[Recovery style, symptoms and psychosocial functioning in psychotic patients: a preliminary study]. / Recovery style, sintomatologia e funzionamento psicosociale in pazienti psicotici: uno studio preliminare.

BACKGROUND: Both integration and sealing over have been identified as global, clinically distinct recovery styles from the psychotic illness. The aim of this study was to investigate the correlation between recovery style, symptoms and global functioning in psychotic patients. METHODS: 106 psychiatric patients in different phases of recovery were studied (no patient at the first episode in our sample). The Integration/Sealing Over Scale, the Recovery Style Questionnaire, the Positive and Negative Syndrome Scale and the Life Skills Profile were completed for all patients; moreover, socio-demographic and clinical data were collected. RESULTS: A relationship was found between the integrative recovery style and age >45 years (p<0.05), integration and affective disorders (p<0.05), delusions and sealing over (p<0.05). CONCLUSIONS: Although the limited study sample, our findings suggest some predictors of integration which should be taken into consideration to "drive" patients toward an integrative recovery style after an acute psychotic episode.

[Factor analysis and psychometric properties of the Italian version of the Neuropsychiatric Inventory-Nursing Home in an institutionalized elderly population with psychiatric comorbidity]. / Proprietà psicometriche e analisi fattoriale della versione italiana della Neuropsychiatric Inventory-Nursing Home in una popolazione di anziani istituzionalizzati in comorbilità psichiatrica.

AIM: Aim of the study was to validate the Italian version of the Neuropsychiatric Inventory-Nursing Home (NPI-NH). The evaluation of neuropsychiatric symptoms in elderly patients with cognitive impairment and/or a chronic psychiatric disorder, is an essential need in nursing home. METHODS: The Italian version of the NPI-NH was administered in 53 patients in a nursing home in Northern-Italy. RESULTS: The internal consistency of the NPI-NH reported a value (α=0.62) according to the literature. The inter-rater reliability was ρ=0.991 and ρ=0.999 for the caregiver distress. There was an almost complete overlap between the assessments of individual items ranging from (ρ) 1 and 0.952. The test-retest reliability was ρ=0.961 and ρ=0.943 for the distress of the caregiver. Factor analysis revealed 4 factors that can explain 62.167% of the total variance: factor 1 hyperactivity, factor 2 mood, factor 3 psychosis and factor 4 withdrawal. CONCLUSIONS: The NPI-NH can be used as an instrument for follow-up of patients and as a tool to support the activities of psychiatric referring and research in nursing home because of his demonstrated psychometric validity and its ease of use.

Migrant pathways to community mental health centres in Italy.

BACKGROUND: Many studies indicate that migrants in western countries have limited access to and low utilization of community mental health centres (CMHCs) despite the high prevalence of mental disorders. AIMS: We aimed to compare migrant pathways to care across four CMHCs located in different Italian provinces and to identify pathway to care predictors. METHODS: Migrants attending the four CMHCs between 1 July 1999 and 31 December 2007 were included in the study. Data were gathered retrospectively from clinical data sets and chart review. RESULTS: Five hundred and eleven (511) migrants attended the four CMHCs, 61% were referred by GPs or other health services and 39% followed non-medical pathways to care (self-referral or through social and voluntary organizations), with important site variations. Younger age and being married were predictors of medical pathways to care; lacking a residence permit and having a diagnosis of substance abuse were related to non-medical pathways. CONCLUSIONS: Pathways to CMHCs are complex and influenced by many factors. Non-medical pathways to care seem to be frequent among migrants in Italy. More attention should be paid to developing psychiatric consultation liaison models that also encompass the social services and voluntary organizations.

Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?

BACKGROUND: Polypharmacy is regarded as an important risk factor for fallingand several studies and meta-analyses have shown an increased fall risk in users of diuretics, type 1a antiarrhythmics, digoxin and psychotropic agents. In particular, recent evidence has shown that fall risk is associated with the use of polypharmacy regimens that include at least one established fall risk-increasing drug, rather than with polypharmacy per se. We studied the role of polypharmacy and the role of well-known fall risk-increasing drugs on the incidence of injurious falls. METHODS: A retrospective observational study was carried out in a population of elderly nursing home residents. An unmatched, post-stratification design for age class, gender and length of stay was adopted. In all, 695 falls were recorded in 293 residents. RESULTS: 221 residents (75.4%) were female and 72 (24.6%) male, and 133 (45.4%) were recurrent fallers. 152 residents sustained no injuries when they fell, whereas injuries were sustained by 141: minor in 95 (67.4%) and major in 46 (32.6%). Only fall dynamics (p = 0.013) and drugs interaction between antiarrhythmic or antiparkinson class and polypharmacy regimen (> or =7 medications) seem to represent a risk association for injuries (p = 0.024; OR = 4.4; CI 95% 1.21 - 15.36). CONCLUSION: This work reinforces the importance of routine medication reviews, especially in residents exposed to polypharmacy regimens that include antiarrhythmics or antiparkinson drugs, in order to reduce the risk of fall-related injuries during nursing home stays.