Carmine Munizza - Academia.edu (original) (raw)
Papers by Carmine Munizza
ITALIAN JOURNAL OF CRIMINOLOGY, 2017
Gli autori affrontano la difficolta di pervenire a una definizione generale di terrorismo, e deli... more Gli autori affrontano la difficolta di pervenire a una definizione generale di terrorismo, e delimitano l’ambito del loro ragionamentoal fenomeno conosciuto come “terrorismo internazionale di matrice islamica”. Illustrano quindi le ragioni per cuil’interpretazione del TIMI come condotta sintomatica di psicopatologia non e accettabile, in quanto le considerazioni sullabase delle quali il terrorista opera la sua scelta possono non essere condivise sul piano morale o politico, ma non possonoessere considerate prive di una loro logica. Altri aspetti di natura psicosociale – eta giovanile, difficolta di integrazione aseguito di una vicenda migratoria propria o dei genitori, contesto violent, tratti di personalita narcisistici o psicopatici, suggestionabilita,fenomeni gregari presenti all’interno del piccolo gruppo o della famiglia, fattori collegati all’identificazionedella religione come elemento di polarizzazione identitaria, o autentiche necessita religiose di espiazione ecc. – posson...
Epidemiologia e Psichiatria Sociale, 2006
Most of the available evidence on the relationship between socioeconomic indicators of social dep... more Most of the available evidence on the relationship between socioeconomic indicators of social deprivation and patterns of use of mental health services has been produced in the United Kingdom, where the Ministry of Health has developed a resource allocation formula based upon the results of those studies. The main aim of the paper is to evaluate the replicability in the Italian context of such research, and of the resulting allocation strategies. Detailed description of the resource allocation method currently adopted in the United Kingdom, whose main purpose consists in reaching the best balance between available funding and patterns of need. Detailed description of resource allocation processes in Italy; discussion of the main methodological and statistical limitations restraining the replicability of the British formula in the Italian context. There is a growing interest in Italy towards the introduction of evidence-based methods in health decision making, in order to correct the overwhelming influence of political issues. What is needed is a better understanding of the relationship between higher levels of equity in health services access, and their effects in terms of better outcomes.
New Trends in Experimental and Clinical Psychiatry
ABSTRACT
Acta psychiatrica Scandinavica. Supplementum
Psychiatric Services
This survey describes neuroleptic prescribing practices in Italian mental health services 15 year... more This survey describes neuroleptic prescribing practices in Italian mental health services 15 years after implementation of a mental health reform law that shifted the focus of care from mental hospitals to community services. The authors conducted a cross-sectional survey of neuroleptic prescribing practices in several psychiatric services throughout the Piedmont region in northern Italy. The relationship between dosing patterns and patients' characteristics was assessed using multiple regression analysis. Sixty-six community mental health services and 14 psychiatric wards in general hospitals participated in the survey in 1991. Among the 3,823 psychiatric patients seen in these settings for whom survey data were available, 67 percent of outpatients and 84 percent of inpatients were prescribed neuroleptic drugs. Twenty-eight percent of outpatients and 45 percent of inpatients received more than one neuroleptic. The average daily dose of neuroleptics was low to moderate; 89 perce...
Epidemiologia e prevenzione
Epidemiology and Psychiatric Sciences, 2011
... 2 articoli (Adli et al., 2006, Barbui & Tansella, 2006); protocollo di revisione: 1 artic... more ... 2 articoli (Adli et al., 2006, Barbui & Tansella, 2006); protocollo di revisione: 1 articolo (Fletcher et al., 2007); editoriale: 1 articolo (Katon & Unutzer, 2006); obiettivo della revisione non pertinente: 2 articoli (Gilbody et al., 2003; Craven & Bland ... ci so no, sepp ur in una percentuale ...
Epidemiology and psychiatric sciences, 2011
Epidemiologia e psichiatria sociale
Social Psychiatry and Psychiatric Epidemiology, 2005
Psychological Medicine, 1995
The prescription pattern of antidepressants was reviewed in a large sample of psychiatric out-pat... more The prescription pattern of antidepressants was reviewed in a large sample of psychiatric out-patients in the Region of Piedmont. Antidepressants were administered to 780 patients; most were diagnosed with mood disorders (62% of prescriptions) and anxiety disorders (34%), the rest with other diagnoses. The mean prescribed dose of antidepressants was at the lower end of, or below, the recommended range for out-patients, with the exception of amineptine and mianserin. The administered dose of tricyclic antidepressants was significantly associated with sex and diagnosis: female patients received a daily dose that was significantly lower than that for males, and patients with a diagnosis of mood disorders received significantly more medication than those with other diagnoses.
Psychiatric Services, 2011
The PROG-CSM (Progetto Centri di Salute Mentale) survey was conducted in all Italian community me... more The PROG-CSM (Progetto Centri di Salute Mentale) survey was conducted in all Italian community mental health centers (CMHCs) with the aim of evaluating the extent to which these services adhered to the standards defined by the Italian National Mental Health Plan 1998-2000. The policy recommendations of the Italian National Mental Health Plan were translated by a multidisciplinary group of experts into key indicators, including continuity of care, coordination with other community-based services, accessibility, implementation of specific programs, and provision of care. There was high adherence to the standards of the National Mental Health Plan in continuity of care and coordination with other services, but there were lower levels of accessibility and implementation of specific projects. CMHCs were sufficiently developed throughout Italy, and continuity of care and service coordination levels were satisfactory; however, adherence to the standards was unrelated to the duration of activity of the CMHCs.
Psychiatric Services, 2008
The aim of this study was to develop indicators of conformance in clinical practice with guidelin... more The aim of this study was to develop indicators of conformance in clinical practice with guidelines for care in schizophrenia. Recommended guidelines rarely apply to all patients and need to allow for social ability, family context, and phase of the disorder. These indicators were therefore devised for tailoring to patient characteristics and allowing for factors that may justify the lack of adherence to clinical guidelines. A team of senior clinicians and methodologists reviewed three clinical guidelines (from the Schizophrenia Patient Outcomes Research Team, McEvoy and colleagues, and the National Institute for Health and Clinical Excellence) and defined criteria for their operationalization into clinical indicators. For each indicator, the team defined criteria for eligibility (requirements to be met to qualify for evaluation), conformance (criteria to be satisfied to comply with each recommendation), and moderators (factors that could justify the lack of application of a given recommendation). These indicators were tested with a random sample of 807 patients with schizophrenia or schizoaffective disorders in outpatient facilities, long-term residential facilities, and hospital units for acute care in the Piedmont region of Italy. A set of 15 indicators was derived, nine concerning pharmacological treatment and six for general care and psychosocial rehabilitation. Moderators such as patient or family refusal of antipsychotic treatment and the patient's level of disability helped to justify a considerable proportion of nonconformant care. The indicators developed are a simple and useful tool to monitor the conformance of care with recommended practices and to identify areas needing improvement.
Mutation Research/Genetic Toxicology and Environmental Mutagenesis, 1998
Combinations of various psychotropic drugs are often used, sometimes for long periods, in the tre... more Combinations of various psychotropic drugs are often used, sometimes for long periods, in the treatment of various forms of psychiatric disorders. This paper evaluates the cytogenetic consequences of daily exposure to polytherapy with antianxiety, antipsychotic and antimaniacal drugs by determining chromosomal aberrations (CA) and sister chromatid exchange (SCE) in peripheral blood samples. The study was performed with a group of 36 psychiatric patients: 18 receiving long-term treatment with lithium carbonate, combined with benzodiazepines (BD) and antipsychotic agents (Group A) and 18 treated with BD and antipsychotics (Group B). Among the latter, 7 patients had only been treated for 1 month (Group B1). The results reveal a significant increase (p<0.01) in cells with aberrations in the two groups of patients (A,B) compared to controls. Moreover, complex aberrations (dicentrics, rearrangements, chromatid exchanges) had a frequency of 0.63% in patients receiving long-term treatment compared to 0.11% in controls, corresponding to the general spontaneous rate. The mean frequency of SCE/cell and the percentage of cells with a high frequency of exchanges (HFC) also showed a highly significant difference compared to controls in both Group A and Group B. Group B1 (patients who only commenced treatment 1 month earlier) did not differ from the control group with regard to the frequency and type of chromosomal aberration or in relation to the mean frequency of SCE/cell. No significant differences were detected between Groups A and B both of which showed similar frequencies of cells with aberrations, SCE/cell and HFC. No correlations were observed in Group A between lithemia and the biological markers studied.
The Journal of Nervous and Mental Disease, 2008
Several reports have described the poor quality of care delivered to psychotic patients. However,... more Several reports have described the poor quality of care delivered to psychotic patients. However, the context in which care was delivered, including the structure, organization, and performance of the health care system, as a possible determinant of quality of care has received less attention. In this study we explored the relationship between conformance with guidelines and structural and organizational characteristics in 2 departments of Mental Health in Italy. Dosing of antipsychotic drugs in the maintenance phase was investigated in 125 patients. Higher than recommended doses could be explained by the high patient caseload per psychiatrist, leading to insufficient contacts with patients and their families and to excessive reliance upon drug treatment. The analysis of structural and organizational determinants of care at the local level may help to explain insufficient quality and to plan suitable interventions.
Journal of Clinical Pharmacy and Therapeutics, 2006
Narrative reviews represent a popular source of information for clinicians, especially where the ... more Narrative reviews represent a popular source of information for clinicians, especially where the evidence on a given subject is sparse and analogies from other fields of medicine may help in filling the information gap. Unfortunately, narrative reviews often follow less stringent criteria for information selection and appraisal than systematic reviews, potentially leading to incomplete or biased recommendations. The objective of the present study was to examine the quality of the recommendations provided by narrative reviews on how to improve patient adherence to pharmacological treatment of unipolar depressive disorders. We sought to locate all narrative review papers addressing adherence to treatment in unipolar depressive disorders. In order to do so, we searched Medline and PsychInfo from 1980 to December 2003, using the following keywords: review, depressive disorders, treatment, dropout, patient compliance and adherence. We inspected the title and the abstract, whenever available to identify the relevant reviews and obtained a full copy of the publications in this subset, and read the articles to identify further relevant reviews. These were in turn copied and reviewed, until no further references were found. We identified 23 reviews, providing a total of 87 recommendations. The most common recommendation was for patient education (19 times), patient-physician empathy/alliance (14 times), and education of family (nine times). Reviewers' recommendations were based on the literature on depression 54 times, and on other medical conditions 17 times. A critical appraisal of the evidence base of the recommendations showed that randomized controlled trials or meta-analyses were quoted to support the recommendations only 23% of the times, while important interventions of proven efficacy in the field of depression or in other chronic conditions (e.g. medication clinics, training of nurses, psychological treatment, and telephone follow-up) were not mentioned. Narrative reviews on adherence to pharmacological treatment of depressive disorders suffer not only from the limited availability of good quality evidence, but also from an incomplete critical appraisal of available evidence on interventions both for depression and for other chronic disorders.
European Psychiatry, 2000
ITALIAN JOURNAL OF CRIMINOLOGY, 2017
Gli autori affrontano la difficolta di pervenire a una definizione generale di terrorismo, e deli... more Gli autori affrontano la difficolta di pervenire a una definizione generale di terrorismo, e delimitano l’ambito del loro ragionamentoal fenomeno conosciuto come “terrorismo internazionale di matrice islamica”. Illustrano quindi le ragioni per cuil’interpretazione del TIMI come condotta sintomatica di psicopatologia non e accettabile, in quanto le considerazioni sullabase delle quali il terrorista opera la sua scelta possono non essere condivise sul piano morale o politico, ma non possonoessere considerate prive di una loro logica. Altri aspetti di natura psicosociale – eta giovanile, difficolta di integrazione aseguito di una vicenda migratoria propria o dei genitori, contesto violent, tratti di personalita narcisistici o psicopatici, suggestionabilita,fenomeni gregari presenti all’interno del piccolo gruppo o della famiglia, fattori collegati all’identificazionedella religione come elemento di polarizzazione identitaria, o autentiche necessita religiose di espiazione ecc. – posson...
Epidemiologia e Psichiatria Sociale, 2006
Most of the available evidence on the relationship between socioeconomic indicators of social dep... more Most of the available evidence on the relationship between socioeconomic indicators of social deprivation and patterns of use of mental health services has been produced in the United Kingdom, where the Ministry of Health has developed a resource allocation formula based upon the results of those studies. The main aim of the paper is to evaluate the replicability in the Italian context of such research, and of the resulting allocation strategies. Detailed description of the resource allocation method currently adopted in the United Kingdom, whose main purpose consists in reaching the best balance between available funding and patterns of need. Detailed description of resource allocation processes in Italy; discussion of the main methodological and statistical limitations restraining the replicability of the British formula in the Italian context. There is a growing interest in Italy towards the introduction of evidence-based methods in health decision making, in order to correct the overwhelming influence of political issues. What is needed is a better understanding of the relationship between higher levels of equity in health services access, and their effects in terms of better outcomes.
New Trends in Experimental and Clinical Psychiatry
ABSTRACT
Acta psychiatrica Scandinavica. Supplementum
Psychiatric Services
This survey describes neuroleptic prescribing practices in Italian mental health services 15 year... more This survey describes neuroleptic prescribing practices in Italian mental health services 15 years after implementation of a mental health reform law that shifted the focus of care from mental hospitals to community services. The authors conducted a cross-sectional survey of neuroleptic prescribing practices in several psychiatric services throughout the Piedmont region in northern Italy. The relationship between dosing patterns and patients' characteristics was assessed using multiple regression analysis. Sixty-six community mental health services and 14 psychiatric wards in general hospitals participated in the survey in 1991. Among the 3,823 psychiatric patients seen in these settings for whom survey data were available, 67 percent of outpatients and 84 percent of inpatients were prescribed neuroleptic drugs. Twenty-eight percent of outpatients and 45 percent of inpatients received more than one neuroleptic. The average daily dose of neuroleptics was low to moderate; 89 perce...
Epidemiologia e prevenzione
Epidemiology and Psychiatric Sciences, 2011
... 2 articoli (Adli et al., 2006, Barbui & Tansella, 2006); protocollo di revisione: 1 artic... more ... 2 articoli (Adli et al., 2006, Barbui & Tansella, 2006); protocollo di revisione: 1 articolo (Fletcher et al., 2007); editoriale: 1 articolo (Katon & Unutzer, 2006); obiettivo della revisione non pertinente: 2 articoli (Gilbody et al., 2003; Craven & Bland ... ci so no, sepp ur in una percentuale ...
Epidemiology and psychiatric sciences, 2011
Epidemiologia e psichiatria sociale
Social Psychiatry and Psychiatric Epidemiology, 2005
Psychological Medicine, 1995
The prescription pattern of antidepressants was reviewed in a large sample of psychiatric out-pat... more The prescription pattern of antidepressants was reviewed in a large sample of psychiatric out-patients in the Region of Piedmont. Antidepressants were administered to 780 patients; most were diagnosed with mood disorders (62% of prescriptions) and anxiety disorders (34%), the rest with other diagnoses. The mean prescribed dose of antidepressants was at the lower end of, or below, the recommended range for out-patients, with the exception of amineptine and mianserin. The administered dose of tricyclic antidepressants was significantly associated with sex and diagnosis: female patients received a daily dose that was significantly lower than that for males, and patients with a diagnosis of mood disorders received significantly more medication than those with other diagnoses.
Psychiatric Services, 2011
The PROG-CSM (Progetto Centri di Salute Mentale) survey was conducted in all Italian community me... more The PROG-CSM (Progetto Centri di Salute Mentale) survey was conducted in all Italian community mental health centers (CMHCs) with the aim of evaluating the extent to which these services adhered to the standards defined by the Italian National Mental Health Plan 1998-2000. The policy recommendations of the Italian National Mental Health Plan were translated by a multidisciplinary group of experts into key indicators, including continuity of care, coordination with other community-based services, accessibility, implementation of specific programs, and provision of care. There was high adherence to the standards of the National Mental Health Plan in continuity of care and coordination with other services, but there were lower levels of accessibility and implementation of specific projects. CMHCs were sufficiently developed throughout Italy, and continuity of care and service coordination levels were satisfactory; however, adherence to the standards was unrelated to the duration of activity of the CMHCs.
Psychiatric Services, 2008
The aim of this study was to develop indicators of conformance in clinical practice with guidelin... more The aim of this study was to develop indicators of conformance in clinical practice with guidelines for care in schizophrenia. Recommended guidelines rarely apply to all patients and need to allow for social ability, family context, and phase of the disorder. These indicators were therefore devised for tailoring to patient characteristics and allowing for factors that may justify the lack of adherence to clinical guidelines. A team of senior clinicians and methodologists reviewed three clinical guidelines (from the Schizophrenia Patient Outcomes Research Team, McEvoy and colleagues, and the National Institute for Health and Clinical Excellence) and defined criteria for their operationalization into clinical indicators. For each indicator, the team defined criteria for eligibility (requirements to be met to qualify for evaluation), conformance (criteria to be satisfied to comply with each recommendation), and moderators (factors that could justify the lack of application of a given recommendation). These indicators were tested with a random sample of 807 patients with schizophrenia or schizoaffective disorders in outpatient facilities, long-term residential facilities, and hospital units for acute care in the Piedmont region of Italy. A set of 15 indicators was derived, nine concerning pharmacological treatment and six for general care and psychosocial rehabilitation. Moderators such as patient or family refusal of antipsychotic treatment and the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s level of disability helped to justify a considerable proportion of nonconformant care. The indicators developed are a simple and useful tool to monitor the conformance of care with recommended practices and to identify areas needing improvement.
Mutation Research/Genetic Toxicology and Environmental Mutagenesis, 1998
Combinations of various psychotropic drugs are often used, sometimes for long periods, in the tre... more Combinations of various psychotropic drugs are often used, sometimes for long periods, in the treatment of various forms of psychiatric disorders. This paper evaluates the cytogenetic consequences of daily exposure to polytherapy with antianxiety, antipsychotic and antimaniacal drugs by determining chromosomal aberrations (CA) and sister chromatid exchange (SCE) in peripheral blood samples. The study was performed with a group of 36 psychiatric patients: 18 receiving long-term treatment with lithium carbonate, combined with benzodiazepines (BD) and antipsychotic agents (Group A) and 18 treated with BD and antipsychotics (Group B). Among the latter, 7 patients had only been treated for 1 month (Group B1). The results reveal a significant increase (p<0.01) in cells with aberrations in the two groups of patients (A,B) compared to controls. Moreover, complex aberrations (dicentrics, rearrangements, chromatid exchanges) had a frequency of 0.63% in patients receiving long-term treatment compared to 0.11% in controls, corresponding to the general spontaneous rate. The mean frequency of SCE/cell and the percentage of cells with a high frequency of exchanges (HFC) also showed a highly significant difference compared to controls in both Group A and Group B. Group B1 (patients who only commenced treatment 1 month earlier) did not differ from the control group with regard to the frequency and type of chromosomal aberration or in relation to the mean frequency of SCE/cell. No significant differences were detected between Groups A and B both of which showed similar frequencies of cells with aberrations, SCE/cell and HFC. No correlations were observed in Group A between lithemia and the biological markers studied.
The Journal of Nervous and Mental Disease, 2008
Several reports have described the poor quality of care delivered to psychotic patients. However,... more Several reports have described the poor quality of care delivered to psychotic patients. However, the context in which care was delivered, including the structure, organization, and performance of the health care system, as a possible determinant of quality of care has received less attention. In this study we explored the relationship between conformance with guidelines and structural and organizational characteristics in 2 departments of Mental Health in Italy. Dosing of antipsychotic drugs in the maintenance phase was investigated in 125 patients. Higher than recommended doses could be explained by the high patient caseload per psychiatrist, leading to insufficient contacts with patients and their families and to excessive reliance upon drug treatment. The analysis of structural and organizational determinants of care at the local level may help to explain insufficient quality and to plan suitable interventions.
Journal of Clinical Pharmacy and Therapeutics, 2006
Narrative reviews represent a popular source of information for clinicians, especially where the ... more Narrative reviews represent a popular source of information for clinicians, especially where the evidence on a given subject is sparse and analogies from other fields of medicine may help in filling the information gap. Unfortunately, narrative reviews often follow less stringent criteria for information selection and appraisal than systematic reviews, potentially leading to incomplete or biased recommendations. The objective of the present study was to examine the quality of the recommendations provided by narrative reviews on how to improve patient adherence to pharmacological treatment of unipolar depressive disorders. We sought to locate all narrative review papers addressing adherence to treatment in unipolar depressive disorders. In order to do so, we searched Medline and PsychInfo from 1980 to December 2003, using the following keywords: review, depressive disorders, treatment, dropout, patient compliance and adherence. We inspected the title and the abstract, whenever available to identify the relevant reviews and obtained a full copy of the publications in this subset, and read the articles to identify further relevant reviews. These were in turn copied and reviewed, until no further references were found. We identified 23 reviews, providing a total of 87 recommendations. The most common recommendation was for patient education (19 times), patient-physician empathy/alliance (14 times), and education of family (nine times). Reviewers' recommendations were based on the literature on depression 54 times, and on other medical conditions 17 times. A critical appraisal of the evidence base of the recommendations showed that randomized controlled trials or meta-analyses were quoted to support the recommendations only 23% of the times, while important interventions of proven efficacy in the field of depression or in other chronic conditions (e.g. medication clinics, training of nurses, psychological treatment, and telephone follow-up) were not mentioned. Narrative reviews on adherence to pharmacological treatment of depressive disorders suffer not only from the limited availability of good quality evidence, but also from an incomplete critical appraisal of available evidence on interventions both for depression and for other chronic disorders.
European Psychiatry, 2000