Failure to reduce benzodiazepine prescriptions through the implementation of a psychological intervention for insomnia in an Italian mental health service.

PURPOSE: Despite the evidence of higher effectiveness of psychological interventions for insomnia compared to pharmacological ones, drug prescriptions for insomnia remain frequent. This study has assessed patterns of prescriptions of BZDs for insomnia before and after the delivery of a training in psychological interventions to professionals working in the services of a Department of Mental Health in northern Italy. METHODS: The intervention consisted in two training sessions about psychological interventions for insomnia delivered to professionals of the participating services. The prevalence of users with a prescription of BZDs for insomnia in an index period after the delivery of the training was compared to the prevalence in an index period before the training. RESULTS: Among 727 people assessed for BZDs prescription at pre-intervention, 306 (42.1%, 95% CI 0.39-0.46) had a prescription, and 344 (49.2%, 95% CI 0.45-0.53) had a prescription among 699 people assessed at post-intervention, corresponding to a significant odds ratio of 1.33 to be prescribed with BZDs in the second index period compared to the first one. Psychological interventions were offered to a small group of patients. CONCLUSION: Prescribing attitudes of BZDs for insomnia were not modified after the training and delivery of a psychological intervention in a mental healthcare outpatient setting. Prescribing habits should be addressed more directly in training, and professionals should be more aware of risks of BZDs assumption. The failure in changing drug prescriptions in this study should prompt more real-world studies of the application of evidence-based strategies, particularly in outpatient mental health settings.

[Effectiveness of cognitive-associated with behavioral therapy psychopharmacological depression. Literature review meta-analyses]. / Efficacia della psicoterapia cognitivo-comportamentale associata a terapia psicofarmacologica nella depressione. Revisione della letteratura metanalitica.

AIM: The main focus is to analyze meta-analyses literature inherent the efficacy of cognitive behavioural therapy (CBT) with pharmacological therapy in the treatment of depression in adults rather than pharmacological therapy alone. METHODS: Systematic research via PubMed, fixed subset criteria. RESULTS: The methanalitic review underlie that the combination of CBT with drug therapy is significantly more effective compared to single pharmacological treatment in adult depression in terms of clinical response and symptomatic improvement. In addition the CBT improves adherence to treatment and reduces the risk of relapse. DISCUSSION: Even though there is only a moderate evidence that combined therapy (pharmacological plus CBT treatment) is better than pharmacological treatment alone on depressive symptoms, the results support the important impact on NHS policies, allowing future implementation of CBT therapy in public services.

[ECT. A critical review of meta-analyses]. / Terapia elettroconvulsivante. Una revisione della letteratura metanalitica.

BACKGROUND: This review is aimed to analize meta-analyses relating ECT in order to evaluate efficacy and safety of this tool compared to sham ECT, placebo as well as psychopharmacology. METHODS: Systematic reviews cited in PubMed, using specific subsets. RESULTS: The meta-analyses agree in outstanding the clinical effectiveness of ECT compared to other kinds of therapy. The main conclusion of the present work, which is related to the safety of this tool would like to reduce the warnings about ECT. These conclusions at present still lack of good quality evidence. DISCUSSION: ECT nowadays is still a tool lacking of quality evidence, but it looks of relevant effectiveness and safety. Because of this, ECT as a technique should get more attention in clinical research and moreover in clinical practice.