Carla Gramaglia

By Carla Gramaglia, Ada Lombardi, Annalisa Rossi, Alessandro Feggi, Fabrizio Bert, Roberta Siliquini and Patrizia Zeppegno

Dual diagnosis (DD) is the coexistence of severe mental illness (SMI) and substance use disorder (SUD). The increase of DD observed in recent years has important implications for mental health services organization. The aim of this study is to assess the prevalence and features of DD over a decade, comparing the periods 2003–2004 and 2013–2014. We performed a retrospective study retrieving sociodemographic and clinical data from the medical records of patients at their first admission to the Psychiatric Ward of University Hospital “Maggiore della Carità” in Novara, Italy. Patients with SMI and comorbid SUD (SMI-SUD) and patients with SMI without comorbidity (SMI) were compared in the two periods, 2003–2004 versus 2013–2014. SMI-SUD patients in both 2-year periods were more likely to be male, younger, unemployed, living with parents (or alone, for the 2013–2014 period) rather than with a family of their own, and single (or divorced, in 2003–2004). The 2003–2004 patients were more frequently diagnosed with a personality disorder, whereas the 2013–2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods as well: in both periods, male gender was associated with an increased risk of DD, whereas age >61 years was associated with decreased risk. Only in the first period (2003–2004) was having a university degree associated with a decreased risk of DD, whereas the diagnosis of a personality disorder was associated with an increased risk of DD; on the contrary, in the second period (2013–2014), living in a protective environment was associated with a decreased risk of DD. The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors that may be the target of prevention and treatment approaches.

Part of the book: Recent Advances in Drug Addiction Research and Clinical Applications

By Carla Gramaglia, Eleonora Gambaro, Fabrizio Bert, Claudia Delicato, Giancarlo Avanzi, Luigi Mario Castello, Roberta Siliquini and Patrizia Zeppegno

In recent decades, Italy has become a desirable destination for immigrants. In 2014, five million people (8.2% of the population) were migrants (regular/irregular, documented/undocumented). This study looks at psychiatric health, an important feature especially for first‐generation migrants and compares the new settlers with the native Italians. It should be noted that the organization of mental health services in Italy strongly relies on outpatient services, while the psychiatric wards, within the general hospitals, usually accommodate patients in acute phases of their disorder. Nonetheless, migrants’ first contact often happens in a psychiatry ward when they are in a severe and acute psychopathological condition. Research methods: Quantitative and qualitative; longitudinal research using official statistical and clinical data obtained from records of a public hospital as well as information obtained through professional interview. Results: In relation to mental health, we found that the migrant patients referred for psychiatric consultation to the emergency department (ED) setting were younger, less frequently treated by psychiatric outpatient services, more commonly going to the ED for self‐injury and presenting with symptoms of substance abuse and alcohol‐related disorders. The native Italian population was older, more frequently retired and/or invalid, more frequently already treated by psychiatric outpatient services for any kind of psychiatric symptoms. Conclusion: The comparison of the sociodemographic and clinical features of immigrants and Italians referred for psychiatric consultation in the ED highlighted some differences. Implications are discussed in the light of the existing literature.

Part of the book: People's Movements in the 21st Century