Rossetto Ilaria, Clerici Massimo, Franconi Filippo, Felthous Alan R, Carabellese Fulvio, Di Vella Giancarlo, Gandellini Maria Gloria, Parente Lia, Carabellese Felice
Poli-REMS Castiglione delle Stiviere, ASST Mantova, Mantova, Italy.
UOC of Psychiatry, Università Milano Bicocca, Milano, Italy.
Front Psychol. 2021 Oct 20;12:708873. doi: 10.3389/fpsyg.2021.708873. eCollection 2021.
The main objective of this study was to compare readmitted (RW) and non-readmitted (NRW) female psychiatric patients after being conditionally or unconditionally released from Italian inpatient forensic psychiatry services, in order to identify variables that were significantly linked with readmission. This study included all patients who were discharged from the female Residences for the Execution of the Security Measure (REMS) of Castiglione delle Stiviere from January 2008 to June 2015 who were not readmitted until December 31, 2018 (48). In addition, data were collected on female patients who were discharged from the same REMS before 2008 and readmitted from January 2008 to December 2018 (42). A key finding of our study was that the readmission into a female REMS was positively associated with the presence of substance use disorders (SUD) and a primary diagnosis on Axis II. To a lesser extent, younger age, being unconditionally discharged when first released, having had a shorter length of inpatient stay and having committed a crime against property for the first REMS admission was also variables that were apparently linked with readmission. The present research continues the previous research on gender-specific mentally ill offenders. Hence, the decision to proceed separately with a sample of men only and one of women only. For all these reasons, young female patients with personality disorder and SUD perhaps should remain longer in REMS and be released with conditions. In most European countries, the length of stay depends on the clinical condition and risk assessment, with some exception where the courts set a maximum length of stay at the outset, as in Italy. All the factors listed above influence the risk assessment. Finally, from integrating these findings into the increasing international literature on conditional release and considering the recent changes in the Italian forensic treatment model, we recommend continuing research on individual risk and protective factors as well as risk assessment instruments on conditionally and unconditionally released inpatients with genders studied separately.
本研究的主要目的是比较意大利住院法医精神病服务机构有条件或无条件释放后再次入院（RW）和未再次入院（NRW）的女性精神病患者，以确定与再次入院显著相关的变量。本研究纳入了2008年1月至2015年6月从卡斯蒂廖内-德拉斯蒂维耶雷女子执行安全措施住所（REMS）出院且直到2018年12月31日未再次入院的所有患者（48例）。此外，还收集了2008年之前从同一REMS出院并在2008年1月至2018年12月再次入院的女性患者的数据（42例）。我们研究的一个关键发现是，再次入住女性REMS与物质使用障碍（SUD）的存在以及轴II的原发性诊断呈正相关。在较小程度上，年龄较小、首次出院时无条件出院、住院时间较短以及首次入住REMS时犯有财产犯罪也是显然与再次入院相关的变量。本研究延续了之前针对特定性别的精神病罪犯的研究。因此，决定分别对仅男性样本和仅女性样本进行研究。基于所有这些原因，患有精神障碍和SUD的年轻女性患者可能应在REMS中停留更长时间并在有条件的情况下出院。在大多数欧洲国家，住院时间取决于临床状况和风险评估，但有一些例外情况，如在意大利，法院在一开始就设定了最长住院时间。上述所有因素都会影响风险评估。最后，将这些发现纳入关于有条件释放的日益增多的国际文献中，并考虑到意大利法医治疗模式的近期变化，我们建议继续针对分别研究的有条件和无条件释放的住院患者的个体风险和保护因素以及风险评估工具进行研究。
