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.

Access to diagnostic evaluation and treatment for dementia in Europe.

This paper reviews and discusses existing barriers to diagnosis and treatment for patients with dementia in Europe as well as approaches to overcome these barriers. The barriers to care are manifold, being present at all levels in each society and between countries in Europe. Multilevel and multifaceted strategies are needed to improve diagnosis and treatments for all patients with cognitive complaints. A multidisciplinary approach based on close collaboration between GPs and specialised memory clinics may be the ideal model for early accurate diagnosis and subsequently early pharmacological and psychosocial interventions. For all healthcare professionals, there should be specialised training in dementia and frequently updated practice guidelines to provide the framework for standards of care. Culture-sensitive strategies to promote public knowledge and destigmatize dementia are essential. Policy makers and authorities should be made aware of the benefits of early access to diagnosis and treatment.

[7-year-follow-up investigations of the geriatric psychiatric inpatient service in a separated care at a state hospital (obligatory service) and an integrated care at a university hospital in Goettingen, Germany -- I. Type of patients]. / Verlaufsuntersuchung zur gerontopsychiatrischen Behandlung im Vergleich zwischen integrierter Versorgung an einer Universität und separierter Versorgung an einem Landeskrankenhaus -- I. Patientencharakteristik.

OBJECTIVE: 7 years after our first investigation we were interested in the stability versus (trends of) change in geriatric psychiatric inpatients while the structure of services was mainly unchanged. METHOD: We performed standardised chart reviews of randomly selected groups of geriatric psychiatric inpatients who had been treated in 1998 and 1999 in the Psychiatric University Hospital (PUK; n = 104) or the Psychiatric State Hospital (LKH; n = 100), which together treat all psychiatric inpatients in the region. With regard to age, the PUK provides integrated and the LKH separated care. RESULTS: Mean patients' age decreased. Compulsory admissions according to state laws decreased significantly. Specialist treatment before admission decreased. Premedication showed a dramatic decrease of antidementia drug treatment and a nearly unchanged high rate of prescriptions of antipsychotics and benzodiazepines. CONCLUSION: With a lower age and lower rate of specialist treatment we could not find signs of a better outpatient care preceding hospital admission during follow-up.

[7-year-follow-up investigations and comparison of the geriatric psychiatric inpatient service in a separated care at a state hospital (obligatory service) and an integrated care at a university hospital in Goettingen, Germany -- II. Diagnosis and treatment]. / Verlaufsuntersuchung zur gerontopsychiatrischen Behandlung im Vergleich zwischen integrierter Versorgung an einer Universität und separierter Versorgung an einem Landeskrankenhaus -- II. Diagnosen und Behandlung.

OBJECTIVE: By use of a 7-y-follow-up investigation of differences between geriatric psychiatric patients and their management in an integrated (with other adult age groups) care in the University Psychiatric Hospital (PUK) compared to those in a separated (only according to age) care in the Psychiatric State Hospital (LKH), which together treat all psychiatric inpatients in Goettingen, Germany, we wanted to show, whether progress can be made visible. METHOD: We performed standardized chart reviews of randomly selected groups of patients, who had been treated in the PUK (n = 104) and the LKH (n = 100) in the years 1998 and 1999. RESULTS: Again, organic brain diseases/dementia was the most frequent diagnosis in the LKH and depression that of the PUK. Less diagnostics were applied compared to the previous investigation, especially neuroimaging. Non-drug treatments are (documented) more frequently now in the LKH. Both institutions - data with respect to frequent syndromes are given - treated the wide majority of patients with psychoactive drugs, especially neuroleptics, typical antidepressants, benzodiazepines. Antidementia drugs were given significantly less. Hospital stays decrease in length. Compared to the respective investigation in Magdeburg there is some evidence supporting specialized care for the elderly. CONCLUSION: Budgetary restrictions could also be shown in inpatient treatment. Progress in specific drug treatment does not reach the patients as much as necessary.

[A comparison of geriatric psychiatric inpatients of two German psychiatric university hospitals in integrated or separated (with regard to age) care--part 1: Type of patients]. / Stationäre gerontopsychiatrische Behandlung--ein Vergleich zwischen integrierter versus separierter Versorgung an psychiatrischen Universitätskliniken--Teil 1: Patientencharakteristik.

OBJECTIVE: We wanted to compare geriatric psychiatric patients and their management in an integrated (with other adult age groups) care in the Psychiatric University Hospital of Göttingen (IGV) compared to those in a separated (according to age) care in the Psychiatric University Hospital of Magdeburg (SGV). The latter provides care for a certain area, while the former is not obliged to. METHOD: We performed standardized chart reviews of randomly selected groups of patients, who had been treated in the IGV (n = 104) and the SGV (n = 144) in the years 1998 and 1999. RESULTS: The SGV patients were significantly older (71.8 +/- 8.9 years versus 67.2 +/- 7.4 years), more often bereaved and/or living alone. The SGV patients' treatment was initiated by law in 23.2 % (IGV 3 %) of the cases. Inpatient pretreatment of psychic disorders was reported in 40 % of the SGV patients and in only 3.9 % of IGV patients, respectively. In addition, the SGV patients had significantly more complicating diseases, like cerebro- and cardiovascular or neurological diseases. CONCLUSION: Older, more severely psychic and somatic ill patients were treated in the SGV. In general for about half of the cases, the hospital treatment had been the first psychiatric treatment at all. Since both are university departments differences in patient profile seem to be influenced by care system (integrated versus separated and obligatory).

[A comparison of geriatric psychiatric inpatients of two German psychiatric university hospitals in integrated or separated (with regard to age) care--part 2: Diagnosis and treatment]. / Stationäre gerontopsychiatrische Behandlung--ein Vergleich zwischen integrierter versus separierter Versorgung an psychiatrischen Universitätskliniken--Teil 2: Diagnosen und Behandlung.

OBJECTIVE: We wanted to compare geriatric psychiatric patients and their management in an integrated (with other adult age groups) care in the Psychiatric University Hospital of Göttingen (IGV) compared to those in a separated (according to age) care in the Psychiatric University Hospital of Magdeburg (SGV). Compared to the former, the latter is also involved in the regional obligatory care system. METHOD: We performed standardised chart reviews of randomly selected groups of patients, wo had been treated in the IGV (n = 104) and the SGV (n = 144) in the years 1998 and 1999. RESULTS: Most patients of the SGV suffered from organic brain diseases/dementia (SGV: 57.6 %; IGV: 36.6 %). In the IGV, depression (51 %) and addiction (27.9 %) were the most frequent diagnoses. Disabilities of vision, audition, speech or tremor and muscle diseases were more often found in the SGV. Specialised diagnostics were performed mostly in the SGV. Both institutions treated the majority of patients with antipsychotic drugs. A program of ergotherapy and physiotherapy was significantly more often documented in the SGV. Nearly half of the SGV patients were released into changed living environments (IGV: 12.9 %). CONCLUSION: Patients with further progressed organic brain diseases/dementia as well as older, psychically and somatically more severely ill patients were treated more frequently in the SGV. Obligatory care seems to be the reason for this and not separation or integration. In general, separated care according to age seems to provide a more diversified treatment approach for the elderly.