Piermaria Furlan

P-881 - Anxiety, depression and quality of life in parents of children affected by rare diseases

Introduction Rare diseases are chronically debilitating, possibly impairing the quality of life both of the patient and of his parents. Aims To examine the quality of life and the coping strategies of the parents of children affected with rare diseases comparing 30 mothers and 25 fathers of children affected by rare diseases with 30 mothers and 26 fathers of non-rare chronic diseases. Anxiety, depression, coping strategies, satisfaction about their life are assessed. Methods All the subjects are interviewed and undergo an evaluation with the self-report tools Satisfaction With Life Scale, Profile of Mood States, COPE, Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety. The data are analyzed using the statistical package SPSS. Results Our results show that subjects having children with rare diseases experience more anxiety, but not a more severe depression, worse psychological well-being and have more difficulties to face the daily living. Comparing the mothers and the fathers of children with rare diseases, the first group show higher scores in HRSA. Conclusions So the feature of uncertainty of a rare disease in terms of aetiology, course and treatment can be associated with a more severe impact on the parents’ psychological end emotional well-being.

EPA-1433 - Study of fifteen years of compulsory treatment: Evolution of diagnoses, psychopathology and behaviours

Introduction The effects of the revolutionary Italian law (180/1978) closing the mental hospitals, limiting the TSO (compulsory treatment) to the general hospitals, have received scant analysis from researchers, for various reasons explaned in the paper. Objectives To confirm if TSO may represent a useful indicator to evaluate the reform. TSO is currently under debate in the Italian Parliament dispite the absence of reliable data. Furthermore the legislation elsewhere in Europe is comparatively different. Aims To conduct a statistical survey to observe diachronically the variations in characteristics (modality, length, diagnoses, frequency, gender, age, nationality...) Methods Quantitative and qualitative analysis of the written records of TSOs in the City of Turin from 2006 to 2011, over 13,000, stored in Turin court archives (special ad hoc software was created to enable investigation) and a comparison of the results with those of a similar study conducted by our Department of Mental Health for the years 1985-1998. Results and conclusions Many results are discussed but we highlight the TSO length (7 days, renewable) which does not need to be modified, the disclosure of diagnoses reveals how much TSO serves as a tool of social control and how diagnoses are prevalently behavioural and outside the leading classification systems. Comparing the 2006-2011 and 1985-1998 results showed that the number of foreign persons and average age of the subjects has increased considerably in the last twenty years. Finally there has been a significant increase of personality disorders and a reduction of schizophrenic psychoses.

JS02-02 - Emergency psychiatry in italy 30 years after the closure of mental health hospitals: past experiences and future projects

The first law on mental health dates back to 1904, and attempted to encourage a uniform national discipline of the mental institutions and established as confinement criteria ‘social danger’ and ‘public scandal’. Very little exists in the scientific literature regarding this topic. A study conducted on the admissions to the Psychiatric Hospital of Collegno and Grugliasco (one of the largest in Italy) has highlighted few predictable aspects of mental health institutions. In particular, it suggests that the stereotype of “psychiatric imprisonment” not only does not correspond to the truth but has become misleading as well. In the past, patients were very often discharged from hospital due to overcrowding and high costs. In 1978 the Italian Parliament enacted the law Number 180. The importance of this law made admissions compulsory but also authorized the modalities and the timing of the Compulsory Psychiatric Treatment (CPT). By confronting the data relative to CPT in Turin from 2007 to 2009 (1,159 CPT per 868 subjects) and those dating back between 1985 and 1998 (4,819 CPT per 3,092 subjects) remarkable results emerge as regards psychiatric emergency in Italy. Recently there has been a higher incidence of CPT due to personality disorders, if compared with schizophrenia. It is clear not only the increasingly higher number of patients affected by these disorders, but also their characterization as emergency cases. In the CPT consent form, terms such as “psychomotor agitation”, “impulsivity” and/or “aggressiveness” are often adopted when making diagnoses both for the clinical evaluation and admission to hospital. These data support the hypothesis that some cases of compulsory admissions are necessary to contain disturbing behaviors, thus confirming CPT as a of social control tool. The institutional function of the Psychiatric Service of Diagnosis and Treatment in general hospital in Italy (PSDT) is responsible for emergency care. A study conducted for 7 years at our PSDT showed that many patients affected by schizophrenia had a positive history of substance abuse and these cases revealed a more severe psychopathology and a major resistance to treatment. Very often the Psychiatric Unit ended up to offering health care assistance to patients presenting with social emergency situations. Our data demonstrate a significant statistical correlation between admitted patients and the length of hospital stays. To fully understand the Italian Psychiatric Reform it is imperative to analyze the university network services and how the 40 Italian universities with psychiatric clinics deal with the education and training of the Mental Health Therapists. The reform established a department model offering diversified and specialized structures within one facility, the Department of Mental Health. The integration and coordination among psychiatry and the other health care services such as addiction treatment facilities, developmental neuropsychiatry, disability, geriatrics and social services had to be regulated. Providing clinical governance, maintaining and improving the quality of patients’ care within the healthcare system, integrating healthcare strategies and diagnostic and therapeutic approaches will be essential to this project.

P03-46 Aggressivity and atmosphere in a general hospital psychiatric emergency service

This research identifies possible indicators of risk of aggressivity in a general hospital psychiatric ward going beyond the analysis of the episode in itself. We suggest that behaviour can be strongly conditioned by the milieu (which is organised in a similar way to other hospital wards) especially since we have found that violence is not correlated with diagnosis. We have used the Overt Aggressivity Scale and our own Ward Atmosphere Evaluation Scale (currently under validation) in order to identify those features which increase or reduce the risk of violent episodes. Factorial analysis and the study of risk probability have enabled us to create a 12 point scale (from red alert to yellow calm) of the probability/possibility of violent episodes. The scale allows psychiatric staff to assess the risk of aggressivity and consequently to modify the management and organisation of the ward if necessary (including emotional and psychological attitudes of the staff).