[Accessibility of electroconvulsive therapy during COVID-19 pandemic in Hungary].

OBJECTIVES: A nationwide survey in Hungary found that 22 out of 58 psychiatric units performed ECT in 2014. Shortly after identifying the first COVID cases, strict control measures were introduced, and the hospital system was fundamentally transformed in the country that affected ECT provision as well. The aim of the current study was to survey the changes in ECT use in Hungary during the four waves of the COVID-19 pandemic. METHODS: All the psychiatric units that indicated they had performed ECT in 2014 were sent a semi-structured question naire requesting information about changes in ECT practice and the treatment profile of the unit. If there was no reply, a follow-up telephone call was made. RESULTS: There were only 3 centers where ECT was performed throughout all four waves of COVID. In nine centers (47%) ECT was suspended in all four waves. The main reason why ECT was halted during COVID was the restructuring of psychiatric inpatient care: six centers were fully transformed into general COVID units, and in the remaining 13 the number of psychiatric beds was reduced in favor of general COVID care. Staff shortage constituted another barrier to the provision of ECT. The number of infected patients in a wave of COVID-19 showed a significant negative correlation with the number of active ECT centers (p=0.05). No COVID-infected patient received ECT in Hungary. CONCLUSIONS: During the COVID pandemic in Hungary, nearly half of the ECT services were suspended and thus a number of patients missed out on receiving an effective treatment.

Violence Against Psychiatric Trainees: Findings of a European Survey.

OBJECTIVES: Violence by patients against health care professionals has been widely described. Although psychiatric trainees are particularly exposed, little is known about the extent, context, and impact of violence toward them in Europe. METHODS: A cross-sectional online survey was distributed between June 2018 and December 2019 among European psychiatric trainees through professional networks, using a snowball approach. The questionnaire asked about experiences of verbal abuse and physical and sexual assaults, as well as their context and impact. Descriptive analyses of the obtained data were conducted. RESULTS: The survey was completed by 827 trainees from 39 countries (68.4% females). Most (83.6%) reported having been abused/assaulted at least once (of these, 92% verbally, 44.1% physically, and 9.3% sexually). Emergency rooms and inpatient units were the most frequent settings. Psychological impact of these events was commonly reported. Most respondents did not report abuses and assaults to their supervisors. They also described a lack of training for staff and aggression management plans at their institutions or of being unaware of their existence. CONCLUSIONS: Violence from patients is reported by many psychiatric trainees across countries in Europe, with very frequent verbal abuse and worrisome figures of physical and sexual assaults. Particularly concerning are the low proportion of trainees reporting to authorities, the lack of staff training and management protocols, and trainees' lack of awareness about those resources. Despite the study limitation of a small response rate, these results support a call for urgent efforts to address this problem in Europe, and possibly beyond.

Research by Psychiatric Trainees and Early Career Psychiatrists-Results of a Survey From 34 Countries in Europe.

Clinical psychiatric practice should be intricately linked with research work. Although psychiatric trainees and early career psychiatrists (ECPs) are in the frontline of clinical services, little is known about how much access they have to research opportunities. A semi-structured questionnaire of 35 questions-exploring research goals achieved, facilitators and barriers as well as personal context-was sent to psychiatric trainees and ECPs across Europe. The survey was disseminated through the local committees of the main professional psychiatric societies in Europe. A total of 258 individuals working in 34 European countries participated. The majority (69.8%) were psychiatric trainees within training in adult psychiatry. Most participants (69.0%) were highly interested in research, but faced major obstacles toward their research activities, such as lack of time and funding. They were highly satisfied with mentoring and publishing papers. Only half of the participants, however, had already published a scientific article, and only a few have been able to contribute to randomized clinical trials (20.9%). A large proportion of participants (87.2%) reported to conduct research after or during a mixture of working hours and after working hours. Only one tenth ever received a grant for their work. These findings highlight that the key barriers for the performance of research are lack of time and funding. Psychiatric trainees and ECPs are motivated to perform research but need support and regular opportunities.

Quality assessment of a consultation-liaison psychiatry service.

BACKGROUND: Consultation-Liaison Psychiatry (CLP) provides services for patients with medical-psychiatric comorbidity at the general hospital. Referral satisfaction is considered as one of the most important outcome measures of CLP interventions. Our aim was to assess the levels of satisfaction with the CLP service amongst medical staff at a university hospital in Denmark. METHODS: Medical staff answered an online survey regarding their experience with different aspects of inpatient and outpatient CLP services. RESULTS: There were 152 responses from 16 medical units, with a survey return rate above 85%. Measured on a 5-point Likert scale, there was a median rating of 4 in response to questions regarding communication and organizational aspects, a median rating of 5 in response to questions regarding overall evaluation of the CLP service on both inpatient and outpatient questionnaire. The questions regarding treatment quality were rated with a median of 4 on the inpatient questionnaire and 2 of the outpatient questionnaire items, and with a median of 5 on 2 outpatient items. Physicians´ evaluations were statistically more positive than nurses´. As a group, respondents already employed before the CLP unit was established and those who used the CLP services more were statistically significantly more satisfied then respondents employed after the establishment of the CLP unit and those who used the CLP service less. CONCLUSION: The CLP services were positively appreciated and considered to be valuable among medical hospital staff. We believe that Consultation-Liaison Psychiatry deserves further help to implement and expand its services in general hospital settings. In addition, our results underline the feasibility of surveys as quality measures of clinical care.

[The public's attitudes towards electroconvulsive therapy in Hungary]. / Laikusok elektrokonvulzív terápiával kapcsolatos attitûdje Magyarországon.

BACKGROUND AND PURPOSE: This research focused on the knowledge and attitude toward to electroconvulsive therapy (ECT) in the general population of Hungary. There are only a few studies in the international literature focusing on the public's attitude towards ECT, and no such study has been published from Hungary. METHODS: Participants were reached through social media and asked to fill out a semi-structured questionnaire on internet that comprised seventeen questions. Participation in the survey was entirely voluntary and anonymous. Participants of the survey were not working in health care; their answers to the questionnaire were compared to those of health-care workers. RESULTS: The result showed a significant difference between healthcare workers' and lay people's knowledge and attitude towards ECT. Two third of lay participants have never heard about ECT. Those familiar with ECT were relatively well-informed about its certain aspects yet rejection of ECT was significantly higher in the group of lay participants than in health-care workers. CONCLUSION: Lay people's incomplete knowledge and negative attitude towards ECT was confirmed by this survey. The dissemination of reliable information - which should be the shared responsibility of mental health professionals and the media - would be vitally important to disperse the prejudices and doubts about ECT.

The prevalence of catatonic syndrome in acute psychiatric wards. / Rozpowszechnienie zespolów katatonicznych w ostroprzyjeciowych oddzialach psychiatrycznych.

OBJECTIVES: The aim of this prospective study was to determine the prevalence of the catatonic syndrome in a cohort of patients admitted to acute psychiatric units in Hungary. METHODS: Patients admitted to the acute inpatient unit of the Center of Psychiatry and Addiction Medicine, SzentIstván and SzentLászló Hospitals in a 4-month period were screened for catatonic signs and symptoms. Catatonic signs/symptoms were scored according to both the DSM-5 diagnostic criteria and the Bush-Francis Catatonia Rating Scale (BFCRS). Clinical diagnoses were established using the Structured Clinical Interview for DSM-IV Disorders (SCID), while cognitive performance was estimated with the Clock Drawing Test and the Mini-Mental State Examination (MMSE). RESULTS: During the study period, 342 patients were admitted to the above-mentioned acute inpatient units. The prevalence figures for the catatonic syndrome were 8.55% and 5.02% according to the BFCRS and the DSM-5, respectively. CONCLUSIONS: The prevalence of catatonic syndrome in an acute inpatient setting is within the broad range of figures reported in the literature. The difference between the standardized assessment (BFCRS) and routine clinical judgment (DSM-5) is noteworthy and suggests that a significant minority of catatonic patients might not be identified in clinical practice. As acute catatonia can be effectively treated, and early treatment could prevent potentially lifethreatening complications, recognition of catatonic symptoms is vitally important.

[Accessibility to Electroconvulsive Therapy in Hungary].

INTRODUCTION: In spite of its efficacy, use of electroconvulsive therapy (ECT) has been declined in Hungary over the past decade. This survey explores the circumstances that have obstructed the accessibility to ECT in Hungary. METHODS: This study was part of a comprehensive survey on the use of ECT in which two semi-structured questionnaires with 25 and 6 questions were sent out to all psychiatric departments in Hungary. The second questionnaire was targeted those departments that did not perform ECT in 2014. Questions were asked about the reasons for not using ECT and the available treatment strategies for patients who needed ECT. RESULTS: Thirty-one of the 58 Hungarian psychiatric departments did not offer ECT in 2014. Twelve chiefs of service asserted that no patient needed ECT in that year. Due to unavailability of ECT, patients were transferred to other departments for ECT in further 12 departments. Finally, in 7 departments, patients who would have needed ECT were treated with pharmacotherapy instead of transferring them to ECT centers. As for the reasons for the lack of access to ECT, 17 departments had no ECT machine, 12 departments did not have access to anesthesiologists, 6 departments had no budget for ECT, and in 5 departments staff with expertise to deliver ECT was not available. CONCLUSION: The rate of ECT use in Hungarian psychiatric departments decreased by 20 percent between 2002 and 2014. The most important reasons for this decline were lack of the modern ECT devices or financial sources to buy a modern ECT machine. Further reasons for not using ECT were the availability of anesthesiologists or the lack of finances to employ them. The lack of experience in administering ECT was another reason for not utilizing ECT. These difficulties could be solved with the centralization of ECT provision to a few centres in the country together with defining the pathways for patients to reach these centres.

Delaying initiation of electroconvulsive treatment after administration of the anaesthetic agent and muscle relaxant reduces the necessity of re-stimulation.

OBJECTIVES: To investigate the effect of delaying initiation of electroconvulsive therapy (ECT) after administration of anaesthetic agent and muscle relaxant. METHODS: A retrospective cohort study utilizing a case-based analysis comparing number of re-stimulations, length of seizures, number of ECTs per series and stimulation dosage before and after introducing a new treatment regimen. In 2013, ECT was initiated approximately 60-90 seconds after administration of thiopental and succinylcholine. This interval was increased to 120 seconds in 2014. Ninety-three patients were included (40 in 2013 and 53 in 2014). Outcome measures were length of seizure, number of re-stimulations, number of ECTs per series and stimulation dosage. Regression model analyses were conducted with entering year of treatment (2013 vs. 2014), sex and age as covariates. RESULTS: We showed that a lowered frequency of re-stimulation was independently associated with the 2014 treatment regimen. No effect of treatment regimen on duration of seizures as measured clinically or by EEG, on number of treatments per series or on stimulation dosage was observed. CONCLUSIONS: We found an association between an increased time interval from administration of thiopental and succinylcholine to ECT and a lowered risk of re-stimulations. The current study substantially strengthens the evidence on the benefits of delaying ECT after administration of anaesthetic agent and muscle relaxant.

Effectiveness of Prescription-Based CNS Stimulants on Hospitalization in Patients With Schizophrenia: A Nation-Wide Register Study.

OBJECTIVE: Negative symptoms and cognitive deficits are main features of schizophrenia but with limited treatment options. Earlier studies have suggested that central nervous system (CNS) stimulants have a small effect on these domains, but with inconclusive results. As the first study to date, we aimed to investigate whether CNS stimulants improve naturalistic outcomes (psychiatric admissions and antipsychotic use) in patients with schizophrenia. METHODS: By using extensive health registers all patients with schizophrenia and their use of CNS stimulants in Denmark were identified. Two models were used to investigate the effectiveness of CNS stimulants in patients with schizophrenia between 1995 and 2014; a mirror-image model with 605 individuals, using paired t tests and Wilcoxon signed rank tests, and a follow-up study with 789 individuals, using a conditional risk-set model. RESULTS: CNS stimulants use was associated with a reduction in number of psychiatric admissions from 3.43 (95% CI = 2.86 to 4.01) to 2.62 (95% CI = 1.99 to 3.25) (P = .009), with a more pronounced reduction for women (mean difference: -1.37, 95% CI = -2.34 to -0.40, P = .006). Psychiatric bed-days were reduced by 40 (95% CI = 24.5 to 55.6, P < .001) for individuals with at least 1 admission before CNS stimulant use. In addition, the total amount of antipsychotic use (Defined Daily Dose [DDD]) was reduced (P = .001). The Hazard rate ratio in psychiatric admissions between women taking CNS stimulants compared to women not taking CNS stimulants was 0.77 (95% CI = 0.67 to 0.88). CONCLUSION: CNS stimulants may have clinical potentials for improving functional outcomes in patients with schizophrenia and randomized clinical studies evaluating this topic are warranted.

Changes in Electroconvulsive Therapy Practice in the Last 12 Years in Hungary.

BACKGROUND: Electroconvulsive therapy (ECT) was rarely used in Hungary in 2002, and the majority of patients receiving ECT were diagnosed with schizophrenia. This study aimed to explore the use of ECT in Hungary in 2014. METHODS: Two semi-structured questionnaires were sent to all acute adult psychiatric units in Hungary. The first questionnaire contained items concerning ECT use, and the second explored the reasons for not using ECT. RESULTS: Fifty-eight acute psychiatric inpatient units were identified, and 54 replied. Although 27 indicated that they used ECT, only 22 actually performed ECT in 2014. Thirty-one units did not offer ECT at all. In 2014, 174 patients received ECT in Hungary, constituting 0.59% of all inpatients treated in the departments where it was offered, equating to 0.176 patients/10,000 population. The indication for ECT shifted from schizophrenia in 2002 (55.6%) to mood disorders in 2014 (58.5%), but the absolute number of ECT-treated patients with mood disorders (110 vs 102) did not change. Reasons for not using ECT included the lack of an ECT machine, unavailability of an anesthesiologist, lack of finances, and lack of experienced staff. CONCLUSIONS: In view of the high frequency of depression and suicide in Hungary, it is very likely that a significant minority of patients who would benefit from ECT cannot access it, which constitutes a violation of their right to the best possible treatment. The main reasons for the inadequate ECT service are the underfinanced hospital system and a lack of necessary knowledge.