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

Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study

BACKGROUND: Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). METHOD: Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). RESULTS: 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. CONCLUSION: Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients

Gender-related distribution of personality disorders in a sample of patients with panic disorder

SummaryObjectiveWe examined gender differences in the frequency of DSM-IV personality disorder diagnoses in a sample of patients with a diagnosis of panic disorder (PD).MethodOne hundred and eighty-four outpatients with a principal diagnosis of PD (DSM-IV) were enrolled. All patients were evaluated with a semi-structured interview to collect demographic and clinical data and to generate Axis I and Axis II diagnoses in accordance with DSM-IV criteria.ResultsMales were significantly more likely than females to meet diagnoses for schizoid and borderline personality disorder. Compared to males, females predominated in histrionic and cluster C diagnoses, particularly dependent personality disorder diagnoses. A significant interaction was found between female sex and agoraphobia on personality disorder (PD) distribution.ConclusionsMale PD patients seem to be characterized by more severe personality disorders, while female PD patients, particularly with co-morbid agoraphobia, have higher co-morbidity rates with personality disorders belonging to the ‘anxious-fearful cluster’.</jats:sec

Distribución relacionada con el género de los trastornos de la personalidad en una muestra de pacientes con trastorno de angustia

ResumenObjetivoExaminamos las diferencias de género en la frecuencia de los diagnóstics de trastorno de la personalidad del DSM-IV en una muestra de pacientes con diagnóstico de trastorno de angustia (TA).MétodoSe seleccionó a 184 pacientes ambulatorios con un diagnóstico principal de TA (DSM-IV). Se evaluó a todos los pacientes con una entrevista semiestructurada para recoger datos demográficos y clínicos y generar diagnósticos del Eje I y el Eje II según los criterios del DSM-IV.ResultadosLos varones tertian significativamente más posibilidades que las mujeres de cumplir los diagnósticos para trastorno esquizoide y límite de la personalidad. Comparado con los varones, las mujeres predominaban en los diagnósticos histriónico y del grupo C, particularmente los de trastorno de la personalidad por dependencia. Se encontró una interacción significativa entre el sexo femenino y la agorafobia en la distribución del trastorno de la personalidad (TP).ConclusionesLos pacientes varones con TA parecen caracterizarse por trastornos de la personalidad más graves, mientras que las pacientes con TA, particularmente con agorafobia comórbida, tienen tasas más altas de comorbilidad con trastornos de la personalidad pertenecientes al “grupo ansioso-miedoso”.</jats:sec

Diferencias clínicas relacionadas con el género en el trastorno Obsesivo-Compulsivo

ResumenEl propósito del presente estudio era investigar las diferencias de rasgos clínicos relacionadas con el género en una muestra de pacientes obsesivo-compulsivos (OCD). Se admitió a 160 pacientes ambulatorios con un diagnóstico principal de trastorno obsesivo-compulsivo (DSM-IV, Y-BOCS = 16). Se los evaluó con una entrevista semiestructurada que cubría las áreas siguientes: datos sociodemográficos, diagnósticos del Eje I (DSM-IV), rasgos clínicos del OCD (edad en el comienzo de los síntomas OC y el trastorno OC, tipo de comienzo, acontecimientos vitales y tipo de curso). Para el análisis estadístico, la muestra se subdividió en dos grupos según el género. Encontramos una edad anterior en el comienzo de los síntomas OC y el trastorno OC en los varones; en este grupo de pacientes se observó también un comienzo insidioso y un curso crónico de la enfermedad. Las mujeres mostraban con más frecuencia un comienzo agudo del OCD y un curso episódico de la enfermedad; comunicaban también con más frecuencia un acontecimiento cargado de estrés en el año que precedía al comienzo del OCD. Entre los varones, era significativamente más común una historia de trastornos de ansiedad con comienzo anterior al OCD y episodios hipomaníacos que se producían después del comienzo de éste, mientras que las mujeres mostraban con más frecuencia una historia de trastornos de la conducta alimentaria. Encontramos tres rasgos del OCD relacionados con el género: los varones muestran una edad anterior en el comienzo, con un impacto más bajo de acontecimientos precipitantes en la provocación del trastorno; el OCD parece ocurrir en una proporción relativamenté alta de varones que tienen ya fobias o trastornos de tics, y la enfermedad tiene curso crónico en un número mayor de varones en comparación con las mujeres.</jats:p