Effects of financial precariousness on mental health.

BACKGROUND: The physical and mental health of a population is based, in particular, on its quality of life and its access to health care. Given these determinants, Greece's population has greatly suffered due to the sharp cuts in the budget for social benefits and health care (some measurable evidence is the recent increase in the suicide rate). Starting January, the 1st of 2015, unemployment benefits in Belgium have been eliminated for all recipients who do not have a full-time year of work over the last three years. Therefore, we must ask whether there will be similar psycho-medical consequences for Belgium's population. SUBJECTS AND METHODS: Open study over a year (01/07/14 - 30/06/15) of emergencies admitted to the University Hospital Center of Mont-Godinne including a psychopathological motif. In addition to general socio-demographic data, psychic disorders are measured, as well as different types of crises (familial, professional or couple crisis), familial support and its dynamic (FACES III of Olson) and finally social integration (social isolation scale from the National Social Life, Health, and Aging Project (NSHAP)). These patients are compared with those admitted during the six months preceding the Act modifying the unemployment benefits. RESULTS: Between July the 1st of 2014 and June the 30th of 2015, we saw an increase in the number of admissions to the psychiatric emergency department by 2.5% in six months, despite a decrease in the number of admissions to all-cause emergencies. Our study also shows a degradation of social network quality characterized by a more pronounced social isolation of our patients. At last, an alteration of cohesion in the patient's origin family was highlighted. CONCLUSION: Although we cannot establish a direct causal link between this law and the results of this study, these may suggest a weakening of the population mental health due to difficult socio-economic context. As a result, we are faced not only with a public health problem but also with one concerning health care organization.

Liaison psychiatry and bariatric surgery: double standards. What are the possibilities for the systematization of the pre-operative psychiatric assessment in Belgium?

BACKGROUND: In the context of health care in Belgium, the psychological or psychiatric opinion of a multidisciplinary team is required in the assessment of bariatric surgery candidates. In clinical practice, a wide variety of liaison psychiatry assessment methods exist. SUBJECTS AND METHODS: On the basis of a post-operative psychiatric comorbidity case report and a literature review on "liaison psychiatry and bariatric surgery" we aim to identify opportunities for the systematization of bariatric pre-surgery psychiatric evaluation. RESULTS: The bariatric pre-surgery evaluation must be rigorous and founded on evidence-based medicine. On this basis, specific psychiatric criteria may be defined and researched in assessments. The issue remains for psychiatric comorbidities that develop after surgery and for which a preventive framework should be sustained in the liaison psychiatry approach. CONCLUSIONS: The aim of the research is to support an improved systematization of the psychological assessments of pre-operative bariatric surgery candidates. We believe that systematic evaluation tools should be defined for the identification of possible absolute or relative contra-indications and that a preventive approach to post-operative psychiatric disorders should be included in this assessment.

Review of disparities in the mental health care of ethnic minority patients.

BACKGROUND: Due to demographic changes, Western societies are increasingly multicultural and diverse. These changes lead to the issue of the equity of care for all groups of society, particularly for ethnic minorities. Within the context of medicine, it has been proven that doctors are sensitive to patient ethnicity, and that this in turn affects doctors' decision-making and the quality of their relationship with the patient. This leads to reduced access and quality of care for ethnic minority patients, which in turn magnifies ethnic inequalities in health care. Little is known about the extent of this issue within the specific field of mental health care. METHODS: We conducted a literature search within three online databases, focusing on two main questions: (I) What are the main types of disparity observed in the provision of mental health care for ethnic minority patients? and (II) How do mental health care providers contribute to disparities in the mental health status of ethnic minority patients? RESULTS: We identified a total of 164 articles relevant to our research questions, published between 1989 and 2013. Of these, only 29 were retained. The main findings are summarised in this paper. CONCLUSION: Mental health care providers should be constantly aware of potential bias due to patient ethnicity and of the potential impact of this bias on the process of care if they want to act in the best interests of patients and avoid contributing to mental health disparities. The contribution of mental health care providers to these disparities is only one aspect of this complex social issue.

Assessment and treatment of the risk of psychosis in adolescents--a review.

BACKGROUND: When psychosis first presents, and particularly in the case of schizophrenia, the guidelines recommend rapid institution of treatment with atypical antipsychotics. Two different clinical pictures can be observed: psychoses with acute onset and those with insidious onset. Acute cases (60% of the total) have a favourable course in 85% of young patients but where onset is insidious and the symptoms are predominantly negative, the course is poor in 25% of subjects. Since acute symptoms are relatively easy to diagnose, it is diagnosis of the 'insidious/negative' cases that represents a major challenge. Is such a diagnosis possible yet? How can we limit the number of false negatives and false positives with the attendant risk of stigma? What treatment should be administered? METHODS: Review of the literature (PubMed, PsycARTICLES, PsycINFO) and comparison with clinical practice here. RESULTS: Young people with a high risk of developing psychosis can be identified using scales such as SOPS (Scale of Prodromal Symptoms), PACE (Personal Assessment and Crisis Evaluation) or from the presence of neuroanatomical and genetic characteristics. Unfortunately, these tools are more specific for positive symptoms, and therefore identify a sub-population of young people at risk: those at Ultra-High Risk (UHR). It can be argued that effective treatment is available for these UHR young people to prevent the condition from developing into schizophrenia. On the other hand, the problem persists for young people presenting an insidious onset and predominantly negative symptoms: to date we have no real way of either screening them or assessing the efficacy of a treatment. CONCLUSION: "Ultra-High Risk" patients are starting to represent a separate nosological entity. This entity is made up of young patients, most of whom have positive symptoms. If left untreated, the course will lead to seriously compromised social and psychological functioning. Rapid diagnosis and treatment for UHRs is therefore essential. In the future we need to refine our diagnostic tools to make them sufficiently specific and sensitive but also so that the widest category of "Risk Syndrome for Psychosis" includes young patients with mostly negative symptoms.

Predictability of levels of physical and mental health in adults and adolescents: a 2 years longitudinal study.

BACKGROUND: Comparative study at two years between adults and adolescents aimed at identifying the social, family, personality traits and health locus of control factors influencing physical and mental health, consumption of medications, and frequency of medical consultations. METHOD: Twenty participants (10 adults and 10 adolescents) were included in a two years long longitudinal study. At baseline, participants' age, gender, family composition, net income, chronic treatments, family dynamics (Family Adaptation and Cohesion Scale), Multidimensional Health Locus of Control, and personality (NEO Personality Inventory) were recorded. Every six months their state of mental and physical health (12 Survey Factors and Hamilton Depression Scale), consumption of medications and number of medical consultations were reassessed. RESULTS: Age has a deleterious effect not only on physical health (r=-0.628*) but also on the frequency of depressive symptoms (r=0.576*). Adults are protected against the above effect by the number of people living in the same household (r=-0.588*). The ideal family or couple is more important than the actual family or couple. The higher these ideals, the healthier the adults (r=0.738*), and the less teenagers go to the doctors (r=-0.648*). Among adults, independence from others is correlated with good mental health (r=-0.829**) and among teens, ability to manage their wishes is positively correlated with good mental health (r=0.718**). CONCLUSION: Although different mechanisms determine adolescents and adults' levels of health, other common mechanisms involved include age and the need for love. The older we grow, the more our health tends to deteriorate; the more we dream of love, the more it improves. The differences depend on the place that is left to others. Among teenagers, the first factor pertains to how well they manage their own desires; among adults, what matters most is independence from others.