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Care across all phases of schizophrenia and initiation of treatment: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project

Published online by Cambridge University Press:  11 April 2011

Mirella Ruggeri*
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Maurizio Bacigalupi
Affiliation:
Dipartimento Salute Mentale Roma B, Roma
Massimo Casacchia
Affiliation:
Dipartimento di Scienze della Salute, Sezione di Psichiatria, Università dell'Aquila, L'Aquila
Maurizio Miceli
Affiliation:
Dipartimento di Salute Mentale MOM-SMA 5 Azienda Sanitaria di Firenze, Firenze
Carla Morganti
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera Niguarda, Ca’ Granda (Milano)
Vincenzo Scavo
Affiliation:
Dipartimento di Salute Mentale, Empoli
Liliana Allevi
Affiliation:
Dipartimento di Salute Mentale, Lecco
Sergio Lupoi
Affiliation:
IV Distretto Dipartimento di Salute Mentale, Roma D
Doriana Cristofalo
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Antonio Lasalvia
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e di Psicologia Clinica, Università di Verona, Verona
Antonio Lora
Affiliation:
Dipartimento Salute Mentale, Azienda Ospedaliera di Vimercate (Milano)
Domenico Semina
Affiliation:
Dipartimento Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti (Bari)
*
Address fo correspondence: Professor: M. Ruggeri, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e Psicologia Clinica, Università di Verona, Policlinico G. B. Rossi, P. le L. A. Scuro 10, 37134 Verona. Fax: +39-045-8027498 E-mail: mirella.ruggeri@univr.it

Summary

Aims – To evaluate the quality of psychiatric care in Italian community-based services and the discrepancy between real practices and NICE recommendations for the treatment of schizophrenia concerning the elements common to all phases of care and the first episode of psychosis. Methods – Data concerning 14 indicators on common aspects of care in all phases and 11 indicators concerning psychosis onset, drawn from NICE Recommendations, were collected in 19 Departments of Mental Health. Results – An optimistic attitude seems to prevail in the staff in all phases of care, while remarkable discrepancies between service practice and recommendations have been found in relation to systematic assessment, availability of informative leaflets and support to relatives. Concerning the treatment of first episode, a lack of specific services and differentiated activities, and paucity of practices based on specific guidelines has been detected. However, Italian community based services proved to have a good capacity to provide help quickly to those seeking help for a psychotic onset, to maintain regular contact with them in the subsequent year, and provide pharmacological treatment reasonably in line with the scientific evidence. Instead, little specific support is provided to the relatives. Conclusions – The results show critical points concerning capacity of assessment and treatment standardization, in all aspects of care and specifically in the treatment for the first episode. Differentiation of activities specifically dedicated to the patients at their first episode should be promoted as well as strategies to support relatives in a more specific way.

Declaration of Interest: none.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2008

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References

BIBLIOGRAFIA

Addington, J., Young, J. & Addington, D. (2003). Social outcome in early psychosis. Psychological Medicine 33, 11191124.CrossRefGoogle ScholarPubMed
American Academy of Family Physicians (2007). Information from your family doctor. Helping a family member with schizophrenia. American Family Physician 75, 18211830.Google Scholar
Asioli, F.(2005). Quali modelli di collaborazione fra Medicina Generale e Dipartimenti di Salute Mentale? Psichiatria di Comunità 4, 59.Google Scholar
Bäuml, J., Froböse, T., Kraemer, S., Rentrop, M. & Pitschel-Walz, G. (2006). Psychoeducation: a basic psychoterapeutic itervention for patients with schizophrenia and their families. Schizophrenia Bulletin 32, Suppl 1, 19.CrossRefGoogle Scholar
Becker, T., Hulsmann, S., Knudsen, H. C., Martiny, K., Amaddeo, F., Gaite, L., Knapp, M., Schene, A. H., Tansella, M., Thornicroft, G., Vazquez-Barquero, J. L. & the EPSILON Study Group (2002). Provision of services for people with schizophrenia in five European regions. Social Psychiatry and Psychiatric Epidemiology 37, 465474.CrossRefGoogle ScholarPubMed
Birchwood, M., Todd, P. & Jackson, C. (1998). Early intervention in psychosis. British Journal of Psychiatry 172, Suppl. 33, 5359.CrossRefGoogle ScholarPubMed
Bonney, S. & Stickley, T. (2008). Recovery and Mental Health:a review of the British literature. Journal of Psyschiatric and Mental Health Nursing 15, 140153.CrossRefGoogle ScholarPubMed
Carrà, G., Barale, F. & Marinoni, A. (Eds.) (2004). Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica. Il Pensiero Scientifico Editore: Roma.Google Scholar
Cocchi, A. & Meneghelli, A. (2002). Obiettivi e sviluppi di una esperienza pilota di intervento precoce nelle psicosi. Psichiatria di Comunità, 1–2, 5767.Google Scholar
Cocchi, A. & Meneghelli, A. (2004). L'Intervento Precoce tra Pratica e Ricerca. Manuale per il Trattamento delle Psicosi all'Esordio. Torino: Centro Scientifico Editore.Google Scholar
Cocchi, A., Meneghelli, A., Breda, A., Galvan, F. & Patelli, G. (2001). L'intervento precoce nelle psicosi: l'esperienza del Programma 2000. Rivista Sperimentale di Freniatria, 125(3), 150ndash;161.Google Scholar
Craig, T. K., Garety, P., Power, P., Rahaman, N., Colbert, S., Fornells-Ambrojo, M. & Dunn, G. (2004). The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 1067.CrossRefGoogle ScholarPubMed
Degmeciéc, D., Pozgain, I. & Filatovi, P. (2007). Psychoeducation and compliance in the treatment of patients with schizophrenia. Collegium Antropologicum 31, 11111115.Google Scholar
Henderson, C., Phelan, M., Loftus, L., Dall'Agnola, R. & Ruggeri, M. (1999). Comparision of patients satisfaction with community based vs. hospital psychiatric services. Acta Psychiatrica Scandinavica 99, 188195.CrossRefGoogle Scholar
Johnson, S. (2007). So what shall we do about assertive community treatment? Epidemiologia e Psichiatria Sociale 17(2), 110114.CrossRefGoogle Scholar
Joseph, R. & Birchwood, M. (2005). The national policy reforms for mental health services and the story of early intervention services in the United Kingdom. Journal of Psychiatry and Neuroscience 30(5), 362365.Google ScholarPubMed
Killackey, E., Yung, A. R. & Mc Gorry, P. (2007). Early psychosis: Where we've been, where we still have to go. Epidemiologia e Psichiatria Sociale 16(2), 102108.CrossRefGoogle ScholarPubMed
Kilkku, N., Munnukka, T. & Lehtinen, K. (2003). From information to knowledge: the meaning of information-giving to patients who had experienced first-episode psychosis. Journal of Psychiatry and Mental Health Nursing 10(1), 5764.CrossRefGoogle ScholarPubMed
Kuipers, E., Holloway, F., Rabe-Hesketh, S. & Tennakoon, L. (2004). An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST). Social Psychiatry and Psychiatric Epidemiology 39, 358363.CrossRefGoogle ScholarPubMed
Lasalvia, A. & Ruggeri, M. (2003). L'Esito della Schizofrenia. Il Pensiero Scientifico Editore: Roma.Google Scholar
Lasalvia, A., Ruggeri, M., Salvi, G., Tansella, M. & EPSILON Study Group (2005). Bisogni percepiti, tipologie di intervento e soddisfazione per le cure ricevute nelle persone con schizofrenia. Un'analisi comparata in cinque paesi dell'Unione Europea. Psichiatria di Comunità 2, 76110.Google Scholar
Lasalvia, A., Gentile, B., Ruggeri, M, Marcolin, A., Nosè, F., Cappellari, L., La monaca, D., Toniolo, E., Busana, C., Campedelli, A., Cuccato, G., Danieli, A., De Nardi, F., De Nardo, V., Destro, E., Favaretto, G., Frazzingaro, S., Giacopuzzi, M., Pristinger, P., Pullia, G., Rodighiero, R., Tito, P., Aprile, F., Nicolaou, S., Coppola, G., Garzotto, N., Gottardi, U., Lazzarin, E., Migliorini, G., Pavan, L., Ramaciotti, F., Roveroni, P., Russo, S., Urbani, P. & Tansella, M. per il Gruppo PICOS-Veneto. (2007). Eterogeneità dei DSM veneti a dieci anni dal Progetto Obiettivo “Tutela Salute Mentale 1994–96”. Quali implicazioni per la pratica clinica? Indagine sui Servizi partecipanti al Progetto PICOS-Veneto. Epidemiologia e Psichiatria Sociale 16(1), 5970.CrossRefGoogle Scholar
Leese, M., Johnson, S., Slade, M., Parkman, S., Kelly, F., Phelan, M. & Thornicroft, G. (1998). User perspective on needs and satisfaction with mental heakth services. British Journal of Psychiatry 173, 409415.CrossRefGoogle Scholar
Lehman, A. F., Lieberman, J. A., Dixon, L. B., McGlashan, T. H., Miller, A. L., Perkins, D. O., Kreyenbuhl, J. (2004). Practice guideline for the treatment of patients with schizophrenia, 2nd ed. American Journal of Psychiatry, Suppl. 161(2), 156.Google Scholar
Lieberman, J. A., Perkins, D., Belger, A., Chakos, M., Jarskog, F., Boteva, K. & Gilmore, J. (2001). The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biological Psychiatry 50, 884897.CrossRefGoogle ScholarPubMed
Lora, A., Corlito, G., Miceli, M., Di Munzio, W., Lasalvia, A., Tanini, A., Mari, L., Casacchia, M., Cristofalo, D., Magnani, N., Semisa, D. & Ruggeri, M. per il Gruppo SIEP-DIRECT's (2008a). The treatment of acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 319330.CrossRefGoogle Scholar
Malla, A. K., Norman, R. M. G., Manchanda, R., Ahmed, R. M., Scholten, D., Harricharan, R., Cortese, L., & Takhar, J. (2002). One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophrenia Research 54, 231242.CrossRefGoogle ScholarPubMed
McGorry, P. D., Edwards, J, Mihalopoulos, C. & Harrigan SM. (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305326.CrossRefGoogle ScholarPubMed
Melle, I., Larsen, T. K., Haahr, U., Friis, S., Johannessen, J. O., Opjordsmoen, S., Simonsen, E., Rund, B. R., Vaglum, P. & McGlashan, T. (2004). Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Archives of General Psychiatry 61, 143150.CrossRefGoogle ScholarPubMed
Melle, I., Larsen, T. K., Haahr, U., Friis, S., Johannesen, J. O., Opjordsmoen, S., Rund, B. R., Simonsen, E., Vaglum, P. Mc & Glashan, T. (2008). Prevention of negative symptom psychopatologies in first-episode schizophrenia: Two-year effects of reducing the duration of untreated psychosis. Archives General Psychiatry 65, 634640.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (NICE) (2004). Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica (ed. it. a cura di Carrà, G., Barale e, F., Marinoni, A.). Il Pensiero Scientifico Editore: Roma.Google Scholar
Paccaloni, M., Pozzan, T. & Zimmermann, C. (2004). Being informed and involved in treatment: what do psychiatric patients think? A review (in Italian) Epidemiologia e Psichiatria Sociale 13(4), 270283.CrossRefGoogle Scholar
Parabiaghi, A., Lasalvia, A., Bonetto, C., Cristofalo, D., Marrella, G., Tansella, M. & Ruggeri, M. (2007). Predictors of changes in caregi-ving burden in people with schizophrenia: a 3-year follow-up study in a community mental health service. Acta Psychiatrica Scandinavica, Suppl. 437, 6676.CrossRefGoogle Scholar
Penn, D. L., Waldheter, , Perkins, D. O., Kim, T., Mueser, K. T. & Lieberman, J. (2005). Psychosocial treatment for first-episode psychosis: A research update. American Journal of Psychiatry 162, 22202232.CrossRefGoogle ScholarPubMed
Pollice, R., Di Giovanbattista, E., Ustorio, D., Di Pucchio, A., Tomassini, A., Mazza, M., Roncone, R. & Casacchia, M. (2007). The Service for Monitoring and Early Intervention against psychological and Mental suffering in young people (SMILE) at the University of L'Aquila: first year experience. Early Intrvention in Psychiatry 1, 271275.CrossRefGoogle Scholar
Royal Australian and New Zeland College of Psychiatrist (2005). Clinical practice guideline team for the treatment of schizophrenia and related disorders.(2005). Australian and New Zealand Journal of Psychiatry 39, 130.CrossRefGoogle Scholar
Ruggeri, M. (2008). Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT's Project serve in the search for a happy medium? Epidemiologia e Psichiatria Sociale 17(4), 270277.CrossRefGoogle ScholarPubMed
Ruggeri, M. & Tansella, M. (2007). Achieving a better knowledge on the causes and early course of psychoses: a profitable investment for the future? Epidemiologia e Psichiatria Sociale 16(2), 97101.CrossRefGoogle ScholarPubMed
Ruggeri, M. & Tansella, M. (2008) “Case management” o “Assertive community treatment”: sono veramente approcci alternativi? Epidemiologia e Psichiatria Sociale 17(2), 9398.CrossRefGoogle Scholar
Ruggeri, M., Lora, A. & Semisa, D. on behalf of the SIEP-DIRECT's Group (2008). The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of the main findings and the practical implications for the future of community based mental health services. Epidemiologia e Psichiatria Sociall 17(4), 358368.CrossRefGoogle ScholarPubMed
Ruggeri, M., Dall'Agnola, R., Agostini, C. & Bisoffi, G. (1994). Acceptability, sensitivity and content validity of VECS and VSSS in measuring expectations and satisfaction in psychiatric patients and their relatives. Social Psychiatry and Psychiatric Epidemiology 29, 265276.CrossRefGoogle ScholarPubMed
Ruggeri, M., Lasalvia, A., Dall'Agnola, R., van Wijngaarden, B., Knudsen, H. C., Leese, M., Gaite, L., Tansella, M. & the EPSILON STUDY Group (2000). Development, internal consistency and reliability of the European version of the Verona Service Satisfaction Scale - EU Version (VSSS-EU). In Standardising European Outcome Measures for Schizophrenia Research. (ed. Becker, T., Knapp, M., Knudsen, H. C., Schene, A., Tansella, M., Thornicroft, G., Vazquez, J. L.-Barquero and the EPSILON Study Group). British Journal of Psychiatry, Suppl. 39, s41–s48.Google Scholar
Ruggeri, M., Lasalvia, A., Bisoffi, G., Thornicroft, G., Vàsquez-Barquero, J. L., Becker, T., Knapp, M., Knudsen, H. C., Schene, A., Tansella, M. & the EPSILON Study Group (2003). Satisfaction with mental health services among people with schizophrenia in five Europe sites: results from the EPSILON Study. Schizophrenia Bulletin 29, 229245.CrossRefGoogle ScholarPubMed
Ruggeri, M., Lasalvia, A., Salvi, G., Cristofalo, D., Bonetto, C. & Tansella, M. (2007). Applications and usefulness of routine measurement of patients’ satisfaction with community-based mental health care. Acta Psychiatrica Scandinavica, Suppl. 437, 5365.CrossRefGoogle Scholar
Salvatore, P., Tohen, M, Kaur Khalsa, H-M, Baethge, C., Tondo, L. & Baldessarini, Rj (2007). Longitudinal research on bipolar disorders. Epidemiologia e Psichiatria Sociale 16, 2, 109117.CrossRefGoogle ScholarPubMed
Semisa, D., Lora, A., Morosini, P. & Ruggeri, M. (2008a). The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence in the treatment of schizophrenia. The design, the indicators, and the methodology of the study (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 278290.CrossRefGoogle Scholar
Semisa, D., Lasalvia, A., Miceli, M., Dall'Agnola, R. B., Pucci, C., Bissoli, S., Visani, E., Pismataro, P., Vanetti, M., Pioli, R., Ruggeri, M.per il Gruppo SIEP-DIRECT's (2008b). The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 291304.CrossRefGoogle ScholarPubMed
Semisa, D., Casacchia, M., Di Munzio, W., Neri, G., Buscaglia, G., Burti, L., Pucci, C., Corlito, G., Bacigalupi, M., Parravani, R., Roncone, R., Cristofalo, D., Lora, A. & Ruggeri, M. per il Gruppo SIEPDIRECT's (2008c). Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 331348.CrossRefGoogle Scholar
Singh, S.P. & Fisher, H.L. (2004). A specialist early intervention for firstepisode psychosis. Psychiatric Services 55, 942943.CrossRefGoogle ScholarPubMed
Sistema Nazionale Linee Guida (2007). Gli Interventi Precoci nella Schizofrenia, Ministero della Salute, 2007. Retrieved August 26, 2008, from http://www.snlg-iss.it/lgn_schizofreniaGoogle Scholar
Tohen, M., Strakowski, S. M., Zarate, C., Hennen, J., Stoll, A. L., Suppes, T., Faedda, G., Cohen, B. M., Gebre-Medhin, P. & Baldessarini, R. J. (2000). The McLean-Harvard First-Episode Project: 6-month symptomatic and functional outcome in affective and non affective psychosis. Biological Psychiatry 48, 467476.CrossRefGoogle Scholar