Marco Zuffranieri

Four-Year Follow-Up of Long-Stay Patients Settled in the Community After Closure of Italy's Psychiatric Hospitals

OBJECTIVE This study reports on the final phase (1996-1999) of closure of Italys psychiatric hospitals. In this phase the last group of patients was resettled in community-based care. These patients were particularly difficult to resettle, and many hospital staff considered their discharge impossible or inappropriate. Shorter-stay inpatients who were previously resettled in community facilities showed improvement in quality of life and socialization and apparent stability of psychotic symptoms. Compulsory resettlement, implemented by community-based practitioners, provided an opportunity to determine whether it could be considered positive for all patients. METHODS A total of 176 patients were discharged in 1998 from two psychiatric hospitals in Northern Italy until 2002. All patients had been hospitalized for more than 20 years (median stay of 37 years). Patients were resettled in sheltered communities with 24-hour staff (N=101), in apartments with daily support (N=24), in residential health care facilities (N=49), and to their previous homes (N=2). Follow-up evaluations were at three and six months and then yearly (total of six). Psychological condition was evaluated with the 18-item Brief Psychiatric Rating Scale. Autonomy and relational skills were assessed with scales developed for the closure project. Analyses of variance were used to assess data. RESULTS Clinical condition steadily improved and substantial improvements were noted in autonomy, socialization, and expression of volition. No worsening occurred in any category. CONCLUSIONS Even among patients with very long hospital stays, resettlement in community-based care and changes in the social framework can have positive results in psychological and social functioning and quality of life.

Presence and significant determinants of cognitive impairment in a large sample of patients with Multiple Sclerosis

Objectives To investigate the presence and the nature of cognitive impairment in a large sample of patients with Multiple Sclerosis (MS), and to identify clinical and demographic determinants of cognitive impairment in MS. Methods 303 patients with MS and 279 healthy controls were administered the Brief Repeatable Battery of Neuropsychological tests (BRB-N); measures of pre-morbid verbal competence and neuropsychiatric measures were also administered. Results Patients and healthy controls were matched for age, gender, education and pre-morbid verbal Intelligence Quotient. Patients presenting with cognitive impairment were 108/303 (35.6%). In the overall group of participants, the significant predictors of the most sensitive BRB-N scores were: presence of MS, age, education, and Vocabulary. The significant predictors when considering MS patients only were: course of MS, age, education, vocabulary, and depression. Using logistic regression analyses, significant determinants of the presence of cognitive impairment in relapsing-remitting MS patients were: duration of illness (OR = 1.053, 95% CI = 1.010–1.097, p = 0.015), Expanded Disability Status Scale score (OR = 1.247, 95% CI = 1.024–1.517, p = 0.028), and vocabulary (OR = 0.960, 95% CI = 0.936–0.984, p = 0.001), while in the smaller group of progressive MS patients these predictors did not play a significant role in determining the cognitive outcome. Conclusions Our results corroborate the evidence about the presence and the nature of cognitive impairment in a large sample of patients with MS. Furthermore, our findings identify significant clinical and demographic determinants of cognitive impairment in a large sample of MS patients for the first time. Implications for further research and clinical practice were discussed.

A inclusão heterofamiliar de apoio a adultos portadores de distúrbios psíquicos (IESA): um recurso terapêutico antigo e eficaz

Este articulo tiene como objetivo presentar el IESA (inserimento Eterofamiliare Supportato di Adulti) - Inclusion de apoyo Heterofamiliar para Adultos que sufren de trastornos psiquiatricos que quieren trabajar para incluir un portador de trastornos mentales en una familia que no es la suya. La hospitalidad es mutua a traves de un reembolso de los gastos mensuales y es una intervencion brindo apoyo a la familia e invitados, por un equipo con una frecuencia de al menos cada quince dias. Es una forma de vivienda con valor terapeutico y la reintegracion social muy grande, alternativa a largas hospitalizaciones en instituciones cerradas, y complementar otras soluciones de suelo residencial. Es una practica centrada en pacientes de todas las edades (incluso los mas jovenes) y no se limita a un tipo especifico de trastorno. El objetivo del IESA es devolver a la sociedad aquellas personas que, por desgracia clinico-existencial, estan en condiciones de vida dificiles, a menudo en condiciones de soledad o insuficiencia de espacios habitables y alienante.

[Adults foster family care in Italian mental health services: a survey].

Adults foster family care in Italian mental health services: a survey