Is depressed mood clinically relevant at the onset of schizophrenia? A longitudinal study.

Aim: Depressed mood (DM) in schizophrenia is often associated with suicide risk and poor outcomes. However, it is generally overlooked in clinical practice, especially in First Episode Schizophrenia (FES). The aims of this investigation were: (1) to calculate baseline prevalence of FES patients with relevant DM, (2) to longitudinally monitor DM severity levels over a 12-month follow-up, and (3) to investigate their associations with clinical data and the specific treatment components of an “Early Intervention in Psychosis” (EIP) program. Material and Methods: The Positive and Negative Syndrome Scale (PANSS) was completed by all FES participant. Individuals with a baseline PANSS “Depression” item subscore of ≥ 5 were classified as having relevant depressed mood (FES/DM+). Chi-square and Mann-Whitney tests were used for inter-group comparisons. A linear regression analysis was also performed. Results: Fifty-three (33.3%) participants were in the FES/DM+ subgroup. Relevant DM at baseline was associated with female gender and a higher PANSS “Positive Symptoms” score. Across the follow-up, FES individuals improved their DM severity levels. This was significantly related to a longitudinal decrease in PANSS “Positive Symptoms” levels. Conclusions: DM is relatively frequent in FES, already at the recruitment in EIP services. However, its severity decreases overtime within specialized EIP programs

DEPRESSIVE FEATURES IN INDIVIDUALS WITH FIRST EPISODE PSYCHOSIS: PSYCHOPATHOLOGICAL AND TREATMENT CONSIDERATIONS FROM A 2-YEAR FOLLOW-UP STUDY

Objective: Comorbid depression is quite common in early psychosis and specifically related to suicidal behavior and poor long-term outcomes. However, Depressive Symptoms (DS) are often neglected in both research and treatment, especially at the psychosis onset. The goals of this investigation were: (a) to longitudinally explore DS levels in patients with First Episode Psychosis (FEP) during 24 months of follow-up, and (b) to investigate the associations of DS with psychopathology and intervention components of an “Early Intervention in Psychosis” (EIP) program across the follow-up period. Method: The Global Assessment of Functioning (GAF) and the Positive And Negative Syndrome Scale (PANSS) were completed by 266 FEP subjects. A linear regression analysis with DS as the dependent parameter and psychopathological and treatment characteristics as independent variables was performed (both at baseline and across the follow-up period). Results: DS had enduring associations with PANSS “Positive Symptoms” and “Negative Symptoms” subscores. During the investigation, FEP subjects significantly improved their DS severity levels. This was related to the number of individual psychotherapy meetings supplied within the EIP protocol, as well as to a higher antidepressant dose and a lower antipsychotic dose prescribed during the follow-up. Conclusions: DS are quite prominent in FEP, even at the recruitment time in EIP services. Nevertheless, DS severity tends to diminish overtime, especially with the provision of specialized EIP treatments

Short‑term disengagement from early intervention service for first‑episode psychosis: findings from the “Parma Early Psychosis” program.

tors of engagement is crucial to maximize mental healthcare interventions in first-episode psychosis (FEP). No Italian study on this topic has been reported to date. Thus, the aims of this investigation were: (1) to examine short-term disengagement rate in an Italian population of FEP patients treated within an EIP service across a 1-year follow-up period, and (b) to assess the most relevant predictors of disengagement in the first year of treatment. Methods All participants were young FEP help-seeking patients, aged 12–35 years, enrolled within the “Parma Early Psychosis” (Pr-EP) protocol. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS), the Health of the Nation Outcome Scale (HoNOS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were used. Results 496 FEP individuals were enrolled in this research. Across the follow-up, a 16.5% prevalence of short-term disengagement was found. Particularly robust predictors of service disengagement were poor baseline treatment non-adherence, living with parents and the presence of brief psychotic disorder or schizophreniform disorder at entry. Conclusion About 16% of FEP patients disengaged the Pr-EP program within the first year of treatment. A solution to reduce disengagement and/or to favor re-engagement of these subjects might be to remain on EIP program caseloads allowing the option for low-intensity support and monitoring, also via remote technology

Presentation of the "Parma Scale" for treatment evaluation in offenders with mental disorders: Presentazione della “Scala di Parma” per la valutazione evolutiva del paziente psichiatrico autore di reato

Routine treatment evaluation is still poorly implemented in the Italian forensic psychiatric practice. This is also a lack of reliable instruments, especially those sufficiently specific and sensitive to longitudinally measure behavioral and functional changes. Moreover, among the very few assessment tools specifically designed to investigate treatment progress of offenders with mental disorders and the changeability of their problematic/protective behaviors, the vast majority were developed in non-Italian countries and cultures. Therefore, given the high specificity of the Italian forensic psychiatric framework, the aim of this paper was to present a new Italian instrument, the “Parma Scale” for treatment evaluation of offenders with mental disorders, which was developed as a quick and easy forensic tool specifically designed for a dynamic assessment of treatment plans (supported by hope and oriented towards a functional, personal and social recovery) and for an accurate application in different forensic psychiatric settings.La valutazione routinaria degli esiti di trattamento con i pazienti psichiatrici autori di reato è una prassi ancora scarsamente attuata nella pratica forense italiana. Ciò è dovuto anche alla mancanza di strumenti valutativi affidabili, in particolare di scale sufficientemente sensibili e specifiche per misurare i cambiamenti clinici, comportamentali e funzionali longitudinali, ovvero in corso di trattamento. Inoltre, sebbene siano pochissimi gli strumenti di valutazione specificatamente progettati per indagare l’andamento temporale del trattamento dei pazienti psichiatrici autori di reato e l’impatto degli inter-venti sui loro comportamenti problematici/protettivi, la stragrande maggioranza di essi è stata svilup-pata in paesi e culture non italiane, ove sono tuttora presenti ospedali psichiatrici giudiziari. Pertanto, data l’elevata specificità del quadro psichiatrico-forense italiano, obiettivo di questo lavoro è quello di presentare la “Scala di Parma” per la valutazione evolutiva dei pazienti psichiatrici autori di reato, da intendersi come strumento forense di facile e rapida somministrazione, specificamente progettato per una valutazione dinamica dei piani di trattamento (sostenuti dalla speranza ed orientati alla recovery funzionale, personale e sociale) e per una puntuale applicazione nei molteplici contesti psichia-trico-forensi attuali (cioè carcere, REMS, paziente in percorso territoriale)

A public early intervention approach to first-episode psychosis: treated incidence over 7 years in the Emilia-Romagna region.

Aim: To estimate the treated incidence of individuals with first-episode psychosis (FEP) who contacted the Emilia-Romagna public mental healthcare system (Italy); to examine the variability of incidence and user characteristics across centres and years. Methods: We computed the raw treated incidence in 2013–2019, based on FEP users aged 18–35, seen within or outside the regional program for FEP. We modelled FEP incidence across 10 catchment areas and 7 years using Bayesian Poisson and Negative Binomial Generalized Linear Models of varying complexity. We explored associations between user characteristics, study centre and year comparing variables and socioclinical clusters of subjects. Results: Thousand three hundred and eighteen individuals were treated for FEP (raw incidence: 25.3 / 100.000 inhabitant year, IQR: 15.3). A Negative Binomial location-scale model with area, population density and year as predictors found that incidence and its variability changed across centres (Bologna: 36.55; 95% CrI: 30.39–43.86; Imola: 3.07; 95% CrI: 1.61–4.99) but did not follow linear temporal trends or density. Centers were associated with different user age, gender, migrant status, occupation, living conditions and cluster distribution. Year was associated negatively with HoNOS score (R = 0.09, p < .001), duration of untreated psychosis (R = 0.12, p < .001) and referral type. Conclusions: The Emilia-Romagna region presents a relatively high but variable incidence of FEP across areas, but not in time. More granular information on social, ethnic and cultural factors may increase the level of explanation and prediction of FEP incidence and characteristics, shedding light on social and healthcare factors influencing FEP

Family burden, emotional distress and service satisfaction in first episode psychosis. Data from the GET UP trial

Background: Literature has documented the role of family in the outcome of chronic schizophrenia. In the light of this, family interventions (FIs) are becoming an integral component of treatment for psychosis. The First Episode of Psychosis (FEP) is the period when most of the changes in family atmosphere are observed; unfortunately, few studies on the relatives are available. Objective: To explore burden of care and emotional distress at baseline and at 9-month follow-up and the levels of service satisfaction at follow-up in the two groups of relatives (experimental treatment EXP vs. treatment as usual TAU) recruited in the cluster-randomized controlled GET UP PIANO trial. Methods: The experimental treatment was provided by routine public Community Mental Health Centers (Italian National Health Service) and consisted of Treatment as Usual plus evidence-based additional treatment (Cognitive Behavioral Therapy for psychosis for patients, Family Intervention for psychosis, and Case Management). TAU consisted of personalized outpatient psychopharmacological treatment, combined with non-specific supportive clinical management and informal support/educational sessions for families. The outcomes on relatives were assessed by the Involvement Evaluation Questionnaire (IEQ-EU), the General Health Questionnaire (GHQ-12), and the Verona Service Satisfaction Scale (VSSS-EU). Differences within and between groups were evaluated. Results: At baseline, 75 TAU and 185 EXP caregivers were assessed. In the experimental group 92% of relatives participated in at least 1 family session. At follow-up both groups experienced improvement in all IEQ and GHQ items, but caregivers belonging to the EXP arm experienced a significantly greater change in 10 IEQ items (mainly pertaining to the "Tension" dimension) and in GHQ items. Due to the low sample size, a significant effectiveness was only observed for 2 IEQ items and 1 GHQ-12 item. With respect to VSSS data at follow-up, caregivers in the EXP arm experienced significantly greater satisfaction in 8 items, almost all pertaining to the dimensions "Relatives' Involvement" and "Professionals' Skills and Behavior." Conclusions: The Family intervention for psychosis delivered in the GET UP PIANO trial reduced family burden of illness and improved emotional distress and satisfaction with services. These results should encourage to promote FIs on caregivers of first-episode psychosis patients

Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum~disorders

Background Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. Methods Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. Results Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. Conclusions Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery

Rates and predictors of service disengagement in adolescents with first episode psychosis: results from the 2‐year follow‐up of the Pr‐EP program.

Service disengagement is a major concern for “Early Intervention in Psychosis” (EIP). Indeed, understanding predictors of engagement is important for the efectiveness of mental health interventions, to improve outcome and quality of life, also in adolescents with frst episode psychosis (FEP). No specifc European investigation on this topic in adolescence has been reported in the literature to date. The aim of this study was to investigate service disengagement rate and predictors in an Italian sample of FEP adolescents treated within an EIP program during a 2-year follow-up period. All participants were adolescents help-seekers (aged 12–18 years) enrolled in the “Parma Early Psychosis” (Pr-EP) program. At baseline, they completed the Positive and Negative Syndrome Scale (PANSS) and the global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were performed. 71 FEP adolescents were recruited in this research. During the 2 years of our follow-up, a 25.4% prevalence rate of service disengagement was found. Particularly robust predictors of disengagement were lower baseline acceptance of psychosocial interventions, substance abuse at entry, and lower baseline PANSS “Disorganization” factor score. Approximately, 1/4 of our FEP adolescents disengaged from the Pr-EP program during the frst 2 years of treatment. A possible solution to decrease disengagement and to favor re-engagement of these young individuals might be to provide the option of low-intensity monitoring and support, also via remote technology