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The treatment of acute psychotic episode: discrepancy between routine practice and evidence. The project SIEP-DIRECT's

Published online by Cambridge University Press:  11 April 2011

Antonio Lora*
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera di Vimercate, Vimercate (Milano)
Giuseppe Corlito
Affiliation:
Dipartimento Salute Mentale Area Vasta Sud Est (Arezzo, Siena, Grosseto)
Maurizio Miceli
Affiliation:
Dipartimento di Salute Mentale, Azienda Sanitaria di Firenze, Firenze
Walter Di Munzio
Affiliation:
Dipartimento di Salute Mentale, Azienda Sanitaria Locale Nocera Inferiore (Salerno)
Antonio Lasalvia
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università degli Studi Verona, Verona
Andrea Tanini
Affiliation:
Dipartimento di Salute Mentale, Azienda Sanitaria di Firenze, Firenze
Luisa Mari
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera S. Paolo, Milano
Massimo Casacchia
Affiliation:
Dipartimento di Scienze della Salute, Università degli Studi L'Aquila, L'Aquila
Nadia Magnani
Affiliation:
Dipartimento Salute Mentale Area Vasta Sud Est (Arezzo, Siena, Grosseto)
Doriana Cristofalo
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università degli Studi Verona, Verona
Domenico Semisa
Affiliation:
Dipartimento Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti (Bari)
Mirella Ruggeri
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università degli Studi Verona, Verona
*
Address fo correspondence: Dr. A. Lora, Dipartimento di Salute Mentale, Azienda Ospedaliera di Vimercate (Milano), Servizio Psichiatrico di Diagnosi e Cura, Presidio di Desio, Via Mazzini 1, 20033 Desio (Milano). Fax: +39-0362-383.865 E-mail: antoniolora@virgilio.it

Summary

Aims – To evaluate the quality of psychiatric care during the acute psychotic episode and the early post-acute period. Methods – Data concerning 24 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT's Project to evaluate the implementation of NICE recommendations in Italian Mental Health Services. Results – The treatment of the acute episode in the Italian Mental Health Services is not based only on admissions in Psychiatric Ward in General Hospitals, but also on intensive home based care. The utilization of day hospital facilities for treating acute episodes is less frequent, as the presence of home based follow up after discharge. About of Departments of Mental Health did not have clinical guidelines concerning the pharmacological treatment in this area. However usually the standard practices followed NICE recommendations in terms of prescribed dosages, monitoring side effects and rationale for shifting to atypical antipsychotic drugs. Antipsychotic drugs, atypical or conventional, were frequently prescribed concurrently, while utilization of atypical antipsychotic drugs was increasing. Conclusions – The results show critical points concerning on one hand the scarce diffusion of clinical guidelines, on other hand the connection between standard practices, clinical guidelines and marketing of atypical antipsychotic drugs. It should be reinforced the role of the community and particularly at service level the capacity of community mental health teams to treat the acute patients.

Declaration of Interest: none.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2008

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References

BIBLIOGRAFIA

American Psychiatric Association (1997). Practice Guideline for Treatment of Patients with Schizophrenia. American Psychiatric Association: Washington DC.Google Scholar
Bezzi, R., Erlicher, A. & Lora, A. (2006). L'efficacia nella pratica del ricovero nei Servizi Psichiatrici di Diagnosi e Cura in Lombardia. Epidemiologia e Psichiatria Sociale 15(3), 233237.CrossRefGoogle Scholar
Campbell, E. G. (2007). Doctors and drug companies. Scrutinizing influential relationships. New England Journal Medicine 357, 17961797.CrossRefGoogle ScholarPubMed
Carrà, G., Barale, F. & Marinoni, A. (Ed.) (2004). Schizofrenia. Linee Guida Cliniche Complete per gli Interventi Fondamentali nella Medicina di Base e Specialistica. Roma: Il Pensiero Scientifico Editore.Google Scholar
Davis, J. M., Kane, J. M., Marder, S. R., Brauzer, B., Gierl, B., Schooler, N., Casey, D. E. & Hassan, M. (1993). Dose response of prophylactic antipsychotics. Journal of Clinical Psychiatry, Suppl. 54, 2430.Google ScholarPubMed
de Girolamo, G., Barbato, A., Bracco, R., Gaddini, A., Miglio, R., Morosini, P., Norcio, B., Picardi, A., Rossi, E., Rucci, P., Santone, G., Dell'Acqua, G. & PROGRES-Acute group (2007). Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy. British Journal of Psychiatry 191, 170177.CrossRefGoogle ScholarPubMed
Dell'Acqua, G. & Cogliati Dezza, M. G. (1985). The end of the mental hospital. A review of the psychiatric experience in Trieste. Acta Psychiatrica Scandinavica, Suppl. 316, 4569.CrossRefGoogle ScholarPubMed
Duggan, L., Fenton, M., Rathbone, J., Dardennes, R., El-Dosoky, A. & Indran, S. (2005). Olanzapine for schizophrenia. Cochrane Database of Systematic Reviews Issue 2, Art. No.: CD001359. DOI: 10.1002/14651858.CD001359.pub2.CrossRefGoogle Scholar
Gaebel, W., Möller, H. J., Buchkremer, G., Ohmann, C., Riesbeck, M., Wölwer, W., Von Wilmsdorff, M., Bottlender, R. & Klingberg, S. (2004). Pharmacological long-term treatment strategies in first episode schizophrenia: study design and preliminary results of an ongoing RCT within the German Research Network on Schizophrenia. European Archives of Psychiatry and Clinical Neuroscience 254, 129140.CrossRefGoogle ScholarPubMed
Gigantesco, A., Miglio, R., Santone, G., de Girolamo, G., Bracco, R., Morosini, P., Norcio, B., Picardi, A. & PROGRES group (2007). Process of care in general hospital psychiatric units: national survey in Italy. Australian and New Zealand Journal of Psychiatry 41, 509518.CrossRefGoogle ScholarPubMed
Gilbert, P. L., Harris, M. J., McAdams, L. A & Jeste, D. V. (1995). Neuroleptic withdrawal in schizophrenic patients. A review of the literature. Archives of General Psychiatry 52, 173188.CrossRefGoogle ScholarPubMed
Grolleau, A., Cougnard, A., Parrot, M., Kalmi, E., Desage, A., Misdrahi, D., Brun-Rousseau, H. & Verdoux, H. (2007). Prescription practices of antipsychotic medication in early psychosis: a two-year follow-up survey of subjects admitted in two psychiatric hospitals of SouthWestern France. Encephale 33, 326331.CrossRefGoogle Scholar
Hunter, R. H., Joy, C. B., Kennedy, E., Gilbody, S. M. & Song, F. (2003). Risperidone versus typical antipsychotic medication for schizophrenia. Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD000440. DOI: 10.1002/14651858.CD000440.CrossRefGoogle Scholar
Jervis, G. (1977). Il Buon Rieducatore. Feltrinelli: Milano.Google Scholar
Johnson, S., Nolan, F., Pilling, S., Sandor, A., Hoult, J., McKenzie, N., White, I. R., Thompson, M. & Bebbington, P. (2006). Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. British Medical Journal 331, 599602.CrossRefGoogle Scholar
Joy, C. B., Adams, C. E. & Rice, K. (2006). Crisis intervention for people with severe mental illnesses. Cochrane Database of Systematic Reviews Issue 4. Art. No.: CD001087. DOI: 10.1002/14651858. CD001087.pub3.CrossRefGoogle Scholar
Kissling, W. (1991). The current unsatisfactory state of relapse prevention in schizophrenic psychoses: suggestions for improvement. Clinical Neuropharmacology 14, Suppl. 2, S3344.Google Scholar
Kulkarni, J. & Paddy, P. (2001). Trattamento del primo episodio psicotico. In Riconoscere ed Affrontare le Psicosi all'Esordio. Un Approccio Preventivo (ed. Mc Gorry e, P. D., Jackson, H. J.). Centro Scientifico Editore: Torino.Google Scholar
Lehman, A. F., Steinwachs, D. M, & PORT Co-investigators (1998). Patterns of usual care for schizophrenia: initial survey results from the Schizophrenia Patient Outcomes Research Team (PORT) survey. Schizophrenia Bulletin 24, 1120.CrossRefGoogle ScholarPubMed
Lelliott, P., Paton, C., Harrington, M., Konsolaki, M., Sensky, T. & Okocha, C. (2002). Variation between services in polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients. Psychiatric Bulletin 26, 418420.CrossRefGoogle Scholar
Lewis, S. W., Davies, L., Jones, P. B., Barnes, T. R., Murray, R. M., Kerwin, R., Taylor, D., Hayhurst, K. P., Markwick, A., Lloyd, H. & Dunn, G. (2006 ). Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of current drug treatment. Health Technology Assessment 10, 1165.CrossRefGoogle ScholarPubMed
Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., Keefe, R. S. E., Davis, S. M., Davis, C. E., Lebowitz, B. D., Severe, J. & Hsiao, J. K. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal Medicine 353, 12091223.CrossRefGoogle ScholarPubMed
Lora, A, Cosentino, U, Gandini, A & Zocchetti, C. (2007). Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy). Epidemiologia e Psichiatria Sociale 16(4), 330338.Google Scholar
Lora, A., Morganti, C., Erlicher, A., Burti, L., Buscaglia, G., Pegoraro, M., Iacchetti, D., Cristofalo, D., Ruggeri, M. & Semisa, D. per il Gruppo SIEP-DIRECT'S (2008). Management of violent behaviour and rapid tranquillisation during acute psychotic episode: discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4).Google ScholarPubMed
Manuali, C., Ciappi, F., De Pascalis, A., Fondi, E., Servadio, L., Turchi, M., Venturi, G. & Vit, R. (1978). Ipotesi di malattia mentale e criteri di operatività sul territorio. Fogli di informazione 50, 336340.Google Scholar
Marshall, M., Crowther, R., Almaraz-Serrano, A., Creed, F., Sledge, W., Kluiter, H., Roberts, C., Hill, E. & Wiersma, D. (2008). Day hospital versus admission for acute psychiatric disorders Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD004026. DOI: 10.1002/14651858.CD004026.CrossRefGoogle Scholar
Martini, P., Cecchini, M., Corlito, G., D'Arco, A. & Nascimbeni, P. (1985). A model of a single comprehensive mental health service for a catchment area: a community alternative to hospitalization. In Focus on the Italian Psychiatric Reform (ed. Perris, C. and Kemali, D.). Acta Psychiatrica Scandinavica, Monograph Supplement No. 316, vol. 71., pp. 95120.Google Scholar
Mason, P., Harrison, G., Gazebrook, C., Medley, I. & Croudace, T. (1996). The course of schizophrenia over 13 years. A report from the International Study on Schizophrenia (ISoS) coordinated by World Health Organization. British Journal of Psychiatry 169, 580586CrossRefGoogle Scholar
Möller, H. J. & van Zerssen, D. (1995). Course and outcome of schizophrenia. In Schizophrenia (ed. Hirsch, S. R. and Weinberger, D. R.), pp. 106127. Blackwell Science: Oxford.Google ScholarPubMed
National Institute for Clinical Excellence (NICE) (2002). Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia. In Technology Appraisal No. 43. National Institute for Clinical Excellence: London.Google Scholar
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 G., Carrà, Barale e, F., Marinoni, A.). Il Pensiero Scientifico Editore: Roma.Google Scholar
Nosè, M. & Barbui, C. (2003). Systemic review of clinical interventions for reducing treatment non-adherence in psychosis Epidemiologia e Psichiatria Sociale 12, 272286.CrossRefGoogle ScholarPubMed
Peralta, V., Cuesta, M. J., Caro, F. & Martinez-Larrea, A. (1994). Neuroleptic dose and schizophrenic symptoms. A survey of prescribing practices. Acta Psychiatrica Scandinavica 90, 354357.CrossRefGoogle ScholarPubMed
Priebe, S. & Fioritti, A. (2004). Dopo la deistituzionalizzazione: stiamo imboccando il cammino contrario? Psichiatria di Comunità 3, 137144.Google Scholar
Regione Lombardia (in press). Il Sistema di Salute Mentale della Regione Lombardia. Milano.Google 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., Lora, A. & Semisa, D. on behalf of the SIEP-DIRECT'S Group (2008a). 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 Sociale 17(4), 358368.Google ScholarPubMed
Ruggeri, M., Bacigalupi, M., Casacchia, M., Miceli, M., Morganti, C., Scavo, V., Allevi, L., Lupoi, S., Cristofalo, D., Lasalvia, A., Lora, A. & Semisa, D. per il Gruppo SIEP-DIRECT'S (2008b). Care across all phases of schizophrenia and initiation of treatment: discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project (in Italian). Epidemiologia e Psichiatria Sociale 17(4), 305318.Google Scholar
Saraceno, B. (2000). La Fine dell'Intrattenimento. Manuale di Riabilitazione Psichiatrica. Editore Etas Libri: Pisa.Google Scholar
Schooler, N., Rabinowitz, J., Davidson, M., Emsley, R., Harvey, P. D., Kopala, L., McGorry, P. D., Van Hove, I., Eerdekens, M., Swyzen, W., De Smedt, G. & Early Psychosis Global Working Group (2005). Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial. American Journal of Psychiatry 162, 947953.CrossRefGoogle ScholarPubMed
Scott, R. D. (1982). Una terapia orientate alla famiglia nell'ambito della comunità e servizi di intervento sulla crisi: principi fondamentali. In L'Ospedalizzazione Psichiatrica e le Alternative al Ricovero. Il Pensiero Scientifico: Roma.Google Scholar
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.Google 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. & Lora, A. 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.Google Scholar
Taylor, D., McConnell, D., McConnell, H. & Kerwin, R. (2001). The South London & Maudsley NHS TRUST 2001 Prescribing Guidelines, 6th ed.Martin Dunitz: London (Le Linee Guida per La Terapia Psicofarmacologica Preparate dal Maudsley Hospital, ed. it. a cura di ParianteC. e DazzanP.).Google Scholar
Tibaldi, G., Munizza, C., Bollini, P., Pirro, E., Punzo, F. & Gramaglia, F. (1997). Utilization of neuroleptic drugs in italian mental health services. A survey in Piedmont. Psychiatric Services 48, 213217.Google ScholarPubMed
Tognoni, G. (1999). Pharmacoepidemiology of psychotropic drugs in patients with severe mental disorders in Italy. Italian Collaborative Study Group on the Outcome of Severe Mental disorders. European Journal of Clinical Pharmachology 55, 685690.CrossRefGoogle Scholar
Tuunainen, A., Wahlbeck, K. & Gilbody, S.M. (2000). Newer atypical antipsychotic medication versus clozapine for schizophrenia. Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD000966. DOI: 10.1002/14651858.CD000966.CrossRefGoogle Scholar
Wagner, E. H. (2004). Chronic disease care. British Medicine Journal 328, 177178.CrossRefGoogle ScholarPubMed
World Health Organization (2001). The World Health Report 2001: Mental Health: New Understanding, New Hope. WHO: Geneva.Google Scholar
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