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Rosaria Di Lorenzo,1 Matteo Reami,2 Diego Dragone,1 Martina Morgante,1 Giulia Panini,1 Paola Ferri,3 Sergio Rovesti3 1Mental Health Department and Drug Abuse, AUSL-Modena, Modena, 41124, Italy; 2School of Medicine & Surgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 41125, Italy; 3Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 41125, ItalyCorrespondence: Rosaria Di Lorenzo, Tel +39-335-5410018, Email saradilorenzo1@alice.it; r.dilorenzo@ausl.mo.itBackground: The Sars-CoV-2 pandemic imposed unprecedented and drastic changes in health care organizations all over the world.Purpose: To evaluate the impact of the pandemic on hospitalizations in an acute psychiatric ward.Patients and Methods: We retrospectively identified and compared acute psychiatric hospitalizations in the Service for Psychiatric Diagnosis and Care (SPDC) of AUSL-Modena during the pre-pandemic (n = 1858) and pandemic period (n = 1095), from 01/01/2017 to 31/12/2022. Data were statistically analyzed using STATA12.Results: We collected 1858 hospitalizations in the pre-pandemic and 1095 in the pandemic. During the pandemic, we observed a progressively sharp reduction in voluntary hospitalizations, whereas involuntary ones remained stable with an increase in 2022 (p < 0.001), longer hospital stays (12.32 mean days vs 10.03; p < 0.001), longer periods of involuntary hospitalizations (8.45 mean days vs 5.72; p < 0.001), more frequent aggressive behaviour (16.10% vs 9.12%; p < 0.001) and referral to psychiatric communities at discharge (11.04% vs 6.13%; p < 0.001); non-Italians (p = 0.001), people with disability pension (p < 0.001) and Support Administrator (p < 0.001) were more frequently hospitalized.Conclusion: During the pandemic, voluntary psychiatric hospitalizations decreased, but not involuntary ones, and the most vulnerable people in serious clinical conditions were hospitalized.Keywords: psychiatric hospitalizations, COVID-19 pandemic, community mental health, psychiatric involuntary treatment

Rosaria Di Lorenzo,1 Matteo Reami,2 Diego Dragone,1 Martina Morgante,1 Giulia Panini,1 Sergio Rovesti,3 Tommaso Filippini,3,4 Silvia Ferrari,3,5 Paola Ferri3 1Mental Health Department and Drug Abuse, AUSL-Modena, Modena, Italy; 2School of Medicine & Surgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 3Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 4School of Public Health, University of California Berkeley, Berkeley, CA, USA; 5Mental Health Department and Drug Abuse, AUSL-IRCCS Reggio Emilia, Reggio Emilia, ItalyCorrespondence: Rosaria Di Lorenzo, Mental Health Department and Drug Abuse, SPDC in OCSAE, via P. Giardini, 1355, Baggiovara, Modena, 41126, Italy, Tel +393355410018, Email saradilorenzo1@alice.it; r.dilorenzo@ausl.mo.itPurpose: We evaluated the differences between demographic (age, sex, nationality, employment, housing, schooling, support administrator), clinical (hospitalization reason, aggressive behaviour, length of hospitalization, psychiatric diagnosis and comorbidities, psychiatric medications, discharge destination, “revolving door” hospitalizations) and environmental (pre-and pandemic period) variables in voluntary (VHs) and involuntary hospitalizations (IHs) in an acute psychiatric ward during a 6-year period.Patients and Methods: We retrospectively collected the selected variables concerning the hospitalizations of subjects over 18 years of age in the Service for Psychiatric Diagnosis and Care of Mental Health and Drug Abuse Department in Modena from 01/01/2017 to 31/12/2022.Results: We observed a progressive and sharp reduction in the number of VHs (n = 1800; 61.41%) during the pandemic and a stability of IHs (n = 1131; 38.59%), which in 2022 became prevalent. We highlighted the following differences between VHs and IHs: an increase in hospitalization length in IHs (14.25 mean days ± 15.89 SD) in comparison with VHs (8.78 mean days ± 13.88 SD), which increased more during the pandemic; an increase in aggressive behavior in IHs, especially during the pandemic (Pearson Chi2 = 90.80; p = 0.000); a prevalence of schizophrenia and bipolar disorders (Pearson Chi2 = 283.63; p = 0.000) and more frequent maladaptive social conditions among subjects in IHs.Conclusion: During the 6-year observation period, we underscored a trend of increasingly reduced recourse to VHs, whereas IHs increased even in the pandemic. Our results suggest that IHs in Psychiatry represented an extreme measure for treating the most severe psychopathological situations such as schizophrenia and bipolar disorders, characterized by aggressive behaviour and precarious social conditions, which needed longer stay than VHs, especially during the pandemic.Keywords: nonadherence to treatment, involuntary psychiatric hospitalizations, pandemic, revolving door

Paola Ferri,1 Carlo Gambaretto,2 Sara Alberti,3 Pierpaolo Parogni,2 Sergio Rovesti,1 Rosaria Di Lorenzo,4 Alfonso Sollami,5 Annalisa Bargellini1 1Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 2Emergency Department, ASST of Mantova, Mantova, Italy; 3Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 4Department of Mental Health and Drug Abuse, AUSL of Modena, Modena, Italy; 5Health Professions Service, University Hospital of Parma, Parma, ItalyCorrespondence: Sara Alberti, Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 41125, Italy, Tel +390592055599, Email sara.alberti@unimore.itPurpose: Acute pain is a prevalent symptomatology in prehospital emergency care. Although inadequate assessment and treatment of acute pain are associated with various complications, about 43% of adults suffering from pain are undertreated. This phenomenon is poorly studied, and limited data are available in the literature. The objective was to investigate the pain management in a prehospital emergency health-care setting, verifying pain assessment, pharmacological treatment adherence and the effectiveness of pain relief therapy.Patients and Methods: A retrospective observational study was conducted in a sample including all adults treated by the professionals of nurse-staffed ambulances and medical cars in an Italian Emergency Medical Services (EMS) from 1 January 2019 to 31 May 2019. We collected both demographic information and Numeric Rating Scale scores, which evaluated presence and intensity of pain, from the EMS paper forms. All analyses were performed using SPSS, version 27.Results: The study sample was composed of 629 people: 310 males (49%) and 319 females (51%), with an average age of 64.2± 22 years (range 18– 108). Pain information was collected in 75.5% (n = 475) of our sample; among them 222 patients (46.7%) suffered from pain. We recorded that 79.7% (n = 177) of the subjects with pain received no pharmacological treatment, and in almost all of the treated cases they did not adhere to the analgesia algorithm in use. Among those who were pharmacologically treated, pain statistically significantly decreased in intensity, from before to after, in both emergency vehicles (nurse-staffed ambulances pre m = 8.36± 0.9 vs post m = 4.18± 2.2, p< 0.001; medical cars pre m = 7.25± 1.7 vs post m = 3.50± 2.6, p< 0.001). Subsequently, pain was only re-ascertained in 24.3% of subjects.Conclusion: Our findings confirm that pain is a prevalent symptom in prehospital patients, especially in the younger age range, but that it remains an underrecognized, underestimated, and undertreated symptom with the risk of causing worse health outcomes.Keywords: pain assessment, pain management, prehospital emergency care, emergency medical services, undertreatment of pain

Rosaria Di Lorenzo,1 Anita Iorio,2 Margherita Pinelli,3 Federica Magarini,3 Mattia Marchi,3 Andrea Sacchetti,3 Chiara Calogero,4 Gian Maria Galeazzi,5 Paola Ferri,5 Sergio Rovesti,5 Alessandro Minarini6 1Service of Psychiatric Diagnosis and Care, Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, Italy; 2Psychiatric Rehabilitation Technique Programme, University of Modena and Reggio Emilia, Reggio Emilia, Italy; 3School of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy; 4Community Mental Health Center, Vignola (MO), Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, Italy; 5Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 6Community Mental Health Center, Vignola (MO), Department of Mental Health and Pathological Addictions, AUSL-Modena, Modena, MO, ItalyCorrespondence: Rosaria Di Lorenzo, Department of Mental Health and Pathological Addictions, AUSL-Modena, Service of Psychiatric Diagnosis and Care, via P. Giardini n. 1355, Baggiovara (MO), 41126, Italy, Email r.dilorenzo@ausl.mo.itPurpose: Antipsychotic long-acting injections (AP-LAIs) are indicated for patients affected by schizophrenia especially those with poor treatment adherence.Patients and Methods: To compare paliperidone palmitate 3-monthly (PP3M), paliperidone palmitate one-monthly (PP1M) and haloperidol decanoate (HAL-D) treatment, we enrolled 90 patients with schizophrenia treated in Mental Health Center with one of the three AP-LAIs for at least six months and followed them for another 6 months. At 6 and 12 months of treatment we administered Clinical Global Impression-Severity, Global Assessment of Functioning and World Health Organization Quality of Life-26 items (WHOQOL-BREF). At 1-year treatment, we evaluated relapses (psychiatric hospitalizations and urgent consultations), side effects and drop-outs.Results: We did not highlight any statistically significant difference among the three treatments in relapses and scale scores. Weight increase was significantly higher in PP1M and PP3M groups. Twelve patients (13.3%) discontinued AP-LAI. At 1-year AP-LAI treatment, 69% of patients rated quality of life as “good” or “very good” and 71% declared themselves to be “satisfied” or “very satisfied”.Conclusion: HAL-D, PP1M and PP3M 1-year treatments were similarly effective in preventing relapses and improving quality of life and health satisfaction. All discontinuations in the new 3-monthly antipsychotic treatment were caused by patient refusal to continue it.Keywords: antipsychotic long-acting injections, schizophrenia spectrum disorders, relapses, quality of life, health satisfaction

Rosaria Di Lorenzo,1 Nicoletta Frattini,2 Diego Dragone,3 Riccardo Farina,3 Filippa Luisi,3 Silvia Ferrari,3 Geminiano Bandiera,4 Sergio Rovesti,5 Paola Ferri5 1Psychiatric Intensive Treatment Facility, Mental Health and Drug Abuse Department of AUSL-Modena, Modena, Italy; 2Department of Biomedical, Metabolic and Neural Sciences, School of Nursing, University of Modena and Reggio Emilia, Modena, Italy; 3Department of Biomedical, Metabolic and Neural Sciences, School of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy; 4Emergency Room and Emergency Medicine Unit, General Hospital of Baggiovara, AOU of Modena, Modena, Italy; 5Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, ItalyCorrespondence: Rosaria Di LorenzoPsychiatrist, Psychiatric Intensive Treatment Facility, Mental Health and Drug Abuse Department of AUSL-Modena, Via Paul Harris, 175, Modena, 41122, ItalyEmail r.dilorenzo@ausl.mo.itBackground: The new SARS-CoV-2 has caused an ongoing pandemic. Health prevention measures to contain the outbreak are profoundly affecting the physical and mental health as well as personal freedom of the population.Aim: To evaluate psychiatric emergencies in a 6-month period during the COVID-19 pandemic in 2020 compared to those of the corresponding period of the previous year.Methods: This monocentric observational study preliminarily collected variables of the urgent psychiatric consultations (UPCs) carried out in emergency room (ER) from 1-3-2020 to 31-8-2020 and the socio-demographic and clinical characteristics of patients who required UPCs in the 6-month period, comparing these data with those collected from 1-3-2019 to 31-8-2019. The data, collected in alpha-numeric code, were statistically analyzed through STATA 12-2011.Results: This research reported a reduction of both UPCs and hospital psychiatric admissions. Concomitantly, we observed an increase of UPCs required by people already being treated by psychiatric and other health services, residents in psychiatric facilities and non-Italians. In 2020, differently from 2019, the most frequent reasons for urgent psychiatric consultations were aggressive behavior and adjustment disorders with anxiety and depressive mood.Conclusion: This preliminary study suggests that, during the COVID-19 epidemic, urgent psychiatric consultations in ER were reduced, except for the most vulnerable people due to their clinical and/or social conditions.Keywords: psychiatric emergencies, urgent psychiatric consultations, COVID-19 pandemic

Paola Ferri,1 Serena Stifani,2 Elena Morotti,2 Maria Nuvoletta,3 Loris Bonetti,4 Sergio Rovesti,1 Anna Cutino,5 Rosaria Di Lorenzo6 1Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy; 2School of Nursing, University of Modena and Reggio Emilia, Modena 41124, Italy; 3Occupational Medicine, Maserati SPA, Modena 41121, Italy; 4Nursing Research and Development Unit, Oncology Institute of Southern Switzerland, Bellinzona 6500, Switzerland; 5Psychiatry, University of Modena and Reggio Emilia, Modena 41124, Italy; 6Psychiatric Intensive Treatment Facility, Mental Health and Drug Abuse Department of AUSL-Modena, Modena 41122, ItalyCorrespondence: Paola FerriDepartment of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Campi, 287, Modena 41125, ItalyEmail paola.ferri@unimore.itIntroduction: Increase in the knowledge of “caring science” among nurses plays a key role in ensuring a correct caring behavior towards patients. Caring training for students is a priority in nursing education, but unfortunately there are limited and conflicting studies which explore this outcome. The purpose of this observational study was to explore the perceptions of caring behaviors by nursing students during their clinical practice training in order to highlight if the level of caring behaviors changes as the nursing course progresses.Materials and Methods: The Caring Behaviors Inventory-24 (CBI-24) was administered to 331 students, enrolled in the three years of an Italian Nursing Course, who accepted to participate in the study (89.2% response rate). The data were analyzed using SPSS software version 26.0 (SPSS Inc., Chicago, IL).Results: The total mean score of CBI-24 was 4.82 in the first, 5.12 in the second and 5.26 in the third-year students. The CBI-24 dimensions “Responding to individual needs” and “Being with” obtained the highest scores among the students of the first year. At the end of the first year, our students were already able to perform expressive caring, whereas instrumental caring developed at a high level in the second and third years. We did not highlight any statistically significant difference between the two gender CBI-24 item scores.Conclusion: In light of our results, we put in evidence that Nursing Degree Programme favours the development in students of both relational and technical components of caring behaviors. We hope that in future students’ self-assessment of caring behaviors could be considered an educational outcome for Nursing Programme.Keywords: Caring Behaviors Inventory, caring, expressive caring, instrumental caring, nursing education, nursing students

Rosaria Di Lorenzo,1 Daniela Perrone,2 Anushree Montorsi,3 Jessica Balducci,4 Sergio Rovesti,5 Paola Ferri6 1Mental Health and Drug Abuse Department of AUSL-Modena, Psychiatric Intensive Treatment Facility, Modena 41122, Italy; 2Mental Health Department, UOC Psychiatry, Fermo 63900, Italy; 3School of Nursing, University of Modena and Reggio Emilia, Modena 41124, Italy; 4School of Specialization in Psychiatry, University of Modena and Reggio Emilia, Modena 41124, Italy; 5General and Applied Hygiene, Department of Biomedical, Metabolic and Neural Sciences, Public Health Section, Modena, 41125, Italy; 6Nursing, Department of Biomedical, Metabolic and Neural Sciences, Public Health Section, Modena, 41125, ItalyCorrespondence: Rosaria Di Lorenzo Email saradilorenzo1@alice.itIntroduction: Negative attitude towards drug therapy can foster limited adherence to treatment, which remains one of the biggest obstacles for implementing effective treatments, especially long term.Purposes: The purposes of the study were 1) to evaluate the attitude towards drug therapy among a representative sample of patients treated in a community psychiatric service using 30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated to DAI-30 score and factors.Methods: The DAI was administered, over a 7-month period, to all patients treated in our psychiatric outpatient services who agreed to participate in this study and provided their informed consent. Data were statistically analyzed.Results: With a response rate of 63.3%, 164 females and 136 males completed the DAI-30 with an average score of 14.24 (± 10.46 SD), indicating moderately positive attitude towards drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability (Cronbach’s alpha=0.84). Our factorial analysis highlighted three factors: Factor 1 (Cronbach’s alpha=0.81), composed of 7 items which indicate positive, trustful attitude; Factor 2 (Cronbach’s alpha=0.78), composed of 5 items indicating negative attitude of suspiciousness; and Factor 3 (Cronbach’s alpha=0.66), composed of 4 items suggesting defensive and control attitude towards drug therapy.Discussion: Among the selected variables, “monotherapy” and “total number of hospitalizations” were negatively correlated to the final score of DAI-30, whereas being “married” was positively correlated to it, in a statistically significant way, using the multiple linear regression model. These correlations suggest that positive attitude towards drug therapy could be reinforced by the condition of being married and reduced by relapses with hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric service, potentially correlated to the long-term treatments of our patients.Keywords: attitude towards drugs, psychiatric disorders, community mental health center, therapy adherence

Rosaria Di Lorenzo,1 Giulia Montardi,2 Leda Panza,3 Cinzia Del Giovane,4 Serena Saraceni,2 Sergio Rovesti,5 Paola Ferri6 1Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, Az-USL Modena, Modena 41122, Italy; 2School of Specialization in Psychiatry, University of Modena and Reggio Emilia, Modena 41124, Italy; 3School of Nursing, University of Modena and Reggio Emilia, Modena 41124, Italy; 4Head of Statistics and Methodology, Institute of Primary Health Care (BIHAM), Bern, Switzerland; 5General and Applied Hygiene, Department of Biomedical, Metabolic and Neural Sciences, Modena 41125, Italy; 6Nursing, Department of Biomedical, Metabolic and Neural Sciences, Modena 41125, ItalyCorrespondence: Rosaria Di LorenzoPsychiatrist, Psychiatric Intensive Treatment Facility, Az-USL Modena, Modena 41122, ItalyEmail r.dilorenzo@ausl.mo.itPurpose: To evaluate the longest hospitalizations in an acute psychiatric ward [Service of Psychiatric Diagnosis and Treatment (SPDT)] and the related demographic, clinical and organizational variables to understand the factors that contribute to long-stay (LOS) phenomenon. The term “long stay” indicates clinical, social and organizational problems responsible for delayed discharges. In psychiatry, clinical severity, social dysfunction and/or health-care system organization appear relevant factors in prolonging stays.Patients and Methods: We divided all the SPDT hospitalizations from 1 January 2010 to 31 December 2015 into two groups based on the 97.5th percentile of duration: ≤ 36 day (n=3254) and > 36 day (n=81) stays, in order to compare the two groups for the selected variables. Comparisons were made using Pearson’s chi-square for categorical data and t-test for continuous variables, the correlation between the LOS, as a dependent variable, and the selected variables was analyzed in stepwise multiple linear regression and in multiple logistic regression models.Results: The longest hospitalizations were significantly related to the diagnosis of “schizophrenia and other psychosis” (Pearson Chi2=17.24; p=0.045), the presence of moderate and severe aggressiveness (Pearson chi2=29; p=0.000), compulsory treatment (Pearson Chi2=8.05; p=0.005), parenteral or other route administration of psycho-pharmacotherapy (Pearson Chi2=12.91; p=0.007), poli-therapy (Pearson Chi2=6.40; p=0.041), complex psychiatric activities (Pearson Chi2=12.26; p=0.002) and rehabilitative programs (Pearson Chi2=37.05; p=0.000) during the hospitalization and at discharge (Pearson Chi2=29.89; p=0.000). Many demographic and clinical variables were statistically significantly correlated to the LOS at our multiple linear and logistic regression model.Conclusion: In our sample, clinical illness severity and need for complex therapeutic and rehabilitative treatments were associated with prolonged psychiatric hospitalizations. Understanding this phenomenon can have not only economic but also clinical, ethical and social relevance.Keywords: psychiatric long-stay, acute psychiatric ward, predictors of long-stay, illness severity

Paola Ferri,1 Sergio Rovesti,1 Maria Stella Padula,1 Roberto D’Amico,2 Rosaria Di Lorenzo31Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy; 2Research and Innovation Area, Department of Maternal-Infant and Adult Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena 41124, Italy; 3Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, Modena 41122, ItalyBackground: Empathy is a relevant clinical competence for nursing students. Involvement of expert patients in nursing education could help students develop their innate capacity to empathize.Objective: To evaluate the effect of expert-patient teaching on empathy development in nursing students.Methods: This randomized controlled trial was conducted among 144 first-year undergraduate nursing students divided into two equal groups. In the experimental group, the educational intervention consisted of a seminar focused on empathy, followed by a presentation on expert-patient function. Subsequently, each student participated in two interactive meetings with nursing teacher and expert patient. At the end, the nursing teacher encouraged students to reflect on this experience. In the control group, students only attended a similar seminar focused on empathy and afterward participated in two interactive meetings with a nursing teacher to reflect on this topic without expert-patient involvement. Before (T0) and after (T1) the training intervention, the Balanced Emotional Empathy Scale, Jefferson Scale of Empathy — Health Professions Student (JSE-HPS), and a short demographic questionnaire were administered to the two student groups to measure their empathy levels. The study was approved by the Local Ethics Committee of Area Vasta Emilia Nord (protocol 1763, May 11, 2017). Data were statistically analyzed.Results: We found a statistically significant difference between mean scores at T0 and T1 in both scales in the experimental group. Male students, who presented significantly lower levels of empathy at baseline in comparison with females, showed increased in empathy after training on the the Balanced Emotional Empathy Scale in both the experimental and control groups.Conclusion: The present study highlights that involvement of expert patients in teaching is effective in improving empathy levels in both male and female nursing students. Expert-patient teaching can be a promising nursing-education modality for developing empathy.Keywords: empathy, nursing education, students, expert patient

Rosaria Di Lorenzo,1 Paola Ferri,2 Michela Cameli,3 Sergio Rovesti,4 Chiara Piemonte5 1Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy; 2Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 3Private Accredited Psychiatric Hospital, Villa degli Ulivi, Caserta, Italy; 4Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 5Private Accredited Psychiatric Hospital, Villa Igea, Modena, Italy Background: Schizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level variability compared to corresponding oral preparations. Purpose: To compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate (PP-OM). Methods: We retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012 to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months before and after LAI implementation. Data were statistically analyzed. Results: The three LAI groups differed significantly only for “need for economic support from social service” (more frequent in the Hal-D group) and “schizoaffective disorder” (prevalent in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 months’ treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (P

Rosaria Di Lorenzo,1 Paola Ferri,2 Carlotta Biffarella,2 Giulio Cabri,3 Eleonora Carretti,4 Gabriella Pollutri,5 Ludovica Spattini,5 Cinzia Del Giovane,6 Harvey Max Chochinov7 1Psychiatric Intensive Treatment Facility, Mental Health Department, Azienda USL, Modena, Italy; 2Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy; 3Service of Psychiatric Diagnosis and Treatment, Mental Health Department, Azienda USL, Modena, Italy; 4School of Nursing, University of Modena and Reggio Emilia, Italy; 5School of Specialization in Pscyhiatry, Faculty of Medicine, University of Modena and Reggio Emilia, Italy; 6Faculty of Medicine, Institute of Primary Care (BIHAM), University of Bern, Bern, Switzerland; 7Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada Background: During the last decades, dignity has been an emerging issue in mental health since its ethical and therapeutic implications became known. This study is an extension of the preliminary validation of the Patient Dignity Inventory (PDI) in a psychiatric setting, originally designed for assessing perceived dignity in terminal cancer patients. Methods: From October 21, 2015 to December 31, 2016, we administered the Italian PDI to all patients hospitalized in an acute psychiatric ward, who provided their consent and completed it at discharge (n=165). We performed Cronbach’s alpha coefficient and principal factor analysis. We administered other scales concomitantly to analyze the concurrent validity of PDI. We applied stepwise multiple linear regression to identify the patients’ demographic and clinical variables related to the PDI score. Results: Our response rate was 93%, with excellent internal consistency (Cronbach’s alpha coefficient=0.94). The factorial analysis showed three factors with eigenvalue >1, which explained >80% of total variance: 1) “loss of self-identity and anxiety for the future”, 2) “concerns for social dignity and spiritual life”, and 3) “loss of personal autonomy”. The PDI and the three factor scores were positively and significantly correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Among patients’ variables, “suicide risk” and “insufficient social and economic condition” were positively and significantly correlated with the PDI total score. Conclusion: The PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, which suggests that both social and clinical severe conditions are closely related to dignity loss. Keywords: dignity perception in psychiatry, patient dignity inventory, patients hospitalized in an acute psychiatric ward, severe psychiatric diseases, suicide risk, insufficient social and economic condition

Rosaria Di Lorenzo,1 Giulio Cabri,2 Eleonora Carretti,3 Giacomo Galli,4 Nina Giambalvo,4 Giulia Rioli,4 Serena Saraceni,4 Giulia Spiga,4 Cinzia Del Giovane,5 Paola Ferri6 1Mental Health Department, Service of Psychiatric Diagnosis and Treatment in NOCSAE General Hospital, 2Private Accredited Psychiatric Hospital villa Igea, Modena, 3Nursing Home of Rubiera, Reggio Emilia, 4Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, 5PhD Statistics Unit, Department of Diagnostic, Clinical and Public Health Medicine, 6Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy Purpose: To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. Patients and methods: After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for 1 (Kaiser’s criterion), which explained >80% of total variance with good internal consistency: 1) “Loss of self-identity and social role”, 2) “Anxiety and uncertainty for future” and 3) “Loss of personal autonomy”. The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Conclusion: Our preliminary research suggests that PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments. Keywords: dignity experience, Patient Dignity Inventory, patients hospitalized in a psychiatric ward, factor analysis, validation study, dignity distress measurement

Paola Ferri,1 Monica Silvestri,1 Cecilia Artoni,2 Rosaria Di Lorenzo3 1Department of Diagnostic, Clinical and Public Health Medicine, School of Nursing, 2School of Psychiatry, University of Modena and Reggio, 3Department of Mental Health, Service of Psychiatric Diagnosis and Treatment, Modena, Italy Background: Workplace violence (WPV) against health professionals is a global problem with an increasing incidence. The aims of this study were as follows: 1) to examine the frequency and characteristics of WPV in different settings and professionals of a general hospital and 2) to identify the clinical and organizational factors related to this phenomenon. Methods: The study was cross-sectional. In a 1-month period, we administered the “Violent Incident Form” to 745 professionals (physicians, head nurses, nurses, nursing assistants), who worked in 15 wards of a general hospital in northern Italy. Results: With a response rate of 56%, 45% of professionals reported WPV. The most frequently assaulted were nurses (67%), followed by nursing assistants (18%) and physicians (12%). The first two categories were correlated, in a statistically significant way, with the risk of WPV (P=0.005, P=0.004, multiple logistic regression). The violent incidents more frequently occurred in psychiatry department (86%), emergency department (71%), and in geriatric wards (57%). The assailants more frequently were males whereas assaulted professionals more often were females. Men committed physical violence more frequently than women, in a statistically significant way (P=0.034, chi-squared test). Verbal violence (51%) was often committed by people in a lucid and normal state of consciousness; physical violence (49%) was most often perpetrated by assailants affected by dementia, mental retardation, drug and substance abuse, or other psychiatric disorders. The variables positively related to WPV were “calling for help during the attack” and “physical injuries suffered in violent attack” (P=0.02, P=0.03, multiple logistic regression).Conclusion: This study suggests that violence is a significant phenomenon and that all health workers, especially nurses, are at risk of suffering aggressive assaults. WPV presented specific characteristics related to the health care settings, where the aggression occurred. Prevention programs tailored to the different care needs are necessary to promote professional awareness for violence risk. Keywords: workplace violence, health professionals, nurses, physicians, patient, general hospital, aggression

Paola Ferri,1 Matteo Guadi,1 Luigi Marcheselli,1 Sara Balduzzi,1 Daniela Magnani,1 Rosaria Di Lorenzo2 1Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, 2Department of Mental Health, AUSL di Modena, Service of Psychiatric Diagnosis and Treatment, Modena, Italy Background: Shift work is considered necessary to ensure continuity of care in hospitals and residential facilities. In particular, the night shift is one of the most frequent reasons for the disruption of circadian rhythms, causing significant alterations of sleep and biological functions that can affect physical and psychological well-being and negatively impact work performance.Objectives: The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction.Methods: This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in 17 wards of a general hospital and a residential facility of a northern Italian city. This study involved 213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data collection was the “Standard Shift Work Index,” validated in Italian. Data were statistically analyzed.Results: The response rate was 86%. The nurses engaged in rotating night shifts were statistically significantly younger, more frequently single, and had Bachelors and Masters degrees in nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in comparison with the day shift workers, in a statistically significant way.Conclusion: Our results suggest that nurses with rotating night schedule need special attention due to the higher risk for both job dissatisfaction and undesirable health effects. Keywords: shift work, night work, health, sleep disorders, job satisfaction, nurses

Rosaria Di Lorenzo,1 Agnese Galliani,2 Alessia Guicciardi,3 Giulia Landi,3 Paola Ferri2 1Mental Health Department, Azienda USL di Modena, Modena, Italy; 2School of Nursing, University of Modena and Reggio Emilia, Modena, Italy; 3Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy Objective: To highlight which demographic, familial, premorbid, clinical, therapeutic, ­rehabilitative, and assistance factors were related to dual diagnosis, which, in psychiatry, means the co-occurrence of both mental disorder and substance use in the same patient.Methods: Our sample (N=145) was chosen from all outpatients with a dual diagnosis treated from January 1, 2012 to July 31, 2012 by both the Mental Health Service and the Substance Use Service of Modena and Castelfranco Emilia, Italy. Patients who dropped out during the study period were excluded. Demographic data and variables related to familial and premorbid history, clinical course, rehabilitative programs, social support and nursing care, and outcome complications were collected. The patients’ clinical and functioning conditions during the study period were evaluated.Results: Our patients were mostly men suffering from a cluster B personality disorder. Substance use was significantly more likely to precede psychiatric disease (P