ABSTRACT
Characterization of mentally ill maternal perpetrators of filicide assigned to a single psychiatric-forensic facility, including previous access to mental health services. A cross-sectional, retrospective analysis of medical records and legal documentation of maternal filicide patients at a single psychiatric-forensic facility (1990-2021) was performed. Socio-demographic, relationship, psychopathological, and criminological characteristics were collected. Data were compared according to previous perpetrators' access to mental health services or not and access within 1 year prior to filicide or not. All 55 detainees (mean age 34.8 ± 6.2 years) were included. There were 64 victims; 15 (23%) were ≤ 1 year old and most (77%) were single victims. Some mothers had history of violence/abuse (29%), an aggressive parent (45%), and violent relationships with their intimate partner (46%) and were socially isolated (49%). Most crimes were motivated by altruism (53%). Women had attempted suicide in 39% of filicide cases. Previous psychiatric diagnoses were available for 56%; 71% had accessed services for ≤ 1 year. Patients unknown to mental health services were less likely Italian, with children below preschool age and with no history of physical abuse/violence, aggressive parent, or suicide attempts. Patients lost to mental health services (> 1 year) were less likely Italian or assuming psychopharmacological therapy, were in shorter relationships, and were mostly diagnosed with personality disorders. Female perpetrators of filicide are often unknown/lost to mental health services prior to the crime. Multifactorial historical and current characteristics aid in identifying mothers at risk. Communication of the availability of mental health services must be multi-lingual.
Subject(s)
Mental Disorders , Mentally Ill Persons , Infant , Humans , Child , Female , Child, Preschool , Adult , Retrospective Studies , Homicide/psychology , Cross-Sectional Studies , Mental Disorders/psychology , Mothers/psychologyABSTRACT
AIMS: To describe patterns of experienced and anticipated discrimination in a sample of schizophrenic patients recruited in Italy in the context of the International Study of Discrimination and Stigma Outcomes (INDIGO). METHODS: Cross-sectional survey on a sample of 50 people with clinical diagnosis of schizophrenia recruited in the Italian INDIGO sites of Verona and Brescia. The 41-item interview-based Discrimination and Stigma Scale (DISC-10), which assesses how experienced and anticipated discrimination affects the life of people with schizophrenia, was used. RESULTS: The most frequently occurring areas of experienced discrimination were discrimination by family members (44%), making and keeping friends (33%), keeping (36%) and finding a job (34%), getting or keeping a driving licence (32%). Anticipated discrimination was common in applying for work, training or education (58%), looking for close relationships (50%) and doing something important (48%); 68% felt the need to conceal their diagnosis. Positive experiences were rare, and getting welfare benefits/disability pensions was the only area where participants reported being treated with advantage (34%) more commonly than with disadvantage (8%). Overall, experienced discrimination reported by Italian patients was in the intermediate position of the score range of all INDIGO sites, whereas anticipated discrimination was lower than that reported in the other countries. CONCLUSIONS: Interventions to reduce discrimination against people with schizophrenia may need to address both actual and anticipated discrimination. Targeted therapeutic strategies aiming to improve self-esteem of people with schizophrenia may be useful to facilitate their social participation and full inclusion in the community.
Subject(s)
Discrimination, Psychological , Schizophrenic Psychology , Adult , Cross-Sectional Studies , Female , Humans , Italy , MaleABSTRACT
BACKGROUND: One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study. METHODS/DESIGN: The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome. DISCUSSION: The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.
