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We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.
Airbus Italia recently developed enhanced passive components as key elements for its telecommunication Ku-band antenna product lines, tailored to reconfigurable payloads. This paper describes the design and qualification of a dual linear polarization Ku-band-radiating chain, developed for the DRA receive (Rx) active antennas embarked on the Eutelsat Quantum satellite. The feed chain covers the entire Ku-band frequency range allocated for fixed satellite services providing receive functionality and embedding sharp rejection features over the adjacent transmit band. The proposed design provides high radiation efficiency (>90%) and polarization purity (XPD > 33 dB), together with low RF losses and flat group-delay variation over a 13% fractional bandwidth, keeping a compact size and reduced axial length. The unit has been optimized for high reproducibility in high volume productions, typical of large DRA applications, for which stringent mass and dimensional constraints, as well as excellent amplitude and phase tracking among similar units, are key features. Details of the feed chain design and an overview of RF and environmental qualification test results are presented.
To provide a comprehensive review of past and current implementation of coercive measures in Italy.
Literature review (cross-referencing in PubMed, Embase, and Index Medicus) concerning the application of coercive measures in Italy. Description of the past and current regulations as well as of the routine implementation of coercive measures in Italy has been also empirically summarized.
The Italian 1978 reform law on mental health care clearly established that medical treatment and tests are mainly voluntary. Only under special circumstances, the medical authority can order a patient involuntary admission and the physician is obliged to provide necessary tests and medical treatment. However, even if coercive measures are usually placed without patient's consent, the first objective should remain to protect patient's interest and rights, in accordance to the Italian Constitution. In Italy, there are no officially recognised protocols on coercive measures for acute inpatient care and each psychiatric ward adopts its own rules and internal norms.
In Italy, patients with aggressive or dangerous behaviours are approached by the staff according to a “de-escalating” model, in which physical and mechanical restraint should be adopted only when any other therapeutic options previously failed. Proposals aimed to improve the implementation of coercive measures in clinical practice will be provided.
To assess trainees’ opinions on the quality of provided educational programs, as recently pointed out in several European countries.
The opinions of 198 Italian trainees in psychiatry on their training and their future career were assessed by means of the Questionnaire on Training in Psychiatry (QTP).
Recruited trainees were predominantly female (68%), with a mean age of 30.0 (± 3.0) years. Thirty-seven percent of them chose psychiatry because “it has always been a dream”, 20% by chance and 17% because they felt “keen on it”. Seventy-seven percent of residents interviewed would make the same choice again if they could turn back time.
Seventy percent of the respondents were “globally satisfied” with their training, especially in clinical psychiatry, psychopathology and psychopharmacology. Residents reported that training in psychotherapy, in psychiatric rehabilitation and in forensic psychiatry were the most neglected areas in their specialization course. Only 9% of them participated in exchange programs, finding them useful for their professional life and experience.
These results show that Italian psychiatric trainees are globally satisfied with the quality of their training. However, they feel that the training course in some neglected areas, such as psychotherapy, rehabilitation and forensic psychiatry, should be improved, and that exchange programs in other countries should be promoted.
a) the socio-demographic characteristics of patients with schizophrenia who were using cannabis at time of first appearing of psychotic symptoms;
b) the impact of cannabis on the duration of untreated psychosis (DUP) and on pathways to care;
c) the influence of cannabis on the clinical onset and on the first three years of the disorder.
Twenty-two patients with a recent onset (< 3 years) of schizophrenia were consequently recruited at the Department of Psychiatry of the University of Naples SUN. Socio-demographic characteristics, pathways to care and DUP were investigated by ad-hoc schedules.
About 60% of patients were using cannabis at onset of schizophrenia. All of them were male and did not have a job and with a lower education level. “Cannabis users” had a first contact with general practitioners earlier than “non cannabis users”, but their DUP was longer, as a consequence of significant delays in access to mental health care. Cannabis users showed higher rates of suicide attempts and relapses in the first three years, suggesting a more severe course of the disorder in the “critical period” of schizophrenia in this population.
The results of the study emphasize the need:
a) to carry out sensitization campaigns among young people in order to reduce the use of cannabis and other illicit drugs;
b) to promote information on schizophrenia for general practitioners.
Cognitive impairment is increasingly regarded as a core aspect of schizophrenia. It is associated with poor functional outcome, may represent a rate limiting factor in rehabilitation programs and is not largely influenced by pharmacological interventions.
Several studies suggest the efficacy of cognitive training programs and advice their inclusion in treatment strategies, while others discourage clinical application.
We recently completed a study involving three Mental Health Departments located in the South of Italy and coordinated by the Department of Psychiatry of the University of Naples SUN. Fifty-eight patients with either a diagnosis of schizophrenia or schizoaffective disorder were recruited and randomly allocated to one of two rehabilitation programs: Social Skill Training (SST) + Computerized Cognitive Training (CCT) (Group A) and usual rehabilitation activities of the Department (Group B). The active treatment phase lasted 6 months. Psychopathological aspects, as well as psychosocial and neurocognitive functioning, were assessed both before and after treatment. Group A subjects participated in two one-hour sessions of CCT and one two-hour session of SST. Group B patients spent an equivalent amount of time in the usual rehabilitation activities.
The two groups did not differ on baseline clinical, neurocognitive and psychosocial variables.
At the end of treatment, a worsening of the negative dimension was observed in group B, but not in group A, in which a significant improvement of two psychosocial indices (participation in family life and availability to work) was found.
The experimental program (SST+CCT) was more effective than usual rehabilitation activities of the departments.
Views on the causes and psychosocial consequences of schizophrenia of the Italian population, patients’ relatives and mental health professionals can influence detection and outcome of these disorders.
To investigate the opinions on schizophrenia in a sample of 614 lay respondents, 465 mental health professionals and 709 key-relatives.
The survey was conducted in 30 randomly selected geographical areas with the Questionnaire about Opinions on mental illness (QO).
The results show significant differences among the three groups as regards opinions about patients’ civil rights and social competence of patients with schizophrenia. In particular, the belief that patients’ behaviors are unpredictable is maintained by 18% of mental health workers and by 35% of family members and the general public. As regards causes, 68% of relatives, 20% of mental health workers and 34% of general public believe that schizophrenia is caused by psychosocial factors only. Forty-eight percent of the relatives affirmed that they are fully convinced of the usefulness of pharmacological treatment compared to 28% of professionals and 25% of the Italian population. With respect to civil rights, about half of the relatives is fully convinced that patients with schizophrenia should not have children compared to 17% of mental health workers and to 19% of the general public.
These results underline the need to conduct sensitization campaigns about schizophrenia focused on specific aspects of the disease, such as unpredictability, civil rights and opportunities to recovery of patients, taking into account the target population to which they are addressed.
Several studies provided evidence that relationship of cognitive impairment with social functioning is stronger than that of psychopathology. In a group of 88 subjects with schizophrenia or schizoaffective disorders we found that verbal memory, executive function and sustained attention indices explained 19.9% of the global disability variance, while negative symptoms explained 4.4% of the variance.
Based on these data our group designed an individualized rehabilitation program including two one-hour sessions of computerized cognitive training and one two-hour session of social skills training per week (Social Skills And Neurocognitive Individualized Training, SSANIT).
In the present study the efficacy of this rehabilitation program was investigated in 58 subjects with chronic schizophrenia or schizoaffective disorder. Patients were recruited in three Mental Health Departments located in the South of Italy and randomly allocated to one of two rehabilitation programs: SSANIT or Usual Rehabilitation Activities (URA) of each department. The active treatment phase lasted 6 months.
At the end of treatment a significant improvement of psychosocial functioning (global psychosocial index, participation in family life and availability to work) was found in the SSANIT but not in the URA group; furthermore a worsening of the negative dimension was observed in the URA, but not in the SSANIT group.
According to our findings, the SSANIT program is more effective than the rehabilitation activities usually implemented in Mental Health Departments (e.g. carpentry and decoupage).
While the efficacy of family psychoeducational interventions in the treatment of schizophrenia is now well documented, few data are available on its efficacy in major depression. This study aimed to verify the effectiveness of a family psychoeducational intervention according to the Falloon model on patients’ clinical status, social functioning and lifestyle and on relatives’ burden and social network.
The study was coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 7 Italian mental health centres. In each centre, 8 patients with major depression and their relatives were recruited if they fulfilled the following criteria: a) diagnosis of unipolar major depression according to the DSM-IV; b) aged between 18 and 65 years; c) in charge to the local mental health centre for at least 6 months; d) at least one depressive episode in the last two years; e) living with at least one relative aged between 18 and 70 years.
Recruited families have been randomly allocated to the experimental group, which received the psychoducational intervention for 6 months, or to the control group, which received the treatment as usual plus an informative brief intervention.
22 families have been treated with the experimental intervention and 22 with the control one. At the end of the intervention, patients’ clinical status and life-style significantly improved in the treated group, as well as family objective burden and social contacts.
Family psychoeducational intervention are useful in reducing personal and family difficulties caused by depression and in improving patients’ lifestyles.
Bipolar disorder is associated with high personal and social burden, impaired social functioning and high levels of disability. The psychoeducational family intervention, found to be effective in the treatment of schizophrenia, may be particularly useful for patients with bipolar disorder and their relatives.
Aims & methods
This study, funded by the Italian Ministry of Health, coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 11 randomly selected mental health centres, included the following phases
1) development of informative materials;
2) training of 2 mental health workers per center;
3) random selection of 16 families of patients with bipolar disorder for each center: 8 being randomly allocated to the experimental group and 8 to the control group.
62 families have been recruited. Mental health workers reported several advantages in conducting the intervention, in particular in the relationship with patients and families. Significant improvements have been reported in professional skills and relationships with colleagues. The advantages tend to increase over time. The main reported difficulties are lack of time to run the intervention, identification of appropriate families, excessive workload and the need to integrate this intervention with other work commitments.
It is possible to provide psychoeducational family intervention for patients with bipolar I disorder and their families, after a relatively short period of training. In order to facilitate the dissemination of this intervention in routine conditions, a better planning of the activities of the mental health centers may be useful.
Pathways to care and duration of untreated psychosis (DUP) strongly influence the long-term outcome of schizophrenia.
To investigate pathways to care, duration of untreated psychosis (DUP) and treatments received by a sample of individuals aged between 18 and 35 years meeting diagnostic criteria for psychosis.
Pathways to care and DUP were explored by an “ad-hoc” schedule administered to patients and caregivers.
The sample consists of 30 patients. The first episode of psychosis, which occurred at 19.7 (± 4.7) years, was characterized by negative symptoms and disorganized behaviours in more than half of the sample, suicide attempts (28%) and hospital admissions (26%). DUP was 41.6 ± 60.4 weeks, being longer than that reported in international literature. In 76% of cases patients’ relatives asked for a first contact with health professionals, referring the patients to psychiatrists (34% of cases), general practitioners (31%), neurologists (21%) or psychologists (13%). When professionals other than psychiatrists were contacted, the interval between the contact and receipt of appropriate psychiatric treatment (according to the current guidelines) was particularly long (15.2 ± 32.1 weeks). 34% of patients were treated with a monotherapy of psychotropic drugs: 24% with antipsychotics, 7% with anxiolytics and 3% with antidepressants; 48% received a poly-pharmacotherapy. 35% were treated with psychotherapy (in most of the cases cognitive-behavioural therapy), which was the only treatment for 18% of patients.
These results emphasize the need to train health professionals on diagnosis and treatment of first episode psychosis. DUP may be reduced by anti-stigma campaigns among general population.
Family burden, defined as the consequences for those in close contact with a severely disturbed psychiatric patient, is now well-documented in schizophrenia research, whereas very few data are available in affective disorders.
1) the levels of family burden in a sample of key-relatives of patients with major depression;
2) the professional and social support for relatives of patients with major depression disorder.
324 patients with major depression and their key-relatives were randomly recruited in 30 Italian mental health centres, randomly selected and stratified by geographical area and population density. Family burden was explored in relation to:
a) patient's clinical status and disability;
b) relatives’ social and professional support.
Reduction of leisure (53% of the sample) and social activities (44%) were the most frequently reported sources of practical burden, whereas psychological burden was mainly due to sense of loss (75%) and worries for the future (61%). Family burden is higher in key-relatives with a lower education level (p < .05), and when patients’ symptomatology and social functioning are more severe. Key-relatives who can rely on a stronger support from social network and from mental health professionals have lower levels of family burden (p < .05).
These results highlight the need to provide supportive interventions for patients with major depression and their key-relatives.
The use of coercive measures in clinical practice represents a common, but understudied problem in Europe. In 2002–2005, the European Commission funded the study “European Evaluation of coercion in psychiatry and harmonization of best clinical practice” (EUNOMIA), coordinated by the Department of Psychiatry of the University of Dresden and carried out in 12 European countries.
This study, carried out on the Italian EUNOMIA sample, aims to:
1) assess the use of coercive measures in five Italian mental health inpatient units;
2) identify the patients’ socio-demographic and clinical characteristics associated with the use of coercive measures;
3) investigate the effect of coercive measures on the outcome of the patients.
The Italian sample included 294 admitted patients. Data were collected on coercive measures (physical restraint, seclusion and forced medication)
Almost 30% of the patients received coercive measures during their hospitalization; in particular, 22% received forced medication, 9% were restrained or fixed by mechanic devices, 7% were seclused. The most frequent reason for prescribing coercive measures was aggression against others. Patients who received coercive measures were more frequently male, with higher BPRS scores and a worse social functioning. At three months after discharge, they showed higher levels of positive symptoms, and reported more negative opinions on the need of hospital admission and on the appropriateness of psychiatric treatments.
In Italy coercive measures are in most of the cases applied to the patients affected by more severe psychopathology and disability.
Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
Studies on the efficacy of psychoeducational family intervention in patients with depression and their relatives are scarce. the effectiveness of this intervention in major depression has not been adequately investigated, probably because it is considered to be less burdensome by mental health professionals compared to schizophrenia or bipolar disorder. This study aims to test the efficacy of a psychoeducational family intervention on: 1) clinical status and social functioning of patients with major depression; 2) family burden and social network. the study has been carried out in 7 Italian mental health centers; 8 families in each center were randomly recruited and allocated to receive a psychoeducational intervention or an informative one. Fourty-four families were examined: 22 from the experimental group and 22 from the control group. A significative reduction in symptoms (p < 0.05), social functioning (p < 0.05), practical burden (p < 0.01), psychological burden (p < 0.05), and an improvement of social contacts (p < 0.05) and of professional support (p < 0.01) have been observed in patients; a significant reduction of practical burden (p < 0,01) and an improvement of social contacts (p < 0.01) and professional support (p < 0.01) have been found in their relatives. the results of this study outline that psychoeducational family intervention is effective in reducing family burden, improving relationships between family members and alleviating family distress. This intervention should be included in the routine management of patients with depression and their relatives.
Studying the pathways followed by psychiatric patients is important to plan both mental health services organization and training programmes for doctors and psychiatrists.
Detecting the main pathways-to-care followed by patients.
Finding the reasons why patients look for psychiatric help and the main responses given to patients’ problems by psychiatric services. Evaluating the delays occurring along the pathways.
The study has been done on 420 Italian patients. In one month, patients with a new episode of disease have been included. Each of them has been administered a questionnaire collecting socio-demographical, medical infos and data concerning health workers, timing and delays along the pathways. Diagnosis done using ICD-10 and an Intervention Detection Schedule filled for each patient.
The Carpi’s sample consists of 43 patients. The 58% has seen the General Practitioner (GP) in the first place, the 19% the hospital doctor (HD), the 16% the psychiatric worker. Nation-widely, most patients have firstly referred to the psychiatrist (34%). In Carpi, the 44% has received a diagnosis of “Neurotic, stress-related and somatoform disorders”. The 93% has been treated with psychotropic medications. The longest pathway has occurred for behavioural syndromes associated with physiological disturbances and physical factors, the shortest for affective disorders.
GP, HD and direct access are the 3 main pathways followed by patients. The importance of the GP is confirmed, so as the necessity for training of sanitary workers within the psychiatric field. A greater cooperation between general practice and mental health services should be pursued
Many qualitative studies have been carried out on the personal experience of relatives living with patients affected by Eating Disorders (EDs). However, quantitative studies on strategies adopted by relatives to cope with the disorder are lacking.
To develop a questionnaire to specifically assess coping strategies of relatives of people with EDs.
To develop and to validate a new instrument, the Family Coping Questionnaire for EDs, which is designed specifically to explore coping strategies adopted by relatives of patients with EDs.
The preliminary version of the questionnaire was developed through a multi-step methodology, including analysis of the relevant literature and focus groups. Subsequently, patients with EDs and their relatives were recruited at three Italian University sites and were asked to fill in the pre-final version of the questionnaire.
The final version of the questionnaire consisted of 32 items, grouped in five subscales according to the Cronbach's alpha analysis. Through the confirmatory factor analysis, the five subscales were grouped in two factors, the problem-oriented and the emotion-focused coping strategies.
The final version of the questionnaire shows good psychometric properties, and requires a short time to be completed. The five subscales identified correspond to those adopted by relatives of patients with other severe mental disorders, such as schizophrenia and bipolar disorders. Further analyses from the same dataset will be performed to better describe the coping strategies adopted by relatives of patients with EDs and to identify predictors of maladaptive coping strategies.
According to several international guidelines, lithium is still the first choice for treating mania and for prophylaxis of bipolar disorder. Nevertheless, in the last decades clinicians prefer to use anticonvulsivant drugs such as valproate and carbamazepine to lithium, which are easier to manage and with less side effects.
1)to describe prescribing patterns in Italian mental health centres in patients with bipolar I disorder;2)to assess clinical and social characteristics of patients receiving lithium.
to assess the current status of use of lithium in the Italian clinical practice.
The study, coordinated by the Department of Psychiatry of the University of Naples SUN, was carried out in 11 randomly recruited Italian mental health centres. In each site, 16 patients were recruited if they had a diagnosis of bipolar I disorder, were aged between 18-65 years, were on the caseload of the local mental health centre for at least six months, and had experienced at least one affective episode in the past three years. Data on pharmacological treatments were obtained from clinical records.
The sample consisted of 140 patients, 118(84%) were receiving mood stabilizers, 84(60%) antipsychotics, 57(41%) antidepressants and 45(32%)benzodiazepines. Valproate was the mood stabilizer more frequently prescribed(58%); lithium was prescribed to 35% of patients. Those receiving lithium had a longer contact with the local mental health centre(105.9±77.6monthsvs. 79.0±68.5;p<.05), had more involuntary admissions(2.0±5.0vs. 0.6 ±1.7;p<.05) and a higher severity of depressive symptoms at the BPRS(2.2±0.9 vs. 1.9± 0.7;p<.05).
Our data confirm the general principle that lithium is not frequently prescribed in clinical practice and it is given only to more severe patients.
The ROAMER project, funded by the European Commission, has been designed to develop a comprehensive, consensus-based roadmap to promote research on mental health in Europe. It has been repeatedly affirmed that the different people involved in the mental health field hold different views about the desirability of clinical outcomes and the general principle is that research agenda should reflect the needs and values of the people who use health services.
To involve different stakeholders in the development of the agenda for mental health research.
To identify priorities in mental health research in Europe for the next ten years.
An online survey was conducted with national associations/organizations of psychiatrists, other mental health professionals, users and/or carers, and psychiatric trainees in the 27countries of the European Union.
One hundred and eight associations/organizations out of the 154 contacted returned the questionnaire(response rate:70%). According to all categories of stakeholders, the five most frequently selected research priorities were early detection and management of mental disorders, quality of mental health services, prevention of mental disorders, rehabilitation and social inclusion, and new medications for mental disorders. The top five research areas in terms of importance were quality of mental health services, suicide prevention, early detection and management of mental disorders, rehabilitation and social inclusion, prevention of mental disorders. The least developed research areas in each country were molecular bases of mental disorders, environmental risk/protective factors for mental disorders, resilience and mental health, prevention of mental disorders, health and well-being of carers.
These results show that some rebalancing in favour of psychosocial and health service research is needed.
The recent global crisis as well as the increasing crimes’ rates have been claimed to be a factor of mental distress and disturbance.
To describe the levels of insecurity and the fear of crime in a sample of patients with mental disorders with a sample of mental health professionals.
The study has been carried out in 24 Italian mental health centres. in each centre 20 patients and 20 mental health professionals have been recruited. Clinical status and social functioning have been evaluated with the Global Assessment of Functioning (GAF), the Hamilton Anxiety scale (HAM-A) and the Hamilton Depression scale (HAM-D). Fear of crime and insecurity have been assessed by Perceived Insecurity Questionnaire (PIQ).
The final sample consists of 426 patients. They are mostly female (70%), employed and married, with a diagnosis of mood disorder (52%). High levels of worries/insecurity at the PIQ are reported by 42% of patients. Perceived insecurity is associated with higher levels of HAM-A and HAM-D. Nearly all respondents report to have worries or fears about the future (93%), in particular as regards bereavement or loss (41%), economic difficulties (28%), mental or physical illness (26%). in multiple regression model, worries about the economic situation are more frequent in person who are male, young, married and with more than two children.
The results suggest an association between perceived insecurity with anxiety and depression. Further studies are needed to better understand this association and to develop educational programs on stress and mental disorders.