L’articolo di Mario Perini è interessante e ricco di tracce per ulteriori approfondimenti. In questo contributo proverò ad evidenziare per punti, alcune linee rilevanti per la sanità rimandando ad ...altri scritti l’analisi del recente omicidio della psichiatra Barbara Capovani. ...
The mental health care system in Italy is based on Law 180/70 which leaves great regional autonomy about the management of adolescent patients suffering from psychiatric diseases. The aim of this ...study is the evaluation of demographic, social, and clinical features of minors admitted to psychiatric wards, as starting point to improve individualized services for them. Data about all under 18s consecutively admitted to Parma’s psychiatric wards from 2013 to 2015 were retrospectively collected from medical records. Diagnoses were classified according to ICD-10 criteria, and statistical analysis was performed using SPSS statistical software (IBM SPSS Statistics 22.0) for Windows. Clinical samples include 51 cases, 30 males (mean age: 15.5 years, ranging from 12 to 17 years) and 21 females (mean age: 15.9, ranging from 14 to 17 years). The most frequent diagnosis is conduct disorder (39.2%), with higher prevalence among males. Following this, 23.5% of the patients present comorbidity issues and 9.8% suffer from personality disorders, which is more frequent among females. High percentages of foreigners (31.4%), adopted minors (15.7%), and drug users (40%) are reported. Furthermore, data reveal that unprotective family environment, registered in 80.4% of cases, plays an important role as risk factor for the development of mental disease, readmissions in psychiatric wards, and discharge to residential facilities. Readmissions, as well as compulsory treatments (11 cases), are mainly required in case of conduct disorders and comorbidity diagnosis. Lastly, in contrast with the situation before hospital admission, most patients (63.3%) are discharged and sent to community residential facilities. Findings can be useful to improve the management of psychiatric emergencies in minors, focusing on their specific needs, such as conduct disorders and substance abuse, and to face emerging challenges, for example, mental health disease associated with the growing phenomenon of immigration.
Nel quarantesimo anniversario della Legge 180/1978 di riforma della psichiatria italiana che ha portato alla chiusura degli Ospedali Psichiatrici, vengono ricordate le premesse per il suo ...funzionamento: una politica a sostegno dei diritti individuali e sociali e un welfare pubblico universalistico. L’allargamento dei diritti individuali e al contempo la sottomissione alla compatibilità economica dei diritti sociali ha creato una condizione contraddittoria e una crescita dell’esclusione sociale. I Servizi per la salute mentale cercano di attuare un lavoro d’inclusione in comunità dove è cambiato il patto sociale. Pertanto vanno rilette le norme su volontarietà/obbligatorietà delle cure, pericolosità sociale, prassi e organizzazione dei Servizi mantenendo un’impostazione universalistica. Nel 2015 anche gli Ospedali Psichiatrici Giudiziari (OPG) sono stati chiusi.
Although the prevalence of mental disorders in prisoners is known to be higher than in the general population, less is known about the antipsychotic (AP) prescribing rate in jail. The aim of this ...research was to investigate prevalence and appropriateness of AP prescription in an Italian prison to expand our understanding on this crucial area of clinical-forensic practice.
A cross-sectional (census day) design was used among male adults in the Parma Penitentiary Institutes (PPI). Sociodemographic, clinical and prescription data were collected from the PPI electronic clinical database management system. The AP prescribing appropriateness was examined in accordance with the therapeutic indications included in the Italian National Formulary. A descriptive statistical analysis was performed.
A total of 98 (14.1%) of 696 PPI prisoners were taking AP medications. Moreover, 90 (91.8%) of the 98 PPI participants were also taking other psychotropic medications concurrently. Quetiapine and olanzapine were the most common prescribed APs. Antipsychotic medications were most likely to be prescribed for off-label indications (74.4%). Less than one fifth of all AP prescriptions were for psychotic disorders.
Antipsychotic medications are widely used in prison, often together with other psychotropic drugs. Considering their common adverse effects, it is crucial to longitudinally monitor their potential risk of metabolic, cardiovascular, and extrapyramidal symptoms and signs, as well as their early risk of mortality. Given the high prevalence of AP off-label prescription, the rationale for AP prescribing should be clearly documented and regularly reviewed within the prison by mental health professionals.
Viene evidenziata una tendenza a espandere le condizioni cliniche che possono portare alla non imputabilità, includendo in particolare i disturbi di personalità. Questa tendenza è in contrasto con le ...cautele espresse da Freud e con le posizioni di una parte della psichiatria la quale ritiene essenziale garantire il diritto al giudizio a tutte le persone anche se affette da disturbi mentali. In ambito giudiziario e peritale un riconoscimento di responsabilità è importante ed essenziale anche per i programmi di cura, riabilitazione e inclusione sociale. There is a tendency to expand clinical conditions, particularly personality disorders, that may lead to non-imputability. This is in contrast with the cautions expressed by Freud, and with the positions of part of psychiatry which considers essential the right to trial to all people even if affected by mental disorders. An acknowledgment of responsibility is important in the judicial and psychiatric expertise fields, as well as essential for programs of care, rehabilitation and social inclusion
Aim
From January 2013, the Parma Department of Mental Health developed a specific protocol of care (the “Parma—Early Psychosis” Pr‐EP program) as a diffused service for early intervention in ...psychosis. The aims of the present research are (a) to describe the Pr‐EP macroscopic organization and (b) to analyse specific process indicators across the first 5 years from its establishment.
Methods
All participants were adolescent and adult help‐seekers, aged 12‐54 years, with a First Episode Psychosis (FEP) or at Ultra‐High Risk for developing psychosis, according to well‐defined diagnostic criteria.
Results
At baseline, 358 individuals were offered a dedicated protocol of care and only 40 (11.8%) dropped out during the first year of intervention. In particular, an increase of referrals over time was notably found (especially in adolescence). Furthermore, Duration of Untreated Psychosis decreased over time. The baseline prevalence of FEP diagnosis was 61.4%, with schizophrenia as markedly prevalent Diagnostic and Statistical Manual of mental disorders, IV edition, Text Revised (DSM‐IV‐TR) diagnosis (41%). The vast majority of UHR individuals met criteria for “Attenuated Psychotic Symptoms” (>90%), and major depressive disorder was the most frequent diagnosis (>55%). Finally, we found considerable percentages of current history of substance abuse (>58%) and of comorbidity with DSM‐IV‐TR personality disorders (60%).
Conclusions
An “Early Intervention in psychosis” service in Italian child/adolescent and adult mental health services is feasible, also in adolescents, who have a high risk of falling through the child‐adult service gap.
Objective
Although suicide behavior is relevant in first‐episode psychosis (FEP), little is known about suicidal ideation and its longitudinal stability. The aim of this study was (1) to assess ...incidence rates of suicide attempts, completed suicide, and suicidal thinking in FEP individuals at baseline and over a 24‐month follow‐up period; (2) to explore any significant association of suicidal ideation with psychopathology at baseline; and (3) to monitor longitudinally suicidal thinking along the 2‐year follow‐up.
Methods
Participants (134 FEP patients, aged 13–54 years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). A Kaplan–Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was also performed.
Results
FEP patients showed a 31.3% percentage of suicidal ideation (i.e., BPRS item 4 cutoff score of ≥ 3) and a 2‐year cumulative incidence rate of attempted suicide of 11%. No completed suicide was found. In the FEP total sample, suicidal thinking was positively correlated with general psychopathology (especially depression) and negative symptoms.
Conclusions
Suicidal ideation is relevant in FEP patients, supporting a routine monitoring of suicide risk during the baseline assessment of adolescents and adults with early psychosis.
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