nuovi farmaci antipsicotici e lo sviluppo di interventi di tipo psicosociale possono rappresentare strumenti che favoriscono nuove strategie di assistenza.Conclusion!- Utilizzare una prospettiva economica implica pensare a quale organizzazione, quali strumenti tecnologici, quali strategie permettono di investire con razionalita le risorse disponibili. Una riflessione su questi temi appare oggi ineludibile non solo per gli amministratori ed i decisori politici, ma anche per gli operatori dei servizi di salute mentale.
Pattern of patients recovered in psychiatric rehabilitation services: defining homogeneous groups. Multivariate analysis of a sample
Authors: Marinoni Alessandra , Carolei Adriana , Paglione Marcello , Pietrantonj Carlo Di , Foresti Giovanni , Cerri Mario , Croce Luigi , Marinato Giorgio , Lavoro Gruppo Di
Published: October 2011

Objective– To provide a multidimensional description about the pattern of patients recovered in some Psychiatric Rehabilitation Sevices, as emerging from identification of similar groups regarded the total severity.Design and Setting– A cross-sectional survey has been conducted on patients recovered in 4 Northern-Italy Psychiatric Rehabilitation Services. A statistical bottom-up analysis (Principal Components and Cluster Analysis) has been performed.Main outcome measures– Any patient has been evaluated using a questionnaire with well-known rating scales (BPRS-psychiatric rating, Katx index and IADL index, IDS index of comorbidity) together with informations on sex, age, social and economic state, psychiatic history, therapeutic devices and staff involvement.Results– We analyzed 455 patients. 267 (58.7%) male and the mean age is 58.517.9. After statistical analysis, 4 clusters of patients has been found: the first group (106 patients) is younger, descrided as not seriuosly compromised, mostly with psychotic problems; the second (96 patients, most of them woman with diagnosis of demetia) is much older, with serious problems of indipendency and comorbidity. The third (82 patients) and fourth (171 patients) group show intermediate patterns. The level of care requested by these groups has been provided.Conclusions– Our results show the usefulness of sophisticated statistical methods to describe patients recovered in psychiatric rehabilitation services. Moreover, our findings could be useful as good proposal to the people involved in this field, planning an active intervention in this area.
Problems of patients with schizophrenic disorders and of their families
Authors: Lanzara Dino , Cosentino Ugo , Maglio Anna Maria Lo , Lora Antonio , Nicolo Anna , Rossini Maria Stella
Published: October 2011

Objective— To evaluate psychopathological symptoms, disabilities and family burden in schizophrenic patients and to analyse predictors of family burden and relatives' satisfaction.Design— Descriptive study of 203 patients with an ICD 10 — F2 diagnosis (schizophrenia and related disorders) in contact with the Desio Department of Mental Health on 31stDecember 1994.Setting— The Desio Department of Mental Health.Main outcome measures— The patients have been evaluated in three areas: disability (by ADC-DAS), psychiatric symptoms (by 24 items BPRS) and family burden (by Family Problems questionnaire). The outpatient, hospital and residential care contacts of the patients have been collected for six months by our service information system. For each area (DAS, BPRS and FP) a principal component analysis and a rotation of the significant components have been performed. Eleven factors, derived from three scales, have been retained as explanatory variables. Finally, a multiple regression analysis has been performed to assess the influence of explanatory variables on the set of response variables regarding family burden and relatives' satisfaction.Results— One third of patients suffer of moderate-severe positive symptoms, while negative symptoms are less frequent.
Evaluating the closure or downsizing of psychiatric hospitals: social or clinical event?
Authors: Lesage Alain D.
Published: October 2011

Objectives – The evaluation matrix recently proposed by Tansella and Thornicroft suggests that the field of social and epidemiological psychiatry has focussed more on the individual/patient level of mental health care services than the system level. Moreover, phenomena such as deinstitutionalisation have been examined more as clinical events than as social ones. The aims here are to deepen our understanding of deinstitutionalisation, particularly as regards the downsizing/closure and role of psychiatric hospitals. Methods – I begin by reviewing the manifest and latent functions of psychiatric hospitals. This is followed by a discussion of how these functions must be met by any comprehensive community-oriented system of mental health care for severely mentally ill patients. Also, in order to reframe the downsizing/closure of psychiatric hospitals as a social event for the field of social psychiatry and psychiatric epidemiology, I posit that the process of deinstitutionalisation is driven today by the same forces that were present at the outset of the movement. Results – I review four recent series of studies addressing primarily the outcomes, but also other aspects, of the downsizing/closure of psychiatric hospitals, with a view to illustrating the methods used, the results obtained and the blind angles missed in this research. Conclusions – Lessons are drawn on how to fill certain vacant cells of the matrix.
Mental disorder and homicide: a review of epidemiological research
Authors: Woodward Mark , Nursten Jean , Williams Paul , Badger Doug
Published: October 2011

Objective– This paper reviews 28 studies on the epidemiology of homicide committed by mentally disordered people, taken from recent international academic literature.Methods– The studies included were identified as part of a wider systematic review of the epidemiology of offending combined with mental disorder. The main databases searched were Embase, Medline, HealthStar, Psyclit, Mental Health Abstracts, Applied Social Sciences Index and Abstracts, and Criminology Penology and Police Science Abstracts. A comprehensive search was made for studies published since 1990, supplemented with key studies from the 1980s identified through citation tracing and personal contacts.Results– A summary is given in tabular form of the content and quality of each study. There is then discussion of the studies in eight categories: descriptive studies, studies of trends, comparative studies amongst homicide offenders, amongst prisoners and including general populations, studies of homicide of relatives, follow-up studies, and studies of recidivism.Conclusions– There is an association of homicide with mental disorder, most particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. However, the quality of epidemiological research in this area is not adequate to answer key questions, and prediction of potential for homicide remains elusive. Further research is needed.
Needs for care in psychiatric patients: a systematic review. I. General concepts and assessment measures. Needs for services
Authors: Lasalvia Antonio , Stefani Benedetta , Ruggeri Mirella
Published: October 2011

Objective– In Italy, mental health care is in phase of reorganisation. In this frame the measurement of users' needs may be a useftil tool in planning individualised mental health service interventions and in their evaluation. Aims of the present study are (I) to highlight the basic concepts of 'needs for care' and give a brief description of the main needs assessment tools specifically developed for psychiatric patients; (II) to review studies assessing needs for mental health services in the general population; (III) to discuss the role played by the assessment of needs in planning mental health care.Methods– Studies published in the international literature from January 1980 to June 1999 were reviewed. The studies were located through a computerised search of the databases MEDLINE and PsycLit; in addition, the reference lists of the studies located through the computerised search and the content of main international psychiatric journals were manually scanned in order to avoid possible omissions. Studies assessing needs for services and studies assessing needs on individual level were separately reviewed. Both groups of studies, in turn, were divided in studies assessing needs for mental health care in the general population and in psychiatric patients.Results– Although most studies on needs for services used indirect methodologies and employed quite heterogeneous experimental design, they provide at large overlapping results. In the general population, about 60%- 70% of patients with anxiety, depression and other neurotic disorders and 30%-40% of psychotic patients do not receive any specialist mental health care, suggesting that the majority of subjects suffering from a psychiatric disorder do not receive the mental health care they need.Conclusions– Unmet needs for services show a higher frequency in patients with neurotic and depressive disorders, indicating a shortage in services delivery that should be taken into account both by psychiatrists and mental health planners. Moreover, the finding that a large number of patients suffering from psychotic disorders do not receive any kind of mental health care is of particular relevance for planning mental health services, since these subjects are usually the most problematic and difficult to treat.
Hospitalisation for schizophrenia in acute psychiatric wards of the Lazio region: a 4-year follow-up study
Authors: Gaddini Andrea , Franco Francesco , Lallo Domenico Di , Biscaglia Lilia
Published: October 2011

Aim– To determine the rates of psychiatric hospitalisation and to evaluate the predictors of readmissions in a cohort of 887 schizophrenic patients at their “first” psychiatric admission.Methods– Data were collected using the hospital dis-charge database of the Lazio region, Italy. The cohort included patients admitted to a psychiatric ward in 1999, with a main diagnosis of schizophrenia and no prior psychiatric hospitalisation during the 5 years preceding the index admission. Psychiatric read-missions were considered up to year 2004. Kaplan-Meier survival curves and logistic procedures were performed to estimate the cumulative readmission incidence and ORs of readmissions for potential confounders.Results– During the 4-year follow-up, 44.3% of the patients were readmitted at least once. An active treatment among community psychiatric facilities at the time of index admission predicted a higher readmission risk. However, for those who experienced their first admission in a private ward read-mission risk was consistently higher, whether or not having had such a treatment.Conclusions– Risk of readmission in a psychiatric ward appears to be related to the level of integration with mental health community facilities, while length of stay is strongly affected by service system variables. Possible uses of medical information systems in this field are described.

Declaration of Interest: none.
Benefits and difficulties in implementing family psychoeducational interventions for schizophrenia in mental health services: results from a multicentre Italian study
Authors: Magliano Lorenza , Fiorillo Andrea , Malangone Claudio , Rosa Corrado De , Favata Grazia , Sasso Annarita , Prezioso Monica , Pezzenati Laura , Gentile Floralba , Casale Lucetta , Bondi Emi , Test Giuseppina Robustelli , Lella Michele Di , Biscussi Elisabetta , Degl'Innocenti Francesco , Bellini Rossella , Nunzio Rita Di , Matrella Lucia , Salmeri Rosa , Cantone Rosario , Gargiulo Luisa , Esposito Aniello , Delcuratolo Vincenzo , Giannini Maria , Maresca Luisa , Cavaliere Giovanna , Scandone Barbara , Folla Matteo , Raffaeli Mauro , Innocente Paola , Dagianti Flavia , Lucania Stefania , Scorsino Angela , Bardicchia Francesco , Cerullo Gennaro , Curreli Riccardo , Miscali Silvana , Scordato Mario , Campo Graziella , Mameli Cinzia , Sodde Carla , D'Ambra Luigi , Malacarne Anna , Maj Mario , Lavoro Gruppo Di
Published: October 2011

Aims – This study aims to explore: a) the feasibility of psycho-educational interventions for families of users with schizophrenia in clinical practice by trained staff; b) the benefits and problems encountered by professionals in the use of these interventions. Methods – 46 professionals from 23 Italian Mental Health Sen'ices (MHS) attended at a three-module training course in psycho-educational interventions and four supervisions in the subsequent year. Following the course, participants provided the intervention to families of users with schizophrenia. The difficulties and benefits encountered by trainees to use the intervention were registered on the Family Intervention Schedule.Results – 83% of the participants completed the training course. Following the course, the intervention started in 71 families from 17 MHS. 76% of trainees provided the intervention to 2-5 families, while 13% of them only held informative sessions on schizophrenia. During the supervision period, the organisational difficulties experienced by the professionals were stable, while the benefits increased. Differences in benefits and difficulties were detected in relation to the trainees’ experience and professional roles. Conclusions – It is possible to introduce psycho-educational interventions in MHS after a relatively brief period of training and supervision of the staff. Organisational difficulties need to be addressed to increase the dissemination of these interventions on a large scale.

Declaration of Interest: None of the authors has had any interest or he/she has received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work. None of the authors has received any form of fee for his/her participation in this study. This study was supported by grants received from the “M. Lugli” Foundation (grant n. 2/18/8) and from the National Institute of Health, Italy (grant no. 1AL/F3).