Clinical trajectories of individuals with severe mental illness continuing and discontinuing long-acting antipsychotics: a one-year mirror-image analysis from the STAR Network Depot study

Evidence on long-acting antipsychotics (LAIs) in unselected populations with severe mental illness is scant. In this mirror-image study, we compared multiple clinical outcomes 1 year before and after a first LAI prescription in adults with severe mental illness, describing clinical trajectories of LAI continuers and discontinuers. We compared LAI continuers and discontinuers through Mann-Whitney U test, Kaplan-Meier survival curves, regression for interval-censored data, and a maximum-likelihood mixed-model with individual random-effect and time as predictor. Of the 261 participants analyzed, 71.3% had schizophrenia-spectrum disorders, and 29.5% discontinued the LAI before 1 year. At baseline, LAI discontinuers had a shorter illness duration, lower attitude and adherence scores. The mirror-image analysis showed reduced hospital admissions only for LAI continuers. Over time, continuers spent less days hospitalized, but had more adverse events and more antipsychotics prescribed, with higher overall doses. In conclusion, this study shows that LAIs might be beneficial in unselected patient populations, provided that adherence is maintained. LAI continuers spent less time hospitalized, but received more antipsychotics and suffered from more cumulative adverse events over time. Therefore, the choice of initiating and maintaining a LAI should be carefully weighed on a case-by-case basis

Patrimoni e scopi. Per un'analisi economica delle fondazioni

Il volume raccoglie i contributi presentati al Primo Workshop sulle Fondazioni organizzato nel 2007 dal Dipartimento di Scienze Economiche e Finanziarie "G. Prato", presso la Facoltà di Economia dell'Università degli Studi di Torino. Il lavoro il tema delle fondazioni viene affrontato in chiave evolutiva, proponendo una classificazione che mette in luce la pluralità di esperienze, ovvero di patrimoni (ingenti e non) associati a differenti scopi.- Indice #7- Prefazione, Giovanni Zanetti #11- Introduzione Dalla «fondazione» alle «fondazioni»: un percorso di lettura, Gilberto Turati, Massimiliano Piacenza, Giovanna Segre #17- Parte prima Aspetti generali #31- Cap.I Fondazioni italiane: per una introduzione a beneficio degli inesperti curiosi, Marco Demarie #33- Cap.II Le fondazioni di origine bancaria: dalla nascita per caso all'esercizio dell'innovazione sociale, Gian Paolo Barbetta #59- Cap.III Quale valutazione per le fondazioni grant-making, Alberto Martini, Barbara Romano #87- Cap.IV Complementarità e/o sostituibilità tra le erogazioni delle fondazioni di origine bancaria e le politiche di spesa degli enti locali: il caso del Piemonte, Stefano Piperno, Federica Givone #107- Cap.V L'evoluzione della legislazione in materia di fondazioni di origine bancaria, Maura Leddi #135- Parte seconda Le esperienze #143- Cap.VI Una valutazione complessiva delle attività di erogazione delle fondazioni grant-making piemontesi, Angelo Miglietta #145- Cap.VII L'attività di una fondazione grant-making: l'esperienza della Compagnia di San Paolo, Flavio Brugnoli #159- Cap.VIII L'attività di una fondazione operativa nella cultura: la Fondazione Teatro Regio di Torino, Carlo Carrà #167- Cap.IX L'attività di una fondazione operativa nel sociale: la Fondazione Banco Alimentare Onlus, Roberto Cena #17

Off-label long acting injectable antipsychotics in real-world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction Information on the off-label use of Long-Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on- vs off-label LAIs and predictors of off-label First- or Second-Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off- or on-label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off-label group. Results SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on- and off-label use. Approximately 1 in 4 patients received an off-label prescription. In the off-label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off-label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co-morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

Interventionist Demonstration

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The Red Rider

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Manifestazione interventista

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Night Scene in Piazza Beccaria

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Woman with Absinth

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