Ballerini Andrea, Boccalon Roberto M, Boncompagni Giancarlo, Casacchia Massimo, Margari Francesco, Minervini Lina, Righi Roberto, Russo Federico, Salteri Andrea, Frediani Sonia, Rossi Andrea, Scatigna Marco
Servizio Psichiatrico Diagnosi e Cura, Santa Maria Nuova Hospital, Firenze, Italy.
BMC Psychiatry. 2007 Jan 19;7:3. doi: 10.1186/1471-244X-7-3.
Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management).
Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO--Psychiatric EmeRgency Study and EpidemiOlogy).
253 FPA aged < or = 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers.
Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved significantly from admission to discharge both for FPA and non-FPA patients.
关于首次因精神病症状入住急症病房患者的数据很少。本文的目的是：（i）描述首次精神病入院（FPA）患者的流行病学和临床特征，包括社会人口学特征、危险因素、生活习惯、发病方式、入院前的精神病诊断和治疗；（ii）评估意大利急性医院精神科病房（称为SPDCs，即诊断与治疗精神科服务）中FPA患者的攻击行为及临床管理情况。
横断面观察性多中心研究，涉及62个意大利SPDCs（PERSEO——精神科急诊研究与流行病学）。
在为期5个月的研究期间，在意大利SPDCs收治的2521例患者中，确定了253例年龄≤40岁的FPA患者。约一半的FPA患者表现出攻击行为，定义为改良外显攻击量表（MOAS）评分大于0，而非FPA患者为46%（p = 0.3651）。最常见的是言语攻击，约20%的FPA患者实际对他人实施了身体攻击。74%的FPA患者入院时未确诊，而40%曾接受过精神药物治疗，主要是苯二氮䓬类药物和抗抑郁药。在SPDC住院期间，96%的FPA患者确诊，95%的患者接受了药物治疗，主要是苯二氮䓬类药物、抗精神病药物和心境稳定剂。
首次入住精神科病房的患者通常未接受过充分的前期精神科评估和诊断程序。首次住院可确立诊断并进行精神药物治疗。在我们的研究人群中，攻击行为相当常见，尽管最常见的是言语攻击。经精神科医生和患者评估，FPA患者和非FPA患者的精神症状从入院到出院均有显著改善。
