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Valentini E, Bianchi S, Menculini G, Cusenza AS, Balena E, Balducci PM, Amantini K, Moretti P, Tortorella A. Suicidality in a psychiatric inpatient unit: a 2-year retrospective study in Umbria, central Italy. Int Clin Psychopharmacol 2023; 38:154-159. [PMID: 36602882 DOI: 10.1097/yic.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Suicide ranks among the 10 leading causes of death worldwide; in Italy, almost 4000 persons per year die by suicide. Studies focusing on suicidality in Italian inpatient samples before the COVID-19 pandemic are scant. We, thus, aimed to define sociodemographic and clinical variables associated with suicidal ideation (SI) and deliberate self-harm (DSH) in a sample of inpatients admitted to a Psychiatric Inpatient Unit. This retrospective study was conducted in the Psychiatric Inpatient Unit of the Perugia Hospital, from January 2018 to December 2019. Sociodemographic and clinical characteristics, including diagnostic and treatment features, were collected from the medical records of subjects admitted for suicidality-related phenomena, namely DSH and SI. The prevalence of suicidality-related phenomena in the sample ( n = 850) was 14.12% (n=120) and was mainly due to DSH ( n = 84; 70%). Subjects hospitalized due to these conditions were more frequently females, separated, and displayed a higher prevalence of personality disorders, especially borderline personality disorder. People in the suicidality-related phenomena subgroup were more often committed involuntarily and reported multiple hospitalizations less frequently than other inpatients. They were receiving community treatment in a higher percentage of cases, and lithium was prescribed more frequently than among inpatients who were hospitalized for reasons other than suicidality. Our study provides a further characterization of psychiatric inpatients who experience SI or perform DSH. Targeted treatment strategies should be considered for subjects suffering from personality disorders who experience suicidality-related phenomena.
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Affiliation(s)
| | | | | | | | | | | | - Kety Amantini
- Department of Mental Health, AUSL Umbria 1, Perugia, Italy
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Mele F, Buongiorno L, Montalbò D, Ferorelli D, Solarino B, Zotti F, Carabellese FF, Catanesi R, Bertolino A, Dell'Erba A, Mandarelli G. Reporting Incidents in the Psychiatric Intensive Care Unit: A Retrospective Study in an Italian University Hospital. J Nerv Ment Dis 2022; 210:622-628. [PMID: 35394976 PMCID: PMC10860884 DOI: 10.1097/nmd.0000000000001504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To evaluate the characteristics of the reported workplace violence in a psychiatric intensive care unit (PICU) by analyzing an electronic hospital incident reporting system (IRS). One hundred thirty reports were retrieved from January 2017 to June 2020, referring to assaults committed by patients (71% males) with an average age of 29.8 years (SD, 14.9). The most frequent psychiatric diagnosis was a neurodevelopmental disorder (33%). Physical aggression (84%) was more frequent than the other types of aggression. Nurses and unlicensed assistive personnel were the most frequent victims (65%). Aggressions were more frequent on Friday (18%) and between 4 p.m. and 8 p.m. (35%). A total of 64.9% of the incidents happened in the first 5 days of hospitalization. A significant association between physical aggression and diagnosis of neurodevelopmental disorder emerged. IRS could be helpful to identify high-risk patient groups and develop clinical strategies to reduce adverse events in clinical practice.
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Affiliation(s)
- Federica Mele
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | - Luigi Buongiorno
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | | | - Davide Ferorelli
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | - Biagio Solarino
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | - Fiorenza Zotti
- Section of Legal Medicine, Interdisciplinary Department of Medicine
| | - Felice Francesco Carabellese
- Section of Criminology and Forensic Psychiatry, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Policlinico di Bari Hospital, Bari, Italy
| | - Roberto Catanesi
- Section of Criminology and Forensic Psychiatry, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Policlinico di Bari Hospital, Bari, Italy
| | | | | | - Gabriele Mandarelli
- Section of Criminology and Forensic Psychiatry, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Policlinico di Bari Hospital, Bari, Italy
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Tarsitani L, Della Rocca B, Pancheri C, Biondi M, Pasquini M, Ferracuti S, Ventriglio A, Mandarelli G. Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study. Int J Soc Psychiatry 2022; 68:429-434. [PMID: 33719677 DOI: 10.1177/00207640211001903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Immigrants in Europe appear to be at higher risk of psychiatric coercive interventions. Involuntary psychiatric hospitalization poses significant ethical and clinical challenges. Nonetheless, reasons for migration and other risk factors for involuntary treatment were rarely addressed in previous studies. The aims of this study are to clarify whether immigrant patients with acute mental disorders are at higher risk to be involuntarily admitted to hospital and to explore clinical and migratory factors associated with involuntary treatment. METHODS In this cross-sectional matched sample study, we compared the rates of involuntary treatment in a sample of first-generation immigrants admitted in a Psychiatric Intensive Care Unit of a large metropolitan academic hospital to their age-, gender-, and psychiatric diagnosis-matched native counterparts. Clinical, sociodemographic, and migratory variables were collected. The Brief Psychiatric Rating Scale-expanded (BPRS-E) and the Clinical Global Impression-Severity (CGI-S) scale were administered. McNemar test was used for paired categorical variables and a binary logistic regression analysis was performed. RESULTS A total of 234 patients were included in the analysis. Involuntary treatment rates were significantly higher in immigrants as compared to their matched natives (32% vs. 24% respectively; p < .001). Among immigrants, involuntary hospitalization was found to be more frequent in those patients whose length of stay in Italy was less than 2 years (OR = 4.2, 95% CI [1.4-12.7]). CONCLUSION Recently arrived immigrants appear to be at higher risk of involuntary admission. Since coercive interventions can be traumatic and negatively affect outcomes, strategies to prevent this phenomenon are needed.
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Affiliation(s)
- Lorenzo Tarsitani
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Bianca Della Rocca
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Corinna Pancheri
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Gabriele Mandarelli
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy
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Mandarelli G, Carabellese F, Di Sciascio G, Catanesi R. Antipsychotic Polypharmacy and High-Dose Antipsychotic Regimens in the Residential Italian Forensic Psychiatric Population (REMS). Front Psychol 2022; 13:722985. [PMID: 35222172 PMCID: PMC8866699 DOI: 10.3389/fpsyg.2022.722985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Few data exist regarding treatment with antipsychotics in forensic psychiatric patient populations with high social dangerousness. We performed a secondary analysis of 681 patients treated with at least one antipsychotic, extracted from a 1-year observational retrospective study, conducted on 730 patients treated in the Italian Residencies for Execution of Security Measures (REMS) (96.4% of the REMS population). We aimed at investigating antipsychotic polypharmacy (prescription of two or more concomitant antipsychotics) and high dose/very high-dose antipsychotics, as well as the possible factors associated with such therapeutic regimens. High dose/very high-dose antipsychotics were defined as a prescribed daily dose to WHO-defined daily dose ratio greater than 1.5 or 3.0, respectively. Binary logistic regression analysis was used in three models to test possible predictors of antipsychotic polypharmacy, high-dose antipsychotics, and very high-dose antipsychotic prescription. Antipsychotic polypharmacy resulted in n = 308 (45.2%) of the patients, n = 346 (50.8%) received high-dose antipsychotics, and n = 96 (14.1%) very high-dose antipsychotics. The multivariate analysis disclosed an association between antipsychotic polypharmacy and male gender (odds ratio (OR): 2.75 and 95% CI: 1.34–5.65), long-acting injectable (LAI) antipsychotic prescription (OR: 2.62 and 95% CI: 1.84–3.74), and aggressive behavior in REMS (OR: 1.63 and 95% CI: 1.13–2.36). High-dose antipsychotics were also associated with male gender (OR: 2.01 and 95% CI: 1.02–3.95), LAI antipsychotic prescription (OR: 2.78 and 95% CI: 1.95–3.97), and aggressive behavior in REMS (OR: 1.63 and 95% CI: 1.12–2.36). The use of antipsychotic polypharmacy and high-dose antipsychotics is frequent in the REMS population. These results might depend on regulatory and organizational aspects of the REMS system, including variability in structures, lack of a common model of care, and lack of stratified therapeutic security.
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Affiliation(s)
- Gabriele Mandarelli
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari “Aldo Moro”, Bari, Italy
- *Correspondence: Gabriele Mandarelli,
| | - Felice Carabellese
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Roberto Catanesi
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari “Aldo Moro”, Bari, Italy
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Muusse C, Kroon H, Mulder CL, Pols J. "Caring for a Crisis": Care and Control in Community Mental Health. Front Psychiatry 2021; 12:798599. [PMID: 35095613 PMCID: PMC8793776 DOI: 10.3389/fpsyt.2021.798599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
In the debate on coercion in psychiatry, care and control are often juxtaposed. In this article we argue that this dichotomy is not useful to describe the more complex ways service users, care professionals and the specific care setting interrelate in a community mental health team (CMHT). Using the ethnographic approach of empirical ethics, we contrast the ways in which control and care go together in situations of a psychiatric crisis in two CMHT's: one in Trieste (Italy) and one in Utrecht (the Netherlands). The Dutch and Italian CMHT's are interesting to compare, because they differ with regard to the way community care is organized, the amount of coercive measures, the number of psychiatric beds, and the fact that Trieste applies an open door policy in all care settings. Contrasting the two teams can teach us how in situations of psychiatric crisis control and care interrelate in different choreographies. We use the term choreography as a metaphor to encapsulate the idea of a crisis situation as a set of coordinated actions from different actors in time and space. This provides two choreographies of handling a crisis in different ways. We argue that applying a strict boundary between care and control hinders the use of the relationship between caregiver and patient in care.
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Affiliation(s)
- Christien Muusse
- Trimbos Institute, Utrecht, Netherlands.,Department Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands
| | - Hans Kroon
- Trimbos Institute, Utrecht, Netherlands.,Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Cornelis Lambert Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands.,Antes, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Jeannette Pols
- Department Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands.,Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands
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