Optimization strategies for the organization of mental healthcare.

AIM: The aim of this paper is to analyse the main issues and obstacles to optimizing the organization of mental healthcare and the strategies that should be applied by presenting the examples from practice. RESULTS: Outcomes of mental healthcare are in relation with 'improved legislation' and the introduction of up-to-date management and economic concepts including continuous treatment model, in addition to the advantages and disadvantages in the provision of mental healthcare within primary and secondary inpatient and outpatient healthcare. Some of these lessons are learned from reforms implemented in Serbia.

[Chlorpromazine-induced status epilepticus: a case report].

INTRODUCTION: It is largely known that some antipsychotic agents could have proconvulsive and proepileptogenic effects in some patients and could induce EEG abnormalities as well. However, the association of status epilepticus with certain antipsychotic drugs has been very rarely reported. CASE REPORT: A case of an 18-year-old adolescent girl, with chlorpromazine therapy started for anxiety-phobic disorder was reported. Her personal history disclosed delayed psychomotor development. Shortly after the introduction of the neuroleptic chlorpromazine therapy in minimal daily dose (37.5 mg), she developed myoclonic status epilepticus, confirmed by the EEG records. Frequent, symmetrical bilateral myoclonic jerks and altered behavior were associated with bilateral epileptiform discharges of polyspikes and spike-wave complexes. This epileptic event lasted 3.5 hours and it was stopped by the parenteral administration ofvalproate and lorazepam; she was EEG monitored until stable remission. Status epilepticus as initial epileptic event induced by neuroleptic agent was not previously reported in our national literature. CONCLUSION: Introduction of chlorpromazine to a patient without history of seizures is associated with the evolution of an epileptic activity, including the occurrence of status epilepticus. Clinical evaluation of the risk factors possibly related to chlorpromazine-induced seizure is recommended in individual patients before administering this drug.

Analysis of quality of life and anxiety in patients with different forms of epilepsy.

BACKGROUND: Anxiety symptoms may have significant implications on the quality of life of patients with epilepsy. The aim of our research is a comparative analysis of the quality of life, i.e., of the level of disability in patients with different forms of epilepsy. METHOD: In this cross-sectional study, the sample consisted of three groups of 30 patients each--with recently diagnosed generalized epilepsy, temporal and extratemporal epilepsy. the anxiety level in these groups was compared with the control group of 30 healthy subjects. Beck anxiety inventory (Bai) was used for assessment of anxiety. level of functional disability due to anxiety was measured according to the Sheehan Disability Scale (SDS). RESULTS: Patients with extratemporal epilepsy had the greatest level of functional disability, while patients with generalized epilepsies had the lowest average of scores on the Sheehan scale. the correlation between the Bai and the SDS was highly statistically significant. CONCLUSIONS: Our results clearly indicate the need for a broader concept of therapy--neurological (antiepileptic therapy) and psychiatric (pharmaco-, psycho- and social therapy) when it comes to anxiety in patients with epilepsy.

Anxiety in epileptic patients.

BACKGROUND: Anxiety may occur as ictal, postictal or interictal symptom in patients with epilepsy. The main aim of this research was to explore the intensity and frequency of anxiety in patients with generalized, temporal and extratemporal epilepsy. SUBJECTS AND METHODS: This is a cross-sectional study of three groups of patients with epilepsy (30 patients per group) - recently diagnosed with generalized epilepsy, temporal epilepsy and extratemporal epilepsy, and a healthy control group (N=30). The Beck Anxiety Inventory (BAI) was used for quantitative assessment of anxiety. RESULTS: Patients with temporal and extratemporal epilepsies had a significantly higher mean total scores on the BAI than the patients with generalized forms of epilepsies (ANOVA: F=6.323, p<0.01). There were no statistically significant differences between the temporal and extratemporal epilepsy groups according to the levels of anxiety on BAI (t-test: t=1.68, p>0.05). For the first three symptoms - numbness, wobbling in the legs and the fear of the worst happening - the group of patients with extratemporal epilepsies had significantly higher average levels of intensity and frequency of symptoms (ANOVA: F1=5.591, F2=6.555, F3=5.906; p<0.01) CONCLUSIONS: Patients with partial epilepsy have more frequent and prominent anxiety symptoms than patients with generalized epilepsy, and also more than the control group. All these findings clearly indicate the necessity to modify treatment strategies accordingly in order to include both the antiepileptic therapy and treatment for anxiety disorders.

Reasons and conditions for involuntary hospitalization with special emphasis on detention without consent of mentally disordered person who voluntarily started hospital treatment.

The nature of some mental illness is such that persons affected by their conduct endangering life, health and safety, as well as life, health and safety of others from their surroundings. These persons, because of their mental condition, are often unable to properly assess their own interest. Because of the above it is permitted for these persons, under certain circumstances, to be forcibly hospitalized against their will. However, the problem of involuntary hospitalization of persons with mental disorders remains a controversial and complex ethical and legal problem, because it is characterized by a conflict of opposing interests and moral values. The main reason is the fact that involuntary hospitalization is an act of deprivation of liberty and intervention into the personal integrity, which at that the measure is taken against the individual who has not committed any crime. In order to provide restricted approach to the application of compulsory hospitalization, it is necessary to pass a legislation on the protection of persons with mental disorders that would more closely define the undertaken proceedings, reasons and conditions for involuntary detention and involuntary hospitalization in a psychiatric institution, forced detention of voluntarily hospitalized persons and penal policy violation of this law. It is necessary to initiate the procedure for amending the Law on Contested Procedure, which would reform the procedure for compulsory hospitalization, as an important segment of mentally disordered persons' rights, in order to be in accordance with international and European standards within this field.

Most common diagnoses requiring physical restriction of psychiatric patients: humanity at the test.

INTRODUCTION: Attitude about physical restriction has been changing through history. It has always been multidimensional approach, including ethic, medical and judicial aspect. OBJECTIVE: The main aim was establishing distribution of physical restrictions of patients for the following years: 2006/07, 2007/08, 2008/09, 2009/10 and 2010/11. METHODS: The research included patients that were hospitalized in the Special Hospital for Psychiatric Disorders "Dr. Laza Lazarevic" in Belgrade from June 1, 2006 to June 1, 2011. Retrospective review of illness history of hospitalized female patients was done (350 in total) and records were formed containing data on physically restrained patients. RESULTS: The largest number of referral diagnoses belonged to groups F20, F23 and F29; it was established that the number of physical restrictions was associated with referral diagnoses on the level of highly statistically significant difference (p < 0.001). The average number of restrainees per hospitalized patient which was growing in the studied period, which was also shown by the trend line (y = 0.5x + 1.06; R2 = 0.7242). CONCLUSION: Physical restrictions of psychiatric patients must backed up by benevolence, and it is not by any means the doctor's arbitrariness, which is strongly criticized and represents breach of ethical norms, human rights and the rights of the patient as guaranteed by law. This topic, which, indeed, refers to modern psychiatry, deserves more attention by public discussions, as well as by legislative regulations.

Psychometric evaluation of the Serbian version of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31).

PURPOSE: To evaluate the psychometric properties of the Serbian-language version of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). METHODS: After undergoing a translation and cultural adaptation of its items in order to create a Serbian-language version of QOLIE-31, we assessed its psychometric properties-reliability, construct validity and criterion validity. The sample consisted of 203 adults with epilepsy. Reliability was tested both by assessing the internal consistency and by the test-retest method. Construct validity was assessed by factor analysis, multitrait-scaling analysis and method of known-groups validation. This was achieved by assessing the relationship between scales and external measures (socio-demographic characteristics, seizure severity and etiology of epilepsy). Criterion validity was assessed by correlation analysis between QOLIE-31 and Short form 36 health survey (SF-36) and Neurotoxicity scale-II. RESULTS: The domains showed high internal consistency (Cronbach's α 0.94). Test-retest reliability for Overall test score was 0.83 (Pearson's coefficient) indicating temporal stability. Seizure severity and etiology of epilepsy significantly influenced all QOLIE-31 domains except the Medication effect domain, with lowest scores in high seizure severity and symptomatic etiology groups. Employment status significantly influenced Overall quality of life, Emotional well-being, Social function and Overall score. Educational level was related to the Emotional well-being domain, with highest scores for students. The QOLIE-31 was highly positively correlated with SF-36 (rho=0.898) and strongly negatively correlated with Neurotoxicity scale-II (rho=-0.783). CONCLUSION: Serbian adaptation of the QOLIE-31 questionnaire is reliable and valid for assessing the quality of life in patients with epilepsy.

Preventing depression in adolescents with epilepsy.

PURPOSE: The goal of the work described in this article was to test the possibility of preventing depression among adolescents with epilepsy. METHODS: Adolescents with newly diagnosed epilepsy (104 patients) were screened for depression. The risk for depression was increased in 30 (28.8%) patients (mean age 17.4, 60% females) who were randomized into two equal treatment groups: (1) cognitive-behavioral intervention (CBI) group and (2) treatment with counseling as usual (TAU) group. The Beck Depression Inventory (BDI), Center for Epidemiological Study on Depression (CES-D) scale, Hamilton Depression Scale (HAMD), and Quality of Life in Epilepsy Inventory (QOLIE-31) were administered at baseline and during the 9-month follow-up. RESULTS: Initial BDI and HAMD scores for the two groups were comparable. Depression was diagnosed during follow-up in three patients in the TAU group. Subthreshold depressive disorder significantly improved at follow-up in the BCI group compared with the TAU group (P<0.05). QOLIE-31 Total scores significantly correlated with both mood improvement and seizure-free state.