E. Gambaro

Immigrants’ Pathways to Outpatient Mental Health: Are there Differences with the Native Population?

A poor use of mental health services has been described in immigrants. We compared the sociodemographic, clinical and treatment features of immigrants and natives attending a Community Mental Health Centre (CMHC). 191 immigrants and 191 randomly selected natives applying to the Borgomanero CMHC between 1 January 2003 and 31 August 2013 were compared. Our sample consisted mainly of the so-called “economic” immigrant. Adjustment disorders and reaction to stress were the most frequent diagnoses; in most cases symptoms onset occurred after migration. Although treatment features overlapped in the two groups (duration, number of contacts), immigrants showed a higher frequency of treatment dropout. While it is necessary to improve access to mental health services for immigrants, for the “economic” immigrant it may be more important to focus on establishing a therapeutic relationship that can be experienced as reliable and trustworthy. The finding of similar pathways to access the CMHC in natives and immigrants is encouraging.

Pathways to and Results of Psychiatric Consultation for Patients Referred from the Emergency Department. Are there Differences between Migrant and Native Patients

The aim of this study was to compare migrants and native Italians on the pathways to care and results of psychiatric consultation (PC) in the emergency department (ED). Patients who were referred from the ED for psychiatric consultation (EDPC) at the Maggiore della Carità Hospital between March 2008 and March 2015 were recruited consecutively. Socio-demographic, clinical and consultation variables were recorded along with information about suicidal behaviours; migrants (n = 379; 42.74% males, 57.26% females; age: 45.38 ± 16.95 years) were compared with native Italians (n = 2942; 43.51% males, 56.49% females; age: 42.08 ± 15.89 years). Migrants were younger, more likely to be unemployed and less likely to be already under the care of a psychiatrist. Symptoms related to use of alcohol or substances were more frequent in migrants, especially female migrants. Migrants were less likely than native Italians to be referred for PC because of the presence of psychiatric symptoms, however they were more likely to be referred because of self-harming behaviour. Nonetheless, migrant status was not identified as a risk factor for suicidal behaviour in the multivariate analysis. The outcome of EDPC showed differences between migrants and natives. In absolute terms migrants were less likely to be admitted to a psychiatric ward after the EDPC than native Italians, while they were more likely to be monitored in the ED before being discharged or referred to outpatient care. In a high percentage of psychiatric examinations of migrants, no psychiatric symptoms were identified. Further studies are warranted to disentangle the meaning of these findings.

Group Activities to Promote Early Rehabilitation in an Acute Psychiatric Ward: A Relationship-Based Approach Focusing on Movies

ABSTRACT Our Psychiatry Institute has a long-standing tradition of providing training in the importance of relational and emotional skills and helping relationships. Here we describe techniques that are routinely used on our psychiatric ward (Maggiore della Carità Hospital, Novara, Italy) to promote early rehabilitation of acute psychiatric inpatients. We focus on the Cinema group, which is typical of our approach to informal, therapeutic group activity. Targeting social and relational issues as adjunct to treatment as usual is useful in acute settings and can begin at an early stage of hospitalization. Our intervention is designed to improve patients’ coping strategies, relational and communication skills, and overall quality of life.

Suicidal Behaviors in Patients Admitted to Emergency Department for Psychiatric Consultation: A Comparison of the Migrant and Native Italian Populations Between 2008 and 2015

In recent decades, Italy has become a desirable destination for immigrants. In 2014, five million people (8.2% of the population) were migrants (regular/irregular, documented/ undocumented). This study looks at psychiatric health, an important feature especially for first‐generation migrants and compares the new settlers with the native Italians. It should be noted that the organization of mental health services in Italy strongly relies on outpatient services, while the psychiatric wards, within the general hospitals, usu‐ ally accommodate patients in acute phases of their disorder. Nonetheless, migrants’ first contact often happens in a psychiatry ward when they are in a severe and acute psy‐ chopathological condition. Research methods: Quantitative and qualitative; longitudi‐ nal research using official statistical and clinical data obtained from records of a public hospital as well as information obtained through professional interview. Results: In rela‐ tion to mental health, we found that the migrant patients referred for psychiatric consul‐ tation to the emergency department (ED) setting were younger, less frequently treated by psychiatric outpatient services, more commonly going to the ED for self‐injury and presenting with symptoms of substance abuse and alcohol‐related disorders. The native Italian population was older, more frequently retired and/or invalid, more frequently already treated by psychiatric outpatient services for any kind of psychiatric symptoms. Conclusion: The comparison of the sociodemographic and clinical features of immigrants and Italians referred for psychiatric consultation in the ED highlighted some differences. Implications are discussed in the light of the existing literature.

Alexithymia, recognition of facial emotion and inference in patients with Eating Disorders (ED) or Substance Abuse Disorders (SAD)

Alexythimia is a psychological construct characterized by difficulty describing emotions and distinguishing them from somatic components of the emotional activation. Patients with eating disorders (ED) or substance use disorders (SAD) commonly present also impairment of recognition of facial expressions and deficits in social inference. Patients with ED and SAD may present impulsiveness, difficulty in emotion-focused coping skills, and search for a concrete relief from psychological suffering. The purpose of study is to compare the ED, SAD and healthy controls (HC), in several variables, including Alexythimia, empathy, and ability to recognize emotions, social inference. Thirty-two patients with ED, 27 patients with SAD and 31 HC were recruited between September 2016 and April 2016 at the psychiatric ward of Novara Hospital, nursing home of Nebbiuno and the nursing home of Viverone. We administrated to patients the same battery of tests, composed by Toronto Alexithymia Scale-20 (TAS-20), Facial Emotion Identification Test (FEIT), the awareness of Social Inference Test (TASIT), temperament and Character Inventory (TCI), Interpersonal Reactivity Index (IRI), Symptoms Checklist-90 (SCL-90). The two clinical groups showed differences in TAS, FEIT and TASIT, highlighting Alexythimic tracts, difficulty in recognizing emotions and deficit of social inference, compared to HCs. The TCI and SCL-90 have also highlighted the common psychopathological characteristics and temperamental in patients with ED and SAD. Alexythimia is particularly represented in patients with ED and SAD, and could represent a maintenance factor, together with deficits in emotions recognition and social inference. The similarities between ED and TD seem to suggest the possibility of shared core features.

Empathy and Social Cognition: a Comparison of Schizophrenic Patients and Healthy Controls

Introduction Patients affected by schizophrenia have deficits in social cognition, functioning and in properly interpreting facial expression. These disabilities contribute to global impairment in social and relational skills. Data started being collected in the context of the Italian-Network-of-Research-on-Psychosis, headed by Mario Maj and Silvana Galderisi, in our centre;collection went on also after the conclusion of the national project. Aims To compare social inference and facial emotion identification in schizophrenic patients and healthy controls. Material and Methods We recruited 50 patients with Schizophrenia and 50 healthy controls (HCs) matched for sex, age and level of education. Socio-demographic characteristics were gathered;assessment of both patients and HCs included The Awareness of Social Inference Test (TASIT) and the Facial Emotion Identification Test (FEIT);furthermore patients were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). Results Some differences in socio-demographic variables emerged (patients are more often unemployed and single). Moreover, the preliminary analyses highlight several differences between schizophrenic patients and HCs at TASIT and FEIT:patients performed significantly worse than HCs in both tests, with longer reaction times. Discussion As expected schizophrenic patients showed social skills deficits and difficulties in identifying facial emotions. Our preliminary results point out disabilities in understanding social messages and interpreting human behaviour;these features underlie poor and limited social relationships proper to schizophrenia. 1 Galderisi S et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia;WorldPsychiatry2014,13(3):275-287 2 Mucci A et al. The Specific Level of Functioning Scale: Construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community Schizophr Res.2014Oct;159(1):144-50

Anxiety and Expressed Emotion in a Sample of Obese Patients

Introduction Expressed Emotion (EE) is a measure of the intensity of the affective family climate and plays a role in disease course and outcome. Especially in urban settings, obesity is a severe problem with serious implications as far as health risks are concerned. Having a high EE caregiver has been suggested to correlate with a worse treatment compliance in obese patients. Objectives To measure level of EE, stressful events and anxiety in obese patients and their caregivers; to investigate the possible correlations between compliance with treatment and emotional temperature of families. Methods We have already recruited more than 150 obese patients and their caregivers. Assessment included: Level of Expressed Emotion Scale (LEE), one version for patients and one for relatives in order to evaluate 4 dimensions: intrusiveness, emotional response, attitude toward disease, tolerance and expectation; the Paykel’s Interview for Recent Life Events; STAI Y1 concerning state anxiety and STAI Y2 concerning trait anxiety. Furthermore we collected demographic characteristics and BMI (Body Mass Index). Results Data collection and analyses are still ongoing. Preliminary results suggest a correlation between obesity and level of anxiety. We expect to find a correlation between level of EE and variation of BMI. Conclusions Levels of EE and anxiety should be considered when planning treatment interventions to enhance compliance in obese patients and to support change in their life-style.

EPA-0777 – Alexithymia, facial emotion identification and social inference in ed patients: a case-control study

Introduction Alexythimia, reduced cognitive empathy and emotion awareness and understanding are present among individuals with Eating Disorders (EDs). Facial expression is a reliable marker of emotion and an important source of social information. Thus, the ability to judge facial expression is essential for successful interpersonal interactions. Objectives To evaluate alexythimia, facial emotion identification and social inference abilities in a sample of ED patients, compared to a sample of patients with another psychiatric diagnosis and a group of healthy controls, matched by gender and age. Aims To describe a specific pattern of emotional dysregulation in ED patients. Methods ED patients and the Psychiatric Control Group are recruited at the Institute of Psychiatry in Novara, while healthy controls are recruited on a community basis. All patients and controls are females, aged 18–65. All patients are undergoing the Structured Clinical Interview for DSM-IV -Patient version (SCID-I-P), healthy controls are administered the Structured Clinical Interview for DSM-IV – Non Patient version (SCID-I-NP). All subjects are undergoing the following: SCID-II, Eating Disorder Inventory − 3 (EDI-3), Binge Eating Scale (BES), Beck Depression Inventory (BDI), Symptom Checklist − 90 (SCL-90), Facial Emotion Identification Test (FEIT), The Awareness of Social Inference Test (TASIT), Temperament and Character Inventory (TCI), Rosenberg Self-Esteem Scale (RSES), Interpersonal Reactivity Index (IRI), Toronto Alexithymia Scale (TAS-20). Results The recruitment and analysis of the samples are ongoing. The ED sample is expected to show greater alexythimia and a poorer performance at FEIT and TASIT, compared to the control samples. Conclusions Clinical implications will be discussed.

EPA-0704 – Migrant pathway to community mental health center of borgomanero

Background International literature indicates that migrants have highest incidence of mental disorders compared to natives, especially for psychotic disorders. Few studies about mental health of migrants in Italy have been published, although net migration rate grew in the last twenty years. Aims to describe socio-demographic and clinical characteristics of migrants attending Community Mental Health Centre (CMHCs) of Borgomanero (Piedmont, Italy) and to evaluate differences in psychiatric diagnoses and pathway to care among different ethnic groups. Methods Migrants attending CMHCs between 1st January 2012 and 31 August 2013 were included in the study. Data were gathered retrospectively from clinical data sets. Results 97 Migrants attended the CMHCs. The most represented ethnicity is East European (36%), the less one is Asian (4%). Most frequent diagnosis is adjustment disorder (33%). In most cases, access to the service follows the family doctors referral (46%), except for patients with schizophrenia, whose access is most frequently direct (they are usually brought to the service by family members) (33%). The majority of those migrating for working reasons suffers from adjustment disorder, schizophrenia or anxiety. Pathway to care and diagnosis seem to be statistically related (p-value 0,00052), as well as migration reason and diagnosis (p-value 0,0452). Lack of regular residence permit seems to be related to non-medical pathways. Conclusions Pathways to CHMCs are complex and influenced by many factors. Most of the sample received a diagnosis of adjustment reaction. More attention should be paid to developing psychiatric consultation liaison models that encompass the physician and social services.