104 research outputs found
Effectiveness of 1-year treatment with long-acting formulation of aripiprazole, haloperidol, or paliperidone in patients with schizophrenia: retrospective study in a real-world clinical setting
Background: Schizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses
after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level
variability compared to corresponding oral preparations.
Purpose: To compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate
(PP-OM).
Methods: We retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012
to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent
consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months
before and after LAI implementation. Data were statistically analyzed.
Results: The three LAI groups differed significantly only for âneed for economic support from social serviceâ (more frequent in the Hal-D group) and âschizoaffective disorderâ (prevalent
in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 monthsâ
treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (P,0.001) and overlapping clinical and
functioning improvement-scale scores (P,0.001), and 14.28% of patients dropped out, with no difference among the three LAI-APDs. Different kinds of adverse effects, though similar
for number and severity, were reported in the three LAI groups.
Conclusion: Our results suggest that both first- and second-generation LAI-APDs represent important therapeutic options, useful for improving schizophreniaâs clinical course and its
economic burden. Our study, which offers a wide and comprehensive observation of real-world clinical settings, combined an effectiveness evaluation through mirror analysis performed for
each individual patient to a subsequent comparison among the three LAI-APDs, allowing us a more complete evaluation of clinical efficacy
Attitude towards drug therapy in a Community Mental Health Center evaluated by the Drug Attitude Inventory
Introduction: Negative attitude towards drug therapy can foster limited adherence to
treatment, which remains one of the biggest obstacles for implementing effective treatments,
especially long term.
Purposes: The purposes of the study were 1) to evaluate the attitude towards drug therapy
among a representative sample of patients treated in a community psychiatric service using
30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying
factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated
to DAI-30 score and factors.
Methods: The DAI was administered, over a 7-month period, to all patients treated in our
psychiatric outpatient services who agreed to participate in this study and provided their
informed consent. Data were statistically analyzed.
Results: With a response rate of 63.3%, 164 females and 136 males completed the DAI-30
with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards
drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability
(Cronbachâs alpha=0.84). Our factorial analysis highlighted three factors: Factor 1
(Cronbachâs alpha=0.81), composed of 7 items which indicate positive, trustful attitude;
Factor 2 (Cronbachâs alpha=0.78), composed of 5 items indicating negative attitude of
suspiciousness; and Factor 3 (Cronbachâs alpha=0.66), composed of 4 items suggesting
defensive and control attitude towards drug therapy.
Discussion: Among the selected variables, âmonotherapyâ and âtotal number of hospitalizationsâ
were negatively correlated to the final score of DAI-30, whereas being âmarriedâ
was positively correlated to it, in a statistically significant way, using the multiple linear
regression model. These correlations suggest that positive attitude towards drug therapy
could be reinforced by the condition of being married and reduced by relapses with
hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which
could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric
service, potentially correlated to the long-term treatments of our patients
ADHD Follow-Up in Adulthood among Subjects Treated for the Disorder in a Child and Adolescent Mental Health Service from 1995 to 2015
Background and Objectives: ADHD is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity and can persist in adulthood. The aim of this study is to deepen knowledge about adult ADHD follow-up. Materials and Methods: This observational study consists of one retrospective part aimed at collecting records of children and adolescents treated for ADHD in the Children and Adolescent Mental Health Service (CAMHS) from 1995 to 2015 and, successively, at identifying their adult follow-up in Adult Mental Health Service (AMHS); the second part consists of ADHD scale administration, Diagnostic Interview for ADHD in Adults (DIVA 2-0)
and Adult Self Rating Scale (ASRSv1.1), for the subjects currently being treated at AMHS who agreed to participate in the study. Results: We observed that among the 55 patients treated at CAMHS between 1995 and 2015 for ADHD and subsequently at the AMHS, none presented a diagnosis of ADHD; instead, they were treated for Intellectual Dysfunction (33%), Borderline Personality Disorder (15%) and Anxiety Disorders (9%), and two individuals were also diagnosed with comorbid substance/alcohol abuse (4%). Of the 55 patients, only 25 (45%) were treated at AMHS during the study period. Though we asked for their informed consent to administer the questionnaires, we were
able to test only seven patients. The ASRS-V1.1 score showed that 43% of patients reported symptoms of ADHD persistence in adulthood. For DIVA 2.0, 57% of individuals reported scores indicating the persistence of the ADHD inattention component, and 43% the persistence of both ADHD dimensions.
Conclusions: ADHD cannot be considered a disorder confined to childhood/adolescence but instead is a chronic and complex condition that can persist into adulthood. The very small size of our final sample may account for both the high ADHD dropout rate over the long follow-up period and the difficult transition from child to adult health care in ADHD treatment. Our investigation suggests the need for specific training in the diagnosis and treatment of adult ADHD and the implementation of transition protocols between minor and adult services to improve long-term treatments
Perceptions of Caring Behavior Among Undergraduate Nursing Students: A Three-Cohort Observational Study
Introduction: Increase in the knowledge of âcaring scienceâ among nurses plays a key role in ensuring a correct caring behavior towards patients. Caring training for students is
a priority in nursing education, but unfortunately there are limited and conflicting studies which explore this outcome. The purpose of this observational study was to explore the
perceptions of caring behaviors by nursing students during their clinical practice training in order to highlight if the level of caring behaviors changes as the nursing course progresses.
Materials and Methods: The Caring Behaviors Inventory-24 (CBI-24) was administered to 331 students, enrolled in the three years of an Italian Nursing Course, who accepted to
participate in the study (89.2% response rate). The data were analyzed using SPSS software version 26.0 (SPSS Inc., Chicago, IL).
Results: The total mean score of CBI-24 was 4.82 in the first, 5.12 in the second and 5.26 in the third-year students. The CBI-24 dimensions âResponding to individual needsâ and
âBeing withâ obtained the highest scores among the students of the first year. At the end of the first year, our students were already able to perform expressive caring, whereas
instrumental caring developed at a high level in the second and third years. We did not highlight any statistically significant difference between the two gender CBI-24 item scores.
Conclusion: In light of our results, we put in evidence that Nursing Degree Programme favours the development in students of both relational and technical components of caring
behaviors. We hope that in future studentsâ self-assessment of caring behaviors could be considered an educational outcome for Nursing Programme
Group therapy with peer support provider participation in an acute psychiatric ward: 1-year analysis
Background: Group psychotherapy improves therapeutic process, fosters identification
with others, and increases illness awareness; (2) Methods: In 40 weekly group sessions held in an
acute psychiatric ward during one year, we retrospectively evaluated the inpatientsâ participation
and the demographic and clinical variables of the individuals hospitalized in the ward, the group
type according to Bionâs assumptions, the main narrative themes expressed, and the mentalization
processes by using the Mentalization-Based Therapy-Group Adherence and Quality Scale (MBT-GAQS); (3) Results: The âworkingâ group was the prevailing one, and the most represented narrative
theme was âtreatment programsâ; statistically significant correlations were found between the group
types according to Bionâs assumptions and the main narrative themes (Fisherâs exact, p = 0.007); at
our multivariate linear regression, the MBT-G-AQS overall occurrence score (dependent variable) was
positively correlated with the number of group participants (coef. = 14.87; p = 0.011) and negatively
with the number of participants speaking in groups (coef. = â16.87, p = 0.025); (4) Conclusion: our
study suggests that the group shows consistent defense mechanisms, relationships, mentalization,
and narrative themes, which can also maintain a therapeutic function in an acute ward
Evaluation of an interprofessional education intervention in partnership with patient educators
Background and aim of the work: Patient involvement in interprofessional education is a novel approach to building collaborative and empathic skills in students. However, this area of teaching is lacking in
rigorous studies. The project aimed to evaluate whether an interprofessional education intervention in partnership with patient educators (IPE-PE) would increase readiness for interprofessional learning and empathy
in health sciences students. Methods: This is the report of a didactic innovation project. Participants included
310 undergraduate health sciences students who took part in an IPE-PE intervention. Data were collected
before and after the training, using the Readiness for Interprofessional Learning Scale (RIPLS) and the
Jefferson Scale of Empathy-Health Professions Student version ( JSE-HPS). Only at the end of the intervention, a data collection form was administered to explore the value of the patient educator in the training and
to investigate the socio-demographic variables. Results: The mean age of participants was 21±3.2 SD years and
76% were female. The Wilcoxon signed-rank test showed significant changes from before to after the IPE-PE
in the RIPLS total score (m=42.7±5.8 SD vs 44.62±5.9 SD, z=-4.168, P<0.001) and in the JSE-HPS total
score (m=112.7±12.5 SD vs 116.03±12.8 SD, z=-4.052, P<0.001). Conclusions: Our students reported that
IPE-PE had helped them to become more effective healthcare team members, to think positively about other
professionals, and to gain an empathic understanding of the perspective of the person being cared for. The
results of the project confirm that the intervention promoted the development of empathy, fostering a better
understanding of the patient-centred perspective
Early death in Munchausen Syndrome: a case report
This case contributes to raising awareness and understanding of the complex clinical presentations of Munchausen syndrome (MS). Education of staff to the seriousness and genuineness of this disorder should be implemented, especially in hospital units, in order to detect such complex clinical situations quickly and accurately, preventing iatrogenic risks
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