Routine treatment pathways in a cohort of patients with major depression and suicidality in Italy: the ARIANNA observational study.

BACKGROUND: Major Depressive Disorder (MDD) with suicidal ideation, intent, or behavior is a psychiatric emergency with controversial care management. Our study describes the comprehensive treatment pathways of this population in Italian routine clinical practice. METHODS: ARIANNA [NCT04463108] is an observational prospective and retrospective cohort study involving both primary data collection and secondary data extract. A total of 137 adult MDD patients with suicidality were enrolled from 24 Italian care sites and followed for 90 days. Other than the description of treatment patterns, the impact of treatment on depressive symptoms and suicidality, the burden on the patient's and caregiver's quality of life, healthcare resource utilization and costs were described. RESULTS: Of the 133 eligible patients, 68.4% were female, and the median age was 47. Approximately half of the study population had a current severe major depressive episode. Treatment strategies at the time of active suicidal ideation with intent definition/confirmation (t0) were heterogeneous, increasing in complexity during observation. According to the MADRS, patients with remission at t0+1 day were 2.6%, with the mean total score decreasing from 37.2 at t0 to 32.3. LIMITATIONS: The study sites were not randomly selected. CONCLUSIONS: To the best of our knowledge, this is the first cohort study that prospectively describes the characteristics of patients with MDD and suicide risk in Italy, and how they are treated in clinical practice. The study confirms this is a difficult-to-treat population. In addition, a lack of rapid, effective treatment for reducing depressive symptoms and suicidality is observed.

[Cognitive-Behavioural group interventions and Multifamily Psychoanalysis group in a Psychiatric Ward]. / Interventi cognitivo-comportamentali di gruppo e psicoanalisi multifamiliare di gruppo in un Servizio Psichiatrico di Diagnosi e Cura.

AIM: This paper aims to study, evaluate and compare the effectiveness of two group interventions within a Psychiatric Intensive Care Unit (PICU). The outcome indicators of the satisfaction of patients and their families with the ward were evaluated with a Satisfaction Questionnaire on the department, and their satisfaction with the groups were evaluated with the Satisfaction Questionnaire for the groups. The two theoretical orientations examined are the cognitive-behavioural therapy, with group cognitive-behavioural intervention in the context of SPDC, and psychoanalysis, with multifamily psychoanalysis groups, according to the model of Jorge García Badaracco. METHODS: The sample is composed of 83 users (42 males and 41 females) participating in the groups; 41 users (23 males and 18 females) not participating in the groups; 54 family members participating in the groups; 41 family members not participating in the groups. RESULTS: The results show an improvement of satisfaction with activities compared to the hospitalisation into the ward (p<.01), an improvement in the perception of the ward climate (p<.01) of the users participating in the groups, regardless of the orientation of reference, but it shows a greater effectiveness of groups with cognitive-behavioral group orientation (p<.001). DISCUSSION AND CONCLUSIONS: The results indicate a greater effectiveness of the groups with cognitive-behavioural orientation, but confirm that psychotherapeutic groups in psychiatric contexts, even in emergency, not only seems to be well accepted and perceived positively by users and family members, but it also contributes to increasing satisfaction with the ward.