Associations between Functional Milestones and Psychiatric Admissions in an Urban Area: Utility of a Cluster-Analytical Approach.

BACKGROUND: The purpose of the study was to identify homogenous subgroups, based upon achievement of two functional milestones (marriage and employment) and Global Assessment of Functioning (GAF) score in a sample of 848 acute patients admitted to the Psychiatric Emergency Service (PES) of the Città della Salute e della Scienza di Torino, during a 24-months period. SUBJECTS AND METHODS: A two-step cluster-analysis, using GAF total score and the achievements in the two milestones as input data was performed. In order to examine whether the identified subgroups differed in external variables that were not included in the clustering process, and consequently to validate the found functional profiles, chi-square tests for categorical variables and analyses of variance (ANOVA) for continuous variables were performed. RESULTS: Five clusters were found. Employed patients (Clusters 4 and 5) had more years of education, less illness chronicity (shorter duration of illness and lower proportion of previous voluntary hospitalizations), lower use of mental health resources in the last year yet higher treatment adherence, larger network size, and higher ordinary discharge. Married inpatients (Clusters 3 and 5) had lower frequencies of substance abuse. CONCLUSIONS: The remarkably high rate of unemployment in this inpatients' sample, and the evidence of associations between unemployment and poorer functioning, argue for further research and development of evidence-based supported employment programs, that put forth diligent effort in helping people obtain work quickly and sustain; they may also help to reduce health care service use among that clientele.

Substance use disorders in hospitalized psychiatric patients: the experience of one psychiatric emergency service in Turin.

In the present study we sought: 1) to estimate the frequency of substance use disorders (SUD), and 2) to investigate whether there is a mere association between diagnosis and SUD in a large cohort of patients with severe psychiatric disorders representative of the usual setting and modality of care of a psychiatric emergency service in a geographically well-defined catchment area in Italy, independent of sociodemographic features, anamnestic data and clinical status. The study was conducted between January 2007 and December 2008. The following rating scales were performed: the Clinical Global Impression-Severity (CGI-S), the Global Assessment of Functioning scale (GAF) and the Brief Psychiatric Rating Scale (BPRS). Factors found to be associated (p<0.05) with SUD[+] in the univariate analyses were subjected to multilevel logistic regression model with a backward stepwise procedure. Among 848 inpatients of our sample 29.1% had a SUD codiagnosis. Eleven factors accounted for 30.6% of the variability in SUD[+]: [a] a Personality Disorder diagnosis, [b] a Depressive Disorder diagnosis, [c] male gender, [d] previous outpatient contacts, [e] single marital status, [f] no previous psychiatric treatments, [g] younger age, [h] lower scores for BPRS Anxiety-depression and [i] BPRS Thought Disturbance, [l] higher scores for BPRS Activation and [m] BPRS Hostile-suspiciousness. The findings are important in identifying (1) the complexity of the clinical presentation of SUD in a inpatients sample, (2) the need for collaboration among health care workers, and (3) the need to develop and apply treatment programs that are targeted at particular risk groups.

Psychiatric symptoms related to the use of lamotrigine: a review of the literature.

Lamotrigine is an established anticonvulsant agent and also an effective maintenance therapy for bipolar disorder. In Italy it is approved for the treatment of epilepsy with partial seizures, partial seizures with secondary generalization and generalized seizures, both in monotherapy and as an add-on therapy in patients with refractory epilepsy; it is also approved for the prevention of depressive episodes in patients with bipolar disorder with a predominant depressive component. Lamotrigine is generally well tolerated; however, some psychiatric problems have been reported in patients using the drug to treat mental disorders (mainly bipolar) or epilepsy. The clinical features of these psychiatric side effects are: affective switches, full acute psychotic episodes, and hallucinations. In conclusion, lamotrigine is an effective drug, very useful in the therapy of epilepsy and mood disorders, but clinicians have to be aware of the risk that it can induce psychiatric symptoms or acute episodes.

Second-generation long-acting injectable antipsychotics in schizophrenia: patient functioning and quality of life.

Long-acting injectable antipsychotics (LAIs) were developed to make treatment easier, improve adherence, and/or signal the clinician when nonadherence occurs. Second-generation antipsychotic LAIs (SGA-LAIs) combine the advantages of SGA with a long-acting formulation. The purpose of this review is to evaluate the available literature concerning the impact of SGA-LAIs on patient functioning and quality of life (QOL). Although several studies regarding schizophrenia patients' functioning and QOL have been performed, the quantity of available data still varies greatly depending on the SGA-LAI under investigation. After reviewing the literature, it seems that SGA-LAIs are effective in ameliorating patient functioning and/or QOL of patients with schizophrenia, as compared with placebo. However, while methodological design controversy exists regarding the superiority of risperidone LAI versus oral antipsychotics, the significant amount of evidence in recently published research demonstrates the beneficial influence of risperidone LAI on patient functioning and QOL in stable patients and no benefit over oral treatment in unstable patients. However, the status of the research on SGA-LAIs is lacking in several aspects that may help physicians in choosing the correct drug therapy. Meaningful differences have been observed between SGA-LAIs in the onset of their clinical efficacy and in the relationships between symptoms and functioning scores. Moreover, head-to-head studies comparing the effects of SGA-LAIs on classical measures of psychopathology and functioning are available mainly on risperidone LAI, while those comparing olanzapine LAI with other SGA-LAIs are still lacking. Lastly, some data on their use, especially in first-episode or recent-onset schizophrenia and in refractory or treatment-resistant schizophrenia, is available.

Gender differences in 353 inpatients with acute psychosis: The experience of one Psychiatric Emergency Service of Turin.

The aim of the study is to evaluate gender-related socio-demographic and clinical differences in a large sample of inpatients with schizophrenia spectrum disorder. A sample of 353 acute patients, consecutively hospitalized between January 2007 and December 2008 in the Psychiatric Emergency Service of the San Giovanni Battista Hospital, was recruited. Psychiatric assessment included the Clinical Global Impression Scale-Severity (CGI-S), the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). Differences between the groups were tested using chi-square test and ANOVA. Data were analyzed using a three-way MANOVA with the six BPRS scales with repeated measures for admission/discharge and BPRS total score baseline and independent groups for men and women. A two-way ANOVA for repeated measures was performed for CGI-S and GAF. Men were younger, more likely to be never married, more often substance abusers. Male patients showed both lower anxious-depressive and anergia symptom scores and higher activation symptom scores than female patients. Brief hospitalization was shown to be highly effective in both groups. Females showed a significantly better improvement in anergia and activation than males. The present evidence suggests that management of acute psychosis should target specific gender differences which should influence therapeutic approach in all its modalities.

Relative contributions of negative symptoms, insight, and coping strategies to quality of life in stable schizophrenia.

The purpose of this cross-sectional study was to examine the relative contributions of negative symptomatology, insight, and coping to quality of life (QOL) in a sample of 92 consecutive outpatients with stable schizophrenia referring to the Department of Neuroscience, Psychiatric Section, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1, Molinette, Italy, in the period between July 2009 and July 2011. In order to assess the specific effect of negative symptoms on QOL and the possible mediating role of insight and coping, two mediation hypotheses were tested, using multiple regression analyses specified by Baron and Kenny (1986). Our findings suggest that (a) higher negative symptoms predict a worse Quality of Life Scale (QLS) intrapsychic foundations (IF) subscale score; (b) attribution of symptoms and coping-social diversion have a direct and positive association with QLS-IF; (c) patients high in negative symptoms are less likely to use attribution of symptoms and coping-social diversion; and (d) attribution of symptoms and coping-social diversion act as partial mediators in the negative symptoms-QOL relationship. The prediction model accounts for 45.3% of the variance of the QLS-IF subscale score in our sample. In conclusion, our results suggest that insight and coping-social diversion substantially contribute to QOL in patients with higher negative symptoms. These factors are potentially modifiable from specific therapeutic interventions, which can produce considerable improvements in the QOL of this population.

Compulsory admissions of emergency psychiatric inpatients in Turin: the role of diagnosis.

Many studies have found high levels of compulsory admission (CA) among non-affective psychoses. Aims of the present study were to investigate whether there was a mere association between diagnosis and CA in a cohort of 848 patients referring to a Psychiatric Emergency Service in a catchment area in Turin during a 2-year period, independent of socio-demographic features, psychiatric history, and clinical status. Diagnosis as a risk factor for CA was assessed constructing a logistic regression model, using the following steps: first, assessing the association between diagnoses and CA, without controlling for confounding factors; second, entering socio-demographic factors; third, entering socio-demographic factors and psychiatric history; and fourth, entering socio-demographic, psychiatric history, and aspects of clinical presentation into the model. At step 1 patients with Non Affective Psychoses, Mania and Personality Disorders had a significantly higher CA risk, compared to patients with Depressive Disorders. At step 4 diagnosis was no longer associated with CA. History of CAs within past 5years and Brief Psychiatric Rating Scale (BPRS) hostile-suspiciousness were positively associated with CA. Length of illness, history of previous suicidal attempts and BPRS anxiety-depression were negatively associated with CA. Overall, the percentage of correctly predicted cases was 39.8%. The remaining 60% can be explained by inherent variability or unknown, lurking variables. Finally, the study was carried out at a single facility. Much of the increased CA likelihood in diagnostic categories might be attributable to specific symptom patterns, not to patients' severity of illness or diagnosis per se.

Predictors of compulsory admission in schizophrenia-spectrum patients: excitement, insight, emotion perception.

PURPOSE: We explored socio-demographic and clinical variables associated with compulsory admissions (CA) compared with voluntary admissions in schizophrenia-spectrum patients; moreover, we investigated the ability of excitement, emotion perception, and lack of insight to predict CA. METHODS: 119 consecutive schizophrenia-spectrum patients admitted to the Servizio Psichiatrico di Diagnosi e Cura (SPDC = PES = psychiatric emergency service) of the Department of Neuroscience and Mental Health-San Giovanni Battista Hospital of Turin in the period between December 2007 and December 2009 were enrolled in the study. A backward stepwise logistic regression was used to test factors contributing to CA. RESULTS: CA rate in our sample was 28.5%. Previous CAs, drop-out, severity of illness, positive symptoms, excitement, emotion perception, and insight were significantly different in CA patients compared to voluntary ones. After backward selection of variables, three variables predicted CA in our sample: excitement, impaired emotion perception and lesser insight. Finally, the effect of excitement on CA status seemed partially mediated by emotion perception, the prediction model accounting for 53.8% of the variance of CA status. Conversely, insight seemed not to be a mediator of excitement on CA. IMPLICATIONS: Understanding CA patterns in special populations represents a first step towards improving clinical decision-making and developing appropriate interventions and service-provision.