BackgroundSchizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level variability compared to corresponding oral preparations.PurposeTo compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate (PP-OM).MethodsWe retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012 to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months before and after LAI implementation. Data were statistically analyzed.ResultsThe three LAI groups differed significantly only for “need for economic support from social service” (more frequent in the Hal-D group) and “schizoaffective disorder” (prevalent in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 months’ treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (P<0.001) and overlapping clinical and functioning improvement-scale scores (P<0.001), and 14.28% of patients dropped out, with no difference among the three LAI-APDs. Different kinds of adverse effects, though similar for number and severity, were reported in the three LAI groups.ConclusionOur results suggest that both first- and second-generation LAI-APDs represent important therapeutic options, useful for improving schizophrenia’s clinical course and its economic burden. Our study, which offers a wide and comprehensive observation of real-world clinical settings, combined an effectiveness evaluation through mirror analysis performed for each individual patient to a subsequent comparison among the three LAI-APDs, allowing us a more complete evaluation of clinical efficacy.

This naturalistic study indicates that long-term PP1M treatment was safe and effective in preventing hospitalizations and urgent consultations as well as in improving clinical course.

Valuing patients underlies good communication in psychiatry and mediates positive outcomes. The aim of this study was to (1) identify and reliably assess valuing and devaluing communicative behaviour of psychiatrists in routine consultations, and (2) explore whether valuing behaviour is associated with patient satisfaction. In an inductive study, psychiatrists’ valuing and devaluing behaviours were operationalized and identified in 100 video-recorded consultations with patients with psychosis. Inter-rater reliability of identifying these behaviours was assessed. Associations with patients’ satisfaction were explored using a mixed linear regression model. We identified 18 different valuing behaviours – e.g. seeking patient’s views and supportive statements – and four devaluing behaviours – e.g. talking over the patient and poor responding to concerns – that could be assessed with good reliability. The inter-rater reliability was high (ICC=.89). More valuing behaviour was linked to higher patient satisfaction with the communication (?=.45, CI .14 to.77, p

IntroductionMen make up approximately 10% of the diagnoses of specified Eating Disorders (ED), with Bulimia Nervosa more common in men than Anorexia. However, Eating Disorder Not Otherwise Specified (EDNOS) are more prevalent in men than Anorexia and Bulimia combined. Rates of concurrent depression and personality disorders are also high in men with EDNOS, as well as rates of medical co-morbidity.ObjectivesTo describe a sample of male patients attending a Psychiatric Day Hospital.AimsTo understand possible links between the diagnosis of ED and medical and psychiatric co-morbidity among male subjects.MethodsClinical data about male patients attending the Psychiatric Day Hospital of Modena from 05/01/2009 to 13/06/2012 were collected and analyzed. Psychiatric diagnoses were defined according to DSM IV criteria, medical comorbidities according to ICD10 criteria.ResultsMale patients with ED were on the whole 11 (7.9% of total patients). Nine of them (81.8%) were diagnosed with EDNOS; 7 had medical co-morbidity, namely gastrointestinal (36.4%), respiratory (9.1%), renal (9.1%), rheumatologic (18.2%), cardiac (9.1%) and hypertension (16.6%); 9 had psychiatric co-morbidity, namely personality disorders (46.2%), major depression (30.8%), substance abuse (15.4%) and anxiety disorders (7.7%). Only 1 male patient (9.1%) was suffering from the ED, with no medical or psychiatric co-morbidity.ConclusionsMale patients suffering from ED are increasing and knowledge on their clinical features are less clear than for female subjects, resulting in a more difficult and less effective clinical management. Despite the small sample size, this study attempts to increase the understanding of this clinical population.