An observational study in psychiatric acute patients admitted to General Hospital Psychiatric Wards in Italy

Abstract

Objectivesthis Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs). Information was focused on diagnosis (DSM-IV), reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode.Methodsassessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS), the Modified Overt Aggression Scale (MOAS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30).Results864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs) completed both admission and discharge visits. A severe psychotic episode with (19.1%) or without (47.7%) aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge) and depression (12.9% at admission and 14.7% at discharge) were the predominant diagnoses. The mean hospital stay was 12 days. The mean (± SD) total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 ± 5.1, 0.38 ± 2.2, and 0.21 ± 1.5. Forty-four (6.0%) patients had episodes of aggressiveness at admission and 8 (1.7%) at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards.The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%), 686 (94.2%) and 676 (92.9%). The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%), typical anti-psychotics (48.3%, 57.0%, 49.6%), atypical anti-psychotics (35.6%, 41.8%, 39.8%) and antidepressants (40.9%, 48.8%, 43.2%). Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20.6% and 26.6% with two drugs, and 53.2%, 57.8% and 59.0% with > two drugs. Benzodiazepines were the most common drugs both at admission (60.0%) and during hospitalisation (85.7%), and 69.5% were prescribed at discharge.Conclusionpatients with psychiatric diseases in acute phase experienced a satisfactory outcome following intensified therapeutic interventions during hospitalisation.

Gender differences in 353 inpatients with acute psychosis: The experience of one Psychiatric Emergency Service of Turin

“…As a positive treatment response is usually defined in the literature as greater than 20% reduction in BPRS (Lachar et al, 1999), our findings showed that a short LOS in our ward was highly effective. Our results are consistent with previous systematic reviews (Alwan et al, 2008;Johnstone and Zolese, 2009) and the two Italian surveys (Ballerini et al, 2007a(Ballerini et al, , 2007bBarbato et al, 2010;Preti et al, 2009), suggesting that a short hospitalization is sufficient for the majority of patients (Frieri et al, 2013).…”

A prospective, observational study of the safety and effectiveness of intramuscular psychotropic treatment in acutely agitated patients with schizophrenia and bipolar mania

“…Given the necessity for immediate treatment in patients suffering from acute agitation either with schizophrenia or bipolar mania, there is a warranted clinical need for very rapid pharmacological intervention. The availability of rapid-acting IM formulations of psychotropic medications and in particular those of the SGA, with rapid efficacy and a more favorable EPS profile represents a valuable alternative in the treatment acute episodes of agitation in patients with schizophrenia or bipolar acute mania [2–4,8,21].…”

The Brief Psychiatric Rating Scale (version 4.0) factorial structure and its sensitivity in the treatment of outpatients with unipolar depression

“…This structure remains stable across the longitudinal course of schizophrenia (Kopelowicz et al, 2008) and cross-culturally (Ruggeri et al, 2005). The 24-item BPRS is also a sensitive measure of symptom reduction occurring after rehabilitation intervention (Ballerini et al, 2007; Gigantesco et al, 2006; Inch et al, 1997; Pioli et al, 2006). Moreover, less clinically experienced professionals could administer the BPRS 4.0 with high levels of inter-rater reliability (Roncone et al, 1999; Ventura et al, 1993a).…”