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Needs for care in psychiatric patients: a systematic review II. Needs for care on individual level

Published online by Cambridge University Press:  11 October 2011

Antonio Lasalvia ,
Benedetta Stefani  and
Mirella Ruggeri
Antonio Lasalvia
Affiliation:
Unità di Valutazione dell'Esito, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Verona
Benedetta Stefani
Affiliation:
Unità di Valutazione dell'Esito, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Verona
Mirella Ruggeri*
Affiliation:
Unità di Valutazione dell'Esito, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dott.ssa Mirella Ruggeri, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Ospedale Policlinico, 37134 Verona. Fax: +39-045-585.871 E-mail: [email protected]
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Summary

Objective - The present paper represents the second part of a larger review on the studies assessing needs for care in mental health field. In the first part, studies assessing needs for services in the general population were reviewed. In this second part studies assessing needs on individual level were reviewed and the role played by the assessment of individual needs in planning mental health care was discussed. Methods - Studies published in international literature from January 1980 to June 1999 were reviewed. The studies were located through a computerised search of the databases MEDLINE and PsycLit; in addition, the reference lists of the studies located through the computerised search and the content of main international psychiatric journals were manually scanned in order to avoid possible omissions. Studies assessing needs in the general population and in psychiatric patients were reviewed separately. The latter were reviewed on the basis of the diagnostic category (psychotic and non psychotic patients) and setting of care (outpatients and inpatients). Studies on particular categories, such as homeless, children and adolescents, elderly and patients with aggressive behaviour, have been also reviewed. Results - Psychotic patients show a wide range of both clinical and social needs. Patients followed by community-based mental health services show similar number of clinical and social needs, while inpatients (with the exception of acute patients) show more social needs. For both community-based mental health patients and inpatients, social needs are most frequently unmet and psychopharmacological treatments are used more frequently than psychotherapeutic or rehabilitative interventions. Non psychotic patients show lower number of needs than psychotic patients; these needs are both clinical and social, with a higher total number of clinical needs, but a higher number of unmet social needs. Conclusions - Studies on needs for care provide an interesting perspective on people suffering from mental illness. In the routine clinical practice needs assessment could be a valuable tool for providing specific, individualised and effective mental health care.

Riassunto

Scopo - Il presente articolo costituisce la seconda parte di un più ampio lavoro di revisione degli studi sui bisogni di cura in ambito psichiatrico. Nella prima parte sono stati analizzati i risultati degli studi sui bisogni di servizi nella popolazione generate. In questa seconda parte viene passata in rassegna la letteratura sui bisogni individuali e discusso il ruolo giocato dalla valutazione di tali bisogni nella pianificazione dell'assistenza psichiatrica. Metodo - Mediante ricerca computerizzata (effettuata con i database MEDLINE e PsycLit) integrata da una ricerca manuale (realizzata consultando gli indici analitici delle principali riviste psichiatriche internazionali) sono stati selezionati i lavori pubblicati sull'argomento da Gennaio 1980 a Giugno 1999. La revisione della letteratura è stata realizzata suddividendo gli studi condotti nella popolazione generale e quelli condotti su gruppi di pazienti psichiatrici. Questi ultimi studi, a loro volta, sono stati ulteriormente suddivisi in base alla categoria diagnostica (pazienti con disturbi psicotici e pazienti con disturbi non psicotici) e al setting (servizi territoriali e strutture di ricovero). Sono stati, inoltre, considerati gli studi condotti su particolari categorie di pazienti (senzatetto, bambini ed adolescenti, anziani e soggetti con comportamento violento). Risultati - I pazienti con disturbi di tipo psicotico presentano una vasta gamma di bisogni sia di tipo clinico che sociale. In quelli seguiti a livello territoriale, i bisogni clinici e sociali tendono ad equivalersi, mentre in quelli ricoverati (ad eccezione dei pazienti acuti) prevalgono i bisogni sociali. Sia a livello territoriale che di strutture di ricovero i bisogni di tipo sociale sono quelli in genere più di frequente insoddisfatti; le terapie psicofarmacologiche sono fornite con maggior frequenza rispetto agli interventi psicoterapeutici e riabilitativi. I pazienti non psicotici presentano un numero minore di bisogni rispetto ai pazienti psicotici; tali bisogni sono di tipo sia clinico che sociale, con una prevalenza dei primi, anche se i bisogni più frequentemente insoddisfatti sono quelli sociali. Conclusioni - Tali studi forniscono preziose informazioni sulle principali esigenze dei soggetti affetti da disturbi psichici attraverso una prospettiva nuova e spesso inesplorata. Nella pratica clinica l'identificazione dei bisogni di cura può costituire un ausilio indispensabile al fine di impostare strategie terapeutiche specifiche, individualizzate ed efficaci.

Keywords

needs for carepsychotic disordersnon psychotic disordershomelesschildren and adolescentelderlyaggressive patientsmental health servicebisogni di curapazienti psicoticipazienti non psicoticipazienti senzatettobambini e adolescentianzianipazienti aggressiviservizi di salute mentale.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 9 , Issue 4 , December 2000 , pp. 282 - 307
Copyright
Copyright © Cambridge University Press 2000

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