The purpose of this study was to calculate the proportion of patients with schizophrenia receiving persistent antipsychotic polypharmacy and excessive dosing in four European countries; to test the hypothesis that excessive dosing and/or antipsychotic polypharmacy is associated with higher levels of

Persistence with polypharmacy and excessive dosing in patients with schizophrenia treated in four European countries

The validity of the severity-psychosis hypothesis in depression.

Background Psychotic depression (PD) is classified as a subtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception among psychiatrists that psychotic features in depression arise as a consequence of depressive severity. The aim of this study was to determine whether the severity of depressive and psychotic symptoms correlate in accordance with this “severity–psychosis” hypothesis and to detect potential differences in the clinical features of PD and non-psychotic depression (non-PD). Methods Quantitative analysis of Health of the Nation Outcome Scales (HoNOS) scores from all patients admitted to a Danish general psychiatric hospital due to a severe depressive episode in the period between 2000 and 2010 was performed. Results A total of 357 patients with severe depression, of which 125 (35%) were of the psychotic subtype, formed the study sample. Mean HoNOS scores at admission differed significantly between patients with non-PD and PD on the items hallucinations and delusions (non-PD = 0.33 vs. PD = 1.37, p  aggression (non-PD = 0.20 vs. PD = 0.36, p = 0.044) and on the total score (non-PD = 10.55 vs. PD = 11.87, p = 0.024). The HoNOS scores on the two items “ depression ” and “ hallucinations and delusions ” were very weakly correlated. Limitations Diagnoses were based on normal clinical practice and not formalized research criteria. Conclusions The symptomatology of PD and non-PD differs beyond the mere psychosis. Furthermore, severity ratings of depressive and psychotic symptoms are very weakly correlated. These findings offer further support to the hypothesis stating that the psychotic- and non-psychotic subtypes of depression may in fact be distinct clinical syndromes.

The validity of the severity-psychosis hypothesis in depression

Aims – To explore the current state of Italian social psychiatry research as evidenced by original papers published in peer-reviewed journals 2004-2006. Methods – Electronic databases and hand searches of leading peer-reviewed journals were used to identify original research papers published in 2004-2006, addressing a social psychiatric issue, having at least one Italian author, and reporting data from Italian samples. Results – A total of 174 papers were identified. A substantial proportion reported findings of international collaborative research. Quantitative methods dominated, with 86 papers on cross-sectional surveys. Only 18 papers showed results of intervention trials with pre and post measures. Most common target group were psychiatric patients in community mental health services which featured in 93 papers. Conclusions – There is a critical mass of Italian social psychiatry research, dominated by a few research centres and with considerable amount of international collaboration. The findings of this survey might reflect the relative shortage of national funding for social psychiatry research.Declaration of Interest: None.

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Italian social psychiatry research: what gets published in peer reviewed journals?

Aims — To investigate in a representative national sample (N=2,962) of patients living in Residential Facilities (RFs) patterns of polypharmacy as well as related variables, association between diagnoses and therapeutic patterns, and the rate of adverse events. Methods — Structured interviews focusing on each patient were conducted by trained research assistants with the manager and staff of each RF. Patients were rated with the HoNOS and the SOFAS, and comprehensive information about their sociodemographic and clinical status, and their pharmacological regimes were collected. Results — Conventional antipsychotics and second-generation antipsychotics were prescribed to 65% and 43% of the sample, respectively. Benzodiazepines were prescribed to two-thirds of the sample, while antidepressants were the least-used class of psychotropics. Polypharmacy was common: on average, each treated patient was taking 2.7 drugs (±1.1); antipsychotic polypharmacy was also common. Many prescriptions were loosely related to specific diagnoses. Antiparkinsonianian drugs were prescribed to approximately 1/4 of the sample. Mild or severe adverse events in the previous month were reported for 9.9% and 1.4% of the sample, respectively. About 15% of patients suffered from tardive dyskinesia. Conclusions — Psychotropic drug prescription patterns for severe patients living in RFs are only sometimes satisfactory and offer the opportunity of improvement. Specific actions are required to improve prescription patterns for severe patients in RFs.Declaration of Interest: in the past two years GdG has received two speaker fees from Janssen-Cilag and from Eli Lilly; GS has received one speaker fee from Solvay. RM, AP, SF and RT have received no fees or other financial support from pharmaceutical companies.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1121189X0000628X

Rodolfo Tomasi

Papers

Drug prescription in Italian Residential Facilities