First-ever admitted psychiatric inpatients in Italy: clinical characteristics and reasons contributing to admission: findings from a national survey.

The aim of this study was to describe the sociodemographic, clinical and treatment-related characteristics of patients admitted to any acute psychiatric inpatient facilities in Italy for the first time in their life, and to identify reasons contributing to admission. Data from the PROGRES-Acute Project, a national survey on facilities admitting acute psychiatric patients in Italy, were used. A cluster analysis was carried out in order to identify patients' groups sharing similar sociodemographic and clinical characteristics. Among patients admitted during the index period, 337 were at their first-ever admission. Median age at admission was 40, and about 46% of patients were not receiving any treatment in the month prior to admission. Social/work functioning problems, social withdrawal and conflict with family members were the most common reasons contributing to admission. Cluster analysis yielded four patient groups: two groups of younger subjects, differentiating each other for frequency of antisocial behaviors, compulsory admissions, treatment at time of admission and family support; two groups of older subjects, with high rates of affective disorders, who showed remarkable differences with regard to their living situation and family support. Our study shows that first-ever admitted patients represent a highly heterogeneous group. Early intervention research should take this sociodemographic and clinical diversity into account, in order to better allocate resources and develop special intervention programs.

A one-day census of acute psychiatric inpatient facilities in Italy: findings from the PROGRES-Acute Project.

On May 8, 2003, a survey was conducted of all inpatients at 369 psychiatric facilities for adult acute patients in all Italian regions except Sicily. The estimated point prevalence rate of admissions was 18.3 per 100,000 adult population. There were 305 involuntarily admitted patients (3.8%, or .70 per 100,000 population). Large differences between public and private facilities were found in age and gender distribution: the proportion of men age under age 35 was larger in public facilities, and the proportion of women age 65 and older was larger in private facilities. In Italy, monitoring and evaluation of community services, at both the local and national levels, is essential for policy development, implementation, and evaluation.

Symptom structure of acute mania: a factor study of the 24-item Brief Psychiatric Rating Scale in a national sample of patients hospitalized for a manic episode.

BACKGROUND: Despite increasing interest in dimensional psychopathology and the use of symptom clusters in clinical research, factor analytic studies of mania are rare. Most studies included not only manic patients, but also patients with a mixed episode or other severe mental disorders. We aimed at further elucidating the symptom structure of manic states. METHODS: As part of a national survey of acute psychiatric inpatient care, all patients admitted to a random sample of Italian public and private facilities during an index period underwent a standardized assessment, including the 24-item Brief Psychiatric Rating Scale (BPRS-24). Eighty-eight patients (90% of all manic patients admitted) with an ICD-10 diagnosis of Bipolar Affective Disorder, Current Episode Manic with complete data were included in this study. Principal axis factor analysis with Varimax rotation was performed on BPRS-24 items. RESULTS: Four factors were extracted, explaining 51% of total variance. They were interpreted as Mania, Disorganization, Positive Symptoms, and Dysphoria. The distribution of the Disorganization factor was positively skewed, with most patients relatively free from disorganization symptoms and some patients showing varying degrees of severity. LIMITATIONS: The sample size was relatively small; also, patients were not administered a structured diagnostic interview. However, reasonably large samples are usually sufficient when communalities are high. Also, the manic episode is a clear-cut diagnostic entity easily identified by experienced clinicians, and the independent BPRS-24 ratings corroborated the diagnosis. CONCLUSIONS: The identification of a Mania, Positive Symptoms, and Dysphoria factor is consistent with most previous studies. The identification of a Disorganization factor in a sample including only manic patients is a new finding that may have clinical implications, as its distribution suggests the possibility of distinguishing two patient groups, which may require different interventions to achieve optimal therapeutic response. The factorially derived BPRS-24 subscales may be useful for evaluation of treatment effects in clinical trials of antimanic agents.

Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy.

BACKGROUND: Legislation in 1978 led to the gradual replacement of mental hospitals in Italy with a full range of community-based services, including facilities for acute in-patient care. AIMS: To survey the main characteristics of Italian public and private in-patient facilities for acute psychiatric disorders. METHOD: Structured interviews were conducted with each facility's head psychiatrist in all Italian regions, with the exception of Sicily. RESULTS: Overall, Italy (except Sicily) has a total of 4108 public in-patient beds in 319 facilities, with 0.78 beds for every 10,000 inhabitants, and 4862 beds in 54 private in-patient facilities, with 0.94 beds per 10,000 inhabitants. In 2001 the rates of psychiatric admissions and admitted patients per 10,000 inhabitants were 26.7 and 17.8 respectively. In the same year the percentage of involuntary admissions was 12.9%, for a total of 114,570 hospital days. Many in-patient facilities showed significant limitations in terms of architectural and logistic characteristics. Staffing showed a great variability among facilities. CONCLUSIONS: The overall number of acute beds per 10,000 inhabitants is one of the lowest in Europe. The survey has provided evidence of two parallel systems of in-patient care, a public one and a private one, which are not fully interchangeable.

Process of care in general hospital psychiatric units: national survey in Italy.

OBJECTIVE: To investigate the process of care in Italian public acute inpatient facilities. METHOD: Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules. RESULTS: Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5+/-7.1 days, 37.0+/-55.3 days and 12.0+/-3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during meal times (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurse provision. CONCLUSIONS: The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital-community mental health service interface.

The components of good community care for people with severe mental illnesses: views of stakeholders in five European countries.

Researchers and practitioners collaborated in a project across five European countries aimed at defining the characteristics of good community care for people with severe mental illnesses and to explore the values ofstakeholders in this debate (clients, families, professionals, policy makers, other citizens). In a concept mapping procedure all stakeholders gave highest priority to a trusting and stimulating relationship between clients and professionals. Secondly, good care was seen as effective treatment tailored to the individual needs. Accessibility of services came in the third place. Differences between the views of stakeholders are discussed.