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Tarricone I, D'Andrea G, Storbini V, Braca M, Ferrari S, Reggianini C, Rigatelli M, Gramaglia C, Zeppegno P, Gambaro E, Luciano M, Ceregato A, Altamura M, Barrasso G, Primavera D, Carpiniello B, Todarello O, Berlincioni V, Podavini F, Morgan C, Murray RM, Di Forti M, Muratori R, Berardi D. First-episode Psychosis and Migration in Italy: Results from a Study in the Italian Mental Health Services (Pep-Ita Study). J Immigr Minor Health 2021; 23:519-527. [PMID: 33689115 PMCID: PMC8068695 DOI: 10.1007/s10903-021-01168-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
Background: Migrants present high rates of psychosis. A better understanding of this phenomenon is needed. Methods: We conducted a multicentre First-Episode Psychosis (FEP) prospective study over two years (January 2012–December 2013) to evaluate first-generation migrants presenting with FEP at the participating Community Mental Health Centers (CMHCs). Results: 109 FEP migrants were identified. Almost half of them were highly educated, employed and in a stable affective relationship. The average age was 32.8 (± 9.8) years, and the average length of stay in Italy was 8.6 (± 8.8) years. About 2/3 of patients were referred to CMHCs following Emergency Department access or psychiatric admission. Conclusions: Our finding of a “high functioning portrait” of FEP migrants allow us to hypothesize that a high burden of negative psychosocial factors is likely to be needed for the FEP onset. Furtherly, mental health services should implement more appropriate resources and organizational methods to respond to migrants’ health needs.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy. .,Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy.
| | - Giuseppe D'Andrea
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Viviana Storbini
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Mauro Braca
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Corinna Reggianini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Marco Rigatelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Eleonora Gambaro
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessio Ceregato
- Mental Health Department A.S.L. TO4, Community Mental Health Service, Chivasso, TO, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Section of Psychiatry and Clinical Psychology, University of Foggia, Foggia, Italy
| | | | - Diego Primavera
- Department of Medical Science and Public Health-Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Medical Science and Public Health-Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Orlando Todarello
- U.O. di Psichiatria - Azienda Ospedaliero-Universitaria "Consorziale Policlinico" Bari; Dipartimento Di Scienze Mediche Di Base, Neuroscienze Ed Organi Di Senso, Università Degli Studi Aldo Moro Di Bari, Bari BA, Italy
| | - Vanna Berlincioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesca Podavini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Roberto Muratori
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Domenico Berardi
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
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Ventriglio A, Bellomo A, Petito A, Pascucci M, Cuozzo E, Vitrani G, Stella E, Borraccino L, Varlese MP, Bhugra D. Factors Associated to the Onset of Mental Illness Among Hospitalized Migrants to Italy: A Chart Review. J Immigr Minor Health 2020; 23:425-433. [PMID: 33030664 DOI: 10.1007/s10903-020-01105-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
Migration is a complex phenomenon and mental illness among immigrants remains a major matter of concern in Italy and worldwide. 243 medical and pharmacy records of patients admitted to University of Foggia hospital between 2004 and 2018 were retrospectively screened and included in the study. Socio-demographic data and clinical characteristics of inpatients were compared in those with and without first-episode of mental illness (FEMI). Subjects (140 men, 103 women; aged 34.4 ± 10.2 years) represented 6.66 ± 3.73% of all hospitalizations in 15 years. Nearly half of them (48.5%) had emigrated from other European countries. 30.8% were diagnosed with a DSM-IV TR unspecified psychosis. 103 patients (42.3%) were in first-lifetime episodes of mental illness. Factors significantly associated with FEMI were: younger age, sex (men), immigrating from Africa, poor language proficiency, lower amount of prescribed psychotropics. Mental health among immigrants is of major concern in Italy. Our findings report on factors possibly associated to the onset of mental illness among immigrant psychiatric inpatients.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy.
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Annamaria Petito
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Marco Pascucci
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Edwige Cuozzo
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Giovanna Vitrani
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Eleonora Stella
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Luisa Borraccino
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Maria Pia Varlese
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
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3
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Miglietta E, Lasalvia A, Bonetto C, Comacchio C, Cristofalo D, Tosato S, De Santi K, Petterlini S, Zanatta G, Cremonese C, Ramon L, Ruggeri M. Pathways to care, DUP, and types of interventions over 5 years following psychosis onset: findings from a naturalistic study conducted in routine generalist mental health services. Soc Psychiatry Psychiatr Epidemiol 2020; 55:175-186. [PMID: 31511926 DOI: 10.1007/s00127-019-01775-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/04/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To describe pathways to care, duration of untreated psychosis (DUP), and types of interventions provided to first-episode psychosis (FEP) patients by routine Italian mental health services over 5 years since the first service contact. METHODS Naturalistic study conducted in Veneto, within the context of the Psychosis Incident Cohort Outcome Study (PICOS). A comprehensive set of measures was used, including schedules designed to collect information on referrals to psychiatric services and on psychological and pharmacological treatments at 1, 2, and 5 years since first service contact. RESULTS Overall, 397 patients were assessed. Most engaged with services with the help of family members (47.4%) and through emergency routes (60.3%). Those referred by clinicians were more likely to access care in a non-emergency way. Mean DUP was 5.62 months (SD 11.8) and longer DUP was associated with poorer functioning at 2 and 5 years. Interventions provided over 5 years were mainly constituted by antipsychotic medications (95.4% at 1 year; 85.8% at 2 years; 80.6% at 5 years), whereas a lower percentage (69.1% at 1 year; 61.5% at 2 years; 44.9% at 5 years) also received some forms of psychological interventions, mainly consisting of unspecific support sessions. Other structured interventions, such as CBT or family interventions, were seldom provided at each time-point. CONCLUSIONS Mental health services in Veneto seem effective in engaging FEP patients within a short time since illness onset. However, type of care provided does not meet quality standards recommended by treatment guidelines, especially regarding psychological interventions.
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Affiliation(s)
- Elisabetta Miglietta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. .,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy.
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Sarah Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | - Katia De Santi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | - Sara Petterlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Gioia Zanatta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Cremonese
- Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Luana Ramon
- Department of Mental Health, NHS, Local Health Authority Portogruaro (VE), Portogruaro, Italy
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
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Ferrara M, Tedeschini E, Baccari F, Musella V, Vacca F, Mazzi F, Ferri M, Srihari V, Starace F. Early intervention service for first episode psychosis in Modena, Northern Italy: The first hundred cases. Early Interv Psychiatry 2019; 13:1011-1017. [PMID: 30672134 DOI: 10.1111/eip.12788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/29/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
AIM To report on the development of an early intervention service in Modena, Italy, with information relevant to the first 4 years of implementation. METHODS The 2-year service was offered to people aged 18-35 with psychotic manifestations, within 2 years from psychosis onset/or naïve to antipsychotics, by teams placed within community mental health Centres, according to a "specialist within generalist" model. Treatment included pharmacological consultation, psychoeducation and social inclusion programs. Health of the Nation Outcome Scale was administered at baseline and every 6 months. RESULTS One hundred cases accepted the treatment from 1 March 2013 to 31 December 2016. Of these, 71% were male with a median age of 23. Ninety percent were diagnosed with non-affective psychosis, yielding an estimated treated incidence of 19.1/105 . General practitioners (GPs)represented the most frequent referrers to the program (38%), followed by referrals from acute general and psychiatric hospital units (22%) and self-referrals (14%). Meaningful clinical improvement was observed, 6 months after enrolment. CONCLUSIONS An early intervention service for psychosis was successfully implemented within existing community outpatient services. GPs represented the main referrals, providing some validation of the "specialist within generalist" model of care. A promising clinical improvement and trend of reduction in duration of untreated psychosis was found, supporting the variety of early detection efforts in the community. The high median age and lack of information about pathways to care underline possible barriers to access for younger patients. These findings will inform refinement of treatments and service models for the Region.
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Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut.,Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Enrico Tedeschini
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Flavia Baccari
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Vincenzo Musella
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Francesca Vacca
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Fausto Mazzi
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Mila Ferri
- Servizio Assistenza Territoriale, Area Salute Mentale e Dipendenze Patologiche, Regione Emilia-Romagna, Bologna, Italy
| | - Vinod Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut
| | - Fabrizio Starace
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
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Gramaglia C, Gambaro E, Delicato C, Di Marco S, Di Tullio E, Vecchi C, Bert F, Castello LM, Siliquini R, Avanzi G, Zeppegno P. Pathways to and Results of Psychiatric Consultation for Patients Referred from the Emergency Department. Are there Differences between Migrant and Native Patients? Transcult Psychiatry 2019; 56:167-186. [PMID: 30198829 DOI: 10.1177/1363461518798844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to compare migrants and native Italians on the pathways to care and results of psychiatric consultation (PC) in the emergency department (ED). Patients who were referred from the ED for psychiatric consultation (EDPC) at the Maggiore della Carità Hospital between March 2008 and March 2015 were recruited consecutively. Socio-demographic, clinical and consultation variables were recorded along with information about suicidal behaviours; migrants ( n = 379; 42.74% males, 57.26% females; age: 45.38 ± 16.95 years) were compared with native Italians ( n = 2942; 43.51% males, 56.49% females; age: 42.08 ± 15.89 years). Migrants were younger, more likely to be unemployed and less likely to be already under the care of a psychiatrist. Symptoms related to use of alcohol or substances were more frequent in migrants, especially female migrants. Migrants were less likely than native Italians to be referred for PC because of the presence of psychiatric symptoms, however they were more likely to be referred because of self-harming behaviour. Nonetheless, migrant status was not identified as a risk factor for suicidal behaviour in the multivariate analysis. The outcome of EDPC showed differences between migrants and natives. In absolute terms migrants were less likely to be admitted to a psychiatric ward after the EDPC than native Italians, while they were more likely to be monitored in the ED before being discharged or referred to outpatient care. In a high percentage of psychiatric examinations of migrants, no psychiatric symptoms were identified. Further studies are warranted to disentangle the meaning of these findings.
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