Background: Adolescents are most at risk of engaging in violent interaction. Targeting violence risk and protective factors is essential for correctly understanding and assessing their role in potential violence. We aimed to use the Structured Assessment of Violence Risk in Youth (SAVRY) tool within the sample of adolescents to capture violence risk and protective factors and personality variables related to risk and protective factors. We further aimed to identify which violence risk and protective factors were positively or negatively related to violence within personal history and if any personality traits are typical for violent and non-violent adolescents. Identifying broader or underlying constructs within the SAVRY tool factor analysis can enable appropriate therapeutic targeting. Methods: We used the Czech standardized version of the SAVRY tool. The study sample comprised 175 men and 226 women aged 12–18 years divided into two categories according to the presence or absence of violence in their personal history. Mann-Whitney U test was used to compare numerical variables between the two groups. SAVRY factor analysis with varimax rotation was used to determine the item factors. We administered the High School Personality Questionnaire (HSPQ) to capture adolescents’ personality characteristics.Results: In our sample, there were 151 participants with violence in their personal histories and 250 non-violent participants. Non-violent adolescents had higher values for all six SAVRY protective factors. The strongest protective factor was P3, Strong attachment and bonds across gender or a history of violence. Using factor analysis, we identified three SAVRY internal factors: social conduct, assimilation, and maladaptation. The SAVRY protective factors were significantly positively related to several factors in the HSPQ questionnaire. Conclusion: The results highlight the significance of protective factors and their relationship with violence prevalence. HSPQ diagnostics could be helpful in clinically targeting personality-based violence risks and protective factors. The therapeutic focus should be on tension, peer rejection, and anxiety. It is also essential to foster positive attitudes toward authority, prosocial behavior, and attitudes toward school. These strategies can help strengthen protective factors of the SAVRY.
Our primary goal was to determine the sources of assaultive behaviour in acutely psychotic patients. To find a few underlying structures for many different questions regarding assaultive behaviour based on Nolan’s semi-structured interview, the Assaults Interview Checklist (AIC), we used factor analysis. Data of 289 psychiatric patients in acute psychotic states perpetrating 820 assaultive attacks were analysed using the polychoric correlation matrix of the AIC items and exploratory factor analysis (EFA). We found five independent factors, i.e. underlying structures of assaultive behaviour: Predatory factors, Personality, Acute psychosis, Contextual Factors, and Cognitive control with high factor loadings explaining an overall 69% of the variance in the acute psychotic assaults. In women, the largest factor loadings were in Personality with Predatory/Psychopathic factors second, whereas in men Psychotic with Predatory gains played the prominent role. We interpret current findings in the framework of the triarchic theory of aggression in psychosis (psychotic, impulsive and predatory/psychopathic) when Predatory factors are dominant with interrelated facets of Personality and Contextual factors, whereas Acute psychosis contributes to psychotic and Cognitive control to impulsive factors. Surprisingly, our analyses show the possible evolutionary role of aggression (co-opting the resources of others) even in an acute psychotic state.
Introduction The only available genome-wide study (Minelli et al., 2018) indicated an association between the neglect CT and MED22, a transcriptional factor gene. Objectives To verify how the dysregulation of MED22 could be affected by environmental and genetic factors, we carried out an analysis on these components and a longitudinal study concerning the effect of trauma-focused psychotherapy in MDD patients that experienced CT. Methods On a large mRNA sequencing dataset including 368 MDD patients we computed the genetic (GReX) and the environmental (EReX) components affecting gene expression in relation to CT. Furthermore, we measured the expression of MED22 in 22 MDD patients treated with trauma-focused psychotherapy. Results The dissection of MED22 expression profiles revealed an association of neglect with environmental and genetic components (p=6x10 ⁻³ p=2.6x10 ⁻⁴ ). Furthermore, in an independent cohort of 177 controls, we also observed a significant association between cis-eSNPs of MED22 and higher neuroticism scores (best p-value: 0.00848) that are usually associated with a decreased amount of resilience to stress events. Finally, the results of psychotherapy revealed a reduction of depressive symptomatology (p<0.001) and 73% of patients resulted responders at the follow-up visit. MED22 expression during psychotherapy showed a change trend (p=0.057) with an interaction effect with response (p=0.035). Responder and non-responder patients showed MED22 expression differences at different trauma-focused psychotherapy timepoints (p=0.15; p=0.012) and at the follow-up (p=0.021). Conclusions Our results provide insights suggesting that some biological and clinical consequences of CT depend on genetic background and environmental factors that could induce vulnerability or resilience to stressful life events. Disclosure No significant relationships.
Reduced impulse control and emotion dysregulation are associated with an increased risk of violence in psychosis. We used an emotional stop-signal task (ESST) with angry and neutral facial expressions stimuli to examine the differences in inhibition in neutral and emotional contexts between acutely violent (N = 117) and non-violent (N = 50) patients with schizophrenia spectrum disorders and healthy volunteers (N = 50). However, 66 violent patients (56.41%) from the final sample with a higher level of self-reported impulsivity did not finish the behavioral task. Inhibition was found to be weaker in emotional than in neutral contexts in both the violent (n = 51) and non-violent patient groups in comparison with healthy controls. At the same time, violent patients had weaker inhibition in both neutral and emotional contexts than non-violent patients and healthy controls. Violent patients also showed significant associations between response inhibition and positive schizophrenia symptoms. These results show that emotion regulation impairment is present in schizophrenia patients in general and violent behavior is associated with higher impulsivity regardless of the emotional context. Impaired response inhibition seems to be a stronger indicator for violent patients than the disorder itself, and it may constitute a marker for the risk of violent behavior in psychotic patients. Positive symptoms might fall into underlying factors of increased impulsivity in acutely violent psychotic patients. However, the emotional stop-signal task seemed to be too strenuous for highly impulsive patients and acutely violent patients with psychosis, and its use was limited to the patients who were able or willing to complete the task.
Objective The study aim was to assess the psychometric properties of the ASRS in the Czech Republic. Although this screening tool is now frequently used, its validity has not been assessed among the general Czech population. Methods The ASRS and WURS were administered online to the general Czech population ( N = 1,518). We performed confirmatory and exploratory factor analyses. Results For the ASRS, confirmatory factor analysis showed good fit for the screening part (SRMR = 0.03, RMSEA = 0.06, CFI = 0.98). For the symptom list, the fit was good according to the SRMR, acceptable according to the RMSEA, and slightly below acceptable according to the CFI. For the WURS, the results showed SRMR = 0.06, RMSEA = 0.07, and CFI = 0.92. Conclusion The Czech translation of the ASRS is appropriate and has acceptable psychometric properties. However, we strongly recommend only using this tool together with clinical judgment.
Objectives: The length of forensic stay (LoS) is a subject to country-specific legal and service systems. Therefore, the identification of common factors targetable by treatment is at the forefront of forensic psychiatric research. In this study, we present the first reports of forensic characteristics of patients from the Czechia. Methods: We conducted a retrospective analysis of data from 260 inpatients discharged from the Bohnice Hospital (Prague) and obtained a set of sociodemographic and clinical variables as well as the Health of the Nation Outcome Scale (HoNOS) and HoNOS-secure scores. Results: The following variables were identified as significantly associated with a longer LoS: older age, length of previous psychiatric hospitalization, olanzapine equivalent, clozapine treatment, psychosocial dysfunction, psychotic or paraphilic disorder diagnosis, and sexual offense. A shorter LoS was associated with being in a relationship, being employed before hospitalization, receiving personal support, and committing an index offense under the influence of substance. While the HoNOS score and HoNOS symptom subscale predicted a longer LoS, the HoNOS-secure subscale predicted a shorter stay. Conclusion: In the European context, our hospital has a relatively low LoS. The results are consistent with findings linking psychotic disorders and paraphilia with a longer LoS in forensic treatment. Higher doses of antipsychotic medication or clozapine prescriptions were associated with a longer LoS. The results show a high level of unmet needs in this population, highlighting the importance of the availability of follow-up service.
Objectives: Pre–electroconvulsive therapy (ECT) evaluation is an essential part of ECT preparation, a standard treatment in the psychiatric field. However, no routine pre-ECT evaluation has been published so far. This preliminary study aimed to explore different practices in pre-ECT evaluation across European countries. Methods: The data were collected as a snowball sample approach using an online survey from September 2019 to April 2020. The final analysis included data from 18 clinics placed in 16 European countries. Results: Regulations on the pre-ECT evaluation were found in 9 countries. All clinics reported doing complete blood count, serum electrolytes, and renal function analysis as a part of regular laboratory testing, alongside with a cardiovascular assessment. Ten clinics reported using psychiatric scales. Six clinics reported doing a cognitive assessment, of which all had regulations on the pre-ECT evaluation. Not one evaluation had the same sets of procedures and diagnostics. Conclusions: The differences in assessment approaches mirror high variability of the pre-ECTevaluation practice across Europe. Cognitive assessment and objectification of psychiatric symptoms should be a regular part of the pre-ECT evaluation because of the monitoring of the most common adverse effect and observing the clinical response to ECT. Standardization of the pre-ECTevaluation and ECT in general would remove criticisms and opposition to the treatment, make it based on the best of our knowledge, and provide a method respectful of patients' best interests and rights.
The evaluation and assessment of outcome is an important issue in psychotherapy research and practice. Since the beginning of empirical research, the effectiveness of treatments has been in the focus of interest to optimise mental health care. Despite this importance, the assessment of outcome by pre‐to‐post comparisons of point measures is hampered by some limitations. These include, amongst others, the predominant use of standard questionnaires neglecting personalised outcome criteria, the focus on point measures that ignore dynamic patterns representing the volatility of mental functioning, memory biases that become important if a recall of longer time periods is urged, and the non‐ergodicity of trajectories of change. Based on new methods of digitalised data collection in the real‐life setting of patients, some conclusions for process and outcome monitoring can be drawn: first, most mental diseases are characterised by specific dynamic patterns (dynamic diseases) whose changes can be assessed by high‐frequency time sampling, for example daily assessments of patients. Second, personal criteria for self‐assessments can be identified by multiperspective case formulations. Third, electronic devices such as smartphones allow for data collection in the real‐world settings of patients, which gives access to experiences in their ecosystems.
One of the challenges in forensic psychiatry is determining when an inpatient is ready to be discharged and return to the community. The comprehension of factors that predict extended treatment or discharge is relatively limited. We assessed the treatment progress of a cohort of forensic inpatients (N=80) divided into two groups: discharged patients and patients who remain detained. We derived sociodemographic and clinical variables from each patient’s medical records and scores on the HoNOS-Secure, GAF, and SAPROF scales. The dataset was subjected to logistic regression and Chi-square analysis to determine the relevant factors. We gained insights into illness as a strong predictor of discharge, which is also associated with the patient’s general compliance with the facility program and participation in occupational therapy. The majority of our sample has moderate or severe functional impairment according to GAF. The instruments used can capture dynamic factors related to discharge or continuing hospitalization, namely the SAPROF total or external factors score, the HoNOS-Secure subscale, and significant items from the HCR-20 clinical and risk subscales.
Introduction Several studies link COVID-19 and the associated lockdown and social-distancing measures to adverse mental health outcomes. In order to address this increase in mental health problems, adequate training of mental health care professionals is of the utmost importance. Objectives: To measure the impact of the COVID-19 pandemic on psychiatric training in Europe and beyond. Methods: The European Federation of Psychiatric Trainees (EFPT) represents more than 20 000 trainees from over 30 European countries. Every year, country representatives, complete the ‘Country Report’, which contains detailed information on psychiatric training in every (member) country. Results: In July 2020, representatives of 34 European and 9 non-European countries completed the survey. In 73% of countries, psychiatric trainees were assigned to COVID-19 wards, in 43% to emergency wards. In 25% of countries, trainees did not receive any training on COVID-19 prior to their assignment. Compared to before the COVID-19 pandemic, trainees reported a decrease in clinical supervision in 65% of countries. In 51% of countries, (parts of) formal psychiatric training was cancelled. Psychotherapy training was cancelled in 25% of countries. In the majority of countries both formal and psychotherapy training were given online, however in 56% trainees experienced difficulties to attend. Conclusions: The COVID-19 pandemic has had an extensive impact on psychiatric training in Europe and beyond. The EFPT calls upon policy makers and supervisors to minimize the impact of COVID-19 on psychiatric training in order to provide psychiatric trainees with adequate skills to deal with the mental health consequences of the COVID-19 pandemic. Disclosure No significant relationships.
The onset or intensification of craving for alcohol in patients with alcohol dependence and associated impairment of ability to control alcohol use are the main causes of relapse and poor treatment effectiveness in general. current ideas about cognitive mechanisms of craving control reveal a number of problem areas, including the relationship between explicit and implicit information processing in individuals with alcohol use disorder and the use of introspective methods of craving measurement. The aim of this study was to assess the influence of cognitive biases on psychophysiological correlates (event-related potentials (ERPs) N1, N2, P2, P3) during experimental induction of craving for alcohol. Materials and methods. 29 inpatients with alcohol use disorder, mean [±Sd] age, 39.7±10.8 years, 4 females (13.8%), were tested by using a modified Go/NoGo flanker task with ERPs recording. An alcohol-related or neutral picture preceded each trial. Generalized linear mixed models with fixed effects were used for statistical analysis. Results. The type of the presented picture was significant for ERPs N1 (p<0.001) and P3 (p=0.029). The congruency and the inhibition effects were significant for ERPs N1, N2, P2, P3 (p<0.001). discussion. These findings suggest that N1 and P3 may reflect craving induction during cognitive control in alcohol addicts. We suppose the significance of both the earliest (implicit perception) and the latest (explicit processes, response inhibition) information processing for craving induction in patients with alcohol use disorder.
The current COVID-19 pandemic confronts psychiatric patients and mental health services with unique and severe challenges. In order to identify these trans-national challenges across Europe, an ad-hoc survey was conducted among 23 experts, each answering for one European or aligned country. A number of important themes and issues were raised for the impact of COVID-19 on mental health and mental health services, barriers to service provision and future consequences. A number of key issues were reported by colleagues across several jurisdictions, even though these were at different stages of their national epidemics. Based on these findings, we articulate some importantlearnings from the early stages of the COVID-19 European pandemic, and highlight key considerations for all countries' mental health services as the current pandemic develops and for future pandemics. Keywords: COVID-19; SARS-CoV-2;mental health; mental health services; psychiatry.
Background A barrier to screening is a specific attitude, opinion or state that prevents the patient from seeking preventive care. The aim of this study was to identify and compare barriers to cervical cancer screening (CCS) in Northern Slovakia between women seeking and not seeking CCS. Methods Data collection was performed in twenty gynaecological departments, each department sending data from five healthy women and five untreated women with cervical cancer. Women completed a validated and standardized questionnaire with 28 statements (the CPC-28 questionnaire: “Creencias, Papanicolaou, Cancer-28” questionaire – Beliefs about Papanicolaou and Cervical Cancer). A four-point Likert scale (item score from 1 to 4) was used to assess responses. A linear transformation was made to calculate the responses. Differences with a p value of < 0.05 were considered statistically significant. Results From the 200 questionnaires, 135 (67.5%) participants were divided into the women seeking CCS (n = 97) and the women not seeking CCS (n = 38). The women not seeking CCS vs seeking CCS had higher barriers according to the CPC-28 domain one (median; interquartile range: 33.33; 28.70-40.74 vs 14.82; 7.41–29.63; p < 0.001). The risk of not seeking CCS was statistically significant in non-working (OR; 95% CI: 2.458; 1.127–5.358; p < 0.024), non-childbearing women (OR; 95% CI: 3.302; 1.421–7.671; p < 0.006) and women without cervical cancer (OR; 95% CI: 4.709; 1.960-11.317; p < 0.001). Conclusion We identified barriers to cervical cancer screening in both of our groups but the results were more frequent and statistically significant in the women not seeking CCS.
Background: This study examined the proximate causes of psychotic patients' aggression upon the admission to the psychiatric wards of a university and two state hospitals. Methods: The authors used a semistructured interview to elicit proximate causes of assaults from the assailants and victims. The treating psychiatrists and nurses provided additional information. Based on this interview, aggressive episodes were categorized as psychotic, impulsive and planned. Results: A total of 820 assaults committed by 289 newly admitted violent psychotic inpatients were evaluated. The interview ratings indicated that 76.71% of the assaults were directly driven by psychotic symptoms and 22.32% of all attacks were labeled as impulsive. Only 0.98% of assaults were categorized as planned. Conclusions: These findings indicate that assaultive behavior among recently admitted acute psychiatric inpatients with untreated or undertreated psychosis is primarily driven by psychotic symptoms and disordered impulse control. Because each type of assault requires a different management, identifying the type of assault is crucial in determining treatment interventions.
In the Czech Republic, Forensic Treatment (FT) services consist of inptatient protective treatment (PT), outpatients treatment and secure detention (SD). Currently, there are 13 facilities providing inpatient PT; 386 clinics providing outpatient treatment and 2 SD. 950 patients receive inpatient and 2,300 outpatient treatment. 85 patients are currently in SD. Czech psychiatric care reform aims to separate the inpatient care from the rest of psychiatric care as well as create Protective Multidisciplinary Teams and services for minority populations. The whole system of care needs to implement risk assessment and adjust recovery management plans to indicated risks.
Background Information about unit costs of psychiatric care is largely unavailable in Central and Eastern Europe, which poses an obstacle to economic evaluations as well as evidence-based development of the care in the region. Objective The objective of this study was to calculate the unit costs of inpatient and community mental health services in Czechia and to assess the current practices of data collection by mental healthcare providers. Methods We used bottom-up microcosting to calculate unit costs from detailed longitudinal accounts and records kept by three psychiatric hospitals and three community mental health providers. Results An inpatient day in a psychiatric hospital costs 1504 Czech koruna (CZK; €59), out of which 75% is consumed by hotel services and the rest by medication and therapies. The costed inpatient therapies include individual therapies provided by a psychiatrist or psychologist, consultations with a social worker, group therapies, organised cultural activities and training activities. As regards the community setting, we costed daycare social facilities, case management services, sheltered housing, supported housing, crisis help, social therapeutic workshops, individual placement and support, and self-help groups. Conclusions The unit costs enable assigning financial value to individual items monitored by the Czech version of the Client Service Receipt Inventory, and thus estimation of costs associated with treatment of mental health problems. The employed methodology might serve as a guideline for the providers to improve data collection and to calculate costs of services themselves, with this information likely becoming more crucial for payers in the future.
Background: The aim of our retrospective naturalistic observational study was to describe the use of maintenance electroconvulsive therapy (M-ECT) in chronic pharmacoresistant schizophrenia. Subjects and methods: We delineated 19 cases of chronic pharmacoresistant schizophrenia (females N=12) recently treated with maintenance electroconvulsive therapy at the Havlickuv Brod Psychiatric Hospital in the Czech Republic. Demographic, clinical and treatment variables were recorded. Results: M-ECT, when applied weekly to monthly mostly over a period of several years, was of no benefit in the treatment of chronic hallucinations and/or delusions. However, it did prove beneficial (p<0.001) in removing chronic serious symptoms like suicidal or violent behavior, automutilation, refusal of food or liquids, stupor or catatonia. Even though almost all of our patients remained hospitalized, we were nonetheless able to transfer them to an unlocked psychiatric ward and let them out for walks or occupational therapy with almost no need for using restraint. No serious adverse side effects of M-ECT were found. Conclusions: Our study is limited by using only one simple standardized measurement (Clinical Global Impression - Severity) that was retrospective. Another limitation of our retrospective study was that the subjects had not been regularly tested for their cognitive functions. According to our results, M-ECT mitigates the impact of the disease and improves social functioning of the patients. M-ECT does not treat chronic schizophrenia but does make the lives of patients more tolerable. We suggest further research into M-ECT and its clinical application in chronic pharmacoresistant schizophrenia.
Background: The greater presence of neurodevelopmental antecedants may differentiate schizophrenia from bipolar disorders (BD). Machine learning/pattern recognition allows us to estimate the biological age of the brain from structural magnetic resonance imaging scans (MRI). The discrepancy between brain and chronological age could contribute to early detection and differentiation of BD and schizophrenia. Methods: We estimated brain age in 2 studies focusing on early stages of schizophrenia or BD. In the first study, we recruited 43 participants with first episode of schizophrenia-spectrum disorders (FES) and 43 controls. In the second study, we included 96 offspring of bipolar parents (48 unaffected, 48 affected) and 60 controls. We used relevance vector regression trained on an independent sample of 504 controls to estimate the brain age of study participants from structural MRI. We calculated the brain-age gap estimate (BrainAGE) score by subtracting the chronological age from the brain age. Results: Participants with FES had higher BrainAGE scores than controls (F(1, 83) = 8.79, corrected P = .008, Cohen's d = 0.64). Their brain age was on average 2.64 ± 4.15 years greater than their chronological age (matched t(42) = 4.36, P < .001). In contrast, participants at risk or in the early stages of BD showed comparable BrainAGE scores to controls (F(2,149) = 1.04, corrected P = .70, η2 = 0.01) and comparable brain and chronological age. Conclusions: Early stages of schizophrenia, but not early stages of BD, were associated with advanced BrainAGE scores. Participants with FES showed neurostructural alterations, which made their brains appear 2.64 years older than their chronological age. BrainAGE scores could aid in early differential diagnosis between BD and schizophrenia.
Background: In the region of Central and Eastern Europe, long-term departments at psychiatric hospitals provide a large proportion of the care for people with complex mental health needs. The System of United Psychiatric Rehabilitation (S.U.P.R.) project focussed on the implementation of a complex set of interventions of psychosocial rehabilitation to increase the quality of care. The aim of this study was to assess the effect of the S.U.P.R. psychosocial rehabilitation programme on the quality of care at the longer-term inpatient psychiatric departments. Methods: All 12 psychiatric hospitals in the Czech Republic were asked to participate in the study. A 'before and after' design was adopted to evaluate the impact of the S.U.P.R. programme. Quality of care was assessed using the internationally validated, web-based tool, QuIRC (Quality Indicator for Rehabilitative Care), which provides percentage scores (0-100%) on seven domains of care and an overall mean quality score. Results: Fourteen long-term wards of 12 psychiatric hospitals for adults in the Czech Republic participated in the S.U.P.R. project. The mean total QuIRC scores were relatively low at the start of the project (range 33% to 53%) but all domain scores increased two years after the S.U.P.R. programme was implemented (range 44% to 62%). Staff feedback was generally positive about the programme, but inadequate staffing was an impediment to its success. Conclusion: Implementing a modern concept for psychosocial rehabilitation aimed at progressing the recovery of people with complex mental health problems can improve the quality of care in longer term inpatient settings.
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