A country report: impact of COVID-19 lockdowns on involuntary psychiatric treatment in Austria.

BACKGROUND: Coercive measures such as involuntary psychiatric admission are considered a last resort in the treatment of people with psychiatric disorders. So far, numerous factors have been identified that influence their use. However, the link between a pandemic - in particular, restrictions such as lockdowns - and the use of involuntary psychiatric admission is unclear. AIM: To examine the association between COVID-19 lockdowns and involuntary psychiatric admissions in Austria. METHOD: This retrospective exploratory study assessed all involuntary psychiatric admissions and use of mechanical restraint in Austria, except for the federal state of Vorarlberg, between 1 January 2018 and 31 December 2020. Descriptive statistics and regression models were used. RESULTS: During the 3-year study period, 40 012 individuals (45.9% females, mean age 51.3 years) had 66 124 involuntary psychiatric admissions for an average of 10.9 days. Mechanical restraint was used during 33.9% of these admissions. In weeks of nationwide COVID-19 lockdowns (2020 v. 2018/2019), involuntary psychiatric admissions were significantly fewer (odds ratio = 0.93, P = 0.0001) but longer (11.6 (s.d.: 16) v. 10.9 (s.d.: 15.8) days). The likelihood of involuntary admission during lockdowns was associated with year (2020 v. 2018-2019; adjusted odds ratio = 0.92; P = 0.0002) but not with sex (P = 0.814), age (P = 0.310), use of mechanical restraint (P = 0.653) or type of ward (P = 0.843). CONCLUSIONS: Restrictions such as lockdowns affect coercive measures and resulted in fewer but longer involuntary psychiatric admissions during weeks of lockdown in Austria. These results strengthen previous findings that showed the dependence of coercive measures on external factors, highlighting the need to further clarify causality and desired prevention effects when using coercive measures.

Female researchers in high-impact psychiatric journals: What do they focus on?

The regular analysis of publication trends, including gender aspects, is an important contribution to the identification of gender-specific differences in academic psychiatry. The present study aimed to characterise publication topics in three high-impact psychiatric journals across three time points within 15 years (2004, 2014 and 2019). Publication patterns of female authors compared to their male colleagues were examined. All articles published in 2019 in the three high-impact psychiatry journals JAMA Psychiatry, British Journal of Psychiatry and American Journal of Psychiatry were included and compared with data from the 2004 and 2014 assessments. Descriptive statistics were calculated and Chi-square tests were performed. In 2019, a total of 473 articles were published, 49.5% were original research articles, of which 50.4% were published by female first authors. The results of this study showed a stable trend in the publication of research on mood disorders as well as schizophrenia and psychotic disorders in high-ranking psychiatric journals. Although the percentage of female first authors in the three most common target populations under study (mood disorders, schizophrenia and general mental health) increased from 2004 to 2019, gender equality has not yet been achieved in these fields. However, in the two most frequent subject matters, basic biological research and psychosocial epidemiology, the percentage of female first authors was more than 50%. Consistent monitoring of publication trends and gender distribution by researchers and journals in psychiatric research should be continued to identify and counteract the possibility of the underrepresentation of women in certain fields.

Diversity in high-impact psychiatric publishing: gender parity within reach?

Gender parity and authorship diversity are declared goals in the publishing world. This study assessed the progress of authorship gender distribution over a quarter of a century and geographic diversity over the last 15 years in high-impact psychiatric journals. All articles published in 2019 in the American Journal of Psychiatry, the British Journal of Psychiatry, and JAMA Psychiatry were included and compared with data from three points in time starting in 1994. Descriptive statistics were gathered, and chi-square tests were performed. All tests were conducted as two-tailed, and p-values < 0.05 were considered to be statistically significant. Inter-rater reliability was calculated via Cohen's kappa. In 2019 a total of 473 articles were published. Forty percent of all authors, 42.3% of first authors, and 29.4% of senior authors were female. Counting original research articles only, female first authorship reached 50.4%. In the 25-year period between 1994 and 2019, female first (p < .001), female senior (p < .001), and female overall (p < .001) authorship has increased. In the specific period between 2014 and 2019, overall female senior authorship in all articles (p = .940) as well as first (p = .101) and senior (p = .157) in original research plateaued. In non-original research articles, female first authorship was higher in 2019 compared to 2014 (p = .014), whilst female senior authorship plateaued (p = .154). Geographic diversity was low and did not change over time. Gender parity in the subcategory original research articles was reached for the first time in 2019. Senior female authorship and geographic diversity remain areas of concern that need further investigation and specific interventions.

Seasonality in Major Depressive Disorder: Effect of Sex and Age.

BACKGROUND: Aside from the concept of seasonal affective disorder, the evidence for a seasonal pattern (SP) of major depressive disorder (MDD) is controversial. Furthermore, the effect of sex and age is still unclear. METHODS: This is a nationwide, registry-based study assessing all inpatient admissions in mental health hospitals due to MDD episodes according to ICD-10 (moderate (F32/33.1), severe (F32/33.2) and severe with psychotic features (F32/33.3)) in Austria across 14 years. Calculations were based on deviations from expected monthly admissions. RESULTS: The sample comprised 231,824 hospitalisations (36.8% men) for MDD. A significant SP (p=0.001) in moderate and severe depressive episodes in both women and men with decreased admission rates in the summer months and December was detected. In psychotic depression a significant SP was only evidenced in women (p = 0.002, men: p = 0.291). Patients older than 55 years had a reduced SP compared to those being younger. LIMITATIONS: Only anonymised admission data of inpatient treatments were available. Hospitalization rates cannot fully be equated to the occurrence of MDD. CONCLUSIONS: The current study indicates a seasonal variation in MDD symptoms that may go beyond seasonal affective disorder. Knowledge about the predictability of depressive symptoms in patients should encourage preventive strategies.

A relationship of sorts: gender and auditory hallucinations in schizophrenia spectrum disorders.

Voice hearing has been conceptualized as an interrelational framework, where the interaction between voice and voice hearer is reciprocal and resembles "real-life interpersonal interactions." Although gender influences social functioning in "real-life situations," little is known about respective effects of gender in the voice hearing experience. One hundred seventeen participants with a schizophrenia spectrum disorder took part in a semi-structured interview about the phenomenology of their voices and completed standardized self-rating questionnaires on their beliefs about their most dominant male and female voices and the power differentials in their respective voice-voice hearer interactions. Additionally, the voice hearers' individual masculine/feminine traits were recorded. Men heard significantly more male than female dominant voices, while the gender ratio of dominant voices was balanced in women. Although basic phenomenological characteristics of voices were similar in both genders, women showed greater amounts of distress caused by the voices and reported a persistence of voices for longer time periods. Command hallucinations that encouraged participants to harm others were predominantly male. Regarding voice appraisals, high levels of traits associated with masculinity (=instrumentality/agency) correlated with favorable voice appraisals and balanced power perceptions between voice and voice hearer. These positive effects seem to be more pronounced in women. The gender of both voice and voice hearer shapes the voice hearing experience in manifold ways. Due to possible favorable effects on clinical outcomes, therapeutic concepts that strengthen instrumental/agentic traits could be a feasible target for psychotherapeutic interventions in voice hearing, especially in women.

Hazardous alcohol consumption among older adults: A comprehensive and multi-national analysis of predictive factors in 13,351 individuals.

BACKGROUND: Older adults exhibit heightened vulnerability for alcohol-related health impairments. Increases in the proportion of older adults within the European Union's total population and prevalence rates of alcohol use disorders in this age group are being observed. This large scale international study was conducted to identify those older adults with an increased risk to engage in hazardous drinking behaviour. METHODS: Socio-demographic, socio-economic, personality characteristics (Big Five Inventory, BFI-10), and alcohol consumption patterns of 13,351 individuals from 12 different European countries, collected by the Survey of Health, Aging, and Retirement in Europe, were analyzed using regression models. RESULTS: Age, nationality, years of education, as well as personality traits, were significantly associated with alcohol intake. For males, extraversion predicted increased alcohol intake (RR = 1.11, CI = 1.07-1.16), whereas conscientiousness (RR = 0.93, CI = 0.89-0.97), and agreeableness (RR = 0.94, CI = 0.90-0.99), were associated with a reduction. For females, openness to new experiences (RR = 1.11, CI = 1.04-1.18) predicted increased alcohol intake. Concerning excessive drinking, personality traits, nationality, and age-predicted consumption patterns for both sexes: Extraversion was identified as a risk factor for excessive drinking (OR = 1.15; CI = 1.09-1.21), whereas conscientiousness was identified as a protective factor (OR = 0.87; CI = 0.823-0.93). CONCLUSION: Hazardous alcohol consumption in the elderly was associated with specific personality characteristics. Preventative measures, crucial in reducing deleterious health consequences, should focus on translating the knowledge of the association of certain personality traits and alcohol consumption into improved prevention and treatment.

When demand exceeds supply: Liver transplantation due to alcohol use disorder in Austria.

BACKGROUND: Alcohol use disorder (AUD) is associated with a high prevalence rate and causes a significant burden on health systems globally. The most severe condition associated with AUD is end-stage alcohol-related liver disease (ARLD), for which liver transplantation (LTX) is the only curative therapy. However, the determination of key epidemiologic figures of both conditions is limited by several difficulties and challenges. Therefore, the goal of this paper is to discuss different epidemiological models to estimate AUD and ARLD prevalence, and compare the results of these models with LTX data. METHODS: A literature search for epidemiological models estimating the prevalence of AUD and associated secondary diseases was conducted. Identified approaches are discussed and recalculated, applying the newest available data for Austria. The thus estimated numbers were, in a further step, set in relation to the national LTX statistics. RESULTS: Besides health survey-based estimations and models based on economic data, estimations based on the mortality of ARLD (Jellinek formula) were identified. Depending on the prediction scenario, the calculated rates of prevalence of AUD ranged between 4.1% and 10.1% for the population aged older than 15 years. Furthermore, while the prevalence of secondary diseases due to AUD is high, only a marginal proportion (about 4%) of end-stage ARLD patients receive a new organ. CONCLUSION: These results suggest that the prevalence of AUD and associated diseases remain underestimated. Furthermore, a pronounced discrepancy between the number of ARLD deaths and the number of LTXs due to ARLD, and distinct regional differences in the supply of LTXs, were found.

[Challenge abstinence-a case report and overview on therapy of alcohol dependence during pregnancy]. / Herausforderung Abstinenz ­ Fallbericht und Übersicht zur Therapie von Alkoholabhängigkeit bei Schwangerschaft.

The potentially deleterious and teratogen effects of alcohol consumption during pregnancy are an important medical as well as socio-economic topic. Maintaining the necessary strict abstinence is especially challenging for pregnant women diagnosed with alcohol dependence. Due to limited data, optimal pharmacological treatment is seldom possible. Importantly, all substances currently approved for relapse prevention are contraindicated during pregnancy. Limited data concerning the off-label-use of Ondansetron (5-HT3 receptor antagonist) as relapse prevention during pregnancy exists. In the portrayed case-report, a pregnant patient received psychopharmacological treatment with Sertraline, Quetiapine and Ondansetron. Under this established pharmacological therapy, the patient achieved abstinence for the remainder of the pregnancy.

The effect of sex on suicide risk during and after psychiatric inpatient care in 12 countries-An ecological study.

BACKGROUND: Suicide risk in patients is markedly elevated during psychiatric inpatient care, as well as after discharge. However, it is unclear whether, and to what extent, this increased suicide risk varies between sex. Thus, the aim of this study was to analyze sex differences for suicides during and after psychiatric hospitalization in various countries. METHODS: National suicide mortality rates and inpatient-related suicide rates (three intervals: during psychiatric inpatient treatment, 1 month, and 1 year after discharge) from 12 countries for 2000-2016 were analyzed, and a logistic model was used to quantify the effect of sex. RESULTS: Persons admitted to or discharged from psychiatric inpatient care exhibited significantly increased rates of suicide compared to those in the general population. Furthermore, increase of suicide risk was significantly higher for females than for males for all investigated time intervals (inpatient suicide odds ratio [OR] 1.85; suicide within 1 month after discharge-OR 1.94; suicide within 1 year after discharge-OR 2.04). CONCLUSION: Analysis confirmed the time during and after psychiatric inpatient care to be significantly associated with an elevated risk for suicide. Further, a significant sex effect was observed, with females in this population being at a proportionally higher risk for suicide during psychiatric inpatient treatment as well as the year following discharge. Our study implicates that more effective suicide preventive measures during inpatient stay, focusing on female patients, are needed.

Pattern of inpatient care for depression: an analysis of 232,289 admissions.

BACKGROUND: The prevalence of major depressive disorder (MDD) in women is up to 50% higher as compared to men. However, little is known about discrepancies in health care utilization between depressed female and male patients. Consequently, the aim of the present study was to elucidate gender differences regarding the frequency of hospital admissions and the length of inpatient treatment for MDD across the lifespan. METHODS: This nationwide, registry-based study analyzed all inpatient admissions in psychiatric hospitals due to recurrent/non-recurrent MDD episodes according to ICD-10 (moderate (F32/33.1), severe (F32/33.2), severe with psychotic features (F32/33.3)) in Austria across 14 years. We calculated weekly admission rates per 100,000 patients by directly age-standardized rates. RESULTS: Across 232,289 admissions (63.2% female) the population based admission rates in MDD were significantly higher in women (p < 0.001). Female to male ratios across subgroups were 1.65 (F32/33.1), 1.58 (F32/33.2), 1.73 (F32/33.3), and peaked around 65 years (ratio ≥ 2 for all subgroups). Length of hospital stay for women was significantly longer in all depression subtypes (p < 0.001). CONCLUSIONS: Elevated rates of inpatient treatment in women cannot solely be explained by a higher MDD prevalence and are dependent on age and type of depressive episode. Irrespective of the type and severity of the mood episode, women exhibit longer hospitalisation times.

Alcohol-Related Mortality in the WHO European Region: Sex-Specific Trends and Predictions.

AIMS: Alcohol is an important risk factor for morbidity and mortality, especially within the European region. Differences in per capita consumption and drinking patterns are possible reasons for regional differences and diverging trends in alcohol-related health outcomes. METHODS: Twenty-nine countries within the World Health Organization (WHO) European region were evaluated for trends and predictions in alcohol-related deaths within the last four decades using data available from the WHO Health for All database. RESULTS: Between 1979 and 2015, age-standardised death rates due to selected alcohol-related causes decreased significantly for both sexes in all assessed countries of the WHO European region, but regional differences are still pronounced. Assuming a similar trend in the future, the model predicted a further decrease until the year 2030. CONCLUSION: Even though alcohol-related mortality may have decreased within the last decades, the detrimental effects of alcohol consumption and alcohol dependence remain a considerable burden of disease within Europe.

End-stage liver disease in alcohol-dependent patients : Case report and overview on clinical management.

This case report is about a 44-year-old woman with alcohol-related end-stage liver disease. Initial contact with the patient was made in the alcohol-outpatient clinic of the Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna. Due to a particularly poor general condition, Child Pugh Score C/MELD Score 20, the patient was admitted to ward 4A, with the clinical and scientific focus of treating patients with alcohol use disorder. The withdrawal process was complicated by a multitude of factors associated with end-stage liver disease. By explaining the theoretical background of possible somatic as well as psychiatric complications of end-stage liver disease and elaborating on treatment options a comprehensive overview of the psychiatric and somatic management of this patient population is given.

[Descriptive examination of inpatient stays of patients with emotionally unstable personality disorder in Austria between 2001 and 2016 with special consideration of age, gender and length of stay]. / Deskriptive Untersuchung der stationären Aufenthalte von Patienten mit emotional instabiler Persönlichkeitsstörung in Österreich zwischen 2001 und 2016 mit besonderer Berücksichtigung von Alter, Geschlecht und Aufenthaltsdauer.

BACKROUND: Emotionally unstable personality disorder (EUPD) has a high prevalence worldwide and especially in in-patient psychiatric settings, varying in age and gender. Due to the complex clinical picture, repeated admissions and high costs, health systems are facing great challenges. METHODS: For the calculations Statistik Austria data of inpatient stays of patients with mental and behavioral disorders with special regard to EUPD as main discharge diagnosis in Austria in the period 2001-2016 were used. Included were patients with age over 14 years, admission to a psychiatric clinic in acute care and maximum length of stay of 365 days. Age, gender and length of stay were analyzed with SPSS®, evaluated in descriptive form and related to each other. RESULTS: The prevalence of EUPD within all mental and behavioral disorders was 4.0%. Of all personality and behavioral disorders, as well as specific personality disorders, EUPD had the highest prevalence (65.3% and 79.3%). About four times more women (79.8%) than men (20.2%) received inpatient treatment. Most patients (23.1%) were admitted at the age of 20-24 years. From 40 years of age the number of admissions clearly decreased. The largest percentage of men was found to be in the age group over 45 years (27.0%) and 183-365 inpatient days (27.0%), those of women aged 15-19 (83.4%) and 0 and 14-182 inpatient days (81.4% each). The average length of stay was 13 days for women and 12 days for men. 11.3% of patients left the clinic on the day of admission, 61.2% were treated for 1-13 days, 27.2% for 14-182 days, and 0.2% for 183-365 days.

[Beliefs and distress related to hearing voices: the German version of the Beliefs About Voices Questionnaire-Revised (BAVQ-R)]. / Überzeugungen und Belastungen durch Stimmenhören: die deutsche Version des Beliefs About Voices Questionnaire ­ Revised (BAVQ-R).

BACKGROUND: Beliefs about voices are a determining factor with regards to distress, coping and therapeutic interventions in verbal auditory hallucinations. Aim of the present study was to use and validate the internationally well established Beliefs About Voices Questionnaire-Revised (BAVQ-R) in a German translation with people suffering from schizophrenic psychoses. METHODS: 93 participants with a diagnosis of schizophrenia and current verbal auditory hallucinations completed the BAVQ-R autonomously for their dominant voice. Sociodemographic and clinical data as well as data concerning the severity of illness (CGI-Sch) and symptom specific dimensions of voice-hearing (PSYRATS-AH) were collected. Construct validity, reliability and test-retest-reliability were calculated. RESULTS: Each of the subscales (malevolence, benevolence, resistance, engagement) with the exception of the subscale omnipotence showed satisfying internal consistency. Good test-retest-reliability was shown for the belief-subscales but not for emotion and behaviour in resistance and engagement. Significant correlations between the subscales showed the expected results, comparable to the results of the original BAVQ-R study. No correlations with severity of the illness, but with amount and intensity of distress through voices and their negative contents correlations were found. CONCLUSIONS FOR PRACTICE: The BAVQ-R is a feasible instrument to collect data about beliefs about voices in a valid and reliable way in people with a diagnosis of schizophrenia. From a therapeutic as well as from a scientific point of view, the question about the conceptualization of the relationship between cognition, emotion and behaviour stays relevant.

Stability and mutual prospective relationships of stereotyped beliefs about mental illness, hope and depressive symptoms among people with schizophrenia spectrum disorders.

Internalized stigma, hope and depressive symptoms are important variables in the recovery process of people with schizophrenia spectrum disorders, but little is known about their stability or relationship among each other over time. This study aims to unravel the longitudinal stability and relationships of these variables. 99 participants were included in this prospective study assessing internalized stigma, hope and depressive symptoms at baseline, with a first follow-up after three months and a second follow-up after six months. Multilevel models examined if the variables changed over time and a correlation coefficient was conducted to show their relationship to each other. Hope stayed stable over time, whereas internalized stigma and depressive symptoms significantly decreased over the study period. The correlation coefficient showed that internalized stigma and depressive symptoms influenced each other moderately over time. Thus, while hope was a stable construct over time, internalized stigma and depressive symptoms changed significantly and were correlated to each other positively. This implies that participants may adjust to their chronic condition over time, and recovery focused interventions should target both psychological dimensions at the same time.

Parenthood among patients with psychotic disorders: gender differences in a non-selective clinical sample.

A large proportion of people with psychotic disorders have children and also live with them. However, research has rarely studied this in clinical populations and included male patients. This exploratory study used routine data of all 709 patients with a psychotic disorder treated in a psychiatric inpatient service in Austria between 2012 and 2015. Socio-demographic and clinical characteristics, number and age of children, and living arrangements were assessed and analysed. More female patients than male patients had children in the total sample (56% vs. 30%), and in diagnostic subgroups with bipolar disorder (71%, 53%), schizoaffective disorder (65%, 24%), and schizophrenia (45%, 21%). Being female, higher age, and living with a partner were associated with having children. Unlike female patients, most male patients with underage children (≤18 years) did not live with them, especially when patients had a diagnosis of schizophrenia. The gender specific differences in parenthood and custody arrangements identified in this study indicate different support needs of mothers and fathers with psychotic disorders. Not living with a child and having limited access might come with feelings of guilt and loss, which should be addressed in research and practice.