Clinician treatment choices for post-traumatic stress disorder: ambassadors survey of psychiatrists in 39 European countries.

BACKGROUND: Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD). METHODS: The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148). RESULTS: About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines. CONCLUSIONS: Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.

Molecular Mechanisms of Posttraumatic Stress Disorder (PTSD) as a Basis for Individualized and Personalized Therapy: Rationale, Design and Methods of the South Eastern Europe (SEE)-PTSD study.

Posttraumatic Stress Disorder (PTSD) is a major health problem in South Eastern Europe (SEE). Available treatment options are not efficient enough and the course is often chronic. Little is known about molecular mediators and moderators of pathogenesis and therapy. Genetic and epigenetic variation may be one central molecular mechanism. We therefore established a consortium combining clinical expertise on PTSD from SEE countries Bosnia-Herzegovina (Sarajevo, Tuzla and Mostar), Kosovo (Prishtina) and Croatia (Zagreb) with genetic and epigenetic competence from Germany (Würzburg) in 2011 within the framework of the DAAD (Deutscher Akademischer Austauschdienst)-funded Stability Pact for South Eastern Europe. After obtaining ethical votes and performing rater trainings as well as training in DNA extraction from EDTA blood between 2011 and 2013, we recruited 747 individuals who had experienced war-related trauma in the SEE conflicts between 1991 and 1999. 236 participants had current PTSD, 161 lifetime PTSD and 350 did not have and never had PTSD. Demographic and clinical data are currently merged together with genetic and epigenetic data in a single database to allow for a comprehensive analysis of the role of genetic and epigenetic variation in the pathogenesis and therapy of PTSD. Analyses will be done to a great degree by PhD students from participating SEE centers who in addition to participation in the project had an opportunity to take part in spring and summer schools of the DFG (Deutsche Forschungsgemeinschaft) funded Research Training Group (RTG) 1253 and thus meet PhD students from Germany and other countries We are confident that our project will not only contribute to a better understanding of genetic and epigenetic mechanisms of PTSD as a basis for future individualized and personalized therapies, but also to the academic development of South Eastern Europe.

Complementary and alternative medicine in the treatment of schizophrenia.

During the past century, many scientific discoveries and industrialization greatly contributed to the progress in medicine and significantly improved a quality of life of psychiatric patients. Schizophrenia is a serious mental disorder. Due to synthesis of numerous high quality antipsychotic medications, a great progress in the treatment of it has been made during the last 50 years. In five thousand years of the recorded history, it is known that in the early times, people used different methods and procedures in the treatment of various psychiatric disorders including schizophrenia. In recent decades after great discoveries, medicine based on facts has also faced a number of disappointments. The medicine gradually begins to understand that some of the alternatives used earlier in centuries are complementary methods that were unnecessarily suppressed and excluded from the treatment. On the other hand, a number of countries where this is legally possible is growing and there is also an increasing number of patients seeking alternative and complementary methods in the treatment of schizophrenia. The aim of this paper is to encourage and reflect upon the meaning of alternative and complementary methods in the treatment of schizophrenia as well as to try and prevent forgetting their meaning whenever it is justified and based on facts.

Metabolic syndrome and schizophrenia from integrative medicine perspective.

BACKGROUND: There has been a growing interest in the effect that comorbid schizophrenia and metabolic syndrome may have on each other. OBJECTIVE: To examine metabolic syndrome from integrative medicine point of view including prevalence of metabolic syndrome in patients with schiziphrenia compared to their first-degree relatives, healthy volunteers without schizophrenia in close family, and patients with PTSD, as well as the percentage patients with schizophrenia without any component of metabolic syndrome. METHOD: Metabolic syndrome according to NCEP/ATP III criteria and number of its components were analysed in 205 patients with schizophrenia, 140 healthy volunteers and 105 patients with combat PTSD. RESULTS: Metabolic syndrome was identified in 45.9% of the patients with schizophrenia, 38.1% of the war veterans with PTSD, 36.7% of the first-degree relatives of patients with schizophrenia and 16.2% of the healthy volunteers without schizophrenia in close family. Only 21.5% of the patients with schizophrenia were without any metabolic syndrome component. CONCLUSION: The comorbidity of schizophrenia and metabolic syndrome is very important for theory and practice of integrative medicine. Almost 80% of the patients with schizophrenia have increased risk or developed cardiovascular disorders,.

Herbal medicine in the treatment of mental disorders.

During five thousand years of recorded history, we know that from the ancient times people have used different methods and procedures in treatment of different psychiatric disorders and very often these were medicinal preparations of plants. Numerous scientific discoveries and industrial age gave a big contribution to medicine development and significantly improved quality of life for psychiatric patients during the last century. However, evidence-based medicine after big bliss faced a lot of disappointments, and an attitude that some natural drugs were unnecessarily thrown out of use step by step came along. On the other hand, there are a huge number of patients that use natural medicinal plants in self-treatment of different psychiatric disorders. The aim of this article is not giving advantage to natural medicines over chemicals, nor to support self-treatment. The aim is to encourage thinking about the meaning of natural medicines in the treatment of mental disorders and an attempt of preventing to push them out totally into silence wherever it is justified and based on facts.