Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology) survey.

BACKGROUND: 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. METHODS: A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. RESULTS: 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. CONCLUSION: Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.

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 < or = 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.

An observational study in psychiatric acute patients admitted to General Hospital Psychiatric Wards in Italy.

OBJECTIVES: this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs). Information was focused on diagnosis (DSM-IV), reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode. METHODS: assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS), the Modified Overt Aggression Scale (MOAS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30). RESULTS: 864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs) completed both admission and discharge visits. A severe psychotic episode with (19.1%) or without (47.7%) aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge) and depression (12.9% at admission and 14.7% at discharge) were the predominant diagnoses. The mean hospital stay was 12 days. The mean (+/- SD) total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 +/- 5.1, 0.38 +/- 2.2, and 0.21 +/- 1.5. Forty-four (6.0%) patients had episodes of aggressiveness at admission and 8 (1.7%) at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%), 686 (94.2%) and 676 (92.9%). The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%), typical anti-psychotics (48.3%, 57.0%, 49.6%), atypical anti-psychotics (35.6%, 41.8%, 39.8%) and antidepressants (40.9%, 48.8%, 43.2%). Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20.6% and 26.6% with two drugs, and 53.2%, 57.8% and 59.0% with > two drugs. Benzodiazepines were the most common drugs both at admission (60.0%) and during hospitalisation (85.7%), and 69.5% were prescribed at discharge. CONCLUSION: patients with psychiatric diseases in acute phase experienced a satisfactory outcome following intensified therapeutic interventions during hospitalisation.

Effect of reboxetine on major depressive disorder in breast cancer patients: an open-label study.

BACKGROUND: Depression is a common disorder in cancer patients, and it is associated with reduced quality of life, abnormal illness behavior, pain, and suicide risk. A few studies have investigated the effects of tricyclic antidepressants and serotonin reuptake inhibitors in cancer patients. No data are available regarding the use of reboxetine, a norepinephrine reuptake inhibitor that has been shown to be safe (e.g., absence of clinically significant drug-drug interactions and cytochrome P450 metabolism) and effective in the treatment of depressed patients, including those with medical illness (e.g., Parkinson's disease, human immunodeficiency virus infection). METHOD: The effects of reboxetine were investigated in 20 breast cancer patients with a DSM-IV diagnosis of major depressive disorder in an open, prospective 8-week trial. Severity of depression was assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D). Psychiatric symptoms (Brief Symptom Inventory [BSI]), styles of coping with cancer (Mini-Mental Adjustment to Cancer [Mini-MAC]), quality of life (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 [EORTC-QLQ-C30]), and Clinical Global Impressions scale scores were also monitored. RESULTS: At 8 weeks, a significant (p <.01) reduction was observed in HAM-D scores, several BSI dimension scores, and Mini-MAC hopelessness and anxious preoccupation scores. A significant (p <.05) improvement from baseline to endpoint was found on the EORTC-QLQ-C30 subfactors emotional, cognitive, dyspnea, sleep, and global. Discontinuation was necessary in 1 subject because of hypomanic switch and in another because of side effects (tachycardia, tension). Seven patients experienced transient side effects (e.g., mild anxiety, insomnia, sweating). CONCLUSION: In this open trial, reboxetine appeared to be well tolerated and promising in reducing depressive symptoms and maladjusted coping styles and in improving scores on quality-of-life parameters.

Perfil da automedicaçäo no Brasil / Aspects of self-medication in Brazil

Os dados apresentados fazem parte de um estudo multicêntrico sobre automedicaçäo na América Latina realizado pela Organizaçäo Mundial de Saúde (OMS). Objetivou-se traçar um perfil da automedicaçäo através da análise da procura de medicamentos em farmácias sem prescriçäo médica ou aconselhamento do farmacêutico/balconista. As especialidades farmacêuticas foram classificadas pelo código "Anatomical Therapeutical Classification" e analisadas sob quatro aspectos qualitativos: valor intrínseco, essencialidade (lista da OMS e Relaçäo Nacional de Medicamentos Essenciais (RENAME), combinaçäo em dose fixa e necessidade de prescriçäo médica. Foram solicitadas 5.332 especialidades farmacêuticas (785 diferentes princípios ativos), sendo 49,5 por cento combinaçöes em doses fixas, 53,o por cento de valor intrínseco näo elevado, 44,1 por cento sujeitos a prescriçäo médica, 71,0 por cento näo essenciais e 40,0 por cento baseados em prescrições médicas anteriores. Os medicamentos mais solicitados foram analgésicos (17,3 por cento), descongestionantes nasais (7,0 por cento), antiinflamatório/antireumático e antiinfecciosos de uso sistêmico, ambos com 5,6 por cento. Os dados sugerem que a automedicaçäo no Brasil reflete as carências e hábitos da populaçäo, é consideravelmente influenciada pela prescriçäo médica e tem a sua qualidade prejudicada pela baixa seletividade do mercado farmacêutico.