L. Del Gaudio

W07-01 - The effect of family psychoeducational interventions on patients with depression

While the efficacy of family psychoeducational interventions in the treatment of schizophrenia is now well documented, few data are available on its efficacy in major depression. This study aimed to verify the effectiveness of a family psychoeducational intervention according to the Falloon model on patients’ clinical status, social functioning and lifestyle and on relatives’ burden and social network. The study was coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 7 Italian mental health centres. In each centre, 8 patients with major depression and their relatives were recruited if they fulfilled the following criteria: a) diagnosis of unipolar major depression according to the DSM-IV; b) aged between 18 and 65 years; c) in charge to the local mental health centre for at least 6 months; d) at least one depressive episode in the last two years; e) living with at least one relative aged between 18 and 70 years. Recruited families have been randomly allocated to the experimental group, which received the psychoducational intervention for 6 months, or to the control group, which received the treatment as usual plus an informative brief intervention. 22 families have been treated with the experimental intervention and 22 with the control one. At the end of the intervention, patients’ clinical status and life-style significantly improved in the treated group, as well as family objective burden and social contacts. Family psychoeducational intervention are useful in reducing personal and family difficulties caused by depression and in improving patients’ lifestyles.

P01-523 - Coercive measures in italian inpatient units: results from eunomia study

Introduction The use of coercive measures in clinical practice represents a common, but understudied problem in Europe. In 2002–2005, the European Commission funded the study “European Evaluation of coercion in psychiatry and harmonization of best clinical practice” (EUNOMIA), coordinated by the Department of Psychiatry of the University of Dresden and carried out in 12 European countries. Objectives This study, carried out on the Italian EUNOMIA sample, aims to: 1) assess the use of coercive measures in five Italian mental health inpatient units; 2) identify the patients’ socio-demographic and clinical characteristics associated with the use of coercive measures; 3) investigate the effect of coercive measures on the outcome of the patients. Methods The Italian sample included 294 admitted patients. Data were collected on coercive measures (physical restraint, seclusion and forced medication) Results Almost 30% of the patients received coercive measures during their hospitalization; in particular, 22% received forced medication, 9% were restrained or fixed by mechanic devices, 7% were seclused. The most frequent reason for prescribing coercive measures was aggression against others. Patients who received coercive measures were more frequently male, with higher BPRS scores and a worse social functioning. At three months after discharge, they showed higher levels of positive symptoms, and reported more negative opinions on the need of hospital admission and on the appropriateness of psychiatric treatments. Conclusions In Italy coercive measures are in most of the cases applied to the patients affected by more severe psychopathology and disability.

2725 – The impact of perceived insecurity on patients' well-being: a study in 24 mental health centres

Introduction The recent global crisis as well as the increasing crimes’ rates have been claimed to be a factor of mental distress and disturbance. Objectives To describe the levels of insecurity and the fear of crime in a sample of patients with mental disorders with a sample of mental health professionals. Methods The study has been carried out in 24 Italian mental health centres. In each centre 20 patients and 20 mental health professionals have been recruited. Clinical status and social functioning have been evaluated with the Global Assessment of Functioning (GAF), the Hamilton Anxiety scale (HAM-A) and the Hamilton Depression scale (HAM-D). Fear of crime and insecurity have been assessed by Perceived Insecurity Questionnaire (PIQ). Results The final sample consists of 426 patients. They are mostly female (70%), employed and married, with a diagnosis of mood disorder (52%). High levels of worries/insecurity at the PIQ are reported by 42% of patients. Perceived insecurity is associated with higher levels of HAM-A and HAM-D. Nearly all respondents report to have worries or fears about the future (93%), in particular as regards bereavement or loss (41%), economic difficulties (28%), mental or physical illness (26%). In multiple regression model, worries about the economic situation are more frequent in person who are male, young, married and with more than two children. Conclusions The results suggest an association between perceived insecurity with anxiety and depression. Further studies are needed to better understand this association and to develop educational programs on stress and mental disorders.

2722 – Training in preventive psychiatry: a survey of early career psychiatrists from 36 countries

Introduction The practice of early interventions in psychiatry has became one of the most prevalent paradigms in modern psychiatry. In the routine care the dissemination remains frustratingly slow. However, little is known about the characteristics of training curricula. Aims To describe: 1) characteristics of training on prevention and early intervention in psychiatry; 2) organizational and clinical differences of early intervention services in the different countries; 3) trainees’ satisfaction and management of patients with mental disorders. Methods Sixty early career psychiatrists have been invited to participate in the survey, recruited from the early career psychiatrists’ network of the World Psychiatric Association (WPA). Respondents were asked to provide the collective input of their trainees’ associations, and not the individual feedback of any officer of the association. Results 36 out of 60 invited countries compiled the questionnaire. University training programs in early intervention for mental disorders are provided in 21 out of 36 countries (58%). Half of early career psychiatrists feel completely or enough confident to provide specialistic interventions to patients during early stages or at the onset of the disorder. Fifty-three percent of respondents are not satisfied with training on preventive psychiatry. Early intervention services most frequently available are those for schizophrenia (76%). Informative campaigns on mental disorders are usually conducted in 33 countries (87%). Conclusions A huge variability exists as regards early intervention training and practice. Further efforts are needed in order to establish training programs according to the educational needs of trainees and early career psychiatrists.

P-523 - Efficacy of psychoeducational family intervention for depression

Studies on the efficacy of psychoeducational family intervention in patients with depression and their relatives are scarce. The effectiveness of this intervention in major depression has not been adequately investigated, probably because it is considered to be less burdensome by mental health professionals compared to schizophrenia or bipolar disorder. This study aims to test the efficacy of a psychoeducational family intervention on: 1) clinical status and social functioning of patients with major depression; 2) family burden and social network. The study has been carried out in 7 Italian mental health centers; 8 families in each center were randomly recruited and allocated to receive a psychoeducational intervention or an informative one. Fourty-four families were examined: 22 from the experimental group and 22 from the control group. A significative reduction in symptoms (p

AS16-01 - Social deprivation and the early course of schizophrenia

Social deprivation has been consistently found as a risk factor for the incidence of psychosis. This study aimed at investigating the effect of social deprivation on short-term outcome of patients with a recent onset of schizophrenia ( A social deprivation score was calculated taking into account a low/very low socio-economic status, unemployment, low school education, and living alone. Psychiatric symptoms were assessed by BPRS. Compulsory and voluntary hospitalizations, engagement with mental health services, and suicidal attempts were also considered as outcome measures. The sample consists of 35 patients, who had a first episode of psychosis at 19.7 (±4.7) years. In the first two years of the illness, 28% of patients committed suicide attempts and 37% were hospitalized. Twenty-six per cent of the patients had high levels of social deprivation. Patients with higher levels of social deprivation had a more acute clinical onset and a worse short-term outcome, characterized by more severe positive symptoms, an higher number of voluntary and compulsory hospitalizations, and a reduced engagement with outpatient mental health facilities. No significant differences were found as regards suicidal attempts. These results highlight that social deprivation has a negative impact on short-term outcome of schizophrenia and on patients’ engagement with mental health services and on, and suggest the need of targeting interventions on the basis of patients’ clinical and social needs.

P-596 - Influence of clinical and socio-demographic features among patients in psychiatric wards on level of perceived coercion

Coercion experienced by patients with mental disorders in psychiatric wards represents a controversial and highly debated topic, in which clinical and medico-legal issues coexist. A few studies have analyzed the relationship between socio-demographic and clinical characteristics and perceived coercion during psychiatric hospital admissions. This study, conducted within the EUNOMIA project on the evaluation of coercive measures in psychiatry in twelve European countries (Bulgaria, Czech Republic, Germany, Greece, Israel, Italy, Lithuania, Poland, Slovakia, Spain, Sweden, and United Kingdom), intended to assess: 1) the clinical and socio-demographic characteristics most frequently associated with higher levels of perceived coercion at admission; 2) the relationship between psychiatric symptoms and levels of perceived coercion. Two thousand, eight hundred and fifteen patients, admitted in psychiatric wards, were consecutively recruited if they experienced high levels of perceived coercion, according to the McArthur Perceived Coercion Scale; 1997 patients have been re-assessed at three months. Perceived coercion, social functioning and psychiatric symptoms were investigated with previously validated assessment instruments. In multivariate analyses, high levels of perceived coercion at admission were associated with legally involuntary admission, female sex, lower social functioning and positive symptoms. Perceived coercion significantly decreased at follow up. In particular, the improvement of social functioning and of positive symptoms was associated with a greater reduction of perceived coercion. The results of this study suggest that pharmacological treatment of positive symptoms and psychosocial interventions are needed in order to improve the outcome of patients admitted to psychiatric wards.