Abstract
BackgroundFew data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management).MethodCross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy).Results253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers.ConclusionSubjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients.
Highlights
Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms
The frequency peak was 30–34 years among women and 25–29 among men. 94 (37.2%) first psychiatric admission (FPA) patients were referred from a psychiatrist, 60 (23.7%) from other health professionals, 99 (39.1%) had not contacted a physician before admission to SPDC
From the overall 2521 cases collected by the PERSEO (Psychiatric EmeRgency Study and EpidemiOlogy) project – a large Italian observational multi-center study involving 62 SPDCs, aimed at assessing the prevalence and incidence of aggressive behavior in patients admitted to a SPDC and at describing the clinical features and management of such patients – we selected a sample of 253 patients aged ≤ 40 years at FPA, which represents the largest studied population of first admitted patients in Italian psychiatric emergency structures
Summary
Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. Few data are available about the clinical characteristics of patients at their first psychiatric admission (FPA), their management, and their subjective well-being. Acute hospital psychiatric wards are specific structures (called SPDCs in Italy, Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management), located within general hospitals, for referral of acute patients with psychiatric-related illnesses. SPDCs could be the perfect setting for the study of mentally ill patients at their first presentation to hospital, in such emergency situations, the implementation of clinical research and epidemiology programs is rather difficult. Little is known about the treatments administered in SPDCs
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