[Request for psychiatric admission: data from eight general hospital psychiatric wards in Lombardy]. / Sulla richiesta di ricovero psichiatrico: i dati di otto SPDC in Lombardia.

OBJECTIVE: To describe requests of admissions to eight General Hospital Psychiatric Wards (SPDC) in Lombardy, Italy, during November 1995. DESIGN: Descriptive prospective multicenter study. SETTING: SPDCs of Busto Arsizio (VA), Calcinate (BG), Desio (MI), Magenta (MI), Merate (LC), Milano San Paolo I, Pavia, Treviglio (BG). The global catchment area sums up to 11% of the whole regional area, and to 18% of the population. MAIN OUTCOME MEASURES: We used a previously developed flow chart with two major key points: who decided to go to the hospital? Did a doctor confirm this initiative? Main sociodemographic characteristics, ICD10 diagnosis and previous psychiatric admissions were collected for each admission. RESULTS: Admissions were 315, patients 246. In 9.5% of cases patients asked for admission without any medical advice. In one third of cases the ward psychiatrist was the first doctor to visit the patient. Compulsive admissions (TSO) were 45 (14.3%), although patient's initiative lacked in 55.6% of cases. A referral from Outpatient Departments (CPS) was present in 28.2%. First-ever admitted were 63 (25.6%): 20.7% sent by CPS, 16% by GPs, 11% by other non psychiatric wards. CONCLUSIONS: Although Goldberg & Huxley's model described General Hospital Psychiatric Wards as the last level of intervention, our data show that Italian SPDCs work as "front lines" services: less than one admission out of two were referred by a psychiatrist. Problems raised by "self-referred" patients are conspicuous and an evaluation of the filtering function of CPSs seems necessary. In this regard, a comparison with different modalities of Department organization could be useful.

Tardive dyskinesia outcomes: clinical and pharmacologic correlates of remission and persistence.

Reversible tardive dyskinesia (TD) outcomes have been reported in long-term neuroleptic (NL)-treated patients. In this study the course of TD outcomes was followed-up for 3 years in a population of 125 institutionalized schizophrenic patients (mean age 57.8 years) receiving continuous NL treatment. Tardive dyskinesia occurrence and severity were assessed by means of the Rockland Simpson Scale (RSS). The prevalence of TD rose from 39.2% at the first examination to 52.8% at last follow-up examination; however, 28.6% of TD-affected patients recovered and 30% improved. Significant risk factors for a persistent TD outcome result included age over 56 years, duration of illness over 30 years, and a total RSS score over 22. Cumulative NL exposure, over 3550 g of chlorpromazine equivalents, was also a significant risk factor for TD. Results from this study confirm that there is the possibility of improvement and remission in an aged, long-term institutionalized population of TD patients. In this report we point out prognostic factors for positive outcome.

Nimodipine in human alcohol withdrawal syndrome--an open study.

The aim of this study was to evaluate the efficacy and tolerability of the DHP Ca2+ antagonist nimodipine in human AWS and post-AWS. Ten hospitalized alcoholics of both sexes with a diagnosis of AWS according to the DSM-III criteria were treated for 3 weeks in monotherapy with nimodipine p.o. at flexible daily dosages. Evaluation of AWS symptoms was performed at baseline and after 3, 5, 7, 10, 14 and 21 days. A statistically significant improvement of AWS was seen at evaluation on day 3, particularly in neurovegetative and psychopathological symptoms, and lasted up to the end of the study. The treatment was well tolerated and no side effects were observed or reported. In this pilot, open study nimodipine proved effective in the treatment of mild-to-moderate AWS. If these data are confirmed in a double-blind study nimodipine could be a rational alternative to benzodiazepines in the treatment of AWS.

Factors affecting the clinical response to haloperidol therapy in schizophrenia.

Fifty-one patients diagnosed as schizophrenics or schizoaffective according to DSM-III criteria were treated with conventional haloperidol regimens for 4 or 6 weeks. The clinical picture and extrapyramidal side effects were assessed by means of the Brief Psychiatric Rating Scale (BPRS), and the Simpson and Angus Scale (EPSE). Evaluations were made at admission and after 4 or 6 weeks of treatment. The clinical response to treatment was reported as the percent change in BPRS scores at the end of treatment from the BPRS scores at baseline. Haloperidol (HAL) and hydroxyhaloperidol (REDHAL) were determined by high-performance liquid chromatography (HPLC) with electrochemical detection in plasma. The mean total BPRS item score at the end of the study was significantly lower than at the beginning of the study. HAL and REDHAL levels were significantly related to the dose, and REDHAL levels were also related to HAL levels. There was no correlation between plasma HAL levels and the percent change in BPRS. The percent change in BPRS at the end of the study was negatively correlated with plasma REDHAL levels and REDHAL/HAL ratios and was positively correlated with the baseline BPRS total score. There was no significant correlation between the duration of illness and improvement, but patients with good improvement had significantly shorter duration of illness. Patients who improved also had higher baseline BPRS scores, lower REDHAL levels and REDHAL to HAL ratios, but not significantly different HAL levels. Therefore, the shorter the duration of the disease, the higher the baseline BPRS and the lower the reduced levels of its ratio to haloperidol levels, the higher the percent improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence and risk factors for tardive dyskinesia: a study in an Italian population of chronic schizophrenics.

The aim of this study was to evaluate tardive dyskinesia (TD) (prevalence and possible risk factors, pharmacological and clinical), in a population of schizophrenic patients after prolonged institutionalization. A total of 148 patients (80 male, 68 female) aged between 28 and 87 years (mean 55, SD 11) diagnosed according to DSM III were included in the study and assessed for the presence and severity of TD using the Abbreviated Rockland Simpson Scale for TD. Of the examined population, 32% were found to be affected by TD. Patients over 55 years had a relative risk of TD that was 2.3 times higher than in subjects under 55 (P less than 0.05). The most frequent movements were orofacial (60%) and in the extremities (56.4%). No significant relationship between duration of neuroleptic treatments, illness or hospitalization, anticholinergic drugs and TD prevalence was found. Severity was related to age, since there was a positive linear relationship between age and Simpson Scale scores (r = 0.45, P less than 0.01).

Alternative prophylactic treatments to lithium in bipolar disorders.

The research literature on alternative drug treatments to lithium therapy for the prevention of recurrences in bipolar disorders is discussed. In particular, the data on anticonvulsants (carbamazepine and valproic acid), antidepressants (alprazolam), and calcium channel blockers (verapamil) are reviewed and original data on clonazepam (CLN) are reported. In a preliminary study on six patients with bipolar disorders (DSM-III-R) without a history of psychotic features in which lithium prophylaxis was ineffective, contraindicated, or badly tolerated, CLN was administered in combination with low-dose neuroleptics or antidepressants in all but one case. All subjects were followed for 13 to 34 months. There were no relapses during the observation period with CLN dose regimens ranging from 1.5-8 mg/day p.o. Side effects were minimal and mostly consisted of transient sedation.