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

Personality disorders and self-perceived quality of life in an elderly psychiatric outpatient population

The aim of this work was to assess the impact of personality disorder and traits on the subjective assessment of quality of life by a sample of elderly psychiatric outpatients (60 years or more). Sixty of the total number of subjects interviewed were included in the test sample since they met the Vragenlijst Klinishe Persoonlijkheid (VKP) criteria for personality disorder. A control sample was also formed, composed of 50 subjects without personality disorders or traits. Quality of life was assessed using the LEIPAD questionnaire. Personality disorder diagnoses were prevalently distributed in cluster C (25%) and in cluster A (20%). A total of 48.3% of patients (n = 29) had more than 1 personality disorder. Sixty percent of the sample (n = 36) presented with comorbid Axis I psychiatric disorders, in most cases depressive pathologies. Comparing the case and control groups, worse LEIPAD scores were achieved by subjects with personality disorders. Between clusters of personality disorders, the worst scores were observed in subjects with more than 1 personality disorder diagnosis. Elderly people who presented with a personality disorder were more vulnerable to late-life distress, especially those with more than one diagnosis. In keeping with linear regression analysis, widowhood, divorcehood and living with others appear to be variables able to negatively influence quality of life in this population., While the VKP needs to be adapted to the application in the elderly, it does seem to be a particularly useful screening instrument. Copyrigh

Life satisfaction in late life: Markers and predictors of level and change among 80+ year olds

The overall aim of the thesis was to examine within-individual and between-individual changes in life satisfaction in the oldest-old using different time metrics and to study life satisfaction within the context of psychosocial and health-related variables. Data were obtained from the Swedish OCTO-Twin Study of individuals aged 80 and older who were able to complete the Life Satisfaction Index-Z (LSI-Z). In Study I the association between life satisfaction and scales and questions regarding demographics, self-rated overall health and medically based health, functional capacity (instrumental and personal activities of daily living), cognitive function, depression, locus of control, and social network was investigated. Analyses indicated that social network quality, self-rated overall health, sense of being in control of one’s life, widowhood, and depressive symptoms were associated with life satisfaction. A gender-specific pattern was found; self-rated overall health and depressive symptoms were related to life satisfaction in women, whereas widowhood was significantly associated with lower satisfaction among men. In Study II the associates identified in Study I; perceived quality of social network, self-rated overall health, depressive symptoms, locus of control, and widowhood, in addition to financial satisfaction and the personality traits neuroticism and extraversion, were investigated as predictors of change in life satisfaction across four measurements over a 6-year period. Growth curve analysis showed a fairly consistent significant linear decline in life satisfaction. Certain markers predicted decrease in life satisfaction; the loss of spouse, particularly in men, and higher levels of depressive symptoms. Results suggest that life satisfaction is influenced by changes in psychosocial variables although there is an overall stability in level of life satisfaction in the oldest old. In Study III different time metrics were examined in the study of late life changes in life satisfaction. Findings of age-graded stability of life satisfaction, despite health-related losses distinctive of the oldest old, suggest that mortality-related processes could be more influential than chronological age. The study investigated changes in life satisfaction at 4 measurement occasions over a 6-year period using two competing parameterizations of time, chronological age and time-to-death. Growth curve analyses showed a linear decrease in both time-structures, but the time-to-death metric revealed a significantly better model fit. Notably, age, gender, SES, years to death, level or change in overall load of disease and self-rated health did not predict time-to-death related changes. Lower overall disease load was, however, related to higher levels of life satisfaction. In individuals with higher disease load, an external locus of control was related to lower satisfaction with life. Among those who rated their health as poor, a higher level of neuroticism was related to lower life satisfaction. The results suggest that a time-to-death metric was superior to chronological age to predict change in life satisfaction. In Study IV the relationships between life satisfaction and 25 specific chronic diagnoses were investigated. Problems with sleep, urinary incontinence and stroke were significantly related to life satisfaction in both men and women. Among men, angina pectoris and eczema were related to lower life satisfaction, whereas among women peptic ulcer was related to lower life satisfaction. The results confirm previous findings of a weak relationship between medically based measures of health and life satisfaction. However, health care and future studies of health and life satisfaction need to recognize and address that the meaning and consequences of various diseases may differ among individuals and that gender differences should be considered in this context. Overall findings from the thesis demonstrate a homogenous decline in life satisfaction in the oldest-old. Despite health-related losses, social network and personal resources accounted for substantial inter-individual differences in life satisfaction. The thesis demonstrated the need to analyse associates of life satisfaction at the intra-individual level and within a broader context of psychosocial and health-related variables also in late lif

Repetition of suicidal behaviour in elderly Europeans: a prospective longitudinal study

The aim of this study was to assess any predictive factors for repeated attempted suicide and completed suicide in a 1-year follow-up on a sample of elderly European suicide attempters (60 years and over). From 1990 to 1993, 63 subjects completed the first interview and were recontacted after 1 year. At follow-up, eight subjects (12.7%) had taken their lives and seven (11.1%) had repeated at least one suicide attempt. On comparison of repeaters and non-repeaters, differences emerged in terms of death of the father in childhood and for mean Suicidal Intent Score. At the end of follow-up period, repeaters reported a more frequent desire to repeat suicidal behaviour and judged their mental health and social assistance received to be worse. Suicides and non-repeaters differed especially in relation to death of father during childhood and number of contacts with General Practitioner. Interpretation of the results must take into account the smallness of the test sample, the difficulties in obtaining complete data for the follow-up interview, the lack of a control group and a diagnosis formulated in a hospital consultation setting. The study confirms, however, the high risk of repetition of suicidal behaviour in the elderly. In old age suicidal ideation is often sustained over long periods of time and requests for help are addressed to relatives and GPs. An interesting finding is the more frequent death of the father during childhood among repeaters. © 2002 Elsevier Science B.V. All rights reserved

Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behaviour.

OBJECTIVE: The authors present an analysis of findings for the 65 years and over age group from the WHO/EURO Multicentre Study of Suicidal Behaviour (1989-93). METHODS: Multinational data on non-fatal suicidal behaviour is derived from 1518 subjects in 16 European centres. Local district data on suicide were available from 10 of the collaborating centres. RESULTS: Stockholm (Sweden), Pontoise (France) and Oxford (UK) had the highest suicide attempts rates. In most centres, the majority of elderly who attempted suicide were widow(er)s, often living alone, who used predominantly voluntary drug ingestion. Non-fatal suicidal behaviour decreased with increasing age, whereas suicide rates rose. The ratio between fatal and non-fatal behaviours was 1:2, that for males/females almost 1:1. In the years considered, substantial stability in suicide and attempted suicide rates was observed. As their age increased, suicidal subjects displayed only a limited tendency to repeat self-destructive acts. Moreover, there was little correlation between attempted suicide and suicide rates, which carries different clinical implications for non-fatal suicidal behaviour in the elderly compared with younger subjects in the same WHO/EURO study