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

Napoli millenovecento. Dai catasti del XIX secolo ad oggi: la città, il suburbio, le presenze architettoniche

Nel volume si trae spunto da un inedito corpus documentario dell’Archivio di Stato di Napoli e dalla prima mappa catastale della città, conservata presso l’Agenzia del Territorio e mai fatta oggetto di una specifica indagine, per ricostruire la storia del catasto napoletano ed offrire ad enti, studenti e studiosi un utile strumento di lettura della città, sotto i molteplici aspetti delle trasformazioni ed espansioni urbane dell'età contemporanea, della consistenza e tipologia del patrimonio edilizio storico (con la denominazione ed ubicazione di centinaia di presenze architettoniche - palazzi, chiese, fontane, edifici pubblici, masserie, mulini, impianti industriali, ecc. - ancora esistenti o scomparse negli ultimi cento anni), dell'individuazione degli antichi percorsi pluviali, degli insediamenti e borghi della città storica, della rete idrografica e di quella infrastrutturale, ed infine del raffronto tra toponomastica storica ed attuale. Lo studio ha richiesto dunque non solo una lunga ricerca archivistica sulle fonti catastali, ma una difficile indagine articolata sia su base cartografica, sia direttamente sul territorio. Dal punto di vista della ricerca sulle fonti storiche, la documentazione che va dal volgere del XVIII secolo al periodo post-unitario, conservata nei fondi Catasto onciario, Catasto francese e Catasto terreni dell'Archivio di Stato di Napoli, è stata analizzata a tappeto ai fini della ricostruzione dell’intera vicenda catastale della città fino al volgere dell’Ottocento, allorché, con la legge del 1886, fu istituito il catasto geometrico-particellare per tutti i comuni d’Italia. Quest’ultimo rilievo, con riferimento al territorio napoletano, è stato pubblicato integralmente nella seconda parte del volume, insieme con la schedatura dei relativi fogli del catasto terreni (1897-1905), raggruppati per aree storicamente significative e corredati da specifiche legende. Si è infine ritenuto indispensabile, per le parti del territorio cittadino e suburbano oggetto delle trasformazioni più cospicue nel corso dell'ultimo secolo, proporre la sovrapposizione informatizzata della mappa catastale sul rilievo aerofotogrammetrico attuale, in maniera da rendere il più possibile evidenti le trasformazioni della struttura urbana avvenute tra il primo e il secondo dopoguerra. A tale scopo si è pure attinto all’ampio repertorio di foto aeree conservate presso l’archivio dell’Istituto Geografico Militare di Firenze, con riferimento ai voli degli anni 1929, 1943, 1956. A. Buccaro è autore in particolare, nella prima parte del volume, del saggio generale intitolato "Il sistema catastale nello Stato napoletano e in Italia: dal metodo 'descrittivo' murattiano al rilevamento geometrico-particellare postunitario" (pp. 21-32); è inoltre autore dei capitoli primo e terzo della seconda parte