ASSOCIATIONS BETWEEN FUNCTIONAL MILESTONES AND PSYCHIATRIC ADMISSIONS IN AN URBAN AREA: UTILITY OF A CLUSTER-ANALYTICAL APPROACH

Background: The purpose of the study was to identify homogenous subgroups, based upon achievement of two functional milestones (marriage and employment) and Global Assessment of Functioning (GAF) score in a sample of 848 acute patients admitted to the Psychiatric Emergency Service (PES) of the Città della Salute e della Scienza di Torino, during a 24-months period. Subjects and methods: A two-step cluster-analysis, using GAF total score and the achievements in the two milestones as input data was performed. In order to examine whether the identified subgroups differed in external variables that were not included in the clustering process, and consequently to validate the found functional profiles, chi-square tests for categorical variables and analyses of variance (ANOVA) for continuous variables were performed. Results: Five clusters were found. Employed patients (Clusters 4 and 5) had more years of education, less illness chronicity (shorter duration of illness and lower proportion of previous voluntary hospitalizations), lower use of mental health resources in the last year yet higher treatment adherence, larger network size, and higher ordinary discharge. Married inpatients (Clusters 3 and 5) had lower frequencies of substance abuse. Conclusions: The remarkably high rate of unemployment in this inpatients’ sample, and the evidence of associations between unemployment and poorer functioning, argue for further research and development of evidence-based supported employment programs, that put forth diligent effort in helping people obtain work quickly and sustain; they may also help to reduce health care service use among that clientele

Psychiatric symptoms related to the use of lamotrigine: a review of the literature

Lamotrigine is an established anticonvulsant agent and also an effective maintenance therapy for bipolar disorder. In Italy it is approved for the treatment of epilepsy with partial seizures, partial seizures with secondary generalization and generalized seizures, both in monotherapy and as an add-on therapy in patients with refractory epilepsy; it is also approved for the prevention of depressive episodes in patients with bipolar disorder with a predominant depressive component. Lamotrigine is generally well tolerated; however, some psychiatric problems have been reported in patients using the drug to treat mental disorders (mainly bipolar) or epilepsy. The clinical features of these psychiatric side effects are: affective switches, full acute psychotic episodes, and hallucinations. In conclusion, lamotrigine is an effective drug, very useful in the therapy of epilepsy and mood disorders, but clinicians have to be aware of the risk that it can induce psychiatric symptoms or acute episode