Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries.

BACKGROUND: Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. METHODS: The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. RESULTS: We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. CONCLUSIONS: We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

Assessing the need for a protected living environment among severely mentally ill adults in the republic of Georgia.

The purpose of this study is to assess the need for a new mental health service called a Protected Living Environment (PLE) in the republic of Georgia. PLE intends to provide residential care for the severely mentally ill (SMI) in the community. Patients and staff members from all six long-term psychiatric hospitals (Tbilisi, Batumi, Rustavi, Khoni, Surami, Bediani) in Georgia have participated in the study. The study includes a quantitative (a structured survey) and a qualitative component (in-depth interviews), which together provide a more comprehensive data. The questionnaire and the questioning route for focus group interviews were self-designed according the recommendations of World Health organization and based on a health facility assessment tool SARA - The Service Availability and Readiness Assessment. The study revealed that consumers and mental health professionals have positive attitudes towards the development of protected residential institutions, which could be an important alternative for residential care and would promote deinstitutionalization and reintegration into society.

Trends in the use of outpatient psychiatric services in the republic of Georgia.

For a long time, in Georgia, as in most eastern European and post-soviet countries, mental health services have been mainly ran in large institutions with restricted financial and professional resources. In 2010, Ministry of Health and Social Affairs of Georgia declared the reforms in mental health care system. The ongoing reforms are actively supported by many international organizations, but there still some local and cultural barriers that should be carefully analyzed. The study aimed to identify factors affecting referral to the outpatient mental health services and to describe the trends of common therapeutic interventions. The cases of patients who referred to the outpatient mental health services during one year in 2011-12 have been studied. Investigation the trends of referral to outpatient psychiatric services in Georgia showed that patients with severe and chronic psychosis less likely apply to outpatient psychiatric services. In most of the cases they come for single consultation and revealed significant problems in treatment adherence. Patients from remote areas prefer to visit central outpatient clinic, rather than go to their local, free of charge facilities. The main reasons of referral appeared behavioural (hyperactivity, retardation) and emotional problems (depression, anxiety). Due to insufficient legislative and financial support patients could not receive psychological treatments. The treatment outcome significantly depends on treatment compliance and level of education. Educated patients were much more disciplined in keeping their prescription and appointments. The additional effort need to be focused on improving patients' attitude toward local psychiatric services and enhancing coordination between in and outpatient mental health services.

[Pain perception among depressed heroin addict patients].

Investigation of heroin addict patients in post-abstinent state revealed that low mood, anxiety, tension and guilt feeling increased sensitivity toward pain, which mostly experienced as algetic, coenestetick and hypochondriacal sensations. Algetic symptoms highly correlated with psychopathology. Efficient treatment of psychopathological symptoms decreased pain. It is concluded that Atypical antipsychotic quetiapin monotherapy could be used for treating such conditions.

Overview of referrals to mental health services in Georgia.

UNLABELLED: The prevalence of mental illnesses in society is difficult to measure accurately as current techniques are relatively poor. Mental health professionals argue that data provided by Ministry of Health of Georgia concerning the prevalence of mental illnesses should be treated with great caution as the official rates of mental disorders are likely to be largely underestimated. The most significant reason of this could be focusing on referral to state mental health institution and ignoring the private sector. In order to understand the gap between official data and real needs in mental health care we compare statistical data of state institutions and private practice. The structured questionnaire was used for obtaining referral information from the Asatiani Psychiatric Hospital, Gotsiridze Psycho-Neurological Dispensary and a private psychiatrist. RESULTS: The state institutions with great proportion serve patients with schizophrenia, schizotypal, delusional and organic mental disorders, while patient with mood disorder and neurotic, stress-related and somatoform disorders preferred private psychiatrist. People with different psychiatric problems (e.g. sleep and eating disorders), especially young and elderly patients seldom are seen by psychiatrist. CONCLUSIONS: Hence, the official data concerning the prevalence of mental illnesses in Georgia are highly underestimated and could not reflect real demands.

The relation between the general intellect of schizophrenic patients and psychopathological deterioration.

The aim of the study was to examine whether the postpsychotic decline in IQ during schizophrenia are due to a dementing process and psychopathological deterioration or this is a state independent premorbid impairment. The IQ score of 32 schizophrenic patients and 25 normal comparison subjects were evaluated three times during an average of 4,5 years, after short (mean 2,3 years) and long (mean 4,6) follow-up periods. The regression analysis was used to evaluate the association of clinical symptoms and IQ scores at the different period of time. The results were examined and related to changes of negative and positive symptoms of the illness. The schizophrenic group had low IQ score at baseline than the normal comparison subjects but showed comparable stability over time. The raw IQ score slightly increased in both groups in follow-up period. The regression analyses revealed that low IQ score especially in the block design (MT) and non-verbal reasoning (LPS3) subtests could be additional predictors for deterioration of negative symptoms. The IQ score of patients with schizophrenia appears to remain stable regardless of psychopathological decline, and even could be improved by learning and rehearsal.

Investigation of explicit verbal memory in patient with paranoid schizophrenia and their first degree relatives.

UNLABELLED: The aim of the current study is to characterize the prevalence, degree and nature of verbal memory deficit in schizophrenia; to study verbal memory task performance in patient with paranoid schizophrenia and their first degree relatives in order to identify, trait cognitive marker of the disorder. Besides the authors studied, whether nonpsychotic relatives of schizophrenic probands had an elevated risk of deficits in cognitive functioning, and, which of specific factors: gender, age, education, illness duration, diagnosis and psychopathological symptoms influenced the tests performance. Twenty schizophrenia inpatients (10 men; mean age=34.2 years, SD=9.1; mean education=13.6 years, SD=2.6) were recruited from the psychiatric hospital. All patients met DSM-IV criteria for schizophrenia and clinically assessed by SANS (negative symptoms) and SAPS (positive symptoms). The patients had no history of neurological disease, systemic disease known to involve CNS functioning, clinically significant head injury, or mental retardation. CONTROL GROUP: twenty-eight nonpsychiatric healthy volunteers (14 men; mean age=35.0 years, SD=10.7; mean education=14.3 years, SD=3.46) were recruited from the community. Schizophrenia patients showed significant impairment of the verbal memory in all domains. In contrast, their first degree relatives having the same education level as the patients did not differ considerably from healthy controls. These results indicate that, probably, the deterioration of explicit verbal memory is not associated with the predisposition for schizophrenia. As the test performance did not correlate with severity of symptoms this finding cannot be attributed to the distractibility due to active psychotic symptoms, or medication effects. Impaired performance on the CVLT task, a measure of explicit verbal working memory, appears to be associated with the cognitive deficits due to the disorder itself.