bluuebunny/crossref_metadata_2025 huggingface dataset:
Course and Prediction of Caregiver Burden: Results of a 2-year Follow-up Study
Authors: Moeller-Leimkuehler A. , Obermeier M.
Published: March 2009

Objective:

The aim of the study was to identify the best predictors of the course of burden during a 2-year follow-up period. The study is part of the Munich 5-year follow-up study in relatives of first admitted patients with schizophrenia or depression.

Method:

A cohort of 60 key relatives was assessed based on a transactional stress model concerning objective and subjective burden, well-being, self-rated symptoms and global satisfaction with life. The stressors were defined as patients' illness variables, and the potential predictors included different dispositions and resources of the relatives. Effects were analyzed by regression models. In a first step, the main predictors of burden were identified at each assessment. In a second step, the resulting predictors were included in a Generalized Linear Modeling procedure.

Results:

Caregivers' burden improved significantly, but well-being and self-rated symptoms remained elevated. In the final regression model, expressed emotion, neuroticism, generalized negative stress response and life stressors resulted as the best predictors of burden. The effects were rather time invariant than time dependent.

Conclusion:

In order to effectively work on long-standing unfavourable patterns of stress response, family interventions should be long-term and targeted to vulnerable caregivers who could be identified by virtue of their personality traits.
The Impact of Paternal Depression in Infancy: A Mechanism for the Intergenerational Transmission of Risk
Authors: Sethna V. , Murray L. , Psychogiou L. , Ramchandani P.
Published: March 2009

The adverse influence of parental psychopathology on child development has been the focus of intense research in recent years, yet we are only beginning to understand the factors that explain this intergenerational transmission. Depressive symptoms in fathers have received relatively little attention when compared to research on the impact of maternal depression on children's emotional and behavioural problems. Recent evidence suggests that paternal depressive symptoms in the postnatal period are associated with an increased risk of toddler behaviour problems, which persist in clinical significance into childhood. This research examines a model of ‘social-environmental transmission’ of paternal psychopathology. We compared patterns of parent-infant interactions among families with depressed and non-depressed fathers to address the following question: Are the early interactions of depressed fathers characterised by maladaptive affect, behaviour and cognitions? This study is part of an on-going longitudinal investigation, The Oxford Fathers Project (OFP) of families who are followed when infants are 3 months to 2 years of age. Paternal behaviours, including verbal comments and interactive behaviour were examined during free-play with their 3-month old infants. Father's behaviour was coded from Fiori-Cowley and Murray's (1996) Global Rating Scale and verbal transcripts were examined for cognitive and mentalizing statements.

Preliminary results suggest a higher proportion of infant directed negativity, in the verbal content of depressed fathers. Further analysis will be conducted and presented at the meeting. Discussion emphasises the importance of dysfunctional communication patterns in father-infant interactions that provide important clinical hypotheses as well as targets for identification and early intervention.
Substance Use During Pregnancy, Postpartum Depression and Child Outcomes: A Longitudinal Study
Authors: Imaz M. , Gelabert E. , Navarro P. , Sanjuan J. , Guillamat R. , Gutierrez A. , Gorneman I. , Canellas F. , Gratacós M. , Costa X. , Torrens M. , García-Esteve L. , Martín-Santos R.
Published: March 2009

Introduction:

Although it is well know that the substance use during pregnancy has a negative impact on mother and child health, there are few data on pregnancy - related substance use as a risk factor for postpartum depression and child outcomes.

Aims: To determine maternal and child outcomes at 8 and 32 weeks postpartum of women who reported substance use during pregnancy.

Method:

This is a cohort study of 1804 Caucasian women in postpartum. Exclusion criteria: psychiatric disorders during pregnancy. Women were evaluated at 2-3 days, 8 and 32 weeks postpartum. Socio-demographic, obstetric, personal and family psychiatric history and substance use during pregnancy; the Edimburgh Postpartum Depression Scale (EPDS) were assessed. All women with EPDS>9 at 8 and 32 weeks were evaluated by a structured interview (DIGS) for DSM-III major depression.

Results:

The mean (SD) age was 31.7 (4.6). Forty-six percent of them were primiparous. Thirty-one percent has a family and 16% a psychiatry history. Fifty percent of women reported substance use during pregnancy: 42% caffeine, 21.6% nicotine, 8% alcohol and 0.6% cannabis. Incidence of major postpartum depression was: 12.7%. Incidence of: Apgar scores < 7 at 5 min after birth:0.4%, gestational age at delivery < 37 weeks:7.3%, birth weigt < 2.5 Kg:7.3%, and congenital malformations:1.4%.

Conclusions:

In the presentation, the maternal and child perinatal outcomes of women exposed to licit and ilicit drugs will be summarize and will include a discussion of the future clinical and research implications. This work has been done in part with Grants: GO3/184;FIS:PI04178;PI041635,PI041783,PI041779,PI041758,PI041761,PI041791,PI041766,PI041782,RD06/0001/1009; CIBER-SAM.
Is the Disability Concept Influencing Treatment Decisions?
Authors: Rössler W.
Published: March 2009

Worldwide psychiatrists are trained to assess symptoms, diagnose illnesses and treat patients on the basis of these information. Such a symptom-centred concept consequently leads to a focus on the illness itself and disregards other aspects of these illnesses. Patients themselves focus much more on the functional consequences of their illness. They complain about what they cannot do any more because of their illness, i.e. fulfilling their roles as partners, in their families, in their profession and in society. To close the gap between professionals and their patients it would be useful to use a common illness concept. Such an illness concept is provided by the International Classification of Functioning, Disability and Health (ICF). The ICF does not only allows to classify the deficits caused by the illness but also takes the resources of the affected persons into account. Then the patient as a whole interacts with her or his environment. This modern disability concept is not static but dynamic. It does not only depend on the patient him- or herself but also on the ways how the environment interacts with the affected person. Such a dynamic approach would be very useful in order to reconcile lay- and professional disease concepts and provide a better platform for cooperation.
Is Supported Employment Replacing Traditional Vocational Rehabilitation Services?
Authors: Lauber C.
Published: March 2009

The only study in Europe that compared traditional vocational rehabilitation with Individual Placement and Support (IPS) in people with psychotic and bipolar disorders clearly showed that IPS is more effective. Based on these data, this paper will review the current situation of vocational rehabilitation in Europe and analyse whether these or other research do influence the daily practice in vocational rehabilitation. Moreover, it will summarise potential for further development of Supported Employment in people with severe mental illness.
Risks of Delirium in Polymedicated Elderly Patients
Authors: Stoppe G.
Published: March 2009

Delirium is a frequent condition and affects 20-60% of the elderly during hospital stay. It is associated with a worse functional outcome, increased length of hospital stay and mortality. Risk factors have been identified like age, dementia, sensory inhibition, infections, dehydration and polymedication. Prevention programs with multi-faceted interventions are in development.

In the German speaking area at least two models deserve further interest because they got a high rate of acceptance in the staffs and were meanwhile implemented into routine care of the respective hospitals. Both models will be presented. One focuses on the continuous individual care through the perioperative process, the other consists of an algorithm with standard assessments of risk-patients by the nurses to identify a beginning delirium just at onset for early interventions.
Polymedication in Elderly Psychiatric Patients Suffering from Comorbidities: Risks for Pharmacokinetic Interactions with Clinical Consequences
Authors: Baumann P.
Published: March 2009

Elderly patients suffering from mental diseases are frequently comedicated with different psychopharmacological agents including antidepressants, antipsychotics, anxiolytics, hypnotics, cognitive enhancers and anticonvulsants used as mood stabilizers. In addition, somatic drugs are co-prescribed for the treatment of other concomitant diseases. This situation increases the risk for pharmacokinetic interactions with pharmacodynamic consequences. This population is particularly sensitive to adverse effects due to an impaired homeostatic reserve. Moreover, drug absorption, distribution, metabolism and elimination (ADME) may be altered in the elderly. However, studies in very old patients (> 80y) are often lacking. Therefore, treatment needs to be carefully and individually tailored. Therapeutic drug monitoring may be a useful tool to optimise treatment, as some “classical” indications apply for this population: Lack of compliance, adverse effects despite the use of generally recommended doses, suspected drug interactions, combination treatment with a drug known for its interaction potential, patients with pharmacokinetically relevant comorbidities (hepatic or renal insufficiency, cardiovascular disease). The increasing knowledge on the role of cytochrome P-450 isozymes in the metabolism of drugs and their interaction potential has fortunately led to a situation, which allows, to some extent, predicting risks for adverse effects after introducing a polymedication.
Posttraumatic Disorders in Patients with Substance Dependence: Dissociative Disorders and Substance Dependence
Authors: Karadag F.
Published: March 2009

There are limited number of studies about dissociative disorders and substance abuse/dependence. Ross et al (1992) found that 39.0% of 100 chemically dependent patients had a dissociative disorder. Dunn et al (1995) found that this rate was 15.0% for 100 patients with substance use disorder at the end of their inpatient treatment. In the third study, 215 consecutive inpatients were recruited. The prevalence of the DSM-IV dissociative disorders was 17.2%. 67.6% of these patients’ dissociative experiences had started 3.6 (SD=2.9, range: 1.0-11.0) years before onset of the substance use in average. Patients with dissociative disorder were younger and average duration of their remission periods was shorter. Dissociative patients tended to use more than one substance whereas drugs were used more frequently than alcohol in this group. The frequency of borderline personality disorder, somatization disorder, history of suicide attempt, and childhood abuse and neglect in this qroup was more than that in the non-dissociative group. Suicide attempt, female gender, and childhood emotional abuse were significant predictors of a dissociative disorder diagnosis. Significantly more patients with dissociative disorder stopped their treatment prematurely. These findings suggest that dissociative disorder comorbidity is not a phenomenon limited to a cross-sectional observation and to a crisis period, but it is involved in all phases of substance dependency and it may have tremendous impact on the course and treatment outcome of the process.
Psychiatric Comorbidity and PTSD in Addicted Prostitutes
Authors: Hauptmann G.
Published: March 2009

In the city of Rotterdam prostitution used to take place not only in sexclubs but also in and around a designated prostitution street-zone in the harbor area outside the city center. The group of sexworkers at this street-zone consisted primarily of severely addicted women. For a long period of time the harm reduction approach had been the major intervention for this socially marginalized group of women. From January 2003 to December 2004 184 of them could be interviewed and diagnosed according to DSM IV. Nearly all of them were addicted to heroin and cocaine and most of them also were dependent on alcohol and benzodiazepines. Psychiatric comorbidity was almost 100 %. Co-morbid conditions existed of cluster B and C personality disorders, psychotic disorders (26 %), affective disorders (31 %), acute PTSD (9 %) and adult-ADHD (8%). In 2006 the government had closed the prostitution street-zone and many of the women could be placed in therapeutic and protected homes. Now, 2 years later, we reinvestigate these women with respect to their actual social situation, their quality of life, psychiatric comorbidity and persisting (acute and chronic) PTSD. During the interviews we use the WHO Quality of life questionnaire and the KIP (clinical interview for PTSD). It is an ongoing study and the (preliminary) results will be presented during the symposium.
Depression and Bipolar Disorder: Is Prevention of Mania Possible? Critical Issues on Diagnostic Criteria
Authors: Amedei S. Gorini , Catena M. , Lejeune F. , Duma S. , Scarpato M.A. , Faravelli C.
Published: March 2009

Diagnostic criteria for bipolar disorder in DSM IV require the occurrence of a manic or hypomanic episode. The scant appropriateness of these criteria compared with Kraepelin"s concept of manic depressive insanity has been repeatedly reported and the concept of bipolar spectrum has been proposed for more than 30 years. The negative consequences of pure adherence to operational diagnostic criteria on clinical needs are presented in terms of community epidemiology results and in terms of clinical evidences and the inadequate treatment of depressive and anxiety episodes and the risk of manic switch with antidepressant drugs are discussed.

The epidemiological survey conducted in Sesto Fiorentino showed that depressive episodes in patients with subthreshold mania or hypomania were different from the clinical presentation of pure unipolar depressives episodes confirming not only the numeric impact but also qualitative differences between these groups of patients.

Our clinical study where predictors of mania have been prospectively evaluated in a trans nosographic sample of outpatients demonstrated that aspects related to bipolarity predicted manic shift regardless of the diagnosis. DSM IV criteria seem not to be able to detect and describe a group of patients relevant both on epidemiological and on clinical level. These findings underline the need of a careful examination of patients treatment and validate the rule of further research in definition of mood disorders boundaries for prevention strategies.
On-line and Off-line Strategies for Preventing Depression
Authors: Smit F. , Cuijpers P.
Published: March 2009

Depression is associated with a formidable disease burden and has substantial economic ramifications. Its burden can only be partially alleviated through treatment. To make a more substantial impact on population health, we need primary prevention to reduce the number of new cases, and we need to do a better job about preventing relapses and recurrences. In this symposium we will present the latest evidence that prevention is a viable option: it is effective and cost-effective when offered as CBT-based self-help (bibliotherapy), and as preventive cognitive therapy for relapses and recurrences. The last couple of years witnessed a new approach to improving population health when some of these preventive interventions became available as internet-based interventions. These on-line interventions can be well structured and conducted either as pure self-help or with support by a therapist. We assume that on-line interventions are acceptable, because people can access these interventions in the privacy of their homes, at times they find convenient, and at a pace that suits them best. We also expect that these interventions can be cost-effective, especially when offered as self-help. Finally, we expect that on-line interventions have great potential to reach many people. It is therefore interesting to outline some of these new strategies and present evidence of their (cost) effectiveness.
Subjective well-being Under Neuroleptic Treatment. Relevance for Compliance and Remission
Authors: Naber D.
Published: March 2009

Within the last decade, success criteria of antipsychotic treatment became more ambitious. The most important change is the long overdue consideration of the patient"s perspective. Among other scales, a self-report instrument has been constructed to evaluate “subjective well-being under neuroleptics” (SWN). Studies indicate:

a.

schizophrenic patients, if no longer acutely psychotic or suffering from severe cognitive deficits, are able to reliably assess their SWN,

b.

high SWN is correlated with high compliance,

c.

atypical antipsychotics increase SWN,

d.

individual improvements of SWN and of PANSS are not strongly related (r=-.30 - -.40), and e) dopamine D2 receptor blockade is highly correlated to reduced SWN (r = .66 - .76).

Several open trials reveal the relevance of early improvement of subjective well-being: In a 12-week trial with 727 patients, 95% of those with early subjective response (within 4 weeks) showed later subjective and/or psychopathological improvement, but only 9% without early subjective response showed later improvement. In another 3-year trial of 2690 patients, again psychopathological response as well as symptomatic and functional remission were mostly related to early (within first 3 months) subjective improvement. Finally, in a first-episode study of 110 patients with a follow-up of 5 years, within the first 6 weeks of antipsychotic treatment only improvement of SWN was related to enduring symptomatic remission (p=.004) while early reduction of PANSS did not predict long-term course. These data indicate the usefulness of self-rating in schizophrenia, insufficient subjective improvement needs to be identified early.
From Psychopathology to Psychosocial Function - The new Outcome Dimension
Authors: Juckel G.
Published: March 2009

While in the past most attention was paid to psychopathology, these days outcome-parameters such as cognitive and occupational performance, emotional stability, quality of life and the psychosocial functioning have been recognized as an important determinant of treatment success. Instead of only reducing the symptoms a therapy with antipsychotics must attain higher goals such as remission and recovery nowadays. The Psychosocial Performance Scale (PSP) offers a validated, reliable and operational tool to assess the psychosocial functioning of patients during the course of treatment as well as in the acute state. Mini-ICF-P might be a similar instrument for measuring psychosocial functioning. In the future, medication and non-medication treatment strategies will also be judged by the ability to improve the psychosocial functioning of patients with schizophrenia, as measured by PSP and Mini-ICF-P.
Assessing Social Functioning in Schizophrenia
Authors: Burns T.
Published: March 2009

Aims:

Social functioning has increasingly become recognised as an important outcome in schizophrenia. While measures of symptom status are highly developed and widely used there has been only limited work on developing instruments for measuring social functioning in a reliable and consistent manner. We aimed to review the schizophrenia literature to identify the structured social functioning measures that have been used with any frequency and compare their features (1).

Method:

A detailed electronic literature search (1990 - 2006) using the key words schizophrenia and social function was carried out and those papers containing details of any structured assessment of social function were used. The most frequently used instruments were identified. A search was also conducted for the use of social function measures in trials of antipsychotics in schizophrenia.

Results:

301 articles employed 87 potential social function measures and of these only 20 were used 3 or more times. Only 14 RCTs of antipsychotics employed them.

Conclusions:

There is limited consensus on the definition and measurement of social functioning but two or three scales show promise for regular usage.
Remission in Schizophrenia: A National Survey of Clinical and Psychosocial Aspects
Authors: Aizenberg D. , Barak Y.
Published: March 2009

Background:

Clinical and psychosocial remission amongst schizophrenia patients is nowadays a defined goal of treatment. This necessitates incorporating quantifiable psychosocial variables with traditional symptomatic data as both influence remission.

Objective:

To assess psychosocial remission in schizophrenia (using the PSRS) along with the quantification of symptomatic remission in a large cohort of community dwelling schizophrenia patients.

Method:

Psychiatrists, nurses and social workers endorsed the PSRS and the American Psychiatric Association symptomatic remission criteria (APA-SR) for schizophrenia patients they have been treating for 6 months or more. Data as to gender, age and pharmacological treatment of each patient were also collected.

Results:

Of 445 participants who completed the survey, 268 (60%) were psychiatrists, 161 (36%) nurses and 16 (4%) social workers. Patients mean age was 43.4±13.1 years; 61% were men and 39% were women. Antipsychotic treatments were as follows: Per-os (PO) 243 (55%), IM long-acting typical antipsychotics (LAT) 102 (23%) and IM long-acting risperidone (Consta) 100 (22%). Overall, 37% of patients achieved symptomatic remission and 31% achieved psychosocial remission. Rates of symptomatic remission were significantly higher in patients treated by LAT and Consta compared with PO (51% and 48% vs., 29% respectively, p=0.0003). Rates of psychosocial remission were also significantly higher in patients treated by LAT and Consta compared with PO (43%% and 41% vs., 24% respectively, p=0.003).

Conclusion:

About a third of schizophrenia patients in Israel were in remission. IM long acting preparations were associated with higher remission rates. Treatment choice may thus influence rates of remission.
Schizophrenia in the Offspring of Antenatally Depressed Mothers and with Familial Risk - the Northern Finland 1966 Birth Cohort
Authors: Mäki P.H. , Riekki T. , Miettunen J. , Isohanni M. , Jones P.B. , Veijola J.M.
Published: March 2009

Aims:

Schizophrenia is considered to be a neurodevelopmental disorder arising as a result of interactions between genetic vulnerability and environmental risk factors. We studied the association between mothers" antenatal depressed mood and schizophrenia in their adult offspring with special consideration to Familial Risk for psychosis.

Method:

In the Northern Finland 1966 Birth Cohort mothers of 12,058 children were asked at mid-gestation at the antenatal clinic if they felt depressed. This general population birth cohort of the children was followed up for over 30 years, being record-linked with the Finnish Hospital Discharge Register (FHDR) for detecting psychosis in the subjects. The FHDR was also used for identifying psychosis in the parents. Familial Risk for psychosis was considered as a genetic risk factor and mothers’ depression as an environmental risk factor.

Results:

Offspring with both Familial Risk of psychosis and depressed mother had the highest cumulative incidence of schizophrenia, 7.4% (adjusted OR 10.3; 4.6-23.0). Of the offspring with only psychotic parent without antenatal depression, 2.3% got schizophrenia (OR 2.6; 1.2-5.4). In the offspring without Familial Risk of psychosis and with maternal depression the risk of developing schizophrenia was not elevated.

Conclusion:

Mothers’ depressed mood during pregnancy per se is unlikely to increase the risk for schizophrenia in the offspring, but may effect in subjects at risk for psychosis. This finding is an example of a gene x environment interaction in the development of schizophrenia.

Acknowledgements:

This work was supported by grants from the Signe and Ane Gyllenberg Foundation and the Academy of Finland.
Specificity of Cognitive Deficits in Psychosis; Initial Presentation and Course of Alterations among Different Diagnoses
Authors: Zabala A. , Eguiluz J.I. , Segarra R. , Elizagarate E. , Enjuto S. , Ezcurra J. , Pinto A.M. Gonzalez , Gutiérrez M.
Published: March 2009

Objective:

To describe possible differences in the initial cognitive profile between schizophrenia and non-schizophrenia first episode psychosis patients.

Method:

We assessed attention, working memory, and executive functioning in 57 first episode psychosis patients at baseline and at a one-year follow-up.

Results:

No significant differences were detected in the cognitive profile among schizophrenia (n=20) and non-schizophrenia (n=37) patients at baseline or at the one-year follow-up. For the overall group, significant reductions in the percentage of omission and commission errors for the sustained attention task (p< 0.001 and p=0.001 respectively), in the total time to complete the Stroop-I task (p< 0.001), in the percentage of omission errors for the working memory task (p=0.001), and in the percentage of perseverative errors for the WCST (p< 0.001) were detected, as well as a significant increase in the number of categories completed in the WCST (p< 0.001). The other cognitive variables analyzed remained stable (4 of the 10 variables tested). The pattern of change was similar for schizophrenia and non-schizophrenia patients in the areas of attention and working memory. For executive functioning, the non-schizophrenia group showed a more beneficial pattern of change.

Conclusions:

Our results indicate a lack of specificity of cognitive alterations related to the degree of affectation, at least during the first year after instauration of treatment. The course of cognitive deficits in first episode psychosis showed significant improvements over this period, being the patter of change in executive functioning slightly more beneficial for patients with a non-schizophrenia psychosis.
The Metabolic Impact of the Antipsychotic Drugs in Patients with Bipolar Disorder
Authors: Tournier M. , Cougnard A. , Bégaud B. , Thiébaut A. , Verdoux H.
Published: March 2009

Objective:

To assess the metabolic impact of adding an antipsychotic to a mood stabilizer or switching a mood stabilizer to an antipsychotic in patients with bipolar disorder.

Methods:

A retrospective fixed cohort study was conducted through the claims database of the French health care program for the self-employed workers. The study population consisted of 3.172 patients age 18 and over who were exposed to mood stabilizers (i.e. lithium, valproate) a 3 month-period in 2004 without dispensing of non-sedative antipsychotic, antidiabetic or lipid-lowering drugs. The outcome was the occurrence of a metabolic incident over the follow-up period, using the dispensing of an antidiabetic drug as a marker of diabetes and the dispensing of a lipid-lowering drug as a marker of hypercholesterolemia or hypertriglyceridemia. A Cox proportional hazard model was used to assess the metabolic impact of the antipsychotics; using mood stabilizers as a reference. Antipsychotic exposition was stratified in «current» and «recent» (discontinued for less than 6 months) at the time of the metabolic incident.

Results:

196 patients (6.2%) received a first-generation antipsychotic, 352 (11.1%) a second-generation antipsychotic, 565 (17.8%) a sedative antipsychotic and 367 patients (11.6%) presented with a metabolic incident over the study period. The recent dispensing of a second-generation antipsychotic was associated with the occurrence of a metabolic incident [HR 2.1 (95%CI 1.2-3.7) p=0.006], while current dispensing or dispensing of first-generation antipsychotics were not.

Conclusion:

Second-generation antipsychotics have a metabolic impact compared to classic mood stabilizers in patients with bipolar disorder.
Low Bone Mineral Density and Psychosis: A Multifactorial Relation
Authors: Coentre R. , Barrocas D. , Levy P.
Published: March 2009

Aims:

Low bone mineral density (BMD) is a major public health issue leading to fractures, pain and disability. The association between psychosis and low bone density has been suggested in the last years.

Method:

The authors review the literature in Medline database using the words ‘bone mineral density’, ‘psychosis’, ‘antipsychotic’, ‘schizophrenia’, ‘bipolar disorder’ and ‘psychiatry disorders’.

Results:

Some studies show elevated prevalence of changes in BMD in patients with psychiatry disorders, namely psychosis. These changes are multifactorial, due to therapeutic factors and/or to the disorder per se. The low BMD induced by some antipsychotic drugs has been attributed mostly to hyperprolactinaemia and its consequences. Lithium, carbamazepine, sodium valproate and the use of thyroid-stimulating hormone-suppressive doses of L-thyroxin used in bipolar disorder also have a negative impact on bone health. Patients with psychosis could be vulnerable to bone abnormalities even without treatment, environmental factors like smoking, sedentary lifestyle, decreased exposure to sunlight, alcoholism, dietary deficiencies and polydipsia are partially responsible for that. Also genetic factors (vitamin D receptor gene, estrogen receptor gene etc.) and biological factors (gender, decreased of peak bone mass, abnormalities in immune-inflammatory mechanisms, hypercortisolemia stress-induced etc.) contribute to the abnormalities in bone dynamics in psychosis.

Conclusion:

The association between low BMD and psychosis has been demonstrated in literature, understanding all the factors involved in this process will help the development of preventive and treatment strategies. A large study including first psychotic episode patients could be useful to distinguish between disorder and drug induced factors of low BMD in psychosis.
Values and Ethics in Psychiatric Training
Authors: Lindhardt A.
Published: March 2009

Aims:

To present reflections on the importance on teaching a method to work with values in psychiatric training

Method:

Based on 6 years of teaching at training courses in values and ethics the papers presented by the trainees on values will be discussed and case exampels be presentend for discussion

Results:

Ethical reflection in psychiatry is influencing many aspects of everyday practise and decision making. the papers presentend by the trainees showed a great variety in capability to reflect abstract ethiocal issues and relate them to practical clinical work. One especially interesting aspect was the confrontation on how different cultural backgrounds amongst the trainees reflect the values with which they practise psychiatry

Conclusion:

A training course involving discussion of ethics and values is essential to raise awareness of ethical reflection and providing tools to do so
Recovery Issues in the Treatment of Schizophrenia: Are we at the end, or still at the Beginning?
Authors: Alptekin K.
Published: March 2009

Recovery and normalized psychosocial functioning are the main targets for the treatment of schizophrenia. However antipsychotics have limited benefit for improving cognitive functions and negative symptoms that predict the patient's ability to work and function independently. Meta-analytic and latest large scale studies such as CATIE and EUFEST have found that Clozapine seemed to be superior compared to other antipsychotics regarding efficacy and Olanzapine was associated with significantly longer time to discontinuation although both were significantly associated with metabolic syndrome. Nevertheless mortality rate is about two times greater than general population in schizophrenia patients, mainly due to metabolic side effects which affect patient's satisfaction and let nonadherence to treatment. One of the important results driven from the CATIE trial has shown that the majority of the patients in each antipsychotic treatment group had discontinued their first treatment due to either inefficacy over schizophrenia symptoms or intolerable side effects. Since clinical effectiveness for antipsychotics is strongly related to adherence, long acting antipsychotics may play an important role in long term treatment. As well as adherence to treatment, patient related variables such as differences in pharmacogenetic and psychosocial factors may also affect outcome and recovery in schizophrenia. Also it is essential to identify outcome measures. Remission of schizophrenia symptoms does not always mean to be recovered from the illness. Outcome measures should include cognitive functions, quality of life and psychosocial functioning. Pharmacotherapy alone is not enough to achieve recovery, therefore psychosocial interventions should be established and integrated with antipsychotics.
Treating of Schizophrenia in Malta
Authors: Grech A.
Published: March 2009

Malta is a small country in the middle of the Mediterranean. It is a member of the European Union and has a population of around 400,000. The culture is European, and around 99% of the population is Roman Catholic. There are no studies on the prevalence of schizophrenia in the Maltese population, but it is most likely that it is about 1%. During the last few years, thousands of illegal immigrants from Africa have been arriving in Malta especially during summer. It seems that the prevalence of schizophrenia in this subgroup is more than that in the local population. Studies are needed to study this phenomenon further to see if this is the case, but they are definitely being a big burden on the local psychiatric services. The National Health Service in Malta provides all treatment for schizophrenia free of charge. The pharmacological management of schizophrenia is similar to that of other European countries. Oral atypical antipsychotics are available within the National Health Services, but depot preparations are not yet available. For admissions there is a main Psychiatric Hospital, Mount Carmel Hospital, and two units in two General Hospitals. Community services are in the process of being developed. An NGO association, the Richmond Foundation also provides community and rehabilitation services. The Maltese family is still a relatively strong unit, with a lot of support in times of help being provided by the extended family. Thus in most psychosocial interventions, the family plays a central role.
Treating Schizophrenia in Mediterranean Region; do we need Reform? State of Art in Italy after 30 Years of Psychiatric Reform
Authors: Nicolo G.
Published: March 2009

In Italy 30 years ago a very radical psychiatric reform has been carried out. All psychiatric hospitals have been closed by law. This reform received very strong political support but was not scientific or evidence based. After 30 years it is necessary to evaluate the Italian reform scientifically.

Basaglia's law was oriented, first to create a net of community care, and then to close Psychiatric Hospitals. The challenge was to improve the quality of life of patients that had spent their life in an Asylum. The patients admitted to psychiatric hospitals, normally had a diagnosis of Chronic Psychosis, Chronic bipolar disorder, mental retardation, but not other more prevalent psychiatric, sometimes more prevalent, diseases. The hypothesis was that psychiatric illness would improve further if the medical interventions were less specialised, thus the psychiatric intervention have to be very generic and supportive, specialization or pharmacologic treatment was perceived as bad practice. Many psychiatric illnesses did not receive specific treatment (panic attacks, personality disorders e.g)

After 30 years this model shows some evidence of efficacy. We must consider weather we can really can apply this model in community treatment or whether we need a scientific based reform in which we can apply algorithms of treatment, early detection of disease and integrated and specialist treatment for severe psychopathology. Data from national health service will be presented and also some specific proposals in a European perspective.
Cross-cultural Psychiatry, Liaison Psychiatry and other Major Challenges for Modern Psychiatrists
Authors: Ferrari S. , Silva V. Barbanti , Forghieri M. , Rigatelli M.
Published: March 2009

Beyond the awareness that psychiatry and contemporary medicine have undergone a dramatic change in recent years, walking the first steps as recently-qualified consultants in psychiatry is a major challenge. As a consequence of changes in society, technological progress and restricted funding availability, modern psychiatrists have to face problems that are new, and difficult to be faced, but also representing an opportunity to grow and contribute massively to medicine.

This is particularly true in two specific fields, cross-cultural psychiatry and consultation-liaison psychiatry. The former is defined as psychiatry of disorders influenced by the cultural background; the latter is defined as the care of psychiatric disturbances in the medically ill. Though generic, these definitions highlight what is challenging in these branches of psychiatry: the disposition towards an inter-disciplinary approach to human illnesses. Both deepen their roots in the bio-psycho-social paradigm of George Engel and were in fact frequently mentioned in Engel's writings as the future of psychiatry. Training and clinical experience in cross-cultural and consultation-liaison psychiatry are to be major components of the curriculum of psychiatric trainees.

Therefore, the role of psychiatrists and psychiatrists-to-be in the contemporary scientific community and society must be a strong one: on the side of scientific knowledge, by marking the complex, systemic nature of physiopathology and therapy; on the side of epistemology, by marking the paradoxes of bio-medicine; on the side of organization of health care, by promoting the need for a person-oriented approach to illness; and finally on the side of culture, society and ethics.
What are the Prerequisites for Good Clinical Practice in Europe?
Authors: Bhugra D.
Published: March 2009

Good Medical Practice and Good Psychiatric Practice are key documents in the UK, indicating characteristics of a good doctor and a good psychiatrist respectively. Individual aspects of what constitutes a professional can be seen in relationship with other disciplines, team members and stakeholders. A key task of any organisation that purports to speak for the profession is to identify what these qualities are, how they are to be inculcated and developed. The Royal College of Psychiatrists, therefore, is in a unique position to do this and take it forward without guilt and shame. Leadership, teams, education, appraisals, careers and research are themes which have to be looked at. For any leadership to be successful it must have vision, strategic thinking, motivation and trust, all of which are being challenged at present. The profession of psychiatry must move from nostalgic professionalism to ‘new’ professionalism. of We as psychiatrists must ascertain our civic and fiduciary responsibilities by identifying and agreeing standards of quality of care, altruism and values of the profession identified by us and worked at with other stakeholders. The primacy of patient welfare and advocacy for our patients is critical. For our medical-moral interdependence we must be honest with ourselves as to what our strengths and weaknesses are, but also with society to declare what we can deliver in reality and what our aspirations are. Courses in ethics, humanities and human values (medical history, social sciences, literature and films) can sensitize the clinician by raising awareness and developing critical reflection.
Promoting appropriate health care in Europe - the case of psychiatry
Authors: Musalek M.
Published: March 2009

Nowadays different professions are involved in mental heath care in Europe, e.g. general practitioners, psychiatrists, psychologists, psychotherapists, social-workers, case-managers, prevention specialists, health ministry bureaucrats etc. As mental health represents a weak concept with vague and ambiguous definitions and delimitations it remains quite unclear who should be responsible for mental health today and in the future. In the last decades psychiatrists gained high expertise in treating mental disorders (e.g. psychopharmacological, psychotherapeutic and social measures) but lost terrain in mental health matters because of a lack of interest in such questions leading to the hardly acceptable contemporary situation that professionals without any psychopathological knowledge and without clinical experiences in mental illnesses as well as in the various transitional states between mental health and disordered health have taken the leading positions in the field of mental health care. Of course, the main tasks of psychiatry are to diagnose and to treat mental disorders, but as the prognosis of mental disorders and the treatment efficacy highly depend on the time of recognizing the disorder (the earlier the recognition of a mental disorders and the earlier the start of therapy the better the treatment out-come and prognosis) early recognition of mental disorders and prevention measures (esp. secondary and tertiary prevention) have to become core fields of psychiatry. Therefore psychiatry cannot any longer restrict itself to the treatment of severe mental disorders but has to take again a crucial role in future mental health care system in cooperation with other mental health stake-holders. This implies that future training programs for psychiatrists have to take into account such considerations and have to include beside usual fields of interests (e.g. psychopathology, neurosciences, psychopharmacology, psychotherapy, medical humanities, etc.) also topics like early recognition, transitional states and prevention of mental disorders as regular parts.
Development of an Instrument to Measure the Level of Evidence-based Practice in Clinical Mental Health Services
Authors: Cawthorpe D. , Oliphant P. , Wilkes T.C.R.
Published: March 2009

Introduction:

While systems of care are identifying the need to employ evidence-based modes of treatment, there are to date few instruments designed to measure the degree to which clinicians apply evidence-based interventions. The interventions survey was designed to tap each clinicians’ understanding of evidence-based interventions and the degree to which they identify theory in relation to evidence-based intervention and diagnosis.

Method:

A literature review was conducted to identify evidence-based interventions. Search strategies included meta-analyses that focused on systematic review of a range of databases. Emphasis in the survey's design was placed on linking evidence-based interventions, diagnosis and theoretical orientations. Clinicians (n = 118) could select among a range of options including evidence-based interventions for specific diagnoses. In addition to mapping evidence to interventions by diagnosis, results include a report of index modal interventions used by staff by type (individual, group, family) and diagnosis. The higher the index reported (range 0-1) the greater the variation of interventions by diagnoses.

Results:

Forty percent of clinical staff favored more that one type of family therapy for different diagnoses, and 35% of staff favored more than one type of group therapy for different diagnoses, whereas about 30% of staff varied their choice of individual intervention as a function of diagnosis.

Conclusions:

The results indicate that the survey is able to tap a range of clinicians’ theoretical orientations and knowledge of evidence-based practices related to child and adolescent mental health interventions.
Self- perceived Health and Alzheimer Disease Incidence Risk. Data from a Population Based Cohort in Spain: NEDICES Study
Authors: Bermejo-Pareja F. , Trincado R. , Rodriguez C. , Fernandez M. , Vega S. , Morales-Gonzalez J. , Benito-Leon J.
Published: March 2009

Background:

Self-perceived health is a well-recognised predictor of later health outcomes and mortality, but its relationship to incident dementia has been scarcely explored.

Objective:

To analyze self- perceived health as a risk factor for dementia and Alzheimer disease (AD) in a population- based survey of the elderly (NEDICES) Study.

Methods:

Participants were evaluated at baseline (1994-1995) with a standardized questionnaire that included subjective and objective (chronic disorders) health status and screening questions for depression and neurologic disorders. At follow-up (a median of 3.2 years later in 1997-1998) an analogous protocol and neurological assessment were performed.

Results:

Of 5,278 participants evaluated at baseline there were 306 prevalent dementia cases, and 161 incident dementia cases were identified among 3,891 individuals assessed at follow-up (D: 115).

Cox hazard ratio analyses showed that age, stroke and illiteracy were independent risk factors for dementia and AD. Aggregation of vascular risk factors was related to a higher risk of both dementia and AD. Good (and very good) versus less than good (fair, bad and very bad) self-perceived health was an independent risk factor for dementia (CI 95% 1.13- 2.16; p= .006) and AD (CI 95% 1.02- 2.18; p= .038) after adjusting by age, sex education and vascular risk factors.

Discussion:

Self-perceived health increased the risk for incident dementia and AD in the NEDICES cohort as it was previously described in the United Kindom MRC- CFA Study of dementia incidence. Global health measurements (self-perceived health, quality of life) needs farther studies as risk for dementia and AD.
My Experience in the First Female Psychiatric Intensive care unit in NHS in UK
Authors: Gintalaite K.
Published: March 2009

Introduction:

A new PICU for women was opened in January 2007, and was the first Unit of its kind in the NHS. It provides an inpatient care for women detained under Mental Health Act 1983 with serious mental illness. The main group of service users comprises women with borderline personality disorder. Median length of stay is 6-12 weeks.The team is multidisciplinary and works closely to ensure that effective gender sensitive care is delivered. As a very new team we experienced powerful internal dynamics for the first year. Lots of support groups, supervisions and psycho educational activities are provided for our staff members by different experts.The therapeutic model is in the process of development and is based on mentalisation theory. An audit on “Care after Intramuscular Rapid Tranquilization” was undertaken on the ward.

Objective:

To present a very new service for women including powerful dynamics within the team, a model of care provided for our client group and audit results.

Method:

Descriptive.

Conclusions:

1.

It illustrates the powerful feelings of the staff during treatment of female service users (the results of analysis of the questionnaire will be provided) within PICU and the way we managed to deal effectively with it.

2.

It clarifies the amount of resources demanded for treatment of this client group.

3.

Audit results reveal the progress made in care after service users are given rapid tranquilisation in 06-08/2007-2008.

4.

It illustrates that the process of agreeing a model of care, as well as the model itself, in a PICU setting is very useful activity.