Psychiatric consultations in pre-orthoptic liver transplantation patients with substance use disorders: focus on timing of cessation and referral and retention by community service

Introduction: In Italy, 6 months of abstinence from alcohol/substances are required before OLT, evidence for this recommendation remaining controversial. No standard approach linking abstinence duration at the index psychiatric pre-OLT evaluation to referral to Community Services is followed. Aims: To report data of the Modena Consultation-Liaison Psychiatric Service (MCLPS) for pre-OLT patients with Substance Use Disorders (SUDs), and to evaluate patients’ concordance with referrals. Methods: Case-control study. Data source: database of MCLPS. Psychiatric evaluations pre-OLT from 01/01/2008 to 31/12/2013 were extracted. Patients were controls if they had a SUD and abstinent for more than 6 months; cases if they had a SUD with less than 6 months of abstinence. Chi-squared analysis was performed with STATA 13.0. Results: 515 consultations were requested for 309 pre-OLT patients, 36.3% (N=112) of patients had a current or past SUD. Controls were 80 (71.3%), while cases - who had stopped use less than 6 months before the consultation, or were still using- were 20 (17.9%). 52.5% of controls (N=42) and 85.0% of cases (N=17) were referred to community services (Chi 5.71; p=0.02). 70.0% of cases (N=14) and 33.6% of controls (N=27) were seen at least twice (Chi 7.22; p=0.01). 16.7% (N=2) of cases and 23.5 % (N=4) of controls referred to community services reported concordance with Consultant’s recommendation at reassessment, a non-significant difference with cases (Chi 0.00; p=1.00). Conclusions: Consistently with previously research in this field, no difference of concordance with recommendations emerged between patients with SUD with different duration of abstinence

The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study

According to the WHO, detainees attempt suicide ten times more than the general population

First-episode psychosis and migration in Italy (PEP-Ita migration): a study in the Italian mental health services

BACKGROUND: It has been frequently reported a higher incidence of psychotic disorders in immigrants than in native populations. There is, however, a lack of knowledge about risk factors which may explain this phenomenon. A better understanding of the causes of psychosis among first-generation migrants is highly needed, particularly in Italy, a country with a recent massive migration. METHODS/DESIGN: The "Italian study on first-episode psychosis and migration (PEP-Ita)" is a prospective observational study over a two-year period (1 January 2012-31 December 2013) which will be carried out in 11 Italian mental health centres. All participating centres will collect data about all new cases of migrants with first-episode psychosis. The general purpose ("core") of the PEP-Ita study is to explore the socio-demographic and clinical characteristics, and the pathways to care of a population of first-episode psychosis migrants in Italy. Secondary aims of the study will be: 1) to understand risk and protective factors for the development of psychotic disorders in migrants; 2) to evaluate the correlations between psychopathology of psychotic disorders in migrants and socio-demographic characteristics, migration history, life experiences; 3) to evaluate the clinical and social outcomes of first-episode psychoses in migrants. DISCUSSION: The results of the PEP-Ita study will allow a better understanding of risk factors for psychosis in first-generation migrants in Italy. Moreover, our results will contribute to the development of prevention programmes for psychosis and to the improvement of early intervention treatments for the migrant population in Italy

Before and after acceding to A&E departments by migrants: data from a 1-year observation

Analisi degli accessi in PS di migranti valutati dal servizio consulenze psichiatriche di Moden

Factors associated to complexity of patients evaluated for inclusion in orthotopic liver transplantation: a retrospective study.

INTRODUCTION In this retrospective study, the main clinical features of patients waiting for orthotopic liver transplantation (pre-OLTx) assessed at the Consultation-Liaison Psychiatric Service (CLPS) of the Modena General University Hospital were collected and analyzed, with the aim to assist early detection of complex patients. METHODS Relevant information about OLTx patients were extracted from the electronic database of the CLPS. Repeated referral for the same patient was considered as indicator con complexity. RESULTS During five years between 1st of January 2008 and 31st of December 2013, a total of 6011 first psychiatric assessment were performed by the CLPS. Of these, 366 (6.09%) were pre-OLTx assessments. Ninety subject (27.6% of total pre-OLTx assessments) were referred for psychiatric assessment more than once, and precisely: 62.2% twice, 27.8% three times and the remaining 10% more than three times. Main reasons for repeated referral of patients were depression (33 patients, 36,7%) and second evaluation pre-OLTx (35 patients, 38,9%). Repeatedly referred patients had the following features: the majority (56, 62.2%) were male, 61,1% (55) had a lifetime positive psychiatric history, 33.3% (30) were already on psychotropics, but 85.6% (77) were not under regular charge of psychiatric services. Among the 90 patients, a psychiatric disorder was diagnosed in 40 (44.4%) subjects, and the most common was depression/adjustment disorder (37.5%). A psychotropic medication was advised to 42 (46.7%) patients, most commonly antidepressants (42.9%) and benzodiazepines (35.7%). Patients were most commonly back-referred to their GP, but 20 (22.2%) were referred to community mental health care centers or to the CLPS itself. CONCLUSIONS A high number of presumably complex management patients were identified among the group of pre-OLTx, requiring better understanding of factors associated to complexity and need of integrated management

Migrant and mental health services in Modena

mental health, migrant

International Study of Student Career Choice in Psychiatry (ISoSCCiP): results from Modena, Italy

Italy was one of the 16 countries to take part in the International Study of Student Career Choice in Psychiatry (ISoSCCiP). This paper reports and comments on the IsoSCCiP data on Italian medical students. Italian fi nal year medical students from the University of Modena and Reggio Emilia were asked to fi ll in an on-line questionnaire during the fi rst semester of two consecutive academic years (2009 – 2010, 2010 – 2011). Step-wise logistic regressions were performed. Of the 231 students invited, 106 returned completed questionnaires (response rate 46.7%). Women constituted 66%, and mean age was 25.14 (SD 1.15). Psychiatry was the second most common choice of possible career by students (5.7%, n 6). Choosing psychiatry was predicted by having volunteered for further clinical/research activities in psychiatry (p 0.01), believing that ‘ the problems presented by psychiatric patients are often particularly interesting and challenging ’ (p 0.01), and by accounts of personal/family experience with physical illness (p 0.01). Both personal factors and factors related to training may be involved in the choice of psychiatry among Italian medical students. Cultural and organizational specifi cities of Italian mental healthcare may be involved, particularly the strong tradition of social psychiatry

Suicidal migrants in Modena

Self-harm behaviours, including attempted and complete suicide, have been reported to be common among migrants. Data from our analysis confirm general epidemiologic features of suicide, with complete suicide by hanging more typical among adult males and self-harm behaviours by drug ingestion more typical among youg adult females

Modalità di presentazione del disagio psichico nei migranti: accessi in pronto soccorso e comportamenti suicidairi.

Dall'analisi degli accessi al PS dei due ospedali di Modena di italiani e stranieri e il numero di suicidi, gli AA fanno alcune considerazioni sulla difficoltà di individuare un percorso di presa in carico psichiatrica per i pazienti migranti che nel 59% dei casi presentano disturbi apsecifici, suggestivi di somatizzazione