Search

Data were collected from 265 heroin-dependent patients in long-term methadone maintenance treatment for methadone dosage, administration method, illicit drug and problematic alcohol use, psychiatric diagnoses, quality of interpersonal relationships, employment, legal problems, health, and cravings. Patients receiving higher methadone doses (more than 80 mg) were more likely to respond to methadone treatment than patients receiving lower doses. Superior outcome was also related to good quality of interpersonal relationships, stable employment, and lower craving scores. Comorbid psychiatric disorders did not appear to influence methadone effectiveness, but psychopharmacological treatment associated with methadone was associated with a lower rate of urine samples positive for drug use. Administration of methadone weekly or twice weekly ('home methadone') was less effective than daily administration. Although our results were obtained through a descriptive study, which does not permit a prospective evaluation, they suggest the need for higher methadone doses. Job and family relationships appear to be associated, together with psychopharmacological treatment, with a more effective outcome. Keywords: Heroin; Methadone maintenance; Outcome; Long-term treatment; Psychiatric comorbidity; Interpersonal relationships; Employment

Aim: To report on the development of an early intervention service in Modena, Italy, with information relevant to the first 4 years of implementation. Methods: The 2‐year service was offered to people aged 18‐35 with psychotic manifestations, within 2 years from psychosis onset/or naïve to antipsychotics, by teams placed within community mental health Centres, according to a "specialist within generalist" model. Treatment included pharmacological consultation, psychoeducation and social inclusion programs. Health of the Nation Outcome Scale was administered at baseline and every 6 months. Results: One hundred cases accepted the treatment from 1 March 2013 to 31 December 2016. Of these, 71% were male with a median age of 23. Ninety percent were diagnosed with non‐affective psychosis, yielding an estimated treated incidence of 19.1/105. General practitioners (GPs)represented the most frequent referrers to the program (38%), followed by referrals from acute general and psychiatric hospital units (22%) and self‐referrals (14%). Meaningful clinical improvement was observed, 6 months after enrolment. Conclusions: An early intervention service for psychosis was successfully implemented within existing community outpatient services. GPs represented the main referrals, providing some validation of the "specialist within generalist" model of care. A promising clinical improvement and trend of reduction in duration of untreated psychosis was found, supporting the variety of early detection efforts in the community. The high median age and lack of information about pathways to care underline possible barriers to access for younger patients. These findings will inform refinement of treatments and service models for the Region. [ABSTRACT FROM AUTHOR]