Development of quality indicators for mental healthcare in the Danube region.

BACKGROUND: Quality indicators are quality assurance instruments for the evaluation of mental healthcare systems. Quality indicators can be used to measure the effectiveness of mental healthcare structure and process reforms. This project aims to develop quality indicators for mental healthcare systems in Bulgaria, the Czech Republic, Hungary and Serbia to provide monitoring instruments for the transformation of mental healthcare systems in these countries. METHODS: Quality indicators for mental healthcare systems were developed in a systematic, multidisciplinary approach. A systematic literature study was conducted to identify quality indicators that are used internationally in mental healthcare. Retrieved quality indicators were systematically selected by means of defined inclusion and exclusion criteria. Quality indicators were subsequently rated in a two-stage Delphi study for relevance, validity and feasibility (data availability and data collection effort). The Delphi panel included 22 individuals in the first round, and 18 individuals in the second and final round. RESULTS: Overall, mental healthcare quality indicators were rated higher in relevance than in validity (Mean relevance=7.6, SD=0.8; Mean validity=7.1, SD=0.7). There was no statistically significant difference in scores between the four countries for relevance (X2 (3)=3.581, p=0.310) and validity (X2 (3)=1.145, p=0.766). For data availability, the appraisal of "YES" (data are available) ranged from 6% for "assisted housing" to 94% for "total beds for mental healthcare per 100,000 population" and "availability of mental health service facilities". CONCLUSION: Quality indicators were developed in a systematic and multidisciplinary development process. There was a broad consensus among mental healthcare experts from the participating countries in terms of relevance and validity of the proposed quality indicators. In a next step, the feasibility of these twenty-two indicators will be evaluated in a pilot study in the participating countries.

[Assessment of health related quality of life among epileptic patients in the context of coping strategies and subjective disease perception]. / Epilepsziás betegek életminoség-vizsgálata a megküzdési stratégiákkal és a betegségészleléssel összefüggésben.

BACKGROUND AND PURPOSE: Psychosocial condition and life quality of epileptic patients are greatly determined by the existence of the disease-related comorbid disorders, like depression, anxiety, and the subjective disease perception, as well as the neuropsychological consequences of the seizures.It has been examined in patients living with epilepsy how subjective disease perception and coping strategies influence life quality, comorbid depression and the condition of anxiety. METHODS: Study patients were asked to fill in a self-completion questionnaire, which examined their psychosocial condition (HADS, Beck Depression Scale), life quality (Qolie-31), coping strategies (FKV-LIS), and subjective disease perception (IPQ-R), as well as sociodemographic and disease variables. The subjects of the study: the data of epileptic patients between the age of 18 to 70 was recorded. Patients were selected from the adult outpatients of a national centre, a regional hospital and two private health care centres located in Budapest. RESULTS: Based on the multiple regression analysis. Beck's depression (b coefficient=-0.351, t=-4.703, p<0.001**). Depressive coping strategy (FKV Dep) (b coefficient = -0.235, t=-3.123, p=0.002**). Subjective health perception (b coefficient =0.232. t=3.643, p<0.001**). Sex (women; b coefficient =-0.162, t=-3.008, p=0.003**). IPQ consequences (b coefficient =-0.161, t=-2.572, p=0.012*). Active coping strategy (FKV Act; b coefficient =0.146, t=2.572, p=0.012*). Type of seizure (b coefficient =-0.138, t=-2.527, p=0.013*), and Sleep quality (b coefficient =-0.125, t=-1.995, p=0.049) explain some 75.6% of the variance of life quality's total score (model3: F=33.333, p<0.001**. adjusted R2=0.733). CONCLUSION: Among the factors of the subjective disease perception (IPQ-R), the physical, mental and social consequences play the most important role. Similarly, the impact of negative emotional representation, as well as the erratic nature of the seizures are decisive. Emotional representation, cyclicity and disease coherence have an important role in coping with disease-related negative emotions.

[Patient Journey in Schizophrenia - Lessons of a Hungarian Survey].

The disorder-related experiences of schizophrenic patients are an important basis for personalized treatment. This illness experience is now described with the concept of patient journey. The patient journey shows how the symptoms and treatment interfere with the patient's personal existence and how they affect the optimal functionality. The purpose of our research was to map the patient journey in Hungary, among patients with schizophrenia, in particular how they represent their illness, what kind of met and unmet needs they have in relation to living with the disorder or their treatment. 155 patients living with schizophrenia participated in the study. The survey was conducted through self-completed questionnaires covering the following topics: first encounter with the disorder, life with the disorder, treatment expectations, experiences, support and needs. The first encounter of the patients with the disease was predominantly traumatizing, and the refusal of the diagnosis was characteristic. The inappropriate information on the disorder and the treatment might have been also responsible for this negative perception. Nevertheless, patients were expecting the information primarily from the treatment staff. The decisive majority expects from treatment the possibility of a normal life, the maintenance of stability, and according to every second patient well-being is also a basic requirement. Three-quarters of the patients think that effective medication and treatment staff are the greatest help in relation to the disorder. A significant proportion of the patients formulated the need for psychic and family support, and the need for social relations. Patients with schizophrenia have significant difficulties with financial problems, medication side effects, and stigma. Our results confirm that the subjective perception of patient journey of patients with schizophrenia is significantly determined by the met and unmet needs. The results also emphasize the importance of adequate information transfer and the therapeutic relationship.

Factors affecting quality of life in Hungarian adults with epilepsy: A comparison of four psychiatric instruments.

PURPOSE: We investigated the impact of 19 factors on life quality in Hungarian patients with epilepsy. Wellbeing was evaluated by several inventories to investigate the impact of factors in more detail. METHODS: A cross-sectional study was performed in 170 patients. Wellbeing was evaluated with the WHO-5 Well-being Index (WHOQOL-5), Diener Satisfaction with Life Scale (SwLS), and the Quality of Life in Epilepsy-31 Questionnaire (Qolie-31). We investigated their association with demographic characteristics, general health status, epilepsy, and its treatment. The impact of these factors on illness perception (Illness Perception Questionnaire, IPQ) was also studied. RESULTS: The four measures correlated highly significantly. In addition, the predictive power of factors was comparable with the four inventories as evaluated by Multiple Regression. Factors explained 52%, 41%, 63% and 46% in the variance of WHOQOL-5, SwLS, Qolie-31, and IPQ scores, respectively. However, associations with particular factors were instrument-specific. The WHOQOL-5 was associated with factors indicative of general health. SwLS scores were associated with health-related and several demographic factors. Neither showed associations with epilepsy-related factors. All four categories of factors were associated with Qolie-31 and IPQ scores. Factors had an additive impact on IPQ, but not on Qolie-31. SIGNIFICANCE: Our findings reveal interactions between the method of life quality assessment and the factors that are identified as influencing life quality. This appears to be the first study that analyses the factors that influence illness perception in epilepsy patients, and suggests that the IPQ may become a valuable tool in epilepsy research.

[Recognition, care and prevention of suicidal behaviour in adults].

Suicide is a major public health problem everywhere in the world and in the WHO European Region suicide accounts for over 120,000 deaths per year. 1. Recognition and diagnosis: An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. 2. Treatment and care: Acute intervention should start immediately in order to keep the patient alive. Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (including dialectical behavior therapy and problem-solving therapy) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant and mood stabilizer treatments decrease the risk for suicidality among responders in mood disorder patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be very effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. 3. Family and social support: The suicidal person should always be motivated to involve family in the treatment. Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks. 4. SAFETY: A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. 5. Education of treatment team: Training of general practitioners is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals. Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. 6. Public aspects: Not only the health care workers are responsible for suicide prevention. All members of our society (including community/political leaders as well as religious and civil organizations) have their own task with more or less competence and responsibility.

Training in psychiatry throughout Europe.

Psychiatry is the largest medical specialty in Europe. Despite efforts to bring harmonisation, training in psychiatry in Europe continues to be very diverse. The Union Européenne des Médecins Spécialistes (UEMS) has issued as from 2000 a charter of requirements for the training in psychiatry with an additional European Framework for Competencies in Psychiatry in 2009. Yet these have not been implemented throughout Europe. In this paper, the diversity in training throughout Europe is approached from different angles: the cultural differences between countries with regards to how mental health care is considered and founded on, the cultural differences between people throughout Europe in all states. The position of psychotherapy is emphasised. What once was the cornerstone of psychiatry as medical specialty seems to have become a neglected area. Seeing the patient with mental health problems within his cultural context is important, but considering him within his family context. The purpose of any training is enabling the trainee to gain the knowledge and acquire the competencies necessary to become a well-equipped professional is the subject of the last paragraph in which trainees consider their position and early career psychiatrists look back to see whether what they were trained in matches with what they need in the working situation. Common standard for training and certification are a necessity within Europe, for the benefit of the profession of psychiatrist but also for patient safety. UEMS is advised to join forces with the Council of National Psychiatric Associations (NPAs) within the EPA and trainings and early career psychiatrist, to discuss with the users what standards should be implemented in all European countries and how a European board examination could ensure professional quality of psychiatrists throughout the continent.

[Relation between adverse childhood experiences and problematic alcohol consumption in adulthood]. / Az ártalmas gyermekkori élmények és a felnottkori alkoholfüggoség közötti összefüggések.

Alcohol use disorder and its consequences are a major public health problem not only worldwide, but in Hungary as well. The problem is aggravated by the low rate of admission to treatment, and by the high dropout rate of the treatment prior to its completion date. The relapse rate is also high, up to more than half of the patients are not able to maintain their abstinence following the first few months after their treatment. Although most patients enrolling in the addiction care system are over the age of 35, the causes of alcohol use disorder often stem from early childhood experiences. Long-term traumas in early childhood are significantly associated with somatic and mental health problems later in life such as substance use, including alcohol dependence. The article begins with reviewing the prevalence of alcohol dependence and defining childhood maltreatment and adverse childhood experiences, then discusses the effects and mechanisms of adverse childhood experiences in light of the development of alcohol use disorders in adults and their low treatment rates. The article also aims to raise awareness of the importance of trauma-focused thinking and trauma-informed approaches in the healthcare system and in planning addiction interventions and services. Orv Hetil. 2023; 164(41): 1628-1636.

The future of diagnosis in clinical neurosciences: Comparing multiple sclerosis and schizophrenia.

The ongoing developments of psychiatric classification systems have largely improved reliability of diagnosis, including that of schizophrenia. However, with an unknown pathophysiology and lacking biomarkers, its validity still remains low, requiring further advancements. Research has helped establish multiple sclerosis (MS) as the central nervous system (CNS) disorder with an established pathophysiology, defined biomarkers and therefore good validity and significantly improved treatment options. Before proposing next steps in research that aim to improve the diagnostic process of schizophrenia, it is imperative to recognize its clinical heterogeneity. Indeed, individuals with schizophrenia show high interindividual variability in terms of symptomatic manifestation, response to treatment, course of illness and functional outcomes. There is also a multiplicity of risk factors that contribute to the development of schizophrenia. Moreover, accumulating evidence indicates that several dimensions of psychopathology and risk factors cross current diagnostic categorizations. Schizophrenia shares a number of similarities with MS, which is a demyelinating disease of the CNS. These similarities appear in the context of age of onset, geographical distribution, involvement of immune-inflammatory processes, neurocognitive impairment and various trajectories of illness course. This article provides a critical appraisal of diagnostic process in schizophrenia, taking into consideration advancements that have been made in the diagnosis and management of MS. Based on the comparison between the two disorders, key directions for studies that aim to improve diagnostic process in schizophrenia are formulated. All of them converge on the necessity to deconstruct the psychosis spectrum and adopt dimensional approaches with deep phenotyping to refine current diagnostic boundaries.

Digitalising mental health care: Practical recommendations from the European Psychiatric Association.

The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare providers and policymakers to navigate this rapidly evolving field. We provide an overview of the current scientific and implementation status across two major domains of digitalisation: i) digital mental health interventions and ii) digital phenotyping, discuss the potential of each domain to improve the accessibility and outcomes of mental health services, and highlight current challenges faced by researchers, clinicians, and service users. Furthermore, we make several recommendations meant to foster the widespread adoption of evidence-based digital solutions for mental health care in the member states of the EPA. To realise the vision of a digitalised, patient-centred, and data-driven mental health ecosystem, a number of implementation challenges must be considered and addressed, spanning from human, technical, ethical-legal, and economic barriers. The list of priority areas and action points our expert panel has identified could serve as a playbook for this process.

Improving mental health care in depression: A call for action.

Depressive disorders have one of the highest disability-adjusted life years (DALYs) of all medical conditions, which led the European Psychiatric Association to propose a policy paper, pinpointing their unmet health care and research needs. The first part focuses on what can be currently done to improve the care of patients with depression, and then discuss future trends for research and healthcare. Through the narration of clinical cases, the different points are illustrated. The necessary political framework is formulated, to implement such changes to fundamentally improve psychiatric care. The group of European Psychiatrist Association (EPA) experts insist on the need for (1) increased awareness of mental illness in primary care settings, (2) the development of novel (biological) markers, (3) the rapid implementation of machine learning (supporting diagnostics, prognostics, and therapeutics), (4) the generalized use of electronic devices and apps into everyday treatment, (5) the development of the new generation of treatment options, such as plasticity-promoting agents, and (6) the importance of comprehensive recovery approach. At a political level, the group also proposed four priorities, the need to (1) increase the use of open science, (2) implement reasonable data protection laws, (3) establish ethical electronic health records, and (4) enable better healthcare research and saving resources.

State of psychiatry in Hungary.

Hungary has a tradition both in biological psychiatry and psychotherapy, and for decades developed together with neurology. From the mid 1980s the speed of development of psychiatry started lagging behind expected standards. Psychiatric care, research and teaching were hit hard in 2007 by unprecedented closures of facilities and budget reductions. Although suicide rates have decreased since the mid 1980s, the country has still the second highest rate in the European Union. The high prevalence of alcohol use and the rapidly increasing prevalence of illicit drug use contribute to comorbidity and related behavioural issues, including the increased frequency of severe violent events committed by people with psychiatric disorders, which have not been properly addressed. The country expects the first major restructuring of its healthcare starting in 2012 since the major political changes of 1989/1990. The profession, patients and their caregivers should use this opportunity to modernize psychiatry in Hungary.

Exercise addiction: symptoms, diagnosis, epidemiology, and etiology.

Regular physical activity plays a crucial role in health maintenance and disease prevention. However, excessive exercise has the potential to have adverse effects on both physical and mental health. The scholastic and empirical discussion of excessive physical activity focuses on obsessive and compulsive exercising, and uses several labels. However, in this review, we argue that the most appropriate term for this phenomenon is exercise addiction, emphasizing that excessive physical exercise fits the typical and most common characteristics of behavioral addictions. The aim of this review is to synthesize the current knowledge on symptomology, diagnosis, epidemiology, and etiology of exercise addiction.

[Psychiatric patient: the most vulnerable traveller]. / Pszichiátriai beteg -- a legkiszolgáltatottabb utazó

Authors analyse questions of medical evacuation of the psychotic patient from abroad to homeland. This task can be considered the most difficult problem for the attending physician and the escorting medical team as well. The main challenge is to recognise the psychotic patient in a foreign country with a different health-care system and to overcome the language barrier and the different cultural background. The second issue is to prepare the patients - who are usually in a poor condition - for the medical evacuation by commercial aircraft. Another important issue is to take the patient through the strict security control. All of these (partially unsolved) problems make the mentally ill patient defenceless. Although the repatriation of a mentally ill patient is vital and urgent, travel insurance policy mostly excludes to cover the cost of treatment and repatriation. The high cost of treatment and repatriation of the patient should be paid by the patient or the family, who are often in the position of insolvency. In this paper authors present the history of a patient and give a brief review on travel-related mental disorders, the epidemiology of mental alterations during travel as well as the problems of appropriate evacuation. Authors conclude that there is a need for a better approach of the airport authorities and insurance decision makers to the mentally ill patient travelling abroad.

Significant association between the C(-1019)G functional polymorphism of the HTR1A gene and impulsivity.

Serotonin-1A (5-HT(1A)) receptors are known to play a role in impulsivity-related behavior. The C(-1019)G functional polymorphism (rs6295) has been suggested to regulate the 5-HT(1A) receptor gene (HTR(1A)) expression in presynaptic raphe neurons, namely, increased receptor concentration and reduced neuronal firing could be associated with the G allele. Previous studies indicate that this polymorphism is associated with aggression, suicide, and several psychiatric disorders, yet its association with impulsivity has rarely been investigated. We studied the relationship between impulsivity and the C(-1019)G polymorphism of the HTR(1A) in a population sample of 725 volunteers using the Impulsiveness subscale (IVE-I) of the Eysenck Impulsiveness, Venturesomeness, and Empathy scale and also the Barratt Impulsiveness Scale (BIS-11). Data were analyzed using analysis of variance with age and gender as covariates and Tukey's HSD post-hoc test. Post-hoc analysis revealed that the study had 0.958 power to detect 0.15 effect size. Significant differences between the C(-1019)G genotype groups (GG vs. GC vs. CC) were found. Subjects carrying GG genotype showed significantly higher impulsiveness scores compared to GC or CC carriers for the IVE-I scale (P = 0.014), for the Motor (P = 0.021), Cognitive Impulsiveness (P = 0.002), and for the BIS total score (P = 0.008) but not for the Nonplanning Impulsiveness (P = 0.520) subscale of the BIS-11. Our results suggest the involvement of the HTR(1A) in the continuum phenotype of impulsivity.

[Hungarian psychiatry in the light of the Hungarian Presidency of the Council of the European Union]. / A magyar pszichiátria az Európai Unió Tanácsa Soros Magyar Elnökségének tükrében.

In order to get an accurate picture of mental health and psychiatric care, the article reviews the relevant structures and functioning of the European Union. It examines a few, important professional events that reflect the gaining significance of the issue of mental health within the EU; the 2005 World Health Organization's European Ministerial Conference, the 2008 European Pact for Mental Health and Well-being, and the results of the so-called Thematic Conferences. For the future of the European Union, the articles stresses the crucial need for the continuing research and development, and highlights the benefits of the European Research Region an its framework programmes especially in the fields of brain research and mental health research. The issue of mental health, its care providing system, and the atmosphere of the work place, as the surveying of the Eurobarometer underscored, should be treated as priorities for the EU and during the Hungarian presidency. The programme of the Hungarian Presidency of the Council of the European Union provides priority to the presentation of the European Pact for Mental Health and Well-being to the Council Conclusion, as well as to the organization of a priority research presidential conference on the regions R and D, entitled "Discovery research in neuropsychiatry: depression, anxiety and schizophrenia in focus." The articles emphasizes the challenges of Hungarian psychiatry, first and foremost the difficulties of human resources, the theoretical context and determined perspectives for the establishment of the new National Psychiatry and Addictology Institute, the need of the move towards GP's and community care, and the importance of the cooperation with civil organizations, and scientific information gathering. The given tasks can only be achieved along with the professional development of psychiatry, with a change of perspectives towards EU since a concentrated multi level allocation of resources is only possible in the forms of collaboration between different national and international bodies. Taking advantage of the Hungarian Presidency in order to achieve these goals will influence the future of both the European and Hungarian psychiatry.

Disrupted memory inhibition in schizophrenia.

A feature of schizophrenia is disrupted executive function leading to learning difficulties and memory problems. In two experiments we measured the ability of patients with schizophrenia to suppress irrelevant parts of acquired information by intentional (executive) and autonomic (non-executive) strategies. In the first experiment using directed forgetting by lists patients were found to be unable to intentionally suppress recently acquired episodic memories. In a second experiment using a procedure that induces inhibition automatically schizophrenic patients showed levels of inhibition comparable to those of normal controls. These findings indicate that in schizophrenia memory is most impaired in tasks that load heavily on control or executive processes.

[Exercise addiction: a literature review]. / Testedzésfüggoség: a sportolás mint addikció.

Exercise in appropriate quantity and of proper quality contributes significantly to the preserve our health. On the contrary, excessive exercise may be harmful to health. The term 'exercise addiction' has been gaining increasing recognition to describe the latter phenomenon. The exact definition of exercise addiction and its potential associations with other disorders is still under study, although according to the authors this phenomenon can be primarily described as a behavioral addiction. Accordingly, exercise addiction, among other behavioral and mental disorders, can be well describe within the obsessive-compulsive spectrum suggested by Hollander (1993). There are several tools used to assess exercise addiction. The authors here present the Hungarian version of the Exercise Dependence Scale (Hausenblas és Downs, 2002) and the Exercise Addiction Inventory (Terry, Szabo és Griffiths, 2004). Exercise addiction has many symptoms in common and also shows a high comorbidity with eating disorders and body image disorders. It may be more closely associated with certain sports but more data is needed to demonstrate this specificity with more certainty. Sel-evaluation problems seem to have a central role in the etiology from a psychological aspect. The relevance of neurohormonal mechanisms is less clear. The authors emphasize the importance of further research on exercise addiction. One important question to be answered is if this disorder is an independent entity to be classified as a distinct clinical disorder or is it rather a subgroup of another disorder.