Psychiatric Service In Italy Research Articles

Psychometric properties of the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ) in a sample of Italian psychiatric outpatients

BackgroundThe present study aimed to examine the reliability and validity of the Italian version of the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ), a screening tool for autism spectrum disorder (ASD) among psychiatric outpatients. MethodsWe recruited 340 subjects via an outpatient psychiatric service in Italy. Forty-eight had a diagnosis of ASD, confirmed after a comprehensive clinical assessment and the administration of the Autism Diagnostic Observation Schedule-2 (ADOS-2). The remaining 292 participants had other diagnoses, confirmed after a careful psychiatric evaluation and the administration of the Structured Clinical Interview for DSM-5 (SCID-5). The ASDASQ was administered to contact clinicians of each subject. ResultsThe ASDASQ showed outstanding accuracy (AUC = 0.96) in discriminating between ASD and non-ASD patients, with good sensitivity (0.85) and specificity (0.92). Agreement with clinical diagnosis was substantial (k = 0.68). Internal consistency of the tool was good (Cronbach’s alpha = 0.82), while intra- (ICC = 0.97) and inter-rater reliability (ICC = 0.92) were excellent. We found also a moderate correlation between ASDASQ and ADOS-2 scores in the ASD sample (r = 0.56). ConclusionOur findings suggest that the ASDASQ, in the Italian adaptation, may be considered a quick, simple, and effective tool to screen for ASD among psychiatric outpatients. Further studies are needed to evaluate its utility in other clinical settings.

Aggression and Violence Toward Healthcare Workers in a Psychiatric Service in Italy: A Retrospective Questionnaire-Based Survey: Erratum.

Aggression and Violence Toward Healthcare Workers in a Psychiatric Service in Italy: A Retrospective Questionnaire-Based Survey: Erratum.

Aggression and Violence Toward Healthcare Workers in a Psychiatric Service in Italy: A Retrospective Questionnaire-Based Survey.

Workplace violence and aggression are receiving increasing attention, especially when perpetrated in at-risk services such as psychiatric and emergency departments. Many healthcare providers have been victims of verbal aggressions (VAs) and physical aggressions (PAs), as well as injuries (INs), at the hands of patients. We conducted a 1-year retrospective questionnaire-based survey to assess workplace violence and aggression experienced by staff working at the Psychiatric Service of the Health District of Bolzano-Bozen (Italy). We performed parametric statistics. Logistic regression estimated the size of the association between PA occurrence and staff characteristics. Our psychiatric service's employees were frequent victims (91.5%) of 1 or more aggression/injury in the previous year. VAs and INs showed comparable frequencies among the three sites of our service, that is, the inpatient (INP), the outpatient (OUTP), and the rehabilitation (REHAB) units, differently from PAs, which were more common at INP (p < 0.001). The logistic regression model showed that female sex, working at INP, and a shorter psychiatry work experience predicted PAs occurrence. Most of the staff felt they could benefit from aggression management. Findings show that VAs, PAs, and INs are common among our psychiatric service's employees and point to the need to provide staff training on de-escalation.

Future psychiatric services in Italy: lesson from the COVID-19 pandemic.

During the COVID-19 epidemic, home care and remote working showed important technological innovations, leading to review all public mental health policies. In this article, some considerations based on the Italian COVID-19 experience in order to plan post-COVID psychiatric interventions are reported. (www.actabiomedica.it)

A Comparison of Inpatient Adult Psychiatric Services in Italy and Canada

We examine the possibility the Organisation for Economic Co-operation and Development (OECD) bed count for Italy may be an underestimation of the actual beds available. We compared bedded services for mental disorders in two regions in Italy and Canada respectively. We found out that if we consider acute psychiatric beds only, the district of Ferrara has 30 beds (8.5 per 100,000) and the Middlesex and Elgin Counties have 89 beds (16.3 beds for 100,000). However, if we include the rehabilitation beds (that are located within a hospital setting in Ontario and in a residential community setting in Ferrara), we find that the district of Ferrara has 95 beds (27.0 per 100,000) and the Middlesex and Elgin Counties have 176 beds (32.3 per 100,000). As a result, the 10/100,000 beds rate for Italy reported by the OECD is an underestimate compared to figures reported for most other countries, as the beds included are hospital beds only.

Памяти Исаака Яковлевича Гуровича: репортаж о совместном заседании Московских отделений РОП и РПА

We present the report on the joint session of the Moscow offices of Russian Society of Psychiatrists and Russian Psychotherapeutic Association. The following topics were discussed during the session: reorganization of the psychiatric service in Italy and using this experience in the Russian system of psychiatric aid. These themes align with the scientific goals of I.Ya. Gurovich, who was commemorated during the session.

Aggression and violence towards healthcare workers in a psychiatric service in Italy. A retrospective questionnaire-based survey

IntroductionViolence at work is a major concern in healthcare services. Prevention programs have been implemented, albeit being scarce in Italy.Objectives or AimsThe Bolzano psychiatric department adopted a de-escalation model developed by the Institut-für-Professionelles-Deeskalations-Management (ProDeMa®). It includes evaluation, prevention, and practical training aimed at preventing/reducing patients’ aggressive behavior toward healthcare workers.MethodsIn 2015, health professionals were interviewed by using a ProDeMa® 11-item questionnaire that assessed the type and frequency of endured patients’ aggressive behavior, as well as the conditions capable of producing or preventing it. One-way ANOVA with Tukey post-hoc test was used for comparisons.ResultsA total of 165/211 (78%) surveyed workers (mean age ± DE = 44.9 ± 7.7; females = 64.6%) completed the questionnaire, of whom 21% employed at the inpatients unit (INP), 37% at the outpatients unit (OUTP), 42% at the rehabilitation facility (REHAB). The one-year number of verbal aggressions (VA) was 9766, with INP (mean ± SD = 15.2 ± 29.6) vs. OUTP (mean ± SD = 6.2 ± 30.6) vs. REHAB (mean ± SD = 8.4 ± 26.1). The one-year number of physical aggressions (PA) was 1502, with INP (mean ± SD = 3.3 ± 12.2) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.7). The one-year number of injuries (IN) was 200, with INP (mean ± SD = 0.5 ± 1.9) vs. OUTP (mean ± SD = 0.1 ± 0.5) vs. REHAB (mean ± SD = 0.1 ± 0.2). ANOVA showed significant differences in terms of mean verbal/physical aggression and injuries among the three workplaces (P-values = 0.000), with post-hoc Tukey test showing a significant difference of INP vs. REHAB and OUTP. The most frequent risk factors identified by the staff for precipitating aggression included rigid rules (15.1%) and inadequate communication (9.1%).ConclusionsThe three types of violence are common in all facilities of our Department.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Group cognitive behavioural therapy for outpatients with obsessive-compulsive disorder in a psychiatric service in Italy

IntroductionGroup Cognitive Behavioural Therapy (GCBT) is a cost-effective modality of treatment alternative to individual Cognitive Behavioural Therapy (CBT). Despite several well-controlled trials demonstrated the efficacy of GCBT for Obsessive Compulsive Disorder (OCD), few studies evaluated the effectiveness of GCBT on outpatients attending routinary psychiatric services, and in Italy this topic appears understudied.ObjectivesThe current study evaluated the effectiveness of a GCBT protocol on OCD symptoms and comorbid depression and anxiety in a group of outpatients attending a psychiatric service in Italy.MethodTwenty outpatients with a diagnosis of OCD were included in the study and received 20 sessions of GCBT, consisting of psychoeducation on anxiety and OCD, relaxation training, in vivo/imaginal exposure and response prevention, cognitive restructuring for obsessive beliefs, cognitive defusion, and assertiveness training. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI) were administered at pre- and post-treatment.ResultsTwo outpatients had a comorbid bipolar disorder, eight had a concurrent personality disorder. Ten outpatients were on concurrent antidepressants, five on antipsychotics. Three outpatients prematurely dropped out from treatment. Among completers, GCBT produced significant changes on OCD symptoms, anxiety and depression from pre- to post-treatment. The GCBT protocol was feasible and the outpatients reported high satisfaction judgements.ConclusionsFuture studies should investigate clinical predictors of best response after GCBT and assess maintenance of symptom changes at long-term follow-up.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Four-Year Follow-Up of Long-Stay Patients Settled in the Community After Closure of Italy's Psychiatric Hospitals

Four-Year Follow-Up of Long-Stay Patients Settled in the Community After Closure of Italy's Psychiatric Hospitals

Service utilisation and costs of first-contact patients in a community psychiatric service in Italy

This study describes service utilisation under routine clinical activity and the costs of providing mental health care for 24 months for the whole population of 330 subjects who had first contact with the Magenta Community Mental Health Centre during one year. The mean age of patients was 42.5 years, and 61% were females. According to ICD 10 criteria, 7% were diagnosed as having schizophrenia, 22% mood disorders, 37% neurotic disorders, 15% personality disorders and 19% other diagnoses. The clinical routine activity was monitored for 24 months from the first contact for each patient. The mean cost for a schizophrenic patient is more than double that of other patients. In-patient activity and community services accounted, respectively, for 49.7% and 50.3% of the total costs. Total health care costs per patient differ widely according to whether patients had been hospitalised during the observation period. Patients with a previous psychiatric contact and a longer duration of illness were more costly than the other patients. Multiple regression analysis was used to assess the association between all the individual variables and costs. For the whole population, the model explains 50% of the cost variation. Higher treatment costs were positively associated with the presence of previous psychiatric contacts and referral to the CPS by other sources than a general practitioner, and negatively associated with age.

Monitoring community psychiatric services in Italy: differences between patients who leave care and those who stay in treatment.

Continuity of care has been monitored rarely in Italian community mental health centres. To estimate the long-term probability of leaving care in first-contact patients attending an out-patient service, and to identify patients most likely to drop out. All patients who had a first contact with the community mental health centre of Magenta during a 1-year recruitment period were followed up for 24 months. Patients who failed to return after the last out-patient visit were regarded as 'drop-outs'. During the 1-year recruitment period 330 subjects were at their first contact. The 1-year incidence of first-contact patients was nearly 33 per 10 000 inhabitants. At follow-up, 46% of patients had dropped out. In comparison with patients with psychoses, subjects suffering from neurotic (P =0.004) and personality disorders (P=0.029) were more likely to drop out. In the Italian system of community psychiatric care nearly half of the patients are no longer in contact after 2 years. Those who stay in treatment are more likely to suffer from psychosis, suggesting a commitment of Italian out-patient facilities to tackling the needs of patients with more severe disorders.

Direct and indirect costs of schizophrenia in community psychiatric services in Italy: The GISIES study

Backround: The present work is a cost-of-illness (COI) study that aims at assessing total direct and indirect costs of schizophrenic patients in community psychiatric services in Italy and identifying the variables that influence costs. Methods: A retrospective prevalence-based multi-centre COI study, was designed. Ten community mental health centres (CMHC) were involved and 100 patients were recruited. Data on patients’ costs were gathered through specifically designed instruments. Results: More than half total direct costs was attributed to CMHC interventions. The yearly average costs of schizophrenia per patient amounted to nearly ITL 50 million: 30% for direct costs and 70% for indirect costs. Conclusion: CMHCs tend to manage long-term ill patients by adopting a strong community-based system of care. Schizophrenia is correlated to loss of working days and lack of well-being. From the results of this study, it might be argued that the de-institutionalisation programme has produced ‘spillovers’ in terms of families’ greater involvement in patients management.

Health care costs of therapy-refractory schizophrenic patients treated with clozapine: a study in a community psychiatric service in Italy.

This study evaluates the utilization of clozapine in the treatment of therapy-refractory schizophrenia in terms both of patterns of care and of health care costs in a community psychiatric service in Italy. Data covering the year prior to commencing clozapine and the year following the initiation of the therapy were collected. Clinical outcome was assessed by means of the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) scales. Cost analysis followed a two-step procedure: (i) to record all health care services provided to patients and (ii) to assign a monetary value to each service. Three of the 15 patients enrolled in the study dropped out before the end of the 12-month period of therapy. Considering the 12 patients on clozapine treatment for at least 1 year, clinical improvements are associated with a substantial modification of the pattern of care. While patients in the pre-clozapine period were mainly managed in hospital settings, patients on clozapine were prevalently placed in the community and participated in intensive rehabilitative programmes. The higher costs of drug therapy and community services in the post-clozapine period were more than offset by the lower costs of acute hospital care.

Clozapine effectiveness in a psychiatric service in Italy

Clozapine was administered to 28 resistant schizophrenics at psychiatric services in Bologna. At 26 weeks 62% responded. Positive and negative symptoms improved, but decrease of negative symptoms partially depended upon improvement of positive and EPS. No cases of agranulocytosis were seen. Some drop-outs were related to difficulties with psychopathological improvement.

Evaluating costs of mental illness in Italy. The development of a methodology and possible applications

RiassuntoScopo- Il presente lavoro, oltre a fare il punto sui più recenti sviluppi della valutazione economica degli interventi effettuati nel settore della salute mentale, propone una metodologia per la valutazione dei costi, applicable nella situazione assistenziale italiana, messa a punto tenendo conto degli sviluppi suddetti.Metodo e risultati- I presupposti per realizzare questo tipo di valutazione sono l'identificazione dei servizi sanitari e sociali offerti ai pazienti con disturbi psichici, la raccolta di dati sull'utilizzazione dei servizi sanitari (costi diretti) e sull'uso di altri servizi e risorse all'interno del sistema socio-economico (costi indiretti) e l'assegnazione di un valore monetario a tali costi. È stato quindi realizzato un elenco dettagliato degli interventi effettuati e delle attività svolte nei Servizi Psichiatrici Territoriali italiani, con particolare riferimento al Servizio di Verona-Sud. Di ciascuno/a di essi è stato stimato il costo (Lista dei Costi Unitari o LICU). Si è tenuto conto, inoltre, degli altri servizi socio-sanitari, pubblici e privati, disponibili sul territorio, degli interventi delle Forze dell'ordine, delle associazioni di volontariato e dei gruppi diself-help. In questo articolo vengono descritte, in dettaglio, le procedure che hanno portato alia quantificazione dei costi per tre di queste attività (le degenze in SPDC, le visite ambulatoriali ed i gruppi socio-riabilitativi). È stata inoltre sviluppata un'intervista (ICAP) per raccogliere i dati sull'utilizzazione dei servizi e sulle condizioni socio-economiche degli utenti. Per verificarne l'applicabilità, le eventuali difficoltà di comprensione e la durata di somministrazione, l'ICAP è stata testata in cinque pazienti.Conclusioni- Uno sviluppo particolarmente interessante ci sembra quello di utilizzare su vasta scala PICAP e la LICU, allo scopo di realizzare studiepidemiologically-basede poter predire ed analizzare i costi in relazione a variabili socio-demografiche, alia diagnosi, alia storia psichiatrica precedente ecc. È necessario sottolineare l'importanza, per le politiche e la pratica sanitaria, di un'analisi combinata di costi, bisogni ed esito (outcome). Una ricerca di questo tipo è attualmente in corso a Verona-Sud.

Suicide, psychiatric reform, and the provision of psychiatric services in Italy.

An ecological approach has been adopted to study the effect on suicide of the 1978 psychiatric reform in Italy. Using regional data, the trend in suicide during the pre-reform quinquennium (1973–1977) is compared with that during the postreform quinquennium (1979–1983). The results show that the suicide rate in Italy as a whole has increased consistently over the past 10–15 years and that the increase is largely confined to the north-central parts of the country. No clear time trend emerged with respect to the proportion of suicides classified as being due to mental illness. The difference between the two 5-year trends (1973–1977 and 1979–1983) was positive (i.e., an increase in the suicide rate) for 10 of the 19 regions in Italy. This difference correlated negatively with the provision of general hospital psychiatric beds, a finding which persisted when controlled for the pre-reform trend in suicide. The post-reform regional provision of mental hospital beds (which have declined considerably in recent years) was not related to changes in the suicide rate. The usefulness of comparing trends in rates, rather than averaged rates, in the investigation of the effect of a new service on suicide is stressed.