The aim of this study was to describe a service operating in Milan, Italy, that provides early intervention for young people aged 17-30 years at the onset and at high risk of psychosis.
Following 2 years of preliminary study and organization, Programma2000 was launched in Milan in 1999. This programme was targeted at early detection and intervention in subjects at the onset of, at risk of, or showing 'prodromal' signs of psychosis. This paper contains data on the organization and activities of Programma2000.
The service has been active since its launch and has received 378 referrals as of March 2009, 342 of which were thoroughly evaluated. At entry, patients undergo a detailed evaluation of their psychopathology, personal and social role functioning, and cognitive status, with repeated testing over time in order to multidimensionally assess outcome. Treatment involves cognitive-behavioural psychotherapy, structured and unstructured psychosocial interventions, and pharmacotherapy when deemed necessary. Treatment appears effective in reducing morbidity and improving social functioning.
A team dedicated to the early identification and treatment of young people with early psychosis is a feasible and sustainable extension of the traditional methods of care for people with mental disorders in Italy.
"All centers provide prompt intervention (within 24 hours) to the referred patients, who are offered a comprehensive, multidimensional evaluation with a package of standardized assessment instruments aimed at evaluating general psychopathology, level of functioning and associated impairment, disability and cognitive deficits [details in 16, 17]. "
[Show abstract][Hide abstract] ABSTRACT: Objective:
This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings.
Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation.
Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2.
The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.
Clinical Practice and Epidemiology in Mental Health 01/2013; 10(1):1-8. DOI:10.2174/1745017901410010001
[Show abstract][Hide abstract] ABSTRACT: A national material flow model for concrete, the most popular construction material in Ireland, was developed based on the framework of material flow analysis. Using this model the Irish concrete cycle for the year 2007 was constructed by analysing the material life cycle of concrete which consists of the three phases of: production (including extraction of raw materials and manufacture of cement), usage (ready-mix and other products) and waste management (disposal or recovery). In this year, approximately 35 million metric tonnes of raw materials were consumed to produce 5 million metric tonnes of cement and 33 million metric tonnes of concrete. Concrete production was approximately 8 metric tonnes per capita. By comparison, the concrete waste produced in that year was minimal at only 0.3 million metric tonnes. Irish building stock is young and there was little demolition of structures in the year of study. However this build up of construction stock will have implications for the future waste flows when the majority of stock built in the last decade (43% of residential stock was constructed in the last 15 years) reaches its end of life.
[Show abstract][Hide abstract] ABSTRACT: Expressed emotion (EE) was examined in a large sample of families of patients with either first-episode psychosis (FEP) within the schizophrenia spectrum, or who met the criteria for ultra high-risk (UHR) of psychosis. The aim of our study was to determine the patterns and relationship of EE with the duration of untreated illness (DUI) or of untreated psychosis (DUP), as well as with illness severity. The sample used in our study included 77 FEP and 66 UHR families. The Camberwell Family Interview was used to assess EE. In both samples, about one-third of patients' families were classified as high EE, with emotional over-involvement (EOI) being the most frequent reason for a family to be classified as high EE. In FEP, higher EE correlated with longer DUI, and higher paternal EOI with longer DUP. DUI, however, was not found to correlate to EE in UHR patients. Severity of illness at the initial assessment did not relate to EE in either FEP or UHR families. Families of FEP and UHR patients were not found to differ in terms of the prevalence of a high EE rating, or of any of its subcomponents. The results of this study only partially support the hypothesis that high EE develops as a reaction to patient status. Patients from families with high EE could possibly benefit from interventions that are targeted at improving their resilience when dealing with problematic family environments.
Psychiatry Research 04/2011; 189(3):331-8. DOI:10.1016/j.psychres.2011.03.021 · 2.47 Impact Factor
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