Socio-demographic and clinical characteristics of SARS-CoV-2-positive psychiatric in-patients: A case-control study in the psychiatric wards of a Great Metropolitan Hospital in Milan.

During the first Covid-19 outbreak, the Niguarda Hospital of Milan featured two Psychiatry wards, one for SARS-CoV-2 positive patient and one for patients requiring hospitalization and negative for SARS-CoV-2. The two groups of patients were compared and were similar in distribution of psychiatric diagnosis, duration of illness and previous hospitalizations. SARS-CoV-2 positive participants had a lower severity of symptoms both at admission and discharge, a lower frequency of psychotic symptoms and substance intoxication at admission. These findings suggest that patients admitted to the COVID ward were hospitalized not only for their mental health condition but also because of the infection.

Drug treatment modalities in psychiatric inpatient practice: a 20-year comparison.

OBJECTIVES: The present study investigated whether the increased number of psychotropic agents available in Italy in the last 20 years increased the proportion of inpatients being treated with individual medication classes and the proportion receiving combined treatments with agents of the same class or of different classes. METHODS: This study was conducted in South-Verona, Italy. From the local Psychiatric Case Register (PCR) all patients consecutively admitted to the inpatient unit during the years 1981/1982, 1991/92 and 2001/02 were extracted. Drug use at discharge was derived from clinical records, while service use data were extracted from the PCR. RESULTS: During the six years surveyed 160 patients were admitted in 1981/82, 139 in 1991/92 and 228 in 2001/02. An increasing proportion of subjects receiving antipsychotic, antidepressant and benzodiazepine treatment at discharge was observed. In addition, we found an increasing proportion of patients receiving two or more psychotropic drugs at discharge, which accounted for almost 80% of cases in 2001/02. The number of psychotropic agents prescribed at hospital discharge was positively correlated with the total consumption of psychotropic drugs. A relevant proportion of patients were also dispensed agents for medical conditions, yielding an average number of 3.2 prescriptions in 2001/02. The Lavik score, a summary index of service use, indicated that subjects admitted in 1981/82 were moderate users of psychiatric services, while those admitted in 1991/92 and in 2001/02 were high users of psychiatric services. CONCLUSION: This study documented emerging trends toward polypharmacotherapy and higher total doses. Additional pharmacoepidemiological research is needed to clarify both the beneficial and, potentially, adverse effects associated with these trends in psychiatric pharmacotherapy.

Development of a registry for monitoring psychotropic drug prescriptions: aims, methods and implications for ordinary practice and research.

In psychiatry, individual-based registries have provided key information on risks and benefits associated with the use of psychotropic drugs but they have rarely been employed for monitoring and evaluating the everyday prescribing of psychopharmacological treatments. This article describes the cultural background that gave impetus to the idea of registering all prescriptions of psychotropic drugs dispensed by physicians working in the South Verona community mental health service, and presents the methodology employed to develop such a registry in a community psychiatric service where a psychiatric case register (PCR) has been operating since 1978. We developed a registry including every patient receiving psychotropic medications in ordinary practice. This registry is linked to the PCR in order to obtain data on social and demographic characteristics, clinical symptoms, diagnosis, use of services, and outcomes. No exclusion criteria are allowed--anyone receiving treatment is automatically included. This system, which can link drug and service-use data with hard outcome indicators, can generate information on the proportion of subjects discontinuing treatment, switching medication because of side-effects, recovery or inefficacy, as well as on the proportion of subjects failing to return to the physician, and the proportion of patients who improve. The innovative aspect of this approach is that this registry is developed, organized and used by physicians interested in monitoring their clinical practice and in providing patients, relatives and the public with accurate information on drug use in their specific context of care.

Are we going to increase the use of antidepressants up to that of benzodiazepines?

OBJECTIVE: The present study compared recent trends in benzodiazepine and antidepressant consumption in Italy and projected their global sales in the future. We investigated whether the increasing use of antidepressants is associated with a progressive reduction in benzodiazepine use. METHODS: Data concerning actual quantities of benzodiazepines and antidepressants dispensed in Italy from 1995 to June 2003 were obtained from IMS Health. For each agent, the number of defined daily doses (DDDs) per 1000 inhabitants per day and the annual expenditure in Euros was calculated. RESULTS: During the 9-year period, benzodiazepine consumption remained substantially stable, accounting for 50 DDDs/1000 per day in 2003. In the same period, antidepressant consumption dramatically rose, from 9 DDDs/1000 per day in 1995 to 26 DDDs/1000 per day in 2003, an increase of nearly three times. While the use of tricyclic antidepressants declined by one-third and that of other older agents remained substantially stable, the use of selective serotonin-reuptake inhibitors and newer agents (venlafaxine, mirtazapine, reboxetine) increased by 623%. Global consumption of antidepressants was projected to increase still further, and, in 2007, the total sales of antidepressants were projected to be similar to the total sales of benzodiazepines. The value of benzodiazepine sales increased from 322 million to 565 million Euros, an increase of 43%; similarly, the value of antidepressant sales increased from 186 million to 569 million Euros, an increase of 67%. CONCLUSIONS: In Italy, the consumption of benzodiazepines was not affected by the increased prescribing of selective serotonin-reuptake inhibitors and newer antidepressants.

Stress situation reveals an association between perfectionism and drive for thinness.

OBJECTIVE: Several theorists have hypothesized that stress situations may trigger abnormal eating and even eating disorders in individuals with a perfectionistic personality. The purpose of this study was to assess whether a stress situation would reveal an association between perfectionism and measures of eating disorders among female high school students. METHODS: A sample of 42 female high school students completed the Multidimensional Perfectionism Scale and the Eating Disorder Inventory three times: on an average school day, on the day of an examination, and on the day they received the evaluation of the examination. Linear regression analysis was calculated to verify whether the dimensions of perfectionism were associated with the measures of eating disorders. RESULTS: Body Dissatisfaction was associated with perfectionism on all the three occasions, whereas Drive for Thinness was associated with perfectionism only on the day the students received the results of the examination. DISCUSSION: The results suggest that among nonclinical female individuals, stress may make significant a previously absent association between perfectionism and an actual desire or plan to lose weight. Such a finding suggests that stress may stimulate behaviors related to eating disorders in individuals with a perfectionistic personality.