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To evaluate the cognitive status in an elderly population including both community-dwellers and institutionalised subjects.
462 subjects (mean age 85.1±6.9 years, 53.2% females) living in the Faenza district (Ravenna, Northern Italy) were interviewed and clinically evaluated. The Cambridge Mental Disorders of the Elderly Examination (CAMDEX) was administered to all participants to collect socio-demographic and clinical information. The cognitive status was evaluated using the cognitive assessment included in the CAMDEX (CAMCOG) and the Mini-Mental State Examination (MMSE) (adjusted by sex and age). Cut-offs were as follow: CAMCOG scores < 80; MMSE scores < 24.
The CAMCOG identified 245 subjects (53.0%) as cognitively impaired; 132 persons (28.6%) had a MMSE score < 24 and were impaired in the activities of daily living. Prevalence of dementia (DSM-IV criteria) was 19.1% (N=88), including 11 cases of ‘questionable’ dementia. Demented subjects were more likely to be women (65.9%), were less educated (p< 0.05) and older than non-demented (p< 0.001). Demented subjects scored significantly lower than non-demented subjects in any cognitive domain at CAMCOG (p< 0.001).
Cognitive domains: mean score and standard deviation (p< 0.001).
Non-demented vs Demented
All subjects: 78.4(±15.9) vs 28.7(±21.7)
Males: 81.1(±13.0) vs 35.0(±19.9)
≤85: 83.3(±12.3) vs 38.0(±20.5)
>85: 75.7(±13.2) vs 34.0(±20.2)
Females all: 75.7(±18.0) vs 24.3(±21.9)
≤85: 82.5(±12.4) vs 58.5(±10.8)
>85: 67.0(±20.2) vs 18.4(±17.5)
Among demented subjects, only 4.5% were treated with acetylcholinesterase inhibitors (p=0.046); 10.2% used other anti-dementia medications (p=0.067).
Despite of the high prevalence of dementia, only few subjects affected by dementia were properly treated.
The Social Skill Training is structured as a cognitive-behavioral therapy for rehabilitation plans whereby the patient can develop and recover social skills.
To verify the effects of a literary workshop for increase assertiveness in patients with eating disorders.
Thirty-two patients consequently admitted to the Ward for Eating Disorders at the Private Clinic “Villa Maria Luigia” in the North of Italy were recruited in the study, and all of them agreed to take part in it. Of the 32 patients, 8 were randomly assigned to treatment and 24 to care as usual, being the difference between treatment and care as usual only represented by the literary workshop. The Rathus Assertiveness Schedule and Verbal Fluency Test (phonemic and semantic) was administered to all patients in the first and last week of hospitalization. The literary workshop consists in 16 weekly 45-minute group sessions. Issues of expressiveness through the use of writing are addressed during the sessions.
A significant improvement of semantic skills (t=-5.60; p< 0.01 vs. t=1.43; p=0.17), phonetic skills (t=-3.66; p< 0.01 vs. t=1.35; p=0.19) and assertiveness (t=4.47; p< 0.01 vs. t=0.94; p=0.93) was registered in the literary workshop group.
Effectiveness of the literary workshop in a rehabilitation program for patients suffering from eating disorders is suggested: improved communication and language skills might have a positive and significant impact on patients’ levels of assertiveness.
INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs/risks of patients. It consists of a structured interview defining 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. The aim of this work was to assess preliminary the effectiveness of a training program on the clinical use of INTERMED.
After a group training on the use of INTERMED carried out between April and September 2009, the method was applied to 30 female patients aged between 20 and 65, subsequently referring to three clinical settings: a GP clinic; a psychiatry day-care clinic; a CLP out-patient clinic. Demographic and clinical data were collected, together with administration of HADS and WHOQoL-bref.
The mean INTERMED score was 20.8, borderline as to definition of complex cases. Patients from the GP clinic and in the CLP setting scored lower (respectively 16.5 and 18.2) than patients from the psychiatric day-clinic (27.8), suggesting that the presence of severe psychiatric disturbances might contribute to increasing the level of case-complexity. Concordance with results at HADS and WHOQoL was high.
A clinical practice in the use of INTERMED after the theoretical phase of the training process is necessary to reinforce effectiveness of the training. These preliminary positive results will hopefully open the way to a wider diffusion of this tool in clinical practice in the area of Modena.
To construct and test the validity of a new psychometric questionnaire to assess psychological impact of facial lipoatrophy (ABCD-F), that is the most stigmatizing feature of HIV-related lipodystrophy.
Construction: The development went through Focus groups and Content Validity, Item reduction and Exploratory Factor Analysis.
Validation: ABCD-F questionnaire was administered together with ABCD and MOS HIV questionnaires. The Cronbach's Alfa was used to test internal consistency, while convergent validity and divergent validity were analyzed by the correlations with MOS, ABCD items and BMI and CD4 counts respectively.
42 HIV+ people participated to focus groups. In the EFA the 17 Items were aggregated around psychological distress and role functioning domains.
ABCD-F showed high internal consistency (Chronbach's alpha = 0.95). Both convergent and divergent validity were confirmed. ABCD-F scores were highly correlated to Physical Health Summary (B 0.59; 95% [CI] 0.35; 0.84; p< 0.0001), Mental Health Summary (B-1.54; 95% [CI] 1.15; 1.93; p< 0.0001), and weakly correlated to CD4 count (B-0.02; 95% [CI] -0.01; 0.06; p=0.54) and HIV viral load (B-0.004; 95% [CI] -2.69; 2.69; p=1.00).
ABCD-F is a valid and reliable questionnaire to assess psychological impact of facial lipoatrophy (FLA).
ABCD-F may result as a useful tool both in clinical and research settings: it's able to identify people experiencing greater psychological impact due to FLA. It may become an objective instrument to evaluate priority and efficacy of plastic surgery to treat lipodystrophy. In research setting may be used to compare different populations or different treatments of FLA.
To test the presence of significant correlations between psychopathological symptoms in patients with dementia and the stress perceived by the primary caregiver.
Primary caregivers of patients with a DSM-IV diagnosis of dementia admitted to the neuro-psycho-geriatric-rehabilitation ward of the private hospital “Villa Maria Luigia”, Parma - Italy, between May and November 2008 were asked to take part in the study. The NPI scale (UCLA Neuropsychiatric Inventory - Commings J.L. et al., 1994) and a socio-demographic data collection schedule were administered to the primary caregiver willing to be involved in the study.
Only 30 of the 40 eligible subjects agreed to take part to the study (75%). 35 significant correlations (according to Spearman's Correlation Index) were found. Those most highly significant (p< 0.001) were between stress perception and the following NPI symptom categories: delirium, hallucination, agitation, euphoria, apathy, disinhibition, aberrant physical activity and sleep disorders.
The psychopathological symptoms found to contribute mostly to distress of caregivers were those most showy and disruptive of behaviour; other symptoms, such as anxiety, depression, irritability and eating disorders are better tolerated as considered normal consequences of ageism. Interventions addressed to caregivers should provide them with detailed and structured coping instruments. Clear, therefore, the need for all health professionals, to structure an intervention aimed at caregivers characterized by two different phases:
1. To provide more tools to recognize those disorders which don’t emotionally involve them;
2. To give detailed, structured information useful to cope with these disorders in everyday life.
INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs and risks of patients. It consists in a structured interview defining 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. The aim of this work was to describe the training process on the use of INTERMED and to assess its effectiveness.
A training group of 9 subjects had two-hour meetings twice a month between April and September 2009. After introductory sessions on theoretical aspects and inter-trainee simulations on interviewing and scoring techniques, students were assigned the task of producing video-recorded clinical material, which was used to comment on interviewing skills and practice on scoring. Individual and consensus scores were collected at the beginning and at the end of the training and compared statistically by means of Cohen's kappa.
Motivation and involvement of students in the training was high (participation was on a voluntary basis during extra-work hours), as satisfaction. Agreement between individual and consensus scores was high already at the beginning of the training (Cohen's kappa mean value of 0.80) and slightly improved during the course.
The training process gave positive results both on the quantitative and the qualitative sides of evaluation. A six-month 25-hour training period is a reasonable time for learning how to master the instrument, although it needs to be followed by the clinical practice.
The project “Social Point” deals in promoting integration of Mental Health Service recipients within contexts of social relationship, voluntary work and community activism. The project is still taking place in the district of Modena.
Assessment of the effectiveness of the project SP: production of a change in quality of life; development of purposeful relationships out of families and health services; development of Mental Health Service recipients’ awareness of being not only a user of the health service but also a resourceful person; change of method and approach within relationship between Mental Health and community and public services.
At the beginning and at the end of the integration courses (autumn/winter 2010 and after 6–8 months), both individuals and collectives, every Mental Health Service recipient was asked to fill in a form with socio-demographic characteristics and the WHOQOL-bref. A social network diagram was subsequently drawn.
At the end of the research (September 2010) joining courses directed to the development of social relationship is forecast to improve the quality of life of the recipients, to increment purposeful relationships and to strengthen empowerment of persons with mental disease by promoting a different project of life no more illness-based but resource-based.
The study will provide evidences about the performance of the project with regard to the promotion of the social integration of citizens with mental disease in contexts, to the empowerment and to the promotion of processes of social.
Drop-out from treatment for Eating Disorders is increasing (Campbell; 2007), and it is a risk factor for relapse and more chronic and severe course of the illness (Fassino et al.; 2009). Drop-out can be caused by interaction of concurrent, individual, familiar ad environmental factors (Sly; 2009).
Aim of the study
To examine possible risk factors of drop-out from inpatient treatment for eating disorders.
Materials and methods
The sample included 41 patients who voluntarily left the treatment before completion (’droppers’) and 88 patients who completed it (’completers’), in the period between 1st January 2006 and 31st December 2009 at Villa Maria Luigia Hospital (Monticelli Terme, PR, Italy). Patients were administered 2 self-report questionnaires and 3 psychometric tests: Eating Disorders Questionnaire, Predisposing, bringing on and maintaining risk factors for eating disorders, EDI-II, BUT, SCL-90.
Droppers appear to be more aggressive (p = 0.022), get worse scholastic results (p = 0.016) and have less friendships and less social interaction (p = 0.021). Parental break-up (p = 0.015), moving house (p = 0.006), father's death (p = 0.005), abortition (p = 0.040), father's alcohol abuse (p = 0.011) and a mother who suffers of eating disorder (p = 0.008) are more frequent in droppers than completers. Catholic religion seems to be a protective factor from drop-out (p = 0.005).
Drop-out is a multifactor phenomenon; identification of risk factors can improve treatment strategies and outcome.
The use of standardized tools for assessment and monitoring of a rehabilitation program is strongly recommended, though not so often accomplished in clinical practice.
To describe the development and feasibility of a computerised method of assessment of rehabilitation activities based on psychometrics.
The software “SVAROSKI” was implemented by means of a relational ER (Entity-Relationship) model with a user interface managed by MS-Access. The rehabilitation activities were: Physical therapy; Locomotion, Occupational Therapy and Reality-Orientation Therapy. Patients were administered at the beginning and at the end of admission the following tests: MMSE, MODA, Barthel Index, Tinetti.
The software enables processing of test data with those obtained from rating scales at each session.
For each patient, two graphical reports are made available:
Punctual performance of each item divided by subject areas;
Overall pace of the three scales assessing rehabilitation (physical therapy was maintained for an evaluation board, partly qualitative, for the sake of the physiotherapist of the structure).
The software allows:
1) the rapid storage of the scores obtained from patients during the course of rehabilitation activities,
2) the real-time consultation of the development of therapeutic and rehabilitation,
3) the comparison of the iteration of several rehabilitation interventions on the patient.
SVAROSKY is a useful tool for analysis and monitoring of developments in the rehabilitation of the patient as a valid tool for the development of a synthesis report of the rehabilitation process.
To evaluate the relationship between depression, somatic symptoms, cognitive impairment and disability in an elderly population.
216 subjects (65-84 years) were clinically examined for somatic symptoms, and underwent a mental health examination. Depression was defined by Geriatric Depression Scale scores >11/30; cognitive impairment by Mini-Mental State Examination scores < 24/30; functional status by Instrumental Activities of Daily Living Scale. Associations between depression, cognitive impairment or somatic symptoms and disability were evaluated by logistic regression analyses, estimating Odds Ratios (ORs) and 95% confidence intervals (95%CI) adjusted by sex, age, education.
Disability was common among depressed individuals (OR(95%CI)=3.60(1.63-7.96)) and among cognitively impaired subjects (OR(95%CI)=7.35(3.07-17.60)). An increasing number of somatic complaints increased the probability of functional impairment: compared with presence of 1-2 somatic symptoms, complaint of 3-6 and 7-12 symptoms were related to disability with OR(95%CI)=3.30(1.11-9.80) and OR (95%CI)=4.20 (1.17-15.09) respectively. Distinguishing pain, gastrointestinal, pseudo-neurological and general symptoms, only general somatic symptoms (palpitations, fatigue, sleep disturbances) were associated with disability (OR(95%CI)=1.81(1.25-2.62), independently by medical conditions (OR(95%CI)=1.57(0.98-2.52)). An additive effect toward disability was observed when general somatic complaints and cognitive impairment were co-existing (OR(95%CI)=23.68(5.50-101.86)). Including simultaneously cognitive impairment, somatic complaints and depression in the model, only cognitive impairment was still significantly related (OR(95%CI)=5.87(2.66-12.96)).
Among many possible causes of disability in the elderly, an important role could be attributed to cognitive deficits.
To evaluate the clinical and functional effects of cannabis abuse in patients at First Episode Psychosis (FEP) referring to Community Mental Health Centre (CMHC) “Bologna Ovest” and in patients admitted with a diagnosis of psychosis at the Modena Emergency Psychiatry Ward (EPW).
All FEP patients, aged 18-35, referring to CMCH “Bologna Ovest” in a 6-years period were evaluated and followed-up at 3 and 12 months. Of the 1559 psychiatric admissions at the Modena EPW in a 3-year period, those with a positive history for substance abuse were selected.
Among the 88 Bologna Ovest FEPs, 32% were cannabis abusers (FEP-c). In Bologna, FEP-c were more frequently natives (23.39% vs 31.13%; c sq=5.1; p=0.02) single (26.38% vs 0,0% c sq=7.3, p=0.007) and unemployed (13.50% vs 18.32%, c sq=2.4, p=0.1). Non FEP-c did not use any other drug (0.0% vs 26.1%, c sq=77.5; p< 0.001). A trend towards higher prevalence of hospital admission at follow-up was found for FEP-c (4.20% vs 2.4%, c sq=3.8, p=0.07). 22.0% of patients admitted at the Modena EPW had a positive history for substance abuse: of these, 7% were diagnosed with paranoid schizophrenia, which significantly correlated with the use of cannabinoids (alone or in association).
Our results enlighten that cannabis use is frequent among psychotic patients admitted to hospital and worsens clinical course of FEP patients, consistently with previous evidence (Hambrecht & Hafner, 1996; Hafner et al., 2004).
INTERMED is a method to assess biopsychosocial case complexity and a screening instrument to identify patients with multiple care needs. It is based on an interview, brief and easy to use, that can be conducted also by a nurse. Various studies in the last 10 years have confirmed its face-validity and reliability as a clinimetric tool. Its self-assessment version (IM-SA) was developed for further implementation in clinical settings.
To evaluate language, structure and fluency of the IM-SA questionnaire.
IM-SA, Italian version 1.0, was administered to 25 patients admitted to an internal medicine ward and to other 25 in the waiting room of a Primary Care outpatient clinic. At the end of the questionnaire, nine extra-questions were specifically added to evaluate comprehension and difficulties encountered by patients while filling in the questionnaire.
Patients admitted to the hospital scored higher and were found to be “more complex” (p < .01). 90% of respondents found the questionnaire easy to answer and 96% answered that the structure of the sentences was not too complex. The majority of patients found IM-SA useful and/or interesting. Contradictions in results also were found, suggesting need for improvement of structural and linguistic properties of the tool.
IM-SA seems to be a feasible and reliable self-assessment method to evaluate biopsychosocial complexity. Further similar studies in different languages are being organized to reach a final version of IM-SA, which will be afterwards compared to the IM professional interview.
To evaluate prevalence rate of suicidal ideation among Italian elderly and to investigate possible socio-demographic and psychopathological features of suicide attempters in a population-based study.
461 subjects (mean age 85 years; 52.9% women; 49.2% widow) were interviewed using the Revised Cambridge Examination for Mental Disorders in the Elderly. the presence of suicidal ideation was assessed by the Scale for Suicide Ideation. the association between suicidal ideation and its correlates was analysed by Logistic Regression Model estimating Odds Ratios and 95% Confidence Intervals (OR, 95%CI).
Eighteen (3,8%) persons refused to answer to questions concerning suicide thoughts. Only one participant declared to have attempted suicide (a 92 years-old men, widow, living on his own and complaining about depressive feelings). Overall suicidal ideation prevalence was 7.3%: wish to die (3.8%) and not worth living (13%). Gender, age, education, marital and socio-economic status were similar in subjects with and without suicidal ideation. Subjects with suicidal ideation had fewer family contacts, were less satisfied of their general health status and had a higher number of depressive and anxiety symptoms. However, when all these conditions were tested in the same model, only depressive symptoms were still significantly associated with suicidal ideation (OR, 95%CI=9.6, 3.3-27.9).
The worldwide aging of the population deserves attention to psycho-geriatric medicine. Study on suicide in late-life are of interest to detect elderly at risk and to emphasize this increasing phenomenon.
A recovery-oriented mental health service system should focus on empowering people with mental illness.
Aim of the study
To analyse the feasibility of setting up a web-radio run by 13 subjects suffering from mental disorders.
Materials and methods
The patients involved in the project attended a one-year preparatory course promoted by the Province of Reggio Emilia, before the factual setting up of “Radio TAB”. After six months, each patient was asked to fill in a qualitative questionnaire addressing motivation and personal competences; opinions on the preparatory course; the identity of the radio, objectives and values shared by participants, the satisfaction they obtained from the activities and their vision of the radio then and for the future.
• great motivation for joining the project and holding on to it
• the preparatory course was judged to be effective to acquire technical, communication and interpersonal skills;
• expectations and objectives of participants were consistent with the values underpinning the radio and the outcomes of the project, suggesting good internal cohesion;
• a well-defined vision of the radio as a result of the work emerged, which will hopefully lead to setting up an actual workplace in future.
The experience of “Radio TAB” could be a good example of empowerment strategies, encouraging individuals to autonomy, reintegration and sense of active citizenship.
Recent reviews of evidence-based guidelines for the clinical management of Bipolar Disorders (BD) have recommended that “all patients with BD should be offered group or individual psychoeducation” to prevent relapse, improve treatment adherence, quality of life and functioning.
The present study aimed at evaluating the psychoeducation in routine mental health.
One hundred and two outpatients were recruited from two Italian DMHs. Inclusion criteria were a lifetime diagnosis of BD type I or II assessed by SCID-I, being euthymic for at least 3 months. Exclusion criteria were a DSM-IV Axis I comorbidity, mental retardation (IQ < 70), organic brain damage. All subjects received standard psychiatric care, with standard pharmacological treatment; one group received additional 21 weekly sessions of psychoeducation group, according to Colom and Vieta model.
Data show that the number of patients hospitalized during the 1-year follow-up, the mean number of hospitalizations per patient and the mean number of days in hospital were significantly lower for psychoeducated patients.
Our study supports the view that group psychoeducation is an efficacious intervention to prevent patients’ hospitalization and decrease hospital days in pharmacologically treated patients with bipolar disorder, also in routine clinical settings. The results seem to confirm that the psychoeducation promotes an improvement in the course of illness, avoiding acute phases, and producing a greater stabilization of the disease and consequently an improvement in quality of life in people with BD.
In a demographic survey in 2005, 13.6% of Italians admitted to have taken CAMs during the 3 years before. A study on hospitalized patients for psychiatric reasons highlighted that 63% of them used CAM in the previous year and 79% did not mention this to their psychiatrists.
To collect the opinions about the use of CAMs in psychiatry among a group of psychiatrists and nurses working in a Mental Health Centre.
To investigate knowledge, opinions and experiences on CAMs.
A mixed qualitative-quantitative method was used: 2 focus groups were conducted in June 2011, involving 12 professionals of one Mental Health Community Centre in Modena, Italy. The audio-recordings of the focus groups were analyzed by 2 researchers, who identified the main themes with an inductive method. The participants were finally asked to fill in a respondent validation questionnaire.
Four main themes were developed:
1) advantages, and
2) disadvantages in the use of CAMs,
3) patients’ and own experiences,
4) variety of therapies under the CAM acronym.
Among the pros, 75% of respondents agreed that CAMs allow a better global approach to the patient, 58% that CAMs may improve quality of life, 66% that conventional psychiatric therapies do not solve every situation. As to disadvantages, some professionals (medical doctors) expressed skepticism on CAMs.
Being realistic, open-minded and ready to listen and cooperate: this could be the best attitude towards patients who take CAMs.
The Consultation-Liaison Psychiatry Service of the Modena General Hospital collaborates regularly with the Cardiology Clinic, within the Woman Wellness Project (WWP). Aim of this collaboration is detection and prevention of post-menopausal correlated diseases, including psychiatric syndromes.
To investigate the association between cardiovascular risk factors (BMI, blood pressure, hyperglycemia, hypertrygliceridemia) and psychiatric symptoms in peri-post menopausal.
Ecological study. Data between January 2008 and December 2012 were collected. Correlations, logistic regessions and categorial regressions were performed with STATA.
675 outpatients attended the WWP. 90 (13.3%) were referred to the psychiatrist; 9 refused the examination. Of the remaining 57.7% had a positive psychiatric history and 22.03% already receaved a psychiatric therapy. 40.6% had at least two medical diseases, mainly: overweight (54.2%), hypertension (40.7%) and dyslipidemia (49.1%). After psychiatric consultation emerged that: 11.9% had anxiety symptoms, 27.1% had depressive symptoms and 47.5% presented both anxiety and depressive symptoms. Only 7 patients (11.9%) had a negative psychiatric examination. The regression analysis pointed out no significant association between the cardiometabolic risk-factors and the psychiatric symptomatology. Differently, the outcome at the end of the psychiatric consultation was associated with BMI (r = −.26; p = .05) and heart rate (r = .33; p = .01).
Heart rate and BMI emerge as factors associated with the psychiatric symptomatology presented by the patient. This finding is consistent with previous researches. The absence of significant associations at the regression analysis could be explained by the small sample considered in the present study.
Vestibular disorders can trigger the onset of psychiatric disorders in predisposed individuals: these comorbidities are often underestimated, untreated and may consequently result in chronicization and poor quality of life. there are still few studies concerning the type and the prevalence of psychiatric disorders in patients with benign paroxysmal positional vertigo (BPPV).
To evaluate psychiatric comorbidities, in particular anxiety, depression, somatisation disorder and alexithymia in a group of BPPV, patients compared to healthy subjects.
Case-control study. We compared for psychiatric morbidity 92 BPPV patients and 141 controls (not suffering from BPPV) recruited at the ENT Unit of Modena General Hospital between November 2007 and December 2010. Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Diagnostic Criteria for Psychosomatic Research (DCPR), Brief Symptom Inventory (BSI) and Toronto Alexithymia Scale (TAS-20) were used to assess psychiatric symptoms.
BDI and STAI scores, BSI subscales for somatization, anxiety and phobic anxiety, DPCR subscales for disease phobia, functional somatic symptoms secondary to a psychiatric disorder and demoralization were significantly different between patients and controls. Conversely, significant differences between the two groups were not found for alexithymia scores.
Affective disorders, such as depression, demoralization, phobia and anxiety, and somatisation appeared to be significantly prevalent in BPPV patients. Contrary to expectations, alexithymia was not found to be more common in these subjects. Further studies are needed, in order to identify psychiatric sufferings at early stages in this population.
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.