Consequences of the COVID-19 pandemic on admissions to general hospital psychiatric wards in Italy: Reduced psychiatric hospitalizations and increased suicidality

Aims: The present investigation aimed at evaluating differences in psychiatric hospitalizations in Italy during and after the lockdown due to the novel coronavirus disease 2019 (COVID-19), compared to the same periods in 2018 and 2019. Methods: We obtained and analyzed anonymized data on psychiatric admissions (n = 4550) from 12 general hospital psychiatric wards (GHPWs) in different Italian regions (catchment area = 3.71 millions of inhabitants). Using a mixed-effects Poisson regression model, we compared admission characteristics across three periods: (a) March 1\u2013June 30, 2018 and 2019; (b) March 1\u2013April 30, 2020 (i.e., lockdown); and (c) May 1\u2013June 30, 2020 (i.e., post-lockdown). Results: During the COVID-19 lockdown, there was a 41% reduction (IRR = 0.59; p 65 years) was observed in the lockdown (40%; IRR = 0.60; 95% CI: 0.44\u20130.82) and post-lockdown (28%; IRR = 0.72; 95% CI: 0.54\u20130.96) periods. Long-stay admissions (>14 days) increased (63%; IRR = 1.63; 95% CI: 1.32\u20132.02) during the lockdown and decreased by 39% thereafter (IRR = 0.61; 95% CI: 0.49\u20130.75). A significant 35% increase in patients reporting suicidal ideation was observed in the post-lockdown period, compared to the rate observed in the 2018 and 2019 control period (IRR = 1.35; 95% CI: 1.01\u20131.79). Conclusion: The COVID-19 lockdown was associated with changes in the number of psychiatric admissions, particularly for older patients and long-stay hospitalizations. Increased admission of patients reporting suicidal ideation in the post-lockdown period merits special attention. Further studies are required to gain insight into the observed phenomena

Scenari e trasformazioni del processo penale. Ricordando Massimo Nobili

L'ordine processuale si è sfaldato in un'apparente armonia di linee ed interpretazioni, dove tutto appare fermo e ricomposto attraverso l'elasticità dei concetti. Gli scenari non sono solo sullo sfondo: tendenze collettive, modi nuovi di operare e comunicare quasi son diventati tutt'uno con i fenomeni che qui interessano, incidendo in profondità sulle categorie della Procedura penale e sugli effetti delle norme. Le trasformazioni, ad opera sia dello ius singolare della postmodernità, sia della giurisprudenza di legittimità e di quella costituzionale, sono divenute il manifesto di una società che cambia, di una politica di governo che cambia, nella tensione eccessivamente frettolosa di adeguarsi ai mutamenti. Da qui, non soltanto i singoli strappi al codice, ma addirittura il rischio della sua dissoluzione in una desuetudine sempre più appariscente: ad esso pare affiancarsi un'altra tipologia di processo. Degradata la persona ad oggetto, riaffiora il mito di una verità assoluta e, correlativamente, di uno sconfinato potere del giudice, rappresentato dal libero convincimento, come strumento essenziale per la realizzazione della pretesa punitiva dello stat

Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders

Background: Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. Methods: Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. Results: Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. Conclusions: Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery