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

Pecuniary Knowledge Externalities in a New Taxonomy: Knowledge Interactions in a Vertically Integrated System

The paper presents a new sectoral taxonomy that focuses on the existence of non negligible external effects, deriving from user-producer knowledge interactions, the latter in turn coupled with intermediate goods transactions, in a system of vertically integrated manufacturing and services sectors. These externalities, the so called pecuniary knowledge externalities, are the main source of changing technological conditions experienced by downstream producers. A distinguishing feature of the taxonomy consists, thus, in being derived from a particularly dynamic contexts of changing production functions. The taxonomy is obtained from an empirical exercise, examining effects generated by idiosyncratic knowledge in a system of input-output intermediate transactions between sectors in the European economy. The results permit to classify sectors in five groups, confirming the previous evidence of relevant differences in technological characteristics among sectors

Periferie tra crescita, diversità e diseguaglianze. Apprendere dall’arcipelago Milano

Il tema delle periferie si è posto nel periodo recente all’attenzione dei ricercatori, del dibattito politico e delle istituzioni. Milano, in controtendenza rispetto alle dinamiche recessive che hanno interessato il Paese, ha sperimentato nell’ultimo decennio movimenti positivi di sviluppo, ma al tempo stesso si trova a confrontarsi con il permanere e l’ac- centuarsi di problemi di declino e degrado di parti importanti dell’area urbana e con l’emergere di forme vecchie e nuove di emarginazione e povertà che pongono nuove domande di politiche e rendono più palesi i divari in termini di diritti di cittadinanza, di accesso alla casa, ai servizi e alle opportunità di crescita

Politiche giovanili innovative a base territoriale: i protagonisti, le pratiche e le sfide. Una visione a supporto del programma triennale di intervento di Fondazione di Comunità Milano [Report della ricerca “Giovani e Milano. Un percorso di ricerca-azione tra protagonismo, politiche, spazi e territorio”]

Report della ricerca “Giovani e Milano. Un percorso di ricerca-azione tra protagonismo, politiche, spazi e territorio” Il progetto ha sviluppato un percorso di ricerca-azione per supportare l’intervento di Fondazione di Comunità a sostegno dei giovani a Milano. Questo appare un tema attuale e urgente per diverse ragioni. Da una parte, la città fatica ad esprimere programmi e strumenti che individuino i giovani come destinatari e ne attivino il protagonismo, rischiando di escludere di fatto chi ha meno esperienze. Bandi e risorse pubbliche spesso si rivolgono a persone e organizzazioni con competenze di progettazione consolidate, o con capacità finanziarie di garanzia e anticipo di spesa che inibiscono la partecipazione di gruppi informali e giovani inesperti. Dall’altra parte, una nuova generazione di giovani solleva temi, questioni e istanze che interrogano le traiettorie di sviluppo e il nostro futuro comune. Una generazione che esprime con determinazione un monito urgente rispetto alla crisi ambientale e climatica, si affaccia oggi, dopo due anni di pandemia e lockdown, su un mondo in cui le disuguaglianze sono in crescita e la ricchezza è sempre più polarizzata, ed il futuro è tutt’altro che certo. Dalla digitalizzazione all’identità di genere, i giovani di oggi non sono quelli di ieri. Quali sono i bisogni delle nuove generazioni e come si esprimono? Quale dimensione spaziale e aggregativa determinano nel tessuto urbano? Che modalità di intervento e quali strumenti possono mettere in campo enti e attori della città di Milano per supportare le nuove idee e domande di socialità, produzione, cultura… Quali sono le nuove domande di città che emergono dai giovani di oggi

Spatial (in)justice in pandemic times: bottom-up mobilizations in dialogue

Marginal urban areas already subject to unequal distribution of welfare facilities and socioeconomic opportunities were badly hit by the Covid-19 pandemic. Taking from a spatial justice perspective, this paper looks at Milan and Rio de Janeiro, two very different and yet similar cities concerning their disadvantaged communities, focusing on the impacts of the virus, the consequent bottom-up mobilizations and collective actions in poor neighbourhoods. It finally draws on possible lessons to learn from their examples