Improving treatment of patients with psychosis in low-and-middle-income countries in Southeast Europe: Results from a hybrid effectiveness-implementation, pragmatic, cluster-randomized clinical trial (IMPULSE).

BACKGROUND: In Southeast Europe (SEE) standard treatment of patients with psychosis is largely based on pharmacotherapy with psychosocial interventions rarely available. DIALOG+ is a digital psychosocial intervention designed to make routine care therapeutically effective. This trial simultaneously examined effectiveness of DIALOG+ versus standard care on clinical and social outcomes (Aim 1) and explored intervention fidelity (Aim 2). METHODS: A hybrid type II effectiveness-implementation, cluster-randomized trial was conducted in five SEE countries: Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia, and Serbia. The intervention was offered to patients six times across 12 months instead of routine care. The outcomes were subjective quality of life (primary), clinical symptoms, satisfaction with services, and economic costs. Intervention fidelity was operationalized as adherence to the protocol in terms of frequency, duration, content, and coverage. Data were analyzed using multilevel regression. RESULTS: A total of 81 clinicians and 468 patients with psychosis were randomized to DIALOG+ or standard care. The intervention was delivered with high fidelity. The average number of delivered sessions was 5.5 (SD = 2.3) across 12 months. Patients in the intervention arm had better quality of life (MANSA) at 6 months (p = 0.03). No difference was found for other outcomes at 6 months. Due to disruptions caused by the COVID-19 pandemic, 12-month data were not interpretable. CONCLUSIONS: DIALOG+ improved subjective quality of life of individuals with psychosis at 6 months (after four sessions), albeit with small effect size. The intervention has the potential to contribute to holistic care of patients with psychosis.

Old age mental health services in Southern Balkans: Features, geospatial distribution, current needs, and future perspectives.

BACKGROUND: Healthcare services are increasingly confronted with challenges related to old age mental disorders. The survey aimed to provide an overview of existing psychogeriatric services in Albania, Bulgaria, Greece, and North Macedonia. METHODS: After identification of psychogeriatric units across the four countries, their head physicians were asked to provide data on their clinical, teaching, and research activity, as well as staff composition. Moreover, the attitudes of head physicians to current needs and future service development were explored. RESULTS: A total of 15 psychogeriatric units were identified (3 in Bulgaria, 8 in Greece, and 4 in North Macedonia). Results show wide variation regarding the location, team size and composition, service availability, numbers of patients attending, and inpatient treatment length. Most head physicians underscored the urgent need for breakthroughs in the graduate and postgraduate education in psychogeriatrics of medical and nonmedical professionals, as well as in the interconnection of their units with community primary healthcare services and long-term care facilities for seniors via telemedicine. They would welcome the development of national standards for psychogeriatric units, potentially embodying clear pointers for action. A number of head physicians advocated the development of nationwide old age mental health registries. CONCLUSIONS: Regional disparities in resources and services for seniors' mental health services were unveiled. These data may enrich the dialogue on optimizing psychogeriatric services through planning future cross-border collaborations mainly based on telemedicine services, especially in the era of the novel coronavirus pandemic, and training/education in psychogeriatrics of mental health professionals.

Are there any gender differences in the QEEG power spectrum in patients with schizophrenia?

UNLABELLED: The aim of the study was to investigate the gender differences in patients with schizophrenia in age of onset, other demographic and clinical characteristics and their relationship with QEEG power spectrum measures. MATERIAL AND METHODS: Thirty patients with schizophrenia were enrolled in the study, 17 female and 13 male, mean age 34 years. Comprehensive assessment of the symptoms of schizophrenia was performed using PANSS (Positive and Negative Syndrome Scale), BPRS (Brief Psychiatric Rating Scale) and CGI (Clinical Global Impression) scale. The age of onset of schizophrenia and the duration of psychosis was assessed using the medical history and parts of the IRAOS (Interview for Retrospective Assessment of Onset of Schizophrenia). RESULTS: Female patients had more severe psychopathology with statistically significant differences in PANSS and BPRS scores (larger total scores) and on the positive subscale of PANSS. QEEG power spectrum showed statistical significant difference only for the beta band in female patients. Women were less employed and had longer duration of illness and previous treatment. There were no differences in the mean age of onset of the disease (26 years in male and 25 years in female patients) and in the familiar occurrence. CONCLUSION: Fast basic activity in beta bands was associated with female patients with schizophrenia who presented more severe psychopathology and had longer duration of the disease and previous treatment. Considering the relatively small sample the current results must be replicated with a larger group of subjects to confirm the findings.

Personal and social functioning in patients with schizophrenia.

AIM OF THE PAPER: To monitor personal and social functioning in patients with schizophrenia and to find out the difference regarding sociodemographic characteristics and out-patient or day hospital treatment. MATERIAL AND METHODS: The investigation included 120 subjects divided into two groups of 60 patients each with a diagnosis F20 according to MKD 10 criteria. Patients from the first group received out-patient care whereas those from the second group had day hospital treatment. Patients were of different age and gender, receiving regular antipsychotic therapy. They were included in individual and group psychosocial therapeutic procedures during the day hospital treatment. The investigation utilized the following diagnostic instruments: standardized clinical interview and PSP scale, Personal and social performance scale, Morosini, Magliano et al. 2000, and a non-standardized questionnaire of sociodemographic data, family support and existence of mental disorder in other family members. RESULTS: The results obtained have shown better personal and social functioning in patients who had family support, in those who are employed, in those with no mental disorder in other family members and in patients on day hospital treatment as opposed to patients receiving out-patient care. CONCLUSION: Day hospital psychosocial therapeutic treatment in combination with regular antipsychotic therapy, family and social support helps in more rapid reintegration and resocialization and a better quality of life in patients with schizophrenia.

Child and adolescent mental health emergency services in Macedonia.

This paper describes the development of child and adolescent mental health emergency services in Macedonia since 1993. The evolution of services through the Mental Crisis Centre for Children and Adolescents, funded by the Open Society Institute, and located in six cities is outlined. The paper also defines traditional services, the nature of child mental health emergencies, the evaluation process, follow-up care and training and supervision. It concludes with concern that the mental health emergency system is not sufficient to meet the needs of the child and adolescent population, particularly in the face of the Kosovar refugee crisis. Recommendations for the future are made.