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The treatment of acute psychotic episode: discrepancy between routine practice and evidence. The project SIEP-DIRECT's

Published online by Cambridge University Press:  11 April 2011

Antonio Lora ,
Giuseppe Corlito ,
Maurizio Miceli ,
Walter Di Munzio ,
Antonio Lasalvia ,
Andrea Tanini ,
Luisa Mari ,
Massimo Casacchia ,
Nadia Magnani  and
Doriana Cristofalo
...Show all authors
Antonio Lora*
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera di Vimercate, Vimercate (Milano)
Giuseppe Corlito
Affiliation:
Dipartimento Salute Mentale Area Vasta Sud Est (Arezzo, Siena, Grosseto)
Maurizio Miceli
Affiliation:
Dipartimento di Salute Mentale, Azienda Sanitaria di Firenze, Firenze
Walter Di Munzio
Affiliation:
Dipartimento di Salute Mentale, Azienda Sanitaria Locale Nocera Inferiore (Salerno)
Antonio Lasalvia
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università degli Studi Verona, Verona
Andrea Tanini
Affiliation:
Dipartimento di Salute Mentale, Azienda Sanitaria di Firenze, Firenze
Luisa Mari
Affiliation:
Dipartimento di Salute Mentale, Azienda Ospedaliera S. Paolo, Milano
Massimo Casacchia
Affiliation:
Dipartimento di Scienze della Salute, Università degli Studi L'Aquila, L'Aquila
Nadia Magnani
Affiliation:
Dipartimento Salute Mentale Area Vasta Sud Est (Arezzo, Siena, Grosseto)
Doriana Cristofalo
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università degli Studi Verona, Verona
Domenico Semisa
Affiliation:
Dipartimento Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti (Bari)
Mirella Ruggeri
Affiliation:
Sezione di Psichiatria e di Psicologia Clinica, Università degli Studi Verona, Verona
*
Address fo correspondence: Dr. A. Lora, Dipartimento di Salute Mentale, Azienda Ospedaliera di Vimercate (Milano), Servizio Psichiatrico di Diagnosi e Cura, Presidio di Desio, Via Mazzini 1, 20033 Desio (Milano). Fax: +39-0362-383.865 E-mail: antoniolora@virgilio.it
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Summary

Aims – To evaluate the quality of psychiatric care during the acute psychotic episode and the early post-acute period. Methods – Data concerning 24 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT's Project to evaluate the implementation of NICE recommendations in Italian Mental Health Services. Results – The treatment of the acute episode in the Italian Mental Health Services is not based only on admissions in Psychiatric Ward in General Hospitals, but also on intensive home based care. The utilization of day hospital facilities for treating acute episodes is less frequent, as the presence of home based follow up after discharge. About of Departments of Mental Health did not have clinical guidelines concerning the pharmacological treatment in this area. However usually the standard practices followed NICE recommendations in terms of prescribed dosages, monitoring side effects and rationale for shifting to atypical antipsychotic drugs. Antipsychotic drugs, atypical or conventional, were frequently prescribed concurrently, while utilization of atypical antipsychotic drugs was increasing. Conclusions – The results show critical points concerning on one hand the scarce diffusion of clinical guidelines, on other hand the connection between standard practices, clinical guidelines and marketing of atypical antipsychotic drugs. It should be reinforced the role of the community and particularly at service level the capacity of community mental health teams to treat the acute patients.

Declaration of Interest: none.

Keywords

acute psychotic episodeschizophrenic disorderantipsychotic drugspsychiatric wards in general hospitalcommunity mental health centers
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 4 , December 2008 , pp. 319 - 330
Copyright
Copyright © Cambridge University Press 2008

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