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)

Ecological monitoring of physical activity, emotions and daily life activities in schizophrenia: the DiAPAson study

Background: Schizophrenia spectrum disorders (SSD) compromise psychosocial functioning, including daily time use, emotional expression and physical activity (PA). Objective: We performed a cohort study aimed at investigating: (1) the differences in PA, daily activities and emotions between patients with SSD and healthy controls (HC); (2) the strength of the association between these variables and clinical features among patients with SSD. Methods: Ninety-nine patients with SSD (53 residential patients, 46 outpatients) and 111 matched HC were assessed for several clinical variables, and levels of functioning by means of standardised clinical measures. Self-reported daily activities and emotions were assessed with a smartphone application for ecological momentary assessment (EMA), and PA levels were assessed with a wearable accelerometer for 7 consecutive days.FindingsPatients with SSD, especially those living in residential facilities, spent more time being sedentary, and self-reported more sedentary and self-care activities, experiencing higher levels of negative emotions compared with HC. Moreover, higher functioning levels among patients were associated with more time spent in moderate-to-vigorous activity. Conclusions: Sedentary behaviour and negative emotions are particularly critical among patients with SSD and are associated with more impaired clinical outcomes. Clinical implications: Mobile-EMA and wearable sensors are useful for monitoring the daily life of patients with SSD and the level of PA. This population needs to be targeted with specific rehabilitative programmes aimed at improving their commitment to structured daily activities

L’ESPERIENZA DELLE REMS: STATO DELL’ARTE E LE PROSPETTIVE

The application of Law 81/2014 has led to the closure of six Judicial Psychiatric Hospitals (OPG) and placed psychiatric patients whocommitted crimes in the mental health departments care system. The function of the Residences for the Execution of Security Measures(REMS) is residual and temporary. The new system requires a review of the operational practices and the roles of all those called to enforcethe law: magistrates, psychiatrists, experts, lawyers, UEPE (Unit for External Criminal Execution), of the Law Enforcement, of socialservices and local communities. The formulation of a "double pact", one for the treatment and another for the prevention of new crimesand social security, is essential. The possible overshoot of REMS is outlined in favor of personalized treatment paths with Health Budgetin order to promote recovery and social inclusion.L’applicazione della legge 81/2014 ha portato alla chiusura dei sei Ospedali Psichiatrici Giudiziari (OPG) e collocato in pazienti psichiatriciautori di reato nell’ambito dei sistema di cura dei Dipartimenti di Salute Mentale. La funzione delle Residenze per l’Esecuzione delleMisure di Sicurezza (REMS) è residuale e temporanea. Il nuovo sistema richiede una revisione delle prassi operative e dei ruoli di tutti isoggetti chiamati a dare applicazione alla legge: magistrati, psichiatri, periti, avvocati, dell’UEPE (Unità per l’Esecuzione Penale Esterna),delle Forze dell’Ordine, dei servizi sociali e delle comunità locali. Risulta essenziale la formulazione di un “doppio patto”, uno per la curae un altro per la prevenzione di nuovi reati e la sicurezza sociale. Viene delineato il possibile superamento delle REMS in favore di percorsidi cura personalizzati con Budget di Salute al fine di favorire la recovery e l’inclusione sociale

La qualità percepita dagli ospiti della REMS di Casale di Mezzani (PR)

Nella Residenza per l’Esecuzione delle Misure di Sicurezza (REMS) di Casale di Mezzani (PR) si svolgono attività riabilitativeindividuali e di gruppo ispirate al modello della Recovery. Da Ottobre ’15 a Gennaio ’17 gli ospiti hanno compilato 17schede per la rilevazione della soddisfazione utenti e 26 questionari di gradimento delle attività. Essi esprimono maggioresoddisfazione per la qualità dell’assistenza medica (88%), infermieristica (89%), l’accoglienza al momento dell’ingresso (83%)e le relazioni con l’équipe (78%); le attività più gradite sono: la Riunione Residenziale, il gruppo Oltre la Rems, Shiatsu,Salute e Benessere, Musica, Uscite individuali e di gruppo. Il questionario di gradimento è uno strumento utile che evidenziala soddisfazione/insoddisfazione e garantisce la corretta individuazione degli ambiti di intervento per il miglioramento delservizio stesso

Primi risultati del questionario sulle residenze per l’esecuzione delle misure di sicurezza (R.E.M.S.) al tempo del Covid-19

In April 2020, all Italian Residences for the Execution of Security Measures (REMS) received a questionnaire on their activities during the Covid-19 pandemic (90% of response). Only 1 REMS had cases among users while 5 REMS had cases among operators. Good adoption of prevention measures while limited (38.5%) the provision of diagnostic tests. Reduced external activities and visits favoring internal activities, phone and video calls. Low the number of adverse events, self-actingand hetero-injurious actions, no physical restraint and protest action. Collaborations with mental health and judiciary departments worsened. Guidelines and Protocols are needed to maintain care activities, also with the use of new technologies both in rehabilitation and in relations with Mental Health and Judiciary Departments.Nell’aprile 2020 tutte le Residenze per l’Esecuzione delle Misure di Sicurezza (REMS) italiane hanno ricevuto un questionario sulle loro attività durante la pandemia Covid-19 (risposta 90%).Solo 1 REMS ha avuto casitra gli utenti mentre 5 REMS hanno registrato casi tra gli operatori. Buona l’adozione di misure di prevenzione mentre limitata (38,5%) la dotazione di test diagnostici. Ridotte le attività esterne e le visite privilegiando le attività interne, telefonate e videochiamate. Basso il numero di eventi avversi, agiti auto ed eterolesivi, nessuna contenzione fisica e azione di protesta. Peggiorate le collaborazioni con Dipartimenti di Salute Mentale e Magistratura.Emerge la necessità di Linee Guida e Protocolli per mantenere le attività di cura, anche con l’utilizzo di nuove tecnologie sia nella riabilitazione che nei rapporti con Dipartimenti di Salute Mentale e Magistratura