Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study

BACKGROUND: Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). METHOD: Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). RESULTS: 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. CONCLUSION: Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients

Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology) survey

<p>Abstract</p> <p>Background</p> <p>The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits and psychiatric diagnoses; and (ii) to assess the clinical management, subjective wellbeing and attitudes toward medications.</p> <p>Methods</p> <p>A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period.</p> <p>Results</p> <p>Almost half of patients (46%) showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%), than in aggression toward other people (20%). A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%), followed by depression (16%) and personality disorders (14%), and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge), while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge) and depression (41 vs 32% during stay and 44 vs 25% at discharge). Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%). Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self-reported compliance increased during hospital stay.</p> <p>Conclusion</p> <p>Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.</p

Quantification of allyl hexanoate in pineapple beverages and yogurts as a case study to characterise a source of uncertainty in dietary exposure assessment to flavouring substances

One source of uncertainty in the estimation of dietary exposure to flavouring substances is the uncertainty in the occurrence and concentration levels of these substances naturally present or added to foodstuffs. The aim of this study was to assess the variability of concentration levels of allyl hexanoate, considered as a case study, in two main food categories to which it is often added: pineapple juice-based beverages and yogurts containing pineapple. Thirty-four beverages and 29 yogurts, with pineapple fruit or juice and added flavourings declared as ingredients on the package, were purchased from the local market (in Rome) and analysed. Analytical methods based on the stir bar sorptive extraction (SBSE) technique for the isolation of the target analyte, and on GC-MS analysis for final determination, were developed for the two food categories. In beverages, allyl hexanoate concentrations ranged from less than 0.01 to 16.71mg l(-1), whereas in yogurts they ranged from 0.02 to 89.41 mg kg(-1). Average concentrations in beverages and yogurts with pineapple as the main fruit ingredient (1.91 mg l(-1) for beverages, 9.61 mg kg(-1) for yogurts) were in fair agreement with average use level data reported from industry surveys for the relevant food categories (4.5 and 6.0 mg kg(-1), respectively). Within the group of yogurts a single product was found to contain a level of allyl hexanoate more than 10-fold higher than the average reported use level. The screening techniques developed by the European Food Safety Authority (EFSA) using use level data provided by industry gave estimates of exposure that were of the same order of magnitude as the estimates obtained for regular consumers who would be loyal to the pineapple yogurt and beverage products containing the highest observed concentration of the substance of interest. In this specific case the uncertainty in the results obtained with the use of standard screening techniques for exposure assessment based on industry reported use levels is low

Commercial fertilizers and organoleptic quality of organically grown apple fruits (cv Golden delicious)

In the organic production only organic fertilizers can be used to supply the soil with nitrogen. The mineralization of these products is slow causing a problem with the nitrogen supply when the demands of the plants is high. Italy is the main producer of organic apples in Europe (about 42,000 MT on 115,000 MT in 2006). More then 60% of the organic apples produced in Italy are grown in Alto Adige region (North-East of Italy). In this region problems with nitrogen supply to apple plants in spring are common. In spring the demand of nitrogen of the apple trees in Alto Adige is high, but the weather conditions are often bad and the temperature of the soil is slow. In these conditions the mineralization of the organic fertilizers starts slowly, the trees own reserves may become exhausted, the nitrogen supply from the mineralization of the soil organic matter is not yet sufficient. Therefore, it is important to supply the plants timely in spring with fertilizer nitrogen. The objective of this work was to determine the effect of various commercial fertilizers used for organic apple growing and the conditions of their use on the organic acid and sugar composition and on the formation of volatile compounds in fruits of Golden delicious cultivar. The fruits were grown in the experimental fields of the Centro di Sperimentazione Agraria e Forestale Laimburg, in Alto Adige region. In addition, fruits from a plot without the use of fertilizer (“control”) and a plot where a mineral fertilizer (“ammonium sulphate”) were grown in Laimburg, harvested and analyzed for comparison. Malic, oxalic and citric acid were the organic acids detected; fructose, glucose and sucrose the sugars identified and quantified. Higher levels of organic acids and sugars were found in the “control “and “ammonium sulphate” samples. The different conditions of fertilization seemed to significantly affect the formation of some aroma volatile compounds. Considering the three main key odorants, butyl acetate level was higher in the “compost + biogas slurry” sample and in the “control”; a higher level of hexyl acetate was found in the “control” only. For both compounds lower levels were found in the “ammonium sulphate” sample and in one of the organic fertilizer “Azocor 105” treatment. No differences were found in the level of 2-methylbutyl acetate. Aknowledgement: Work carried out in the project “Qualità nutrizionale ed organolettica e impatto ambientale di produzioni biologiche. Un caso studio: il melo”, funded by Ministero delle Politiche Agricole Alimentari e Forestal

Effects of different organic and conventional fertilisers on flavour related quality attributes of cv. Golden Delicious apples

Abstract The effects of the application of different organic and conventional fertilisers on some flavour quality attributes (aroma volatiles, sugars and organic acids) of cv. Golden Delicious apples were investigated by an experimental field trial in two harvest years (2010 and 2012). Through a balanced randomised block design, five organic fertilisation treatments (three different fertilisers at the same nitrogen dose, increase and fractionation of dose for one of the fertiliser) were compared to each other, to a conventional treatment based on a mineral fertiliser and to a non-fertilised control. Fertilisation treatments significantly affected the level in fruits of several flavour related compounds, such as some aroma volatiles, sugars and organic acids, but few of these responses were consistent across the two harvest years and of remarkable size. Even when treatments gave place to marked differences in the soil mineral nitrogen level, this reflected in a limited impact on flavour related compounds in the fruit, the strongest effect being a 45% change in C6-aldehydes level. The different organic fertilisation treatments weakly affected the considered fruit quality attributes. Significant differences were observed for several sensory attributes between apples coming from different fertilisation treatments and characterised by a quite similar chemical profile

Patterns of care in patients discharged from acute psychiatric inpatient facilities

Objective: To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care. Methods: Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004. Results: About one half of the samplehad schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (&gt;60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients' discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects. Conclusions: This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care. \ua9 Steinkopff Verlag Darmstadt 2009