Summary:Cognitive function is more frequently impaired in people with epilepsy than in the general population, and the degree of cognitive impairment varies according to the epilepsy syndrome. Behavioral disorders are also more frequent in people with epilepsy than in individuals who do not have epilepsy. Behavioral disturbance is observed more frequently in people with drug-resistant epilepsy, frequent seizures, and/or associated neurological or mental abnormalities. In children and adolescents, many data suggest a close link between behavior/cognition and some specific epilepsy syndromes. For example, aspects of mood, behavior, personality, and cognition may be related to temporal lobe epilepsy or juvenile myoclonic epilepsy. Behavioral disorders may precede, occur with, or follow a diagnosis of epilepsy; they differ between children and adults. Predictors of behavioral disorders in children with epilepsy are the epilepsy itself, treatment, the underlying lesion, and personal reactions to epilepsy. More specifically, conditions in which behavioral disorders may be associated with epilepsy include depression, psychosis, particular personality traits, aggression, anxiety, and attention deficit and hyperactivity disorder.
Introduction Information on the off–label use of Long–Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on– vs off–label LAIs and predictors of off–label First– or Second–Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off– or on–label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off–label group. Results SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on– and off–label use. Approximately 1 in 4 patients received an off–label prescription. In the off–label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off–label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co–morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns.
IntroductionThe closure of forensic psychiatric hospitals and the conversion to a residential model of care based on secure residential units in the community (REMS) has made Italy the first and only country in the world to have followed the principles of the deinstitutionalization movement. Following the reform, several management issues have emerged, such as the creation of long waiting lists for admission to REMS. Improper hospitalization in Acute Psychiatric Units (SPDC) has often been used to address this issue. In addition, the handover of inmates’ care to Mental Health Departments (DSMD’s) has posed further challenges. To date, the field has received little attention from international literature.ObjectivesDescription and analysis of a sample of offender inpatients hospitalized in an acute psychiatric unit.MethodsWe conducted a retrospective study including male offenders admitted to the SPDC of San Gerardo Hospital (ASST Monza), between January 2007 and September 2022. Data analysis was performed by using SPSS.Results120 male offenders were included for a total of 204 admissions. 98 offenders (81.7%) were hospitalized once. We observed an absolute (N=1; N=30) and percentage (0.2%;12%) increase in the number of hospitalized offenders per year during the time period under study. Jail was the main provenance in the sample (46.6%), followed by residential care facilities (27%) and the psychiatric observation unit (ROP) of Monza’s jail (10.8%). The two most prevalent diagnoses were personality disorders (37.5%) and psychosis (39.2%). In addition, 66 subjects (55%) had a history of substance abuse. The average duration of hospitalization was 19.45 days; it increased to 77 days for inpatients waiting to be transferred to REMS. Hetero-aggressive behavior as the reason for admission was associated with longer hospitalization (p=0.031), while attempted suicide correlated to shorter hospital stay (p=0.032). Out of the 55 offenders who attempted suicide, 41 came from jail (74.5%). Finally, longer hospitalizations were associated with an increased number of adverse events (p=0.001).ConclusionsPsychiatric hospitalizations of offenders have increased over the last years. This population tends to require longer hospital stays (regional average of SPDC hospitalization in Lombardy: 14 days), which are even lengthier for inpatients destined to REMS. Longer hospitalizations exert a large burden on DSMD’s and impact the general health of patients, exposing them to a higher risk of adverse events. Further studies are needed to confirm our findings and to develop better strategies for the management and care of offender patients.Disclosure of InterestNone Declared
L'odierna Psichiatria Forense italiana non può dimenticare le sue origini legate alla Medicina Legale, quale modello fondativo e strutturale. La realtà odierna, però, è caratterizzata da un rilevante iato culturale ed organizzativo che separa norme, forse troppo radicali, e risorse, strutturalmente carenti. Tutto ciò si traduce spesso in percorsi articolati ma di grande difficoltà, se non impossibili, soprattutto qualora la formazione in ambito psichiatrico non preveda un percorso strutturato che renda idonei gli specialisti all'impiego degli strumenti dell'arte forense. Il panorama internazionale è di difficile confronto per una questione ontologica correlata sostanzialmente alle differenze legali e dell'iter giudiziario, ma sicuramente può essere da spunto per pensare all'opportunità di un riconoscimento di specifici requisiti in ambito forense. Stante la persistenza di modelli talvolta arcaici e di pratiche non di rado obsolete per quanto attiene alla realtà contemporanea in ambito forense, si rende necessario attualizzare i modelli didattici della disciplina, così da poter chiedere al legislatore anche una riforma dei parametri valutativi e del contesto di riferimento dove si opera. Ciò renderebbe il lavoro peritale maggiormente qualificato e degno di essere identificato e riconosciuto come parte integrante di una Psichiatria contemporanea, ovvero una rielaborazione culturale e didattica in grado di allargare gli orizzonti di una disciplina certamente nobile.giustificazione del minore, ma di responsabilizzazione dell'adulto e di inquadramento contestualizzante. In tale contesto la chiave di lettura della Criminologia, opportunamente corredata in specie in presenza di casi di disagio psichico dal contributo interpretativo della Psichiatria forense, può costituire uno strumento operativo di rilevanza centrale in prospettiva sia trattamentale che preventiva.
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