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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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Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M. Delusional Themes Across Affective and Non-Affective Psychoses. Front Psychiatry 2018; 9:132. [PMID: 29674982 PMCID: PMC5895977 DOI: 10.3389/fpsyt.2018.00132] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/27/2018] [Indexed: 02/01/2023] Open
Abstract
The current debate about the diagnostic significance of delusion revolves around two positions. The neurocognitive position conceives delusion as a non-specific, though polymorphic, symptom. The psychopathological position views features of delusion such as content and structure as having meaningful connections with diagnostic entities. This study aims at contributing to this debate by examining the association between delusional themes and diagnosis in a sample of 830 adult psychotic patients. All diagnoses were made by experienced psychiatrists according to DSM-IV or ICD-10 criteria, and in 348 patients were established with the SCID-I. All patients were administered the Brief Psychiatric Rating Scale (BPRS). In each patient, the presence of somatic delusions and delusions of guilt, grandiosity, and persecution was determined by examining the scores on relevant BPRS items. Delusions of guilt were almost pathognomonic for a psychotic depressive condition (psychotic major depression 40%; psychotic bipolar depression 30%; depressed schizoaffective disorder 8%; bipolar and schizoaffective mixed states 6 and 7%, respectively). Only 1% of patients with schizophrenia and no patient with delusional disorder or bipolar or schizoaffective manic state showed such delusions. The difference between unipolar and bipolar depression and the other diagnostic groups was highly significant. Delusions of grandiosity characterized mostly patients with manic symptoms (bipolar mania 20%; bipolar mixed states 19%; manic schizoaffective disorder 10%). They were observed significantly more often in bipolar mania than in schizophrenia (7%). Persecutory delusions were broadly distributed across diagnostic categories. However, they were significantly more frequent among patients with schizophrenia and delusional disorder compared with depressed and manic patients. Somatic delusions were also observed in all diagnostic groups, with no group standing out as distinct from the others in terms of an increased prevalence of somatic delusions. Our findings suggest a middle position in the debate between the neurocognitive and the psychopathological approaches. On the one hand, the widespread observation of persecutory delusions suggests the usefulness of searching for non-specific pathogenic mechanisms. On the other hand, the association between some delusional contents and psychiatric diagnosis suggests that a phenomenological analysis of the delusional experience may be a helpful tool for the clinician in the diagnostic process.
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Affiliation(s)
- Angelo Picardi
- Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Laura Fonzi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mauro Pallagrosi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Gigantesco
- Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Cocchi A, Balbi A, Corlito G, Ditta G, Di Munzio W, Nicotera M, Meneghelli A, Pisano A, Preti A. Early intervention in psychosis: a feasibility study financed by the Italian Center on Control of Maladies. Early Interv Psychiatry 2015; 9:163-71. [PMID: 24673891 DOI: 10.1111/eip.12135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 02/05/2014] [Indexed: 11/29/2022]
Abstract
AIM In November 2005 the Italian Center on Control of Maladies, a department operating under the Ministry of Health, financed a project aimed at evaluating the feasibility of a protocol of intervention based on the early intervention in psychosis (EIP) model within the Italian public mental health-care network. METHODS The study was carried out between March 2007 and December 2009. It involved five centres operating under the Departments of Mental Health of Milan (Programma 2000), Rome (area D), Grosseto, Salerno (Nocera) and Catanzaro (Soverato). RESULTS Enrolment lasted 12 months, at the end of which 43 patients were enrolled as first-episode psychosis (FEP), and 24 subjects as ultra high-risk (UHR) patients. Both FEP and UHR samples included a preponderance of male patients. A family history of psychosis was rarely reported in both samples. The FEP incidence rate was lower than expected on the basis of international estimates of the incidence of schizophrenia but within the expected figure for the estimated Italian rates in three centres out of five. CONCLUSIONS Overall, the study proved that an EIP centre can be established within the public Department of Mental Health to reach a good fraction of the cases in need of treatment. Since then, several studies have been set up to assess the feasibility of EIP in the Italian public mental health sector in Lombardy and Tuscany, and in 2012 the Emilia-Romagna Regional Authority started an educational plan aimed at implementing the EIP model in all the Mental Health Departments in the region.
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Affiliation(s)
- Angelo Cocchi
- Dipartimento di Salute Mentale: Programma 2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
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Cocchi A, Cerati G, Lora A, Meneghelli A, Monzani E, Percudani M, Petrovich L, Mirabella F, Picardi A, Preti A. Patients With First-Episode Psychosis are Not a Homogeneous Population: Implications for Treatment. Clin Pract Epidemiol Ment Health 2014; 10:1-8. [PMID: 24600479 PMCID: PMC3942866 DOI: 10.2174/1745017901410010001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/20/2014] [Accepted: 01/22/2014] [Indexed: 11/22/2022]
Abstract
Objective: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. Methods: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. Results: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. Conclusions: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.
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Affiliation(s)
- Angelo Cocchi
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Giorgio Cerati
- Dipartimento di Salute Mentale, Azienda Ospedaliera Ospedale Civile di Legnano, Italy
| | - Antonio Lora
- Dipartimento Salute Mentale, Azienda Ospedaliera della Provincia di Lecco, Italy
| | - Anna Meneghelli
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Emiliano Monzani
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Mauro Percudani
- Dipartimento di Salute Mentale - A.O. "G. Salvini", Garbagnate Milanese, Italy
| | - Lorenzo Petrovich
- Comitato Tecnico per le Innovazioni in Salute Mentale. Direzione Generale Sanità - Regione Lombardia, Milan, Italy
| | - Fiorino Mirabella
- Reparto Salute Mentale, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Picardi
- Reparto Salute Mentale, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio Preti
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
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Lanfredi M, Rossi G, Rossi R, Van Bortel T, Thornicroft G, Quinn N, Zoppei S, Lasalvia A. Depression prevention and mental health promotion interventions: is stigma taken into account? An overview of the Italian initiatives. Epidemiol Psychiatr Sci 2013; 22:363-74. [PMID: 23445538 PMCID: PMC8367333 DOI: 10.1017/s2045796013000085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- M. Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G. Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - R. Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - T. Van Bortel
- King's College London, Institute of Psychiatry, London, UK
| | - G. Thornicroft
- King's College London, Institute of Psychiatry, London, UK
| | - N. Quinn
- School of Applied Social Sciences, University of Strathclyde, Glasgow, UK
| | - S. Zoppei
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - A. Lasalvia
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
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