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Biomedical subjects

B Saraceno

Publications and source records attributed to B Saraceno.

At least 19 recordsLinked to original sources
PubMed2003

Trends in mortality from suicide, 1965-99.

OBJECTIVE: To analyse trends in mortality from suicide over the period 1965-99. METHOD: Data were derived from the WHO database, including data for 47 countries. RESULTS: In the European Union (EU), all age suicide mortality peaked at 16.1/100,000 in men in 1980-84, and declined thereafter to 14.4/100,000 in 1995-98. In females, the fall was 29% to reach 4.6/100,000. A similar pattern of trends was observed in several eastern European countries. In contrast, mortality from suicide rose substantially in the Russian Federation, from 37.7/100,000 in males in 1985-89 to 58.3/100,000 in 1995-98 (+55%), and to 9.5/100,000 (+12%) in females. In the USA and most other American countries providing data, no consistent pattern was evident for males, but falls were observed in females. Steady declines were registered for Japan, starting from the highest suicide rates worldwide in the late 1950s. Suicide rates were upwards in Ireland, Italy, Spain, the UK, Cuba, Australia and New Zealand. Substantial rises were observed in a few countries (Ireland, Cuba, Mexico, Australia and New Zealand) for young males. CONCLUSION: In spite of mixed trends, suicide remains a significant public health problem worldwide.

Adolescent↗
PubMed2001

Mental health in EMRO: the future is now.

Recognizing the magnitude of the problem of mental health disorders globally, the World Health Organization has made mental health the focus of the year 2001. In this paper three priority areas for action in the Eastern Mediterranean Region are suggested, namely: human rights, mental hospitals and community care, drug abuse, and reconstruction of the health care system in Afghanistan.

Afghanistan↗
PubMed1999

QUALYOP project 2: monitoring the dismantling of Italian psychiatric hospitals. Psychotropic drug use in 1072 inpatients.

OBJECTIVE: This study describes the use of psychotropic drugs in a sample of eight Italian psychiatric hospitals. METHODS: A cross-sectional approach was used to collect information about sociodemographic and clinical characteristics of the inpatient population, and about medications prescribed. Prescribing behaviour in the hospitals was compared using three indicators: the number of patients taking psychotropic drugs, the use of high doses of neuroleptics and the use of multiple neuroleptics. RESULTS: More than a thousand patients were resident in the eight hospitals on the census day, 56% of them males. Half the population had an ICD-X diagnosis of schizophrenia, one third of mental retardation. Sixty-nine percent of the sample was on neuroleptic therapy, nearly 47% on benzodiazepines and 4% on antidepressants. Twenty percent of the sample did not take any psychotropic drug on the census day. After adjustment for sociodemographic and clinical variables, setting-related variables resulted as determinants of psychotropic drug use. CONCLUSIONS: These data call for continuing education in psychopharmacology towards a more rational use of drugs; longitudinal audits of clinical practice should be implemented to guide clinicians toward a more rational use of psychotropic drugs.

Journal Article↗
PubMed1999

The Qualyop Project. 1: Monitoring the dismantlement of Italian public psychiatric hospitals. Characteristics of patients scheduled for discharge.

OBJECTIVES: Monitoring and evaluating the Italian psychiatric hospitals closure process, stated by the law to be concluded by 31 December 1996, and then postponed to 31 March 1998, identifying characteristics related to the possibility of discharge in 4493 patients living in twenty-two public psychiatric hospitals. METHOD: Sociodemographic and clinical data, information on impairment and functioning and plans for discharge in the subsequent twelve months of all patients were collected at baseline using a standard questionnaire. RESULTS: Discharge was planned within twelve months for 11% of the patients: 4% to other psychiatric or non-psychiatric institutions and 7% to community settings. Severely disabled patients and patients with some behavioural problems were more frequently scheduled to go to institutional settings. For both types of discharge, an adequate network of social relationships was an important determinant. Patients were more frequently planned for discharge if they resided in hospitals with a higher care providers/patients ratio, and in Emilia Romagna and Rome, than in Lombardy and Liguria. CONCLUSION: Frequency of planned discharge depended partly on the patients' personal characteristics related to independence and functioning, but the effect of these factors on frequency of planned discharge was influenced by characteristics of the hospitals where the patients lived.

Activities of Daily Living↗
PubMed1998

Antidepressant agents: from tricyclics to serotonin uptake inhibitors.

BACKGROUND: The number of antidepressant drugs available in the market has grown rapidly in the last few years. The present paper underlines some of the pre-clinical and clinical problems that call close attention from the regulatory authorities when approving new drugs. METHODS: We present here a review of the literature. RESULTS: A wide heterogeneity in the action of the various antidepressants precludes any single theory about the pathogenesis and therapy of depression. Antidepressant activity, in fact, may be achieved by acting on a number of different monoaminergic mechanisms. The variety in the neurochemical effects of antidepressants is not reflected in clinical trials, which tend to stereotypy. In many cases clinical trials aim at demonstrating equivalence rather than differences in efficacy. Regulatory authorities should, therefore, pay attention in accepting the equivalence of effects of a new drug in relation to a reference one: most clinical trials of new antidepressant drugs do not have the power to detect clinically relevant differences. CONCLUSIONS: Unconventional new pre-clinical tests are needed to generate antidepressants with a different mechanism of action. Clinical studies are needed to promote objective comparative evaluation of the cost, benefits and toxic effects of new antidepressants.

Antidepressive Agents↗
PubMed1997

Epidemiology of psychiatric care of patients with severe mental disorders in Italy. Rationale and design of a prospective study, and characteristics of the cohort. Italian Collaborative Study Group.

The rationale and design of a large, multicentre, prospective follow-up study on the outcome of severe mental disorders is presented. The study is currently under way in Italy, where psychiatric care has been uniquely characterised since 1978 by the statutory prohibition of admitting patients to psychiatric hospitals. The main purpose of the study is to describe the 5-year outcome of patients with a diagnosis of schizophrenia, paranoid disorder, affective psychosis, reactive psychosis or personality disorder with respect to five areas (clinical condition, personal autonomy, work, and family and social relationships); a secondary objective is to describe the heterogeneity of practices and resources of psychiatric services. The study is being carried out by 76 outpatient psychiatric services throughout the country, covering approximately one-tenth of the Italian population.

Adult↗
PubMed1997

Poverty and mental illness.

OBJECTIVE: To assess the relationship between poverty and mental illness in order to stimulate debate on future international cooperation programs in mental health. METHOD: Epidemiological data in the international literature addressing the issue of material poverty as a risk factor for the development of mental illness and as a prognostic factor for the outcome of mental illness were reviewed. RESULTS: The international literature reviewed supports the notion that material poverty is a risk factor for a negative outcome among mentally ill people. In addition, preliminary epidemiological data suggest that service-related variables may be determinants of outcome of mental illnesses. In our view, cooperation with developing countries is a great opportunity to evaluate mental health services in a natural setting. CONCLUSIONS: A new generation of programs for international cooperation in mental health is needed, in which knowledge and technology transfer is based on a service-research attitude. Attention should be focused on variables related to the poverty of services that might be linked to the course and outcome of mental illnesses.

Cross-Cultural Comparison↗
PubMed1996

The provision of psychiatric care in southern Italy. Results from the 'Psychiatry in Southern Italy's Services' (De PISIS) survey.

OBJECTIVE: To describe structural features, attenders' characteristics and intervention habits in a large sample of Community Mental Health Departments (CMHDs) in Southern Italy. DESIGN AND SETTING: 1) Survey of resources and organization features of collaborating CMHDs; 2) Unreplicated registration of all attenders and of therapeutic interventions during an index week. RESULTS: A self-selected sample of 47 CMHDs in Southern Italy recruited 3845 patients during the last week of October 1992. Participating CMHDs were serving a socially deprived and severely ill population: 45.8% of attenders had 8 years or less of formal education; only 18.9% were employed, 30.9% of diagnoses were of the schizophrenia spectrum group and 23% of the affective disorders group. Sixty-eight per cent of patients were being treated with psychotropic drugs, while only 19% received rehabilitative interventions. The activity of CMHDs were oriented more towards the control of active symptomatology than towards rehabilitation. A significantly higher proportion of patients receiving a schizophrenia-spectrum disorder diagnosis were found in contact during the index week with those CMHDs providing both residential and semiresidential (day-hospital, community center) facilities.

Adolescent↗
PubMed1995

Mental health care in the primary health care setting: a collaborative study in six countries of Central America.

The results of a naturalistic epidemiological study conducted in 6 Central American countries in collaboration with the WHO/PAHO Regional Office are reported, aimed at describing the patients with mental distress presenting to the primary health care setting, the interventions enacted and the evolution of the patients over the 6 months following recruitment. A total of 812 patients were recruited by the personnel of 11 primary health care centres. A high degree of heterogeneity was observed with respect to the patients' characteristics and the patterns of care provided. The factors potentially contributing to the heterogeneity, identified through multivariate analyses, are discussed in detail against the specific background differences between countries and between areas within each country. Interestingly albeit expectedly, besides the differences in health care provision and availability, social needs appear to influence both interventions and outcomes.

Adolescent↗
PubMed1994

Consequences of mental distress recognition in general practice in Italy: a follow-up study. Italian Cooperative Group on Mental Distress in General Practice.

Many reports have been recently published on the accuracy of mental distress detection by general practitioners. Recognition of 'caseness', irrespective of its accuracy, nevertheless determines the implementation of therapeutic interventions. This paper reports the results of a naturalistic study describing the consequences for the patients of being identified as 'cases' in the general practice (in terms of referral strategies at recruitment and outcome 3 months and 1 year later), in the context of care provision generated by the 1978 Italian psychiatric reform. Sixty-eight GPs recruited 878 'cases' according to implicit criteria. Overall 20% of the patients were referred the psychiatric setting; only half of these for psychiatric care. After 3 months and 1 year from recruitment respectively 12% and 23% of the subjects were no longer 'cases'. The factors contributing to predict the outcome at three months were age, symptom duration, comorbidity, presence of social context risk factors and prior psychiatric history (or presence of 'major' symptoms); after one year the predictors of caseness were caseness status at 3 months, and clinical severity, symptom duration and presence of somatization at recruitment. GPs remain the main care providers in the short- and long-term. The results of the study indicate the need for a reappraisal of the emphasis to be put on caseness recognition and on the development of standardized instruments for the identification of mental distress. Non-clinical variables concurring in the definition of caseness in general practice, and the factors influencing physicians' decision-making in the implementation of alternative intervention strategies should be further clarified by ad hoc studies.

Adult↗
PubMed1993

Suicide mortality in Italy: an update from 1955 to 1987.

Suicide mortality in Italy over the period 1955-87 has been analysed in terms of age-specific and age-standardised death certification rates, and using a log-linear model to disentangle the effects of age, cohort of birth and calendar period at death. In males, the overall age-adjusted rate (on the World Standard population) was 8.6/100,000 in 1955-59, decreased to 6.7/100,000 in 1965-69, but steadily increased thereafter to reach 9.2/100,000 in 1985-87. In women, overall suicide mortality was 3.3/100,000 in 1955-59, decreased to 2.7/100,000 in 1965-69, and increased to 3.2/100,000 in the late 1980's. The percent rise over the last two decades was approximately 35% for males and over 15% for females, corresponding to an excess of over 1,000 deaths per year. The rise in males was attributable to both a period and a cohort effect, and appreciable increases were evident among younger generations over most recent periods. For females, trends at younger ages were more favourable, and the recent increases were essentially on a period of death basis. Recent unfavourable trends are discussed in relation to increased unemployment in Italy during the early 1970's, and to changes in psychiatric care delivery, since a radical psychiatric reform was implemented in Italy in 1978. Differences of trends for males and females, and comparison with suicide trends in other Western countries, however, would not support any simple relationship between these factors and national suicide rates.

Adolescent↗