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The risk of psychotic spectrum disorders in Western countries seems to be higher among immigrants than natives. The higher vulnerability may be related to biological, psychological and social factors while cultural and diagnostic difficulties seem to delay an effective therapeutic intervention, with longer DUP (duration of untreated psychosis).
Aim of the study is to analyze the characteristics of psychotic patients of foreign origin with a particular attention to their use of mental health services.
We studied all migrant patients attended to 3 Community Mental Health Centres (CMHC) and to the Psychiatric Hospital (PH) of Modena over a period of a month.
The socio-demographic and clinical data were collected by means of a structured culturally-oriented form.
63 patients of foreign origin attended to the Services. 46% of all diagnoses is a psychotic disorder (most frequent diagnosis being that of brief psychotic episode: 19.15% in CMHC, 22% in PH).
Psychotic disorders are prevalently present among Asian, South American and Eastern European populations.
Use of second generation antipsychotics is frequent in the CMHC (23.4% of all psychopharmacological treatments, p = 0.003) while combined therapies dominate in PH (42.86%). The DUP is on average 12 weeks in PH, 8 in CMHC.
We would confirm a high incidence of psychosis among migrant subjects, with a tendency to use emergency health services. Often there are difficulties in establishing a continuous and territorial therapeutic relationship, or to intervene in the early stage of onset.
In Italy, 6 months of abstinence from alcohol/substances are required before OLT, evidence for this recommendation remaining controversial. No standard approach linking abstinence duration at the index psychiatric pre-OLT evaluation to referral to Community Services is followed.
To report data of the Modena Consultation-Liaison Psychiatric Service (MCLPS) for pre-OLT patients with Substance Use Disorders (SUDs), and to evaluate patients' concordance with referrals.
Case-control study. Data source: database of MCLPS. Psychiatric evaluations pre-OLT from 01/01/2008 to 31/12/2013 were extracted. Patients were controls if they had a SUD and abstinent for more than 6 months; cases if they had a SUD with less than 6 months of abstinence. Chi-squared analysis was performed with STATA 13.0.
515 consultations were requested for 309 pre-OLT patients, 36.3% (N=112) of patients had a current or past SUD. Controls were 80 (71.3%), while cases – who had stopped use less than 6 months before the consultation, or were still using- were 20 (17.9%). 52.5% of controls (N=42) and 85.0% of cases (N=17) were referred to community services (Chi 5.71; p=0.02). 70.0% of cases (N=14) and 33.6% of controls (N=27) were seen at least twice (Chi 7.22; p=0.01). 16.7% (N=2) of cases and 23.5 % (N=4) of controls referred to community services reported concordance with Consultant's recommendation at re-assessment, a non-significant difference with cases (Chi 0.00; p=1.00).
Consistently with previously research in this field, no difference of concordance with recommendations emerged between patients with SUD with different duration of abstinence.
Hospital A&E departments are the most frequent access to healthcare among migrants, often accounting for improper admissions. This also impacts massively on delivery of psychiatric care and prevention, making it hard to provide a health program, and not just solving an acute situation.
To analyze admissions to the A&E by migrants, focusing on previous medical/psychiatric history and health program after discharge.
Electronic databases were searched for all migrants accessing the A&E departments of the two general hospitals in Modena, Italy, during 2010.
Of the patients evaluated in the A&E, 10.24% were migrants. For 5% of these, the reason for admission was psychiatric, for 36% non-psychiatric (mostly traumatic); for the remaining 56%, admission was due to mild somatic symptoms, possibly medically unexplained symptoms suggestive of somatization (i.e. 16.59% gastro-intestinal symptoms, 10.92% joint pains).
Only 32% of the migrants accessing because of explicit psychiatric reasons (attempted suicide, alcohol abuse, aggressiveness) were investigated by a psychiatrist. After the psychiatric consultation, 35% of patients were referred to community mental health centers, 20% to psychiatric wards, 22% to primary care, 6% to services for substance abuse.
Migrants in the A&E are referred to psychiatry only for severe psychopathology and disturbances, very rarely for symptoms suggestive of somatization, which are particularly difficult to recognize in the A&E: this may result in delay in diagnosis and chronicization.
A challenging medicine dissertation: to design a psychiatric therapeutic community.
A medical student winning a grant addressed to architects and farm laborers aimed to convert a rural area through Social Innovation programmes, a group of young enthusiastic psychiatrists and a donor involved in psychiatric circumstances are the actors of the project for turning a rural building located in the small village of “Villa San Bartolomeo” (Reggio Emilia, Italy) into a psychiatric social-rehabilitation community.
The project started reviewing the literature concerning community-based psychiatry residential facilities. Later, a structured interview has been carried out with the village's inhabitants in order to investigate both their perception of stigma towards mental illness and the perceived needs of their city. The answers have then been used to organize the activities within the psychiatric community, ranging from recreational through sportive until occupational ones, such as farming vegetable gardens, breeding domestic animals, producing handiworks. These labors are intended both to satisfy the village demands and realize a greater integration of the community itself within the surrounding social network.
The therapeutic interventions that are going to be realized within the residential home will be aimed to promote patients’ personal growth and adapting capacity. These interventions are intended to allow the accomplishment of a greater housing independence of the hosts by restructuring their affective, relational and social backgrounds.
This is an ambitious project, started by chance, representing the desire and the hope for curing mental illness by establishing a contact with the natural environment.
Self-harm behaviours (SHB), including attempted suicide, and completed suicide (CS) have been reported to be common among migrants. the objective of this study is to provide a retrospective analysis of migrants that committed SHB and CS, in relation to their psychiatric history and care, in the same catchment area and in the same period.
Data on migrants referred to psychiatric consultation from the A&E department for SHB during 2010 and 2011 at the Consultation-Liaison Psychiatry Service in Modena were compared to data on migrants that committed CS recorded in the database of Modena Forensic Medicine Service.
Of the 297 total SHB referred to psychiatric consultation in the two years, 102 were of migrants (34.3%), mainly women (54.8%) with a mean age of 31.4 years (SD = 12.2). in the same period, CS among migrants were instead only 5.7% of total (122), all male (100%), with a mean age of 36.3 years (SD = 10.9). the majority (70.2%) of SHB migrants were not under psychiatric care at the moment of SHB, but 39.3% had a positive psychiatric history. After psychiatric referral, 26.8% were admitted to the psychiatric ward. SHB were more than one in the two-year period for 13.6% migrant patients. Hanging was the most frequent method for CS (71.4%), whereas drug ingestions were for SHB (42.9%).
Data from our analysis confirm general epidemiologic features of suicide as well as the finding of SHB being particularly common among migrants.
QTc interval prolongation is considered a risk factor for fatal polymorphic ventricular tachycardia, which can result in sudden cardiac death. Most psychotropic drugs have a dose-dependent potential to prolong the QTc interval. However, other factors require appropriate consideration, including: age; gender; other medications; electrolyte abnormalities; severe comorbid conditions, such as co-occurring alcohol or substances abuse/dependence.
The objective was to study the potential mediating roles of alcohol/substances abuse on QTc prolongation.
The Italian research group STAR Network, in collaboration with the Young Italian Psychiatrists Association, aimed to evaluate the frequency of QTc interval prolongation in a sample of patients under treatment with psychotropic drugs through a cross-sectional national survey.
A sample of 2411 unselected patients were enrolled after performing an ECG during the recruitment period. Sociodemographic and clinical characteristics were collected from medical records. Collected data underwent statistical analysis.
A total of 11.2% of patients reported alcohol abuse, and only 8.9% psychotropic substances. According to the threshold, less than 20% of patients had a borderline value of QTc, and 1% a pathological value. Patients with co-occurring alcohol misuse and drug abuse were more likely to have longer QTc interval.
The present study describes the frequency of QTc prolongation in real-world clinical practice. Before prescribing a psychotropic drug, the physician should carefully assess its risks and benefits to avoid this type of adverse reaction, particularly when additional risk factors are present. The potential role of alcohol and substances on QTc length could be particularly useful in emergency settings.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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