The aim of the study was to examine the ethnic differences in knowledge, attitude and practice towards mental illness in a sample of Qatari and non-Qatari Arabs.
This is a cross sectional survey conducted in Primary Health Care centers, Qatar from October to June 2009. A representative sample of 3000 Qatari and non-Qatari Arabs above 20 years of age were approached and 2514 subjects (83.8%) gave consent to participate in this study.
More than non-Qatari Arabs, a significant proportion of Qataris thought that mental illness can be a punishment from God (44.5% vs 50.6%; p=0.002) and that people with mental illness are mentally retarded (35.1% vs 45.1%; p<0.001). Qatari nationals had a poor knowledge about causes of mental illness compared to non-Qatari Arabs such as a belief that mental illness is due to possession of evil spirits (40.5% vs 37.6%) and psychiatric medication will cause addiction (61% vs 57.3%).
The study revealed that there is an ethnic diversity within Arab societies in their knowledge, attitude and practice towards mental illness.
Emerge is an innovative Child and Adolescent Mental Health Service that provides support for 16-17 year olds. The team provide a community based multi-disciplinary, open access model, texting young people and travelling to locations convenient to them. There is an enhanced duty system providing a rapid flexible response within working hours.
To examine the referral data as part of the ongoing annual audit cycle and to establish prevalence of alcohol, cigarettes and substance use among young people referred to the service.
Data from the case notes was analysed using Statistical Package for Social Science. Demographic details, referrer profession, reason for referral, other services involved and substance use were examined.
There were 437 patients referred to Emerge between 1/4/2010 and 31/3/2011, and 387 patients were accepted while 50 were signposted on. Cases were not accepted if they fell outside the age and geographical area, or were not in need of a mental health service. Overall, 24% of young people were reported to consume alcohol, 19% used cannabis and 9% reported using cigarettes. In all categories there were areas where documentation was not complete, and we suggest that these figures are an underestimate.
This data has been fed back to the team, a full morning of teaching regarding drugs and alcohol has been delivered. Emerge often works with young people who are marginalised and may be harder to reach, consequently early sessions require neutral and supportive questions, thus if young people do not return after the first appointment, histories may be incomplete. The team will be reflecting on the lessons learned and considering ways to optimise their work.
The aim of this study was to estimate the prevalence of cannabis use among Swiss students and to assess their attitudes regarding health and safety issues associated with drug use.
After a workshop, 173 students (23.1% male, 75.7% female; 44.4% age 16, 43.8% age 17 and 11.8% age 18) from a Swiss school were surveyed by questionnaire.
59.3% (n=103) of all participants had tried cannabis, and 30.1% of those who reported cannabis use had consumed more than 100 joints. Of those 103 students with cannabis experience, 6.8% rated the risk of cannabis-related psychic effects as low, and 9.8% were not concerned about driving under the influence of cannabis. In cases of heavy cannabis use, the chance of increased tobacco, alcohol or other drug use is higher than for those with less or no cannabis use at all (odds ratios of 4.33-10.86).
This paper deals primarily with cannabis prevalence data in adolescents from previous studies and sources, and shows that our findings deviate significantly - and surprisingly - from past research. Our data from a school survey indicates higher cannabis use than data from official drug policy studies. Additionally, our data shows that the students' self-reported attitudes towards health and safety issues were mostly realistic. The examination of methodological issues that might impact prevalence estimates should be added to the cannabis literature.
Smith-Magenis syndrome (SMS) is a clinically recognizable multiple congenital anomaly and mental retardation syndrome caused by an interstitial deletion of chromosome 17 pll.2. Although the physical and molecular genetic features of SMS are increasingly well understood, work is more limited on SMS's behavioral phenotype, which includes self-injury, tantrums, aggression, attention deficit, and sleep disturbance. This case-report describes the lowering of the aggression level of a 13 year old individual with SMS.
Psychiatric reforms in Upper Austria have considerably improved the quality of life of psychiatric patients. Modernizing the status of acute psychiatric departments based on a bio- psycho-, social concept implemented multidimensional approach in diagnostics and therapeutic methods applied by multiprofessional teams. Prophylactic procedures and rehabilitation programs have minimized chronification of psychiatric diseases. By "late rehabilitation programs" increased autonomy, more individualized planning of life processes could be achieved even with "chronic" patients. We do not see any need to confine "chronic" psychiatric patients in psychiatric hospitals. These patients are cared for, socially integrated by special rehabilitation measures and professional rehabilitation in community - based services and units of Pro Mente Upper Austria - a non-profit organization. Problems are decreased duration of stay in psychiatric hospitals, increased admission rates when the number of beds in psychiatric departments was considerably decreased in the course of psychiatric reforms in Austria. In our province - Upper Austria - these problems are of lesser importance because private non-profit organizations like Pro Mente Upper Austria have provided a variety of community-based services (mental health centres, day clinics, housing facilities and special services for drug addicts and geriatric patients ) in ever increasing numbers. Still there is need of further development of community-based services provided by specially trained professionals. These services are financed mainly by the state, the provincial government, the labour market services and to a small degree by funds of the European Union. In these days of reduced social budgets of the state and social departments of provincial governments it is not easy to keep our standards and meet the increased needs of our clients.
Peptic ulcer disease is a common clinical problem. The relationship between stress and ulcer has been shown in a large series of methodologically sound studies.
To estimate the effect of psychosocial distress on stomach ulcer mortality rate at the aggregate level.
Trends in age-adjusted, sex-specific suicide (as an integral indicator for psychosocial distress) and stomach ulcer mortality rate in Russia from 1965 to 2005 were analyzed employing an ARIMA analysis in order to assess the bivariate relationship between the two time series.
Time series analysis indicate the presence of a statistically significant association between the two time series for males (r=0.45; SE=0.16). The association between the two time series for females was also positive, however it was not statistically significant (r=0.25; SE=0.14).
The results of the present study suggest a positive association between male suicide and stomach ulcer mortality rate at the aggregate level. This paper presents new epidemiological evidence that supports the psychosomatic concept of stomach ulcer disease.
Psychiatric reforms in Upper Austria have considerably improved the quality of life of psychiatric patients. Modernizing the status of acute psychiatric departments based on a bio- psycho-, social concept implemented multidimensional approach in diagnostics and therapeutic methods applied by multiprofessional teams. Prophylactic procedures and rehabilitation programs have minimized chronification of psychiatric diseases. By "late rehabilitation programs" increased autonomy, more individualized planning of life processes could be achieved even with "chronic" patients. We do not see any need to confine "chronic" psychiatric patients in psychiatric hospitals. These patients are cared for, socially integrated by special rehabilitation measures and professional rehabilitation in community-based services and units of Pro Mente Upper Austria--a non-profit organization. Problems decreased the duration of stay in psychiatric hospitals, and increased admission rates when the number of beds in psychiatric departments was considerably decreased in the course of psychiatric reforms in Austria. In our province--Upper Austria--these problems are of lesser importance because private non-profit organizations like Pro Mente Upper Austria have provided a variety of community-based services (mental health centres, day clinics, housing facilities and special services for drug addicts and geriatric patients) in ever increasing numbers. Still there is the need for further development of community-based services provided by specially trained professionals. These services are financed mainly by the state, the provincial government, the labour market services and to a small degree by funds of the European Union. In these days of reduced social budgets of the state and social departments of provincial governments it is not easy to keep our standards and meet the increased needs of our clients.
To analyze trend the suicide rates in Croatia during the pre-war period of socialistic Yugoslavia (1966-1990), war period in the former Yugoslavia (1991-1995) and the post-war period of Croatian independence and democratization (1996-2002).
Using official suicide statistics, this study examined suicide rates in Croatia over a 36-year span (1966 to 2002) as a function of gender, age, marital status, time, war and social changes. Suicide rates were displayed graphically and compared with some neighbouring countries (Slovenia, SCG, Hungary and Italy).
During the period of socialistic Yugoslavia, suicide rate in Croatia was constantly increasing with small variations. During the war time suicides with firearms were significantly increased. Since 1993 (the period of independence and democratization) there has been a trend of evident decrease in total suicide rate.
This study demonstrated that Croatia has still had high suicide rates with declining trend since 1993, probably related to democratization, more national, religious and cultural rights, better availability of SSRIs and systemic campaign for education of general practitioners for early recognition and treatment of depressive disorders.
The association between alcohol and homicide is well documented. Research evidence suggests an important role for cultural and social context in the alcohol-homicide association.
To estimate the aggregate level effect of alcohol consumption on homicide rate in the former Soviet Slavic republic of Belarus.
Trends in homicide and alcoholic psychoses morbidity rate from 1970 to 2005 in Belarus were analyzed employing ARIMA analysis in order to assess the bivariate relationship between the two time series.
The results of time series analysis suggest a close relationship between homicide and alcoholic psychoses rate at zero lag.
This study replicates the previous findings that suggested a close link between alcohol and homicide at the aggregate level. The outcome of the present findings suggests that alcohol is responsible for the fluctuation in homicide rate over time in the former Soviet republic of Belarus. This study also supports the hypothesis that homicide and alcohol are closely connected in the prevailing culture with its intoxication-oriented drinking pattern.
The paper deals with the data on suicides of the hospitalised chronic schizophrenic patients in the pre-war, war and post-war time, i.e. the period from 1972 to 2002. The subjects are the schizophrenic patients from the Psychiatric hospital of Domanovići who were moved at the beginning of war to the premises of the Clinical hospital of Mostar. Special attention in the analysis has been paid to the war year of 1992, when a high rate of suicides was registered among the hospitalised schizophrenic patients, the data showing their number, gender, age, diagnosis, duration of illness, hospitalisation as well as earlier attempts of suicide or suicides in their families. The results of the research show the increase in the number of suicides in the period of the most terrible war events, caused by their displacement, inadequate accommodation, lack of food and medicines. This research is epidemiological, retrospective, descriptive and analytic.
From 1991-1995, the war in Croatia cost tens of thousands of lives (approximately 11834 persons killed between 1991-1994), and human rights abuses led to significant numbers of disappeared persons (3052). A total of 2395 families were searching for one disappeared person and 168 families of disappeared were searching for more than one person. 2035 men were reported disappeared and 528 women. However, while the majority or 60% (1226) of the men were between the ages of 18-49, 83% (438) of the women were between the ages of 50-96. Though the majority of missing persons of both genders were civilians, the disappeared women were more likely to be civilians (99%) than the disappeared men (52%), though only 23% of the men were regular army military personnel. The majority (55%) of men were previously engaged in paid employment, while 81% of women were farm or housewives, or pensioners. Most men (53%) were reported by informants to have disappeared outside of their home, while the majority (75%) of women disappeared from their home. Among those searching for the disappeared, 27% of those searching for men believed the person was alive or might still be alive, in contrast, only 18% of those searching for women believed them still alive. An important gender difference occurred in the pattern of disappearance in Croatia; most disappeared men were of combatant age, employed, and similar to the general population in key demographic characteristics, while most disappeared women were rural, less educated, and elderly.
The traumatic events experienced in Bosnia and Herzegovina during the 1992-1995 conflict may have a lasting effect on the mental health of the citizens, characterized by high rates of post-traumatic stress disorder (PTSD), depression, and anxiety. A diagnosis of PTSD, depression, and anxiety among family physician residents could affect their ability to diagnose and treat patients for depression, anxiety and PTSD.
To assess PTSD, depression and anxiety symptoms and prevalence amongst family medicine residents (FMR) who were general practitioners (GP) in different war engagements and compare them with FMR who were medical students, 9 years after the 1992-1995 war in Bosnia-Herzegovina (BH).
We applied the Bosnia-Herzegovina versions of both the Harvard Trauma Questionnaire (HTQ) for PTSD symptoms, and Hopkins Symptom Checklist - 25 (HSCL-25) for anxiety and depression symptoms to 78 residents (age 30-45 years, 84.6% females), who lived in BH during the conflict years.
PTSD prevalence of 10.3% and depression and anxiety prevalence of 21.8%, was found. The anxiety symptoms score was significantly higher amongst FMR who were GPs (1.69+/-0.66) than medical students (1.40+/-0.41, t-test=2.219, P=0.029) during the war.
With regard to historical, economical, cultural, climate and probably genetic diversity of the Republic of Croatia, it is to be expected to find significant regional differences in suicide rates. The aim of this paper is to describe the specific regional characteristics of suicide rates in Croatia and compare it with that in neighbour countries like Slovenia, Hungary and Italy.
Using official suicide statistics, this study examined suicide rate in Croatia over a 8-years span (1993-2001) as the function of age, gender, employment and marital status and geographical regions.
Our results demonstrated: a). higher suicide rate in the Continental part (21.96) in comparison with the Mediterranean part (15.42) of Croatia as well as lower suicide rate in the South (10.91) compared to the North (22.28) of Mediterranean Croatia; b). higher suicide male/female ratio in the Continental (3.49) than in the Mediterranean (2.36) Croatia as well as in the North (2.77) than in the South (1.94) of Mediterranean Croatia; c). bigger percentage of suicide in younger age (15-24 years) in the South (11.58%) than in the North (3.97%) of Mediterranean Croatia; d). lowest rate of homicide and lowest divorce rate were found in the South of Mediterranean Croatia with lowest suicide rates.
This study showed significant regional differences in suicide rates accros the Republic of Croatia. With its south Mediterranean part, Croatia share the same low rate with Mediterranean neighbour Italy, while with its west-north continental part Croatia with high suicide rate is similar to its neighbours Slovenia and Hungary.
Children with Down syndrome (DS) are an everyday casuistry of pediatric clinical medicine. The prevalence of DS is dependent on socio-demographic and cultural conditions of a community. Antenatal screening is not carried out mainly due to religious views, and the prevalence of DS in our region is really considered a "natural phenomenon". The aim of the study was to analyze some epidemiological characteristics of infants with Down syndrome in the western region of Herzegovina in the period between year 1994-2013.
We performed a retrospective analysis of hospital records of children who were supervised and treated at Children's Hospital through the twenty-year period.
In this period there were 44,100 liveborn infants. Down syndrome was detected in 78 children (54 male and 24 female). The prevalence is estimated at 1.8/1,000 of live births. Aborted fetuses and stillbirths were not analyzed. 37 (47%) of the parent couples were over 35 years of age. Out of that 65 cytogenetic analysis, a regular type of trisomy 21 was found in 94% of cases, and the translocation in 6%. From major malformations (MM) heart failure was more often present (47%), then the anomaly of the gastrointestinal and genitourinary systems. Ten children (12%) died, most often in the early period of infancy due to complications of the cardiovascular system.
The prevalence of DS throughout these two decades has been uniform in the region of western Herzegovina. Improvement in perinatal care in recent years caused higher survival and a better quality of life for the children with DS and thus their families. DS is less a desirable family tragedy, and increasingly a tolerable family fate.
The media have an important role in maintaining and creating social relations and social environment. This especially refers to the war and post-war period in which the media can form a part of the prevention context, i.e., the media can facilitate the process of recovery from war trauma, but they can also contribute to stigmatization and retraumatization. Our aim was to analyze Croatian newspaper reports about Croatian war veterans and to determine the differences in ways of dealing with the subject during 1996 and 2006.
The data were gathered by reviewing two daily papers, Novi list and Ve?ernji list and Globus weekly. The analysis included newspaper reports related to the subject of Croatian war veterans, published in the first six months of 1996 and 2006. Quantitative and qualitative methods were used to analyze both the form and the content of the reports.
A total of 538 newspaper reports were published in the above-stated periods. In the first half of 2006 the number of reports related to the subject of Croatian war veterans dropped 6.5 percent compared to the first half of 1996. Topics prevalent at the end of the war were different from those ten years later. The 1996 articles mostly reported on activities organized by various associations, medal-awarding ceremonies, military operations etc. Ten years later the topics focused on war crimes, trials of Croatian war generals and dissatisfaction with veterans' rights and legislation. Moreover, articles relating to crime and reports about suicides and attempts of suicide increased significantly in 2006.
During the ten-year period, the media image of Croatian war veterans significantly changed, which was expected owing to different social circumstances immediately after the war and ten years later. The prevalence of topics negative in tone and a lack of proactive stories reflect, but also create, a social context which can affect the process of recovery from traumatization.
There are very few investigations about sex differences in suicide which include some other variables (e.g. age, profession etc). Data which concern suicide sex differences are obscure and usually are given in statistical accounts of causes of death. The aim of our study was to investigate sex differences in realized suicides within the city of Belgrade during the last eight year period. Data was taken from the index records of suicide in the city of Belgrade held at the Institute for Informatics and Statistics. We took sex as the main observed variable, and analyzed nine other variables as related to sex. Statistical analysis was done by using the crude specific rate. The variability of the rate was estimated by computing a confidence interval. The results of our study gave the profile of males and females who committed suicide in Belgrade in the period of the last eight years. Although there were significant quantitative differences, the female/male profile of completed suicides is similar, and differs only in the method of suicide: both males and females choose hanging, drowning and suffocation as the most common method of suicide, while poisoning is on the second most common method chosen by females and firearms the second most common method for males. The frequency of suicide, in both sexes, showed a tendency to decrease over the observed period (the highest suicide rate was in 2000- females 9.7, males 19.7, and the lowest in 2004- females 4.5 males 9.1). Male to female suicide rate ratio was 2 to 1. Sex differences were registered in all of the observed nine variables.
Since the 1930s, the Department of Psychiatry and Psychotherapy at Semmelweis University (DPPSU) in Budapest has played a leading role in convulsive therapy in Hungary. The aim of this study was to describe the pattern of ECT use at the DPPSU over an 11-year period.
Analysis of the medical notes of all patients treated with ECT in this academic centre between 1999 and 2009.
During the study period, 28,230 patients were admitted to the DPPSU, of whom 457 (1.6%) received ECT. More than 50% of patients receiving ECT were diagnosed with schizophrenia. The percentage of female patients receiving ECT significantly exceeded that of the male patients, above what was expected in view of the diagnostic mix.
The data indicate that in the first decade of the 21(th) century, ECT use shows a declining tendency in this Hungarian academic centre. The mean number of treatment sessions was relatively low and nearly the same across diagnostic groups. ECT was mainly used as a last resort for treatment-resistant patients. In the majority of cases, bifronto-temporal brief pulse stimulation was applied. Seizures were monitored with EEG and EMG.
ADHD it is a syndrome characterized by the progressive development of excessive hyperactivity, impulsiveness and attentional difficulties. The purpose of our study is to verify the therapeutic effectiveness of repetitive Transcranial Magnetic Stimulation (low frequency (1Hz, 1200 stim/die for five days)), applied on the impending scalp additional motor area, in a subject affected by ADHD. Results show a significant improvement that lasted for at least 4 weeks. Placebo control did not show any improvement.
The purpose of the study was to research gender differences in suicides committed in Podgorica between 2000 and 2006, including sociodemographic variables (e.g. age, marital status, education etc.), methods of and motives for committing suicide. Data were taken from the Police Directorate of Montenegro.
We used data on 220 males and 83 females who committed suicide. Statistical analysis was done by using the crude specific rate. Significance between two independent crude rates is constructed around their 95% confidence intervals and it utilizes the difference between the two rates (D) to determine significance.
The incidence of suicide in males was found to be higher than in females (the male to female suicide ratio is 2.6 to 1). Females were older than males. Females had completed elementary education more frequently , and they were single or divorced or widows. Males had completed secondary education more frequently and they were married. The most frequent employment status of both gender groups implied pensioner and unemployment statuses. There was a significant difference in suicide rates between the genders during the reporting period. Suicide rates increase with age in both genders. Males chose firearms, hanging, strangulation and suffocation and jumping. Females chose hanging, strangulation and suffocation, jumping and drowning as the most frequent methods of suicide. The most frequent motive for suicide in both gender groups was physical illness. The second most frequent motive was mental illness. Emotional and financial difficulties were motives which were more common in males, whereas family problems appeared to be motives two times more frequent in females.
The complex multifactorial etiology of suicide suggests the need to consider gender differences when developing effective strategies for the therapy and the prevention of suicide.
Quality of life (QoL) is known to be indicative of the level of social functioning in mental health patients. However, the research on QoL, in the field of psychiatry, is not as comprehensive as it is in other domains of medicine. The aim of this study was to review the research evidence on QoL in psychiatric patients, published in Serbian medical journals during the last decade.
The research data from studies on quality of life in psychiatric patients, published in Serbian medical journals from 2000 to 2009, were obtained by searching the databases Kobson and Medline.
We found eight studies on QoL in psychiatric patients published in Serbian medical journals from 2000 to 2009. The reviewed articles were focused on the comparison of QoL between psychiatric patients and healthy controls, or somatic patients, the research on the relationship of QoL and general psychopathology, and the research on QoL and medical treatment.
QoL in patients suffering from mental disorders, as the outcome variable, is of a paramount interest in the follow-up treatment studies in psychiatry targeting critical issues of mental illness management strategies. QoL of psychiatric patients in Serbia is still under-researched, and it would be important to measure QoL from both a patient's and observer's (i.e. family members, friends, nursing staff, mental health professionals, etc.) perspective, in the context of social, economic, and cultural background of the patient. In the future, the studies on QoL in psychiatric patients in Serbia should also rely on "disease specific" assessment scales, which would consider particular aspects of psychopathology, and eventually follow up longitudinal course of mental illness, treatment outcome, and recovery.
A comprehensive insight into drug utilization as an economic and primarily a public health issue can only be acquired in the context of overall health state of the respective population. The objectives of the study were: 1) to determine the real outpatient utilization of psychopharmaceuticals in Zagreb, 2) to determine the psychopharmaceutical prescribing quality during the study period; and 3) to propose appropriate interventions in Zagreb on the basis of the results obtained.
Data on drug utilization were obtained from all Zagreb pharmacies. The number of defined daily doses (DDD) and number of DDD per 1000 inhabitants per day (DDD/1000/day) were calculated from the number of particular drug packages. The Drug Utilization 90% (DU90%) method was used as a criterion of prescribing quality.
Outpatient utilization of psychopharmaceuticals showed a declining pattern from 115.40 DDD/1000/day in 2001 to 93.15 DDD/1000/day in 2006. Anxiolytics accounted for the majority of this drug group utilization in the City of Zagreb, although the anxiolytic/antidepressant ratio decreased from 7.19 in 2001 to 3.86 in 2006. The utilization of selective serotonin reuptake inhibitors showed a 2.5-fold increase and accounted for 90% of overall antidepressant utilization. A 2.5-fold decrease was recorded in the utilization of antipsychotics, while the atypical/typical antipsychotic ratio changed from 1:2 in 2001 to 1.1:1 in 2006.
Despite some improvement observed in the prescribing quality, the predominance of benzodiazepines in the utilization of psychopharmaceuticals points to the need of additional rationalization in the field.
The 24th C.I.N.P. meeting was held in Paris, France, from June 20-24, 2004. The opening ceremony and welcome reception was chaired by Professor Herbert Y Meltzer, Vanderbilt University, Nashville, TN, USA, President of C.I.N.P., and a new president was elected (Professor Brian E. Leonard, Ireland). Congress included the rich social program, combined with lectures of invited speakers, speeches and awards. There were 6650 registered participants all over the world. The meeting consisted of 4 plenary lectures (held by Professor FE Bloom, Department of Neuropharmacology, The Scripps Research Institute, La Jolla USA, Professor HY Meltzer, Vanderbilt University, Nashville, TN, USA, Professor CL Masters, The University of Melbourne, and the Mental Health Research Institute of Victoria, Melbourne, Australia, and Professor JP Changeux, CNRS URA 2182 Recepteurs and Cognition, Paris, France), 69 symposia, 5 synthesia, 25 satellite symposia, 2 electronic interactive sessions, 6 meet the expert sessions, 11 sessions that were held under the name breaking scientific news, 6 workshops, 5 joint meetings, and 2 poster sessions with 657 posters. Posters were displayed for 2 days between 12.00 to 18.00 h, and presenters were available between 16.30 and 18.00 h to answer the questions. Abstracts from the congress were published in International Journal of Neuropsychopharmacology, vol 7, Supplement 1, June 2004. The 24th Collegium Internationale Neuro-Psychopharmacologicum (C.I.N.P.) Congress introduced some new exciting data, summarized some new knowledge, and its goal was to connect the preclinical and clinical data and to introduce some news into clinical practice. The smaller part of the congress that I was able to follow was well organized, and very good attended, with diverse topics, covering all aspects of neuropsychopharmacological research. The sponsorship by the pharmaceutical industries was visible only in the selected sponsored symposia.
The program covered all persons who had not been in contact with a physician for two years or had failed to notice symptoms themselves or to timely respond to the symptoms observed. The aim of the present study was to analyze the results of the program and try to draw conclusions regarding the necessity further implementation.
This paper analyzes data on a cohort of 1375 subjects aged 45+, collected on preventive examinations by family physicians during the 2009-2013 period.
Results show 24.4% smokers and 15.5% former smokers. Up to three alcoholic drinks per week consumed 18.5% respondents (27.8% male and 11.2% female). Overweight (body mass index 25-30) was recorded in 50.6% and 38.6%, obesity (body mass index >30) in 30.1% and 29.4%, hypertension in 14.6% and 11.8%, isolated systolic hypertension in 20.5% and 17.4%, and isolated diastolic hypertension in 3.3% and 3.0% of male and female subjects, respectively. Suspicion of one or more newly diagnosed disease was recorded in 52.9% (95% CI 50.2-55.5) of study subjects. Fifty-four subjects (7.4%; 95% CI 5.5-9.3) were suspected to have neoplasm and they were immediately referred for further diagnostic evaluation.
Timely manner suspicion of malignant disease is of crucial influence on the course of treatment and outcome of the disease. The study results confirm the importance of continuing the implementation of prevention programs.
To review current practice at the John Connolly Wing ECT clinic and to explore compliance with NICE ECT guidance. Standards used included the ECT TA59 guidelines of 2003 with the updated depression guidance CG90 of 2009. To recommend a programme of action to the Trust which would ensure that clinical practice and service delivery within the Trust complies with NICE guidance.
A retrospective baseline Trust wide audit was conducted between the period of January 2010 to July 2010 inclusive. Cases were identified using ECT clinic record then computer Rio notes explored for evidence of compliance with NICE guidelines as set out in the audit standards. All data was extracted from the case notes on the Rio system. An audit tool was completed for each case. The data recorded on the audit tool was explored and entered onto an Excel spreadsheet for analysis.
A total of 14 patients were identified. Of these, 6 were male and 8 were female. They comprised of 8 inpatients and 6 outpatients. The majority of patients had a diagnosis a severe depressive episode. 13 patients received bilateral ECT. In 1 case the first 3 sessions were unilateral and the rest were bilateral due to patient choice. 9 patients consented to ECT; 5 lacked capacity to consent and 1 of those was treated under Section 62 of the Mental Health Act. The number of treatments ranged from 0-15 with an average number of 7. This included 1 patient who did not receive ECT at all due to concerns raised by anaesthetist once at the ECT clinic. Reasons for stopping ECT included a response being achieved in 5 patients; anaesthetic risk in 3; withdrawal of consent in 2; T6 no longer valid in 1; no reason documented in 3 patients. Compliance with NICE guidelines was particularly good regarding the indications for ECT. An adequate trial of treatment was evidenced prior to consideration of ECT. Documentation of the exploration of the risk to benefit ratio both amongst the team and with the patient was poor. Assessment of the patient after each ECT and on-going cognitive assessment was poor.
This audit highlights the need for sound documentation of our practice. It also stresses the need for further clarity regarding the roles and responsibilities of the RMO and their team and the ECT team.
An ECT Care Pathway document has been produced to improve compliance with NICE guidance and improve documentation of practice. This document has been introduced for use in the Trust. We plan to re-audit for improvement in compliance.
This article aims at determining the place of benzodiazepines in the current treatment of anxiety disorders in opposition to antidepressants, neuroleptics and anticonvulsants. Belgium and France are the only two European countries which prescribe the most benzodiazepines despite the dissuasion of the international guidelines (NICE) issued in the nineties concerning the high risk of dependance of these molecules. What about the respect of these guidelines and the use of benzodiazepines in general practice in 2014?
Review of the literature with the following key words "anxiety disorder, benzodiazepines, anxiolytic, treatment" in the international database of PubMed, Medline, PsycINFO, PsycARTICLES and consulting of various reference books.
No class of molecules could measure up to benzodiazepines until now, neither from the point of view of efficiency, nor from the point of view of cost-efficiency. This is why the guidelines (NICE) discourage the few available alternatives in the general practice. International figures from Belgium and France show a continuous increase in the use of benzodiazepines in the treatment of anxiety disorders, even after the nineties. Given the fact that benzodiazepines differ from one another at the level of their action profile (graphical representation in "stars") and are therefore able to relieve several symptoms simultaneously, these molecules still respond nowadays to many expectations of the clinical practitioners.
The divergence between the guidelines and the practice confirm the irreplaceability of benzodiazepines at the present time. Nevertheless, the expectation of new molecules with fewer side effects should be investigated in further research.
Today, psychological processes and brain is no longer looked at as something less scientific in comparison with physical processes, so mental diseases will become equal as physical diseases very soon. Until recently, brain functioning could be observed only in patients with cerebral lesions, after surgery, and on animals, but it is possible today to observe it directly with modern imaging techniques.
The aim of this presentation is to point out that optimal health and functioning, which are basic assumptions of both neuroscience and psychotherapy is related to increased level of integrity and neural networks growth.
Therefore, neurological development can be seen as development determined by experience. More neural networks will be developed during critical periods then, ultimately, will be used. Environment in which child lives and develops determines which networks are going to live through, and those that were not stimulated are susceptible for neural extinction (pruning). Quality of parental relationship has basic impact on brain development. Mother's capacity to regulate newborn's affects is directly linked to future child's capacity to regulate his/her own affects.
Positive experiences from an early childhood, together with positive genetic heritage, ensure proper brain development. First years in human life are also a period of most turbulent brain development, and those early experiences have disproportionally large impact on human brain development.
Brain growth and differentiation are not only determined genetically but also with constant interactions with environment. This epigenetic brain information doesn't end in an early childhood. There is a lifelong redistribution of cortical networks, depending on individual experience, including creation of de-novo generation of neurons in adult hippocampus, as recently proved, and neuroplasticity is precondition for any persisted behavioral change, behavior, cognition and emotion.
To prospectively evaluate depressive symptoms and risk factors for depression in patients with chronic hepatitis C (CHC) treated with pegylated interferon alpha therapy combined with oral ribavirin (PEG-IFN-α+RBV) and to analyze self-rating scale for depression in comparison to observer-based scale in the given population.
The Hamilton Depression Rating Scale and Zung Self Rating Depression Scale were used to screen for depressive symptoms in 74 subjects with CHC before PEG- IFN-α (mean dose 152.6±25.6 mcg), and in the follow-up visits (4, 12 and 24 week).
Incidence of depressive symptoms in patients (mean age 39.9±13.4 years; equal sex distribution p=0.225) treated by PEG- IFN-α was the highest on 12th week of the treatment, when more than a 20% of our sample had moderate/severe symptoms of depression, and about 30% had minor depressive symptoms. For the screening of depression during PEG- IFN-α self-assessment scale was equally reliable as observer-based assesment of depressive symptoms. Common clinical parameters- subject related risk factors (age (p=0.955 ), sex (p=0.008), lifetime psychiatric disorder (p=0.656)), illness related risk factors (duration of CHC (p=0.267 ), i.v drug aplication as way of transmission (p=0.292)) and therapy-related risk factors (recommended duration of PEG-IFN-α (p=0.993) and dose of PEG-IFN-α (p=0.841)) were not signifcantly associated with depressive symptoms on PEG-IFN-α.
Liason-consultation services should collaborate with hepatologists in creating screening programmes, supplemented by objective criteria and guidelines, for early recognition and treatment of interferon-induced depression.
One of the most challenging problems in clinical psychiatry are inter-individual differences in clinical response to antipsychotic treatment. Several studies were investigating the impact of the polymorphic cytochrome P450 2D6 gene (CYP 2D6) on the psychopathological and extrapyramidal symptoms, but the results were conflicting. There is a lack of clinical studies of the impact of CYP2D6 polymorphism on therapeutic efficacy, especially in the long-term treatment of schizophrenia. The aim of the presentation was to evaluate the impact of CYP2D6 genotype on psychopathological and extrapyramidal symptoms in a group of Slovenian outpatients with schizophrenia or schizoaffective disorder in stable remission, who were receiving long-term maintenance therapy.
The purpose of this study was to investigate the phenomenology of a newly structured Austrian tertiary - care hospital consultation - liaison (C - L) psychiatry service.
We compared two 1 - year surveys over two years of observation (2003 - 2005). Survey A (August 1, 2003, until July 31, 2004) comprised 1474 consecutive new consultations, and the more recent Survey B (August 1, 2004, until July 31, 2005) extended over 1833 consecutive new referrals to our C - L service. Psychiatric referrals were analyzed with regard to consultation rate, demographic characteristics, referring departments, principal reasons for referral, diagnostic characteristics, and intervention patterns.
The consultation rate increased by 0.61% from 2.69% in Survey A to 3.30% in Survey B. Internal medicine consistently accounted for almost 31% of all referrals in both surveys. In Survey A, the most common psychiatric diagnoses were adjustment disorders (21.4%), depressive disorders (18.5%), and delirium (18.1%). The most prevalent diagnoses in Survey B were adjustment disorders (24.5%), delirium (18.8%), and depressive disorders (14.3%). Pharmacotherapy was the most frequent action in both surveys and accounted for between 45% and 49% of all actions.
This study underscores the need for specially planned C - L services in Austria that provide both psychiatric and psychosocial care for patients who are medically ill.
After initial psychological treatment patients with Obsessive Compulsive Disorder are treated with selective serotonin re-uptake inhibitors (SSRIs). Treatment may later be augmented with clomipramine and/or an antipsychotic. This study focuses on the biological treatment received after, or in parallel to, the psychological.
To collate and evaluate the levels of biological treatment currently received by OCD outpatients in the Bedford east catchment of Bedfordshire and Luton mental health and social care partnership NHS trust.
In particular we wished to establish how many of the patients were receiving an atypical antipsychotic as well as maximal SSRIs.
An anonymised database of 45 outpatients with symptoms of OCD was prepared. Treatment groups were identified and the percentage of the cohort occupied by these groups was calculated. The possibilities for increased medication were noted.
Only 7% of patients had one SSRI, at maximum dose, plus clomipramine, plus an antipsychotic, even here the dosing was not maximal. Another 7% had a second SSRI instead of the tricyclic and may benefit from a trial of clomipramine. In the remaining 86% there was further scope for increasing biological therapy.
Relatively few of our patients were having maximal SSRI treatment and an antipsychotic, despite guideline recommendations.
There is plenty of leeway for the escalation of patients’ biological therapy. Given the number of patients currently receiving secondary care, an escalation of their treatment should result in better patient health and a subsequent increase in discharges.
Prescribing Observatory for Mental Health (POMH-UK) runs national audit-based quality improvement programmes open to all specialist mental health services in the UK to help improve prescribing practice in discrete areas.
The baseline sample and this re-audit represent the largest audits of antipsychotic prescribing in PWLD that have been conducted to date; and thus provide the most generalisable picture of such prescribing nationally.
A case note audit of use of antipsychotic medication in PWLD was conducted using standard data collection tool provided by POMH-UK. Trust wide, 7 clinical teams in Essex and Bedfordshire & Luton, participated in the re-audit. Analysis and benchmarking was conducted centrally by POMH-UK and an individualised Trust report was compiled by POMH-UK for local review and consideration.
The indication for treatment with antipsychotic medication should be documented in the clinical records (Deb 2006). The continuing need for antipsychotic medication should be reviewed at least once a year (Deb 2006). Side effects of antipsychotic medication should be reviewed at least once a year. This review should include assessment for the presence of extrapyramidal side effects (EPS), and screening for the 4 aspects of the metabolic syndrome: obesity, hypertension, impaired glucose tolerance and dyslipidaemia (NICE schizophrenia guideline update CG82, 2009).
Out of three standards measured, Standard One maintained 100% throughout the baseline and re-audit and Standard Two achieved over 90% throughout baseline and re-audit. Standard 3 has improved from baseline to re-audit. Overall, there has been clear improvement in all 3 standards from baseline audit.
Reduced n-3 and n-6 polyunsaturated fatty acids (PUFAs) content in red blood cell (RBC) membranes and abnormal membrane phospholipid metabolism were repeatedly implicated in the etiology of schizophrenia.
Prenatal and perinatal depletion of PUFAs interferes with normal brain development and function. The lack of docosahexaenoic acid - DHA in the brain is reflected in lower membrane DHA/AA (AA - arachidonic acid) ratio, increased activity of AA-metabolizing enzymes, and disturbance of downstream metabolic pathways involved in signaling, growth modulation, brain glucose uptake, immune functions, neurotransmission, synaptogenesis and neurogenesis. Preliminary high-throughput metabolomic studies revealed abnormal biochemical profile in patients with schizophrenia or brief psychotic disorder when compared to healthy controls. The results of both metabolomic and proteomic studies pointed to energy metabolism and lipid biosynthesis being impaired in schizophrenia. The usefulness of antipsychotic medication and supplementation with PUFAs in reverting to the normal metabolic state has been suggested in early treatment of the first psychotic episode. Abnormalities of phospholipid metabolism can be also detected as attenuated niacin skin flush response in the variety of neuropsychiatric disorders.
Disturbances of lipid homeostasis could represent biochemical markers in the preclinical phase of neuropsychiatric illnesses and could serve as triggers in genetically vulnerable individuals. The assessment of patients' lipid status may also help in monitoring the course of the disease and treatment response. In this regard, simple, cheap and fast niacin skin flush test might be valuable. It might help in diagnosis of adolescents and young adults with psychotic behaviour, or in defining the necessity for long-term antipsychotic therapy. Along with antipsychotic medication schizophrenic patients need specific medical nutrition therapies.
Suicides and induced abortions are primarily both premature deaths. Standardized death rates often show the certain level of medical standards in the different countries. The aim of this paper was to determine suicide rates in Croatia and its neighbouring countries (Hungary, Slovenia and Italy) associated with induced abortions and standardized death rates Method: It was a register linkage study. Information on suicides of women in Croatia, Hungary, Slovenia and Italy were linked with induced abortions and standardized death rates in these countries. Nationwide data in Croatia, Hungary, Slovenia and Italy in the period 1996-2002 i.e. the latest available data for each county was used.
There were suicide rates in women: Croatia (2000)-10.3, Hungary (1999)-15.4, Slovenia (1999)-13.4 and Italy (1998)-3.6. There were induced abortions (% of live born children): Croatia (2002)-17.8, Hungary (2002)-69.7, Slovenia (2002)-49.6 and Italy (2002)-24.0. There were standardized death rates (1/10.000 population): Croatia (1998)-113.8, Hungary (1996)-109.3, Slovenia (1996)-109.3 and Italy (1996)-70.7.
The Croatian suicide rate and induced abortions have been lower than in Hungary and Slovenia. Croatia has been at the last place according to induced abortions but Croatia has been at the first place due to standardized death rates.
The purpose of the present study was to determine which aspects of motivational, cognitive and emotional functioning were impaired in a group of alcoholics after 8 weeks of abstinence. We also examined the clinical applicability of the BIS/BAS Scales (Carver & White 1994) used in order to identify a potential association between behavioural inhibition / activation tendencies and emotional and cognitive deficits in alcohol abstainers.
33 right- handed middle- aged (mean age 45.0 years) male alcohol inpatients in treatment and 36 healthy volunteers without a previous drinking history, matched for age, education and handedness participated in the study. Both groups were assessed with the composite of tests in the following domains: motivation, attention, emotional processing, visuospatial functioning and working memory.
Alcohol abstainers revealed heightened BAS sensitivity, more pronounced depressive symptoms and attentional deficits compared to controls, while working memory and visuospatial abilities did not significantly differ between the groups. Elevated BAS sensitivity correlated with the length of abstinence, whereas BIS sensitivity associated with the presence of suicidal history and with selective attention difficulties.
Our research confirmed several previous studies that some cognitive and visuospatial deficits could improve during alcohol abstinence, while motivational tendencies, attentional and emotional functioning take longer to recover. Application of the BIS/BAS Scales proved a useful instrument for assessment of the alcohol abstainers' rehabilitation process. In this regard, when planning treatment programmes for alcoholics, approach and withdrawal motivational tendencies, neuropsychological dysfunctions and psychiatric comorbidity should be considered.
There are many evidences of co-morbidity influence on alcohol dependency treatment outcome. We were interested in the question 'Do alcohol dependent patients with different co-occurring mental and medical conditions significantly differ in subjective attributes of well-being and in abstinence rate two years after the end of intensive alcohol dependency treatment'.
222 ex - patients participated in the research 24 months after the end of intensive alcohol dependency treatment, 74% of them males (mean age = 46.17, SD = 8.79) and 26% females (mean age = 46.35, SD = 8.10).
No significant differences were found in any dependent variable regarding any independent variable in "presence of any somatic diagnose" (yes/no) and "personality disorders". "Depressive vs. non depressive" differed significantly only in the evaluation of important interpersonal relations, while "anxious vs. non - anxious" and "benzodiazepine dependent vs. nondependent" significantly differed in all self - evaluations, except in evaluation of important interpersonal relations. No significant differences were found between (non)abstinents regarding any of six categories of mental disorder and medical conditions (yes/no) and no significant differences were found in any self - evaluation regarding the participation in different kinds of after-care. A greater number of patients continued to abstain from alcohol if they continued in aftercare 24 months after the end of intensive treatment.
Patients with different somatic and mental co-occurring disorders did not differ in abstinence rate. However, membership in after-care 24 months after the end of intensive therapy significantly contributed to the abstinence rate. Abstinence was found to be connected with more positive self-evaluation. Patients with somatic co-occurring diagnoses tended to have more positive self-perceptions than patients with co-occurring mental disorders.
The psychosomatic department is the first institution of this kind in Upper-Austria. Our intention is to present a competence center for the treatment of mind and body. In interdisciplinary co-operation we want to create a field of learning based on the bio-psycho-social model of disease, which provides a possibility for patients to improve their quality of life and therefore helps to soothe the symptoms of illness or to avoid its worsening.
Our aim was to investigate is there association between level of religious moral beliefs and severity of PTSD symptoms, depressiion symptoms, anxiety and severity of alcohol abuse we tested 152 war veterans on presence of PTSD, depression symptoms, anxiety, alcohol misuse and level of religious moral beliefs.
We used Harvard trauma questionnaire (HTQ), Hopkins Check Scale SBCL 25, check list for alcohol misuse MAST. Subjects were assessed with regard to the level of belief in some basic ethical principles that arise from religious moral values. The score of religious moral belief index was used to correlate with severity of PTSD symptoms, depression symptoms, anxiety and severity of alcohol misuse.
Mean age of tested subjects was 40.8 (SD=6.6) years. The score of the moral belief index was negatively correlated to PTSD symptom severity and depressiveness (Pearson's r=-0.325, p<0.001; r=-0.247, p=0.005, respectively). Besides that the score of moral belief index negatively correlated with presented anxiety (Pearson's r=-0.199,p=0.026). Related to severity of tobacco and alcohol misuse we found negative association of these with the moral belief index (Pearson's r=-0.227, p=0.011; r=-0.371, p<0.001, respectively).
A higher index of religious moral beliefs in war veterans enables better control distress, providing better mental health stability. It enables post traumatic conflicts typical for combatants' survivors to be more easily overcome. It also causes healthier reactions to external stimuli. A higher index of religious moral beliefs of war veterans provides a healthier and more efficient mechanism of tobacco and alcohol misuse control. In this way, it helps overcoming postwar psychosocial problems and socialization of the personality, leading to the improvement in mental health.
Violence is what the victims experience as violence. Only they are able to measure what oppression, injury, pain or sexual violence can cause. Violence starts where human beings are constrained, humiliated, abjected and injured in their self-determination by other human beings. The experienced violence causes a trauma in most cases and in many cases also a PTSD. As a lot of epidemiological studies have affirmed, the highest lifetime-prevalence of PTSD appears after one respectively after a repeated act of sexual violence.It is important to define the circumstances of the action, by defining three fields of violence: domestic sexual violence, sexual violence in civil everyday life respectively violence, that occurs not inside families and sexual violence in wartime.Victims of all fields of violence can be found in Western Europe, the last mentioned form of violence predominant among refugees, but also among survivors of the last world war.
The Psychiatric emergency clinic (PEC) was established at University Psychiatric Hospital Ljubljana in 2004. 2760 patients were examined in the PEC until the end of May 2004.
We have gathered data from medical documentation about the patient's age, suicidal behaviour, pharmacotherapy and psychoactive substances misuse. We compared patients with substance misuse and patients without substance misuse regarding suicidal behaviour and prescribed psychopharmacotherapy.
There was a significant difference in suicidal behaviour between the group of those, who abused PAS (n=497) and those who did not (35.4% vs. 28.0%, N = 1753, Pearson Chi-Square Test, p<0.001). More patients who abused PAS attempted suicide (9.5% vs. 3.5%, N = 2760, Fisher's Exact Test, p < 0.001). However, we have not observed a difference between the groups regarding suicidal threats and thoughts (17.2% vs. 18.0%, N = 2592, Fisher's exact test, p = NS). The subgroup of patients with PAS abuse have been prescribed pharmacotherapy more often than others (19.4% vs. 11.4%, N = 2592, Fisher's Exact Test, p < 0.001). Our data is in accordance with previous observations that PAS abuse is a risk factor for suicidal behaviour.
Our aim was to evaluate domestic violence among nurses in eastern Turkey.
Ninety six (96) female nurses with an intimate partner were enrolled. Modified form of Abuse Assessment Screen Questionnaire was used.
Twenty two (22.7%) of the participants reported domestic violence. None of them took legal steps. Most frequent domestic violence type was economic abuse (46%). Nurses, whose mothers were exposed to domestic violence, had significantly higher abuse rates. The abused group had also significantly higher smoking and miscarriage rates.
Nurses need to be well informed for taking legal steps in case of domestic violence. Family history, smoking status and abortion rates may be further research focus for risk factors of domestic violence. Legal interventions should be optimized in order to encourage the victims to take legal steps.
The educational process brings a considerable amount of stress to medical students that can influence mental health status and contribute to further professional burnout. The authors assessed the academic stress influences, mental health status and burnout syndrome, with the intent to find different patterns in female and male medical students.
The applied cross sectional study was in the form of an anonymous questionnaire which included: socio-demographic data, self-reported health status and influence of studying activities on stress level in 755 medical students who attended two final years. Mental health status was explored by the General Health Questionnaire (GHQ-12), and Maslach Burnout Inventory (MBI).
Female students assessed their physical health status and general stress level as worse compared to males (p<0.001). Exams were described as a high stressor in about 50% of all examined students. However, this stressor was significantly more frequent in female students (p<0.001). Female students frequently declared high stressful effects of contacts with patients (p=0.009) and autopsy (p<0.001). The scores of the GHQ-12 questionnaire were above the threshold or high in 51.5% of all students, and also significantly higher in females (p=0.001). High scores were found among 52.6% of all examined students on MBI subscale of Depersonalization, and 33.6% on MBI subscale of Emotional exhaustion without gender difference.
Measures for prevention of academic distress should be targeted at optimization of the educational process, development of the clinical skills and professionalism, with special concern to female students who manifested high vulnerability.
Psychiatry is in the midst of the paradigm shift. The new field called theoretical psychiatry is fundamental for further scientific and professional maturation of psychiatry at the twenty first century. The cross disciplinary interactions and transdisciplinary systems approach are of great importance in science and the paradigm shift.
Suicide is a major health concern. Effective acute interventions are lacking. Recent studies have suggested an acute decrease of suicidal ideations following repetitive Transcranial Magnetic Stimulation (rTMS). However, placebo effects could not be excluded. We aimed to evaluate the acute effect of accelerated intermittent theta burst stimulation (TBS) on suicide risk in depression.
In 12 suicidal therapy-resistant depressed patients accelerated intermittent TBS was delivered on the left dorsolateral prefrontal cortex in a randomized, sham-controlled cross-over fashion. Patients received 20 sessions spread over 4 days. The change in severity of suicidal ideation was measured by the Beck Scale of Suicidal Ideation (SSI) before and after treatment.
We found a significant decrease of SSI score over time; unrelated to active or sham stimulation. Furthermore, the attenuation of suicidal thinking was not merely related to depression severity changes caused by TBS.
Accelerated TBS treatment in depressed suicidal patients was found to be safe and well tolerated and may have the potential to acutely decrease suicidal ideations. However, the efficacy compared to sham has not yet been proven and further sham-controlled research including longer follow-up is needed to substantiate these preliminary findings.
Vehicle accidents are a common cause of disease and death among people over 30 years of age. Essentially, reaction to stress due to the vehicle accident does not differ from the reaction to other stress factors. There are still no uniform viewpoints about the kind of sequels and their percentage representation after vehicle accidents.
The research was provided as a prospective study, included 150 subjects who had vehicle accident minimum 2 years prior to the examination. A questionnaire adjusted to the needs of the research and a battery of psychological tests was used.
Affective disorders occurred in 35.33% of subjects, 65% of persons suffer from travel anxiety, 9% of the total number of examinees doesn't drive any more, 65% have somatisational dysfunctions of the vegetative nervous system, while the posttraumatic stress disorder is present in 36% of subjects.
In 87.4% of persons psychiatric consequences last over two years. Long term consequences in 60% of subjects occur as a combination of multiple psychiatric disorders, so the posttraumatic stress disorder and affective disorders never occur one at a time.