Skip to main content

Advertisement

SpringerLink
Log in

Patterns of care in patients discharged from acute psychiatric inpatient facilities

A national survey in Italy

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Objective

To analyze the characteristics of patients scheduled for discharge from acute psychiatric inpatient facilities in Italy, and their pattern of care.

Methods

Socio-demographic and clinical characteristics, and patterns of care of 1,330 patients discharged from public and private inpatient facilities in Italy were assessed with a standardized methodology during an index period in the year 2004.

Results

About one half of the sample had schizophrenia or bipolar disorder. However, the case-mix differed between public and private facilities, where in-patients had more frequently mood and anxiety disorders. The use of two or more drugs was very common, involving more than 90% of patients and including typically benzodiazepines and antipsychotics. Structured psychosocial treatments were rarely initiated during the hospital stay. Increasing age, male gender, long stay in the facility (>60 days), personality disorder and type of facility were associated with a higher likelihood of being discharged to a community residential facility. Predictors of discharge to another psychiatric facility were increasing age, being single, schizophrenia, personality disorder and organic mental disorder. Families were not involved in decisions about patients’ discharge in a significant proportion of cases. University psychiatric clinics and private facilities were less coordinated with the community system of care than General Hospital Psychiatric Units. Referral of patients with substance use disorder to drug addiction services occurred in just 30% of subjects.

Conclusions

This study provides information on the characteristics and the pattern of care of patients discharged from inpatient facilities in a country that has closed down all its mental hospitals. This information may be relevant for those countries that are affording now the downsizing of MHs, and the expansion of community-based models of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Advokat C, Eustis N, Pickering J (2005) Relationship between diagnosis and disposition of patients admitted to a state psychiatric hospital. Psychiatr Q 76:97–106

    Article  PubMed  Google Scholar 

  2. Becker T, Hülsmann S, Knudsen HC, Martiny K, Amaddeo F, Herran A et al (2002) Provision of services for people with schizophrenia in five European regions. Soc Psychiatry Psychiatr Epidemiol 37:465–474

    Article  PubMed  CAS  Google Scholar 

  3. Bezzi R, Erlicher A, Lora A (2006) Effectiveness of hospitalisation in acute psychiatric in patient units in Lombardy (Italy). Epidemiol Psichiatr Soc 15:233–237

    PubMed  Google Scholar 

  4. Biancosino B, Barbui C, Marmai L, Donà S, Grassi L (2005) Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study. Int Clin Psychopharmacol 20:305–309

    Article  PubMed  Google Scholar 

  5. Boot B, Hall W, Andrews G (1997) Disability, outcome and casemix with acute psychiatric inpatient units. Br J Psychiatry 171:242–246

    Article  PubMed  CAS  Google Scholar 

  6. Botvinik L, Ng C, Schweitzer I (2004) Audit of antipsychotic prescribing in private psychiatric hospital. Australas Psychiatry 12:227–233

    Article  PubMed  Google Scholar 

  7. Boyer CA (1997) Meaningful linkage practices: challenger and opportunities. New Dir Ment Health Serv 73:87–101

    PubMed  Google Scholar 

  8. Boyer CA, McAlpine DD, Pottick KJ, Olfson M (2000) Identifying risk factors and key strategies in linkage to outpatient psychiatric care. Am J Psychiatry 157:1592–1598

    Article  PubMed  CAS  Google Scholar 

  9. Bruffaerts R, Sebbe M, Demyttenaere K (2004) Effects of patient and health-system characteristics on community tenure of discharged psychiatric inpatients. Psychiatric Serv 55:685–690

    Article  Google Scholar 

  10. Burti L (2001) Italian psychiatric reform 20 plus years after. Acta Psychiatr Scand (Suppl) 410:41–46

    Article  Google Scholar 

  11. Chiappelli M, Grigoletti L, Albanese P, Taras MA, Tulli P, Grassi A, I-Psycost Gruppo (2007) The cost and utilization of psychotherapy in community-based mental health services. A multicentre study in five Italian areas [Article in Italian]. Epidemiol Psichiatr Soc 16:152–162

    PubMed  Google Scholar 

  12. Cuffel BJ, Held M, Goldman W (2002) Predictive models and the effectiveness of strategies for improving outpatient follow-up under managed care. Psychiatric Serv 53:1438–1443

    Article  Google Scholar 

  13. Davids E, Bunk C, Specka M, Gastpar M (2006) Psychotropic drug prescription in a psychiatric university hospital in Germany. Prog Neuropsychopharmacol Biol Psychiatry 30:1109–1116

    Article  PubMed  Google Scholar 

  14. de Girolamo G, Cozza M (2000) The Italian psychiatric reform. A 20-year perspective. Int J Law Psychiatry 23:197–214

    Article  PubMed  Google Scholar 

  15. de Girolamo G, Bellini M, Bocchia S, Ruggeri M (1995) Brief psychiatric rating scale versione 4.0 “ampliata” (BPRS 4.0). Epidemiol Psichiatr Soc 4:69–85

    Google Scholar 

  16. de Girolamo G, Tansella M (2006) Psychiatric units in general hospitals. Problems and perspectives in Europe. Epidemiol Psichiatr Soc 15(2):85–90

    Google Scholar 

  17. de Girolamo G, Barbato A, Bracco R, Gaddini A, Miglio R, Morosini P et al (2007) The characteristics and activities of acute psychiatric inpatient facilities: a national survey in Italy. Br J Psychiatry 191:170–177

    Article  PubMed  Google Scholar 

  18. de Girolamo G, Bassi M, Neri G, Ruggeri M, Santone G, Picardi A (2007) The current state of mental health care in Italy: problems, perspectives, and lessons to learn. Eur Arch Psychiatry Clin Neurosci 257:83–91

    Article  PubMed  Google Scholar 

  19. de Girolamo G, Picardi A, Santone G, Falloon I, Morosini P, Fioritti A, Micciolo R, PROGRES Group (2005) The severely mentally ill in residential facilities: a national survey in Italy. Psychol Med 35:421–431

    Article  PubMed  Google Scholar 

  20. de Jong A (2000) Development of the International Classification of Mental Health Care (ICMHC). Acta Psychiatr Scand Suppl 405:8–13

    Article  PubMed  Google Scholar 

  21. Eichler T, Schützwohl M, Priebe S, Wright D, Adamowski T, Rymaszewska J et al (2008) Loss to follow-up in longitudinal psychiatric research. Epidemiol Psichiatr Soc 17:138–147

    PubMed  Google Scholar 

  22. Gigantesco A, Miglio R, Santone G, de Girolamo G, Bracco R, Morosini P et al (2007) The process of care in general hospital psychiatric units: a national survey in Italy. Aust N Z J Psychiatry 41:509–518

    Article  PubMed  Google Scholar 

  23. Glover G (2007) Adult mental health care in England. Eur Arch Psychiatry Clin Neurosci 257:71–82

    Article  PubMed  Google Scholar 

  24. Henderson C, Hales H, Ruggeri M (2003) Cross-cultural differences in the conceptualisation of patients’ satisfaction with psychiatric services—content validity of the English version of the Verona Service Satisfaction Scale. Soc Psychiatry Psychiatr Epidemiol 38(3):142–148

    Article  PubMed  Google Scholar 

  25. Hugo M (2000) Comparative efficiency ratings between public and private acute inpatient facilities. Aust N Z J Psychiatry 34:651–657

    Article  PubMed  CAS  Google Scholar 

  26. Ito H, Koyama A, Higuchi T (2005) Polypharmacy and excessive dosing: psychiatrists’ of antipsychotic drug prescription. Br J Psychiatry 187:243–247

    Article  PubMed  Google Scholar 

  27. Lasalvia A, Gentile B, Ruggeri M, Marcolin A, Nosè F, Cappellari L et al (2007) Heterogeneity of the Departments of Mental Health in the Veneto Region ten years after the National Plan 1994–1996 for Mental Health. Which implication for clinical practice? Findings from the PICOS Project [Article in Italian]. Epidemiol Psichiatr Soc 16:59–70

    PubMed  Google Scholar 

  28. Lelliott P (2006) Acute inpatient psychiatry in England: an old problem and a new priority. Epidemiol Psichiatr Soc 15(2):91–4

    PubMed  Google Scholar 

  29. Lincoln TM, Wilhelm K, Nestoriuc Y (2007) Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence and functioning in psychotic disorders: a meta-analysis. Schizophr Res 96:232–245

    Article  PubMed  CAS  Google Scholar 

  30. Lora A, Cosentino U, Gandini A, Zocchetti C (2007) Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy). Epidemiol Psichiatr Soc 16:330–338

    PubMed  Google Scholar 

  31. Magliano L, Guarneri M, Fiorillo A, Marasco C, Malangone C, Maj M (2001) A multicenter study of patients’ relatives’ beliefs about schizophrenia. Psychiatric Serv 52:1528–1530

    Article  CAS  Google Scholar 

  32. Magliano L, Fiorillo A, Guarneri M, Marasco C, De Rosa C, Malangone C et al (2004) Prescription of psychotropic drugs to patients with schizophrenia: an Italian national survey. Eur J Clin Pharmacol 60:513–522

    Article  PubMed  Google Scholar 

  33. Magliano L, Fiorillo A, De Rosa C, Malangone C, Maj M, the National Mental Health Project Working Group (2005) Family burden in long-term diseases: a comparative study in schizophrenia vs. physical disorders. Soc Sci Med 61:313–322

    Article  PubMed  Google Scholar 

  34. Magliano L, Fiorillo A, Malangone C, De Rosa C, Maj M, Group Family Intervention Working (2006) Implementation of family psychoeducational interventions for schizophrenia in mental health services: preliminary results from a multicentre Italian study. Psychiatric Serv 57:266–269

    Article  Google Scholar 

  35. Magliano L, Fiorillo A, Malangone C, De Rosa C, Maj M, the National Mental Health Project Working Group (2006) Social network in long-term diseases: a comparative study in relatives of persons with schizophrenia and physical illnesses vs. a sample from the general population. Soc Sci Med 62:1392–1402

    Article  PubMed  Google Scholar 

  36. Mauri MC, Regispani F, Beraldo S, Volonteri LS, Ferrari VM, Fiorentini A et al (2005) Patterns of clinical use of antipsychotics in hospitalized psychiatric patients. Prog Neuropsychopharmacol Biol Psychiatry 29:957–963

    Article  PubMed  Google Scholar 

  37. Morosini P, Magliano L, Brambilla L, Ugolini S, Pioli R (2000) Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 101:323–329

    PubMed  CAS  Google Scholar 

  38. Piccinelli M, Politi P, Barale F (2002) Focus on psychiatry in Italy. Br J Psychiatry 181:538–544

    Article  PubMed  Google Scholar 

  39. Preti A, Miotto P, De Coppi M (2002) Deaths by unintentional illicit drug overdose in Italy, 1984–2000. Drug Alcohol Depend 66:275–282

    Article  PubMed  CAS  Google Scholar 

  40. Rittmannsberger H, Meise U, Schauflinger K, Horvath E, Donat H, Hinterhuber H (1999) Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinic. Prog Neuropsychopharmacol Biol Psychiatry 26:547–551

    Article  Google Scholar 

  41. Rojo JE, Ros S, Aguera L, de la Gandara J, de Pedro JM (2005) Combined antidepressants: clinical experience. Acta Psychiatr Scand 112(s. 428):25–31

    Article  Google Scholar 

  42. Ruggeri M, Leese M, Slade M, Bonizzato P, Fontecedro L, Tansella M (2004) Demographic, clinical, social and service variables associated with higher needs for care in community psychiatric service patients. The South Verona Outcome Project 8. Soc Psychiatry Psychiatr Epidemiol 39:60–68

    Article  PubMed  Google Scholar 

  43. Ruud T, Lindefors N, Lindhardt A (2006) Current issues in Scandinavian acute psychiatric wards. Epidemiol Psichiatr Soc 15(2):99–103

    PubMed  Google Scholar 

  44. Salize HJ, Rössler W, Becker T (2007) Mental health care in Germany: current state and trends. Eur Arch Psychiatry Clin Neurosci 257:92–103

    Article  PubMed  Google Scholar 

  45. Schneider SE, Ross IM (1996) Ultra-short hospitalizations for severely mentally ill patients. Psychiatr Serv 47:137–138

    PubMed  CAS  Google Scholar 

  46. Slade M, Phelan M, Thornicroft G, Parkman S (1996) The Camberwell Assessment of Need (CAN): comparison of assessments by staff and patients of the needs of the severely mentally ill. Soc Psychiatry Psychiatr Epidemiol 31(3–4):109–113

    Article  PubMed  CAS  Google Scholar 

  47. The Sainsbury Centre for Mental Health (2002) The search for acute solutions. A project to improve and evaluate acute mental health inpatient care. The Sainsbury Centre for Mental Health Publishing, London

    Google Scholar 

  48. Thornicroft G, Tansella M (2004) Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. Br J Psychiatry 185:283–290

    Article  PubMed  Google Scholar 

  49. Tomasi R, de Girolamo G, Santone G, Picardi A, Micciolo R, Semisa D et al (2006) The prescription of psychotropic drugs in psychiatric residential facilities: a national survey in Italy. Acta Psychiatr Scand 113:212–223

    Article  PubMed  CAS  Google Scholar 

  50. Trauer T, Callaly T, Hantz P (1999) The measurement of improvement during hospitalization for acute psychiatric illness. Aust N Z J Psychiatry 33:379–384

    Article  PubMed  CAS  Google Scholar 

  51. Verdoux H (2007) The current state of adult mental health care in France. Eur Arch Psychiatry Clin Neurosci 257:64–70

    Article  PubMed  Google Scholar 

  52. West JC, Wilk JE, Olfson M, Rae DS, Marcus S, Narrow WE et al (2005) Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice. Psychiatric Serv 56:283–291

    Article  Google Scholar 

  53. Wheeler A, Humberstone V, Robinson G (2006) Trends in antipsychotic prescribing in schizophrenia in Auckland. Australas Psychiatry 14:169–174

    Article  PubMed  Google Scholar 

  54. World Health Organization (1992) Tenth revision of the international classification of diseases and related health problems (ICD-10). WHO Press, Geneve

    Google Scholar 

Download references

Acknowledgments

Giorgio Bignami, MD, provided continuous support throughout the entire National Mental Health Project, during which this study was conceived. Francesca Bellini, MD, and Vincenzo Menniti, MD, gave a valuable contribution to the preparation of this manuscript. The study was entirely funded by a grant from the Italian Ministry of Health, Rome, Italy. This paper is dedicated to the memory of Pierluigi Morosini, M.D., who was the Scientific Director of the National Mental Health Project, and enthusiastically supported and contributed to the development and conduct of this national research project. The Authors wish to thank Ms. Melinda Tucker for her help in the revision of the English translation.

Author information

Authors and Affiliations

  1. Dept. of Psychology, University of Cagliari, Cagliari, Italy

    Antonio Preti

  2. Dept. of Medicine and Public Health, University of Bologna, Bologna, Italy

    Paola Rucci

  3. Dept. of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Paola Rucci

  4. Mental Health Unit, Centre of Epidemiology, Health Surveillance and Promotion, Italian National Institute of Health, Rome, Italy

    Antonella Gigantesco & Angelo Picardi

  5. Psychiatric Clinic, United Hospitals of Ancona, Ancona, Italy

    Giovanni Santone

  6. Polytechnic University of Marche, Ancona, Italy

    Giovanni Santone

  7. Faculty of Statistics, University of Bologna, Bologna, Italy

    Rossella Miglio

  8. IRCCS Centro S. Giovanni di Dio-Fatebenefratelli, Via Pilastroni 4, 20125, Brescia, Italy

    Giovanni de Girolamo MD

Authors
  1. Antonio Preti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Rucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonella Gigantesco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Santone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelo Picardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rossella Miglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giovanni de Girolamo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The PROGRES-Acute Group

Corresponding author

Correspondence to Giovanni de Girolamo MD.

Additional information

The PROGRES-Acute group includes: National and Regional Coordinators, and scientific consultants: F. Amaddeo MD, A. Barbato MD, G. Borgherini MD, G. Borsetti MD, R. Bracco MSW, R. Canosa MD, M. Casacchia MD, I. Casula MD, P. Ciliberti MD, A. Colotto MD, A. D’Aloise MD, G. de Girolamo MD, G. Dell’Acqua MD, M. De Palma MD, W. Di Munzio MD, A. Gaddini MD, G. Grassi MD, N. Longhin MD, M. Miceli MD, R. Miglio D. Stat, P. Morosini MD, M. Nicotera MD, M. Percudani MD, B. Norcio MD, A. Picardi MD, R. Potzolu, E. Rossi MD, P. Rucci D. Stat, G. Santone MD, S. Schiaffino MD, F. Scotti MD, R. Tomasi MD, G. Turrini MD, E. Zanalda MD. Researchers: G. Agostani, F. Basile MS, F. Basilico MS, N. Battino MS, L. Bavero, G. Bazzacco, L. Biscaglia MS, R. Borio MS, S. Buttacavoli, B. Caporali, F. Cappelletti OT, L. Caserta, L. Cifarelli MD, P. Congia MSW, M. Dazzi, L. Elia, E. Fantini, A. Galli, R. Gangi, A. Ghirardo MS, L. Giordano MSW, S. Goldoni, A. Guidoni, S. Marchegiani, G. Morelli MD, M. Nassisi BS, E. Paltrinieri MD, K. Pesaresi, A. Pettolino MD, L. Pinciaroli MS, G. Pitzalis MD, M. Severini, C. Sighinolfi MS, G. Spinetti MD, A. Trequattrini, U. Unterfrauner MD, K. Wolf MS, L. Zecca MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Preti, A., Rucci, P., Gigantesco, A. et al. Patterns of care in patients discharged from acute psychiatric inpatient facilities. Soc Psychiat Epidemiol 44, 767–776 (2009). https://doi.org/10.1007/s00127-009-0498-2

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-009-0498-2

Keywords

Search

Navigation