Psychiatria Danubina最新文献

In 2022, psychiatric condition-related admissions constituted 3.2 per cent of all emergency room admissions in Italy, according to the Ministry of Health's latest mental health report. Psychiatric crises are an increasingly significant portion of emergency department (ED) visits nationwide, with around 1 in 8 visits involving mental health and substance use disorders. Patients facing psychiatric emergencies tend to experience longer lengths of stay and boarding times in the ED, along with higher admission rates compared to those with other medical conditions. Extended boarding times for psychiatric patients in the ED increase their vulnerability to adverse events, such as medication errors, the use of restraints, and assaults. Moreover, the prolonged boarding of psychiatric patients contributes to ED overcrowding, which negatively impacts all ED patients, leading to increased morbidity and mortality due to delays in treatment and preventable errors. One of the most effective strategies to counteract this phenomenon has been the choice of directing psychiatric emergencies that are deferrable or compatible with a territorial crisis management from the Trent ED to the Mental Health Center in the territory. This option, promoted through the application of experimental procedures that are currently in the process of being definitively ratified as official company procedures, has, first and foremost, numerous advantages for psychiatric users, who are received in less medicalized settings that are more attentive to the relational and psychological component, while still having suitable medical and nursing equipment. It also fosters continuity of care with the territorial therapeutic network, allows early interception of situations that are promptly taken care of by the territorial specialist center, and more easily offers treatment alternatives to hospitalization. This approach allows for the optimal utilisation of resources and expertise available at Mental Health Centres within the community, thereby preventing the overcrowding of hospital emergency departments.

Introduction: Nowadays, suicide represents a serious public health problem worldwide. Nurses can play a critical role in suicide prevention. Knowing risk factors and recognizing warning signs for suicide should be part of the professional background of any nurse training programs.

Methods: Our study presents the preliminary descriptive findings from an online survey in nursing staff operating in various areas (medical, surgical, critical and emergency) in the Apulia region. The survey aimed to assess the current knowledge, attitudes, behaviors and training needs of nurses regarding suicide prevention. We administered a questionnaire created with Google forms to a sample of subjects obtained through sampling a reasoned choice.

Results and conclusions: Our study highlighted the lack of perceived competence toward the suicidal patient and the need to implement specific training programs for nurses on the management of patients at risk of suicide. An adequate level of knowledge and competence regarding suicide prevention among healthcare professionals could significantly contribute to improving the quality of care provided to patients at risk for suicide, reducing the risk of suicidal events and improving the overall quality of the care pathway.

In clinical practice, mental health professionals face diagnostic and therapeutic challenges daily. The diagnostic identification of mixed states allows the management of diagnostic and therapeutic trajectories appropriately. In our study, we evaluated 484 patients at a psychiatric rehabilitation center. The initial pre-admission diagnosis of the mixed state of 3.71% (at baseline) increased to 32.23%. The observation period was three years. The therapeutic efficacy of the pharmacological association of Antidepressants (Ads) or Second Generation Antipsychotics (SGAs) with a mood stabilizer (sodium valproate, lithium, lamotrigine, gabapentin, and pregabalin) was evaluated. An improvement in psychopathological symptoms was observed in different groups analyzed. The most significant differences were observed with the association SGAs + mood stabilizer [olanzapine + valproate sodium (p=0.005); risperidone + pregabalin (p=0.072)] and SSRIs + mood stabilizer [escitalopram + valproate sodium (p=0.005), vortioxetine + mood stabilizers (valproate or gabapentin). However, these are preliminary data and are under evaluation.

Background: Suicide is a major global health concern, particularly among young people. This study evaluates an online suicide risk calculator based on the Risk Assessment of Suicidality Scale (RASS), which is designed to enhance accessibility and early detection of suicide risk.

Methods: The study involved 444 participants who completed the RASS via an online calculator. Results were compared with data from the COMET-G study's Russian sample (n=7572). Descriptive statistics, correlation analysis, and two-way ANOVA were used to analyze the data.

Results: The mean age of participants was 22.71 years (SD=7.94). The mean total RASS standardized score was 837.7 (SD=297.8). There was a significant negative correlation between age and RASS scores (r=-0.463, p<0.0001). The online calculator sample showed significantly higher RASS scores compared to the COMET-G sample, with 71% of online users scoring above the 90th percentile of the COMET-G sample.

Conclusion: Our study demonstrated the advantage of the on-line suicidality risk calculator based on the RASS scale as a sensitive tool in detecting suicidal behaviours and measuring the severity of suicidality risks, offering a capability for broad reach and immediate assessment during clinical conversation between doctor and patient. Moreover, the RASS on-line psychometric instrument, when being freely distributed among the general population over internet sources, enabled to attract vulnerable groups of respondents with significantly higher suicidality risks. Future research should focus on integrating such tools into comprehensive suicide prevention programs and developing appropriate follow-up monitoring strategies for high risk-cases.

Accurate diagnosis of mood disorders, particularly depression and bipolar disorder, is essential for effective treatment planning and patient management. This article emphasizes the need for systematic symptom assessment and longitudinal analysis in facilitating the precise diagnosis and planning appropriate treatment interventions. By meticulously evaluating the symptomatology and delineating the longitudinal trajectory of the illness, clinicians can distinguish between unipolar depression and bipolar disorder, and therefore optimise patient outcomes. The article describes the inherent complexities in diagnosing mood disorders. It describes the overlapping symptomatology and diagnostic challenges. Through a comprehensive review of literature and clinical insights, it argues for a structured approach to symptom assessment, focusing on both the current presentation and also retrospective evaluation of illness progression. By elucidating the longitudinal trajectory of the illness, including the presence of episodes of high mood suggestive of bipolar disorder, clinicians can differentiate between mood disorders accurately. The article discusses the implications of accurate diagnosis on treatment planning and patient prognosis. A precise diagnosis enables clinicians to plan treatment strategies to the specific needs of the individual, including pharmacotherapy, psychotherapy, or both. By addressing the underlying mechanisms and trajectory of the illness, clinicians can implement targeted interventions which reduce the risk of misdiagnosis and which optimize therapeutic outcomes.

The Mental Health Service of Trento has consistently adopted a community-based, recovery-oriented approach. Adhering to these paradigms, and aiming to facilitate an intervention centred on the individual and their needs within their familial and social context, it is imperative to ensure a prompt and effective response to crises at the community level. Psychiatric emergencies present a significant challenge for health systems globally. Timely and appropriate management of these crises is crucial to prevent negative short and long-term outcomes. Providing such management in an extra-hospital setting, adaptable to the situational needs, can enable the individual to better achieve their recovery goals. Trento, with its dedicated Crisis service and the active involvement of Peer Support Specialists ("ESP" in italian), exemplifies how an integrated, multidisciplinary territorial approach that values the role of the socio-family context can enhance the outcomes of acute psychopathological crises and user engagement. This article discusses the organisation, advantages, and challenges compared to intra-hospital management, and the impact this intervention can have on public stigma regarding mental health.

The study reports findings from an observational cross-sectional study involving patients experiencing their first psychotic episode with acute catatonia (n=82), compared to non-catatonic patients (n=74) and a group of healthy volunteers (n=47). Diagnostic procedures spanned two days: the first involved clinical interviews to assess psychosis structure and gather objective data (from relatives and medical records), while the second included psychometric evaluations using PANSS and BFCRS scales. Between these days, participants completed the Big Five Personality Factor Questionnaire (5PFQ) and Beck's Personality Beliefs Questionnaire (PBQ). Comparative analysis (H-test) across the three groups highlighted differences in the 5PFQ factor "expressiveness vs. practicality," predominantly influenced by the "sensitivity vs. insensitivity" parameter. Patients exhibiting catatonic symptoms demonstrated significantly lower scores compared to controls in this regard.

Introduction: Self-harm behavior is a significant global concern, with Russia among the countries with high prevalence rates. Adolescents and young adults (15-29 years old) are particularly vulnerable, with suicide being the fourth leading cause of death in this age group. Our objective was to present statistics on suicidality and non-suicidal self-harm behavior (NSSH) among adolescents in the Samara region and to identify psychosocial differences between patients hospitalized for the first time and those hospitalized repeatedly.

Subjects and methods: This study is a retrospective chart analysis of adolescents hospitalized due to suicidal ideation or attempts in 2023. Data were collected from hospital records, comprising a diverse sample of adolescents.

Results: The sample included 76 adolescents, with a significant gender imbalance, as 84.2% were female. Chronic family conflicts presumably were the most influential factor, rather than family composition. Data on hereditary predisposition were subjective and presumably did not correlate with the number of hospitalizations. Fetal hypoxia was the only notable perinatal pathology. Self-harm behavior was more common in readmissions, while suicidal thoughts were present in similar proportions in both initial and repeat hospitalizations. The main reasons for self-harm behavior were the desire to gain control over life or to relieve emotional pain. Only 2.6% of cases were directly aimed at suicide.

Conclusions: Identified risk factors for suicidal behavior among adolescents included female gender, an unfavorable family environment, and NSSH, which, although not directly suicidal, increased the risk of future suicidal behavior. These factors should be considered in the diagnosis and prevention of suicidal behavior.

Suicide and suicidal behaviors seem to have a heritable component, and evidences from adoption, twins and families studies underline observations that greater familial suicidal behavior correlates with earlier onset and higher risk in offspring, supporting the presence of a genetic component. In this paper we report data from the literature, highlighting the scientific relevance of research in important topic as suicidal behaviours.

Background: To analyze the results of domestic and foreign studies of the comorbidity of anxiety-depressive disorders and discogenic back pain in adult patients.

Subjects and methods: An analysis of Russian-language and foreign literature was carried out with a search depth of 5 years (2019-2024) in the following databases: PubMed, Springer, Wiley Online Library, Taylor & Francis Online, US National Library of Medicine National Institutes of Health, ScienceDirect and e-Library.

Results: Numerous studies have shown that depression and anxiety influence treatment outcomes in intervertebral disc degeneration (IVDD). Ineffective pharmacotherapy and inappropriate surgical interventions for depression and anxiety may significantly negatively affect the outcomes reported by patients with IVDD and chronic discogenic back pain. In addition, depression and anxiety have been reported to be risk factors for complications, chronic pain, and readmission after spinal surgery. Symptoms associated with mental stress, including depression and anxiety, were shown to be associated with changes in skeletal muscle tension symmetry in patients with IVDD, indicating that mental state is associated with muscle function. Therefore, it is useful for neurologists and neurosurgeons to identify anxiety and depressive disorders in patients with IVDD in order to promptly prescribe appropriate therapy for them.

Conclusion: Timely diagnosis of anxiety and depressive disorders and anxiety in patients with IVDD and chronic discogenic back pain requires an interdisciplinary approach with the participation of psychiatrists, neurologists and clinical pharmacologists, which is important for improving positive treatment outcomes and improving the quality of life of patients.