Genetic association of the tachykinin receptor 1 TACR1 gene in bipolar disorder, attention deficit hyperactivity disorder, and the alcohol dependence syndrome.

Single nucleotide polymorphisms (SNPs) in the tachykinin receptor 1 gene (TACR1) are nominally associated with bipolar affective disorder (BPAD) in a genome-wide association study and in several case-control samples of BPAD, alcohol dependence syndrome (ADS) and attention-deficit hyperactivity disorder (ADHD). Eighteen TACR1 SNPs were associated with BPAD in a sample (506 subjects) from University College London (UCL1), the most significant being rs3771829, previously associated with ADHD. To further elucidate the role of TACR1 in affective disorders, rs3771829 was genotyped in a second BPAD sample of 593 subjects (UCL2), in 997 subjects with ADS, and a subsample of 143 individuals diagnosed with BPAD and comorbid alcohol dependence (BPALC). rs3771829 was associated with BPAD (UCL1 and UCL2 combined: P = 2.0 × 10(-3)), ADS (P = 2.0 × 10(-3)) and BPALC (P = 6.0 × 10(-4)) compared with controls screened for the absence of mental illness and alcohol dependence. DNA sequencing in selected cases of BPAD and ADHD who had inherited TACR1-susceptibility haplotypes identified 19 SNPs in the promoter region, 5' UTR, exons, intron/exon junctions and 3' UTR of TACR1 that could increase vulnerability to BPAD, ADS, ADHD, and BPALC. Alternative splicing of TACR1 excludes intron 4 and exon 5, giving rise to two variants of the neurokinin 1 receptor (NK1R) that differ in binding affinity of substance P by 10-fold. A mutation in intron four, rs1106854, was associated with BPAD, although a regulatory role for rs1106854 is unclear. The association with TACR1 and BPAD, ADS, and ADHD suggests a shared molecular pathophysiology between these affective disorders.

Are there future psychiatrists among medical students in Croatia? The role of premedical and medical factors on career choice in psychiatry.

Despite the high prevalence of mental disorders, a worldwide shortage of psychiatrists exists. Moreover, the number of students interested in choosing psychiatry as their future profession is low and psychiatry is frequently regarded as one of the least wanted medical specializations. We report the findings of a cross-sectional quantitative survey of final year Croatian medical students as part of the International Survey of Student Career Choice in Psychiatry (ISoSCCiP). The questionnaire consisted of three sections: socio-demographic factors, psychiatric education during medical school, and attitudes and personality characteristics. Out of 200 students, 122 completed the questionnaire (response rate 61%). The overall student evaluation of the compulsory psychiatry curriculum was 'average'. Significantly higher ratings were reported by students who attended special psychiatry teaching modules, or felt more involved in the teaching of the subject. Poor evaluation of medical school psychiatric education significantly increased the likelihood of not choosing psychiatry as a future career. The choice of psychiatry was also predicted by attitudes towards psychiatry and by personal characteristics. In conclusion, student ratings of medical school psychiatric education and involvement in teaching appear to influence choice towards psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice.

Experience of psychiatry teaching at medical school influences Croatian medical students' attitudes towards choosing psychiatry as a career.

BACKGROUND: Reports indicate that the number of students interested in choosing psychiatry as their future profession is constantly decreasing in the last decades. Our aim was to determine the proportion of medical students intending to pursue a career in psychiatry and to define undergraduate education-related factors influencing that choice. SUBJECTS AND METHODS: We report the preliminary findings of a cross sectional quantitative survey of final year Croatian medical students as part of the International Survey Of Student Career Choice In Psychiatry (ISOSCCIP). We surveyed medical students attending their final year at Zagreb School of Medicine in the academic year 2009/2010, using a structured questionnaire examining demographics, students' preferences on future career choice and their evaluations of undergraduate psychiatry teaching. RESULTS: The overall student evaluation of the compulsory psychiatry curriculum was "average". Significantly higher ratings were reported by students who felt more involved in the teaching of the subject. The possibility of psychiatry as a career choice correlated significantly with better evaluation grades of psychiatry lectures. Furthermore, poor evaluation grades predicted a higher likelihood that medical students completely ruled out choosing a career in psychiatry. CONCLUSION: This is the first survey of this kind in Croatia. Student ratings of medical school psychiatric education and perceived involvement in teaching appears to influence the likelihood of a stated career in psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice.

Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

BACKGROUND: Little is known about the factors influencing treatment choice in psychosis, the majority of this work being conducted with specialists (consultant) in psychiatry. We sought to examine trainees' choices of treatment for psychosis if they had to prescribe it for themselves, their patients, and factors influencing decision-making. METHODS: Cross-sectional, semi-structured questionnaire-based study. RESULTS: Of the 726 respondents (response rate = 66%), the majority chose second-generation antipsychotics (SGAs) if they had to prescribe it for themselves (n = 530, 93%) or for their patients (n = 546, 94%). The main factor influencing choice was perceived efficacy, 84.8% (n = 475) of trainees stating this was the most important factor for the patient, and 77.8% (n = 404) stating this was the most important factor for their own treatment. Trainees with knowledge of trials questioning use of SGAs (CATIE, CUtLASS, TEOSS) were more likely to choose second-generation antipsychotics than those without knowledge of these trials (χ2 = 3.943; p = 0.047; O.R. = 2.11; 95% C.I. = 1.0-4.48). Regarding psychotherapy, cognitive behavioural therapy (CBT) was the most popular choice for self (33.1%; n = 240) and patient (30.9%; n = 224). Trainees were significantly more likely to prefer some form of psychotherapy for themselves rather than patients (χ2 = 9.98; p < 0,002; O.R. = 1.54; 95% CIs = 1.18-2.0). CONCLUSIONS: Trainees are more likely to choose second-generation antipsychotic medication for patients and themselves. Despite being aware of evidence that suggests otherwise, they predominantly base these choices on perceived efficacy.

Analysis of genetic deletions and duplications in the University College London bipolar disorder case control sample.

Genetic deletions and duplications known as copy number variants have been strongly implicated in genetic susceptibility to schizophrenia, autism, attention deficit hyperactivity disorder and epilepsy. The overall rate of copy number variants in the University College London (UCL) bipolar disorder sample was found to be slightly lower than the rate in controls. This finding confirms the results from other studies that have also shown no increased rate of copy number variants in bipolar disorder. However, some rare duplications and deletions were observed only in bipolar disorder cases and not in controls, these included some that had previously been detected only in rare cases of bipolar disorder. We conclude that copy-number variant analysis shows no obvious sharing of the same genetic susceptibility between schizophrenia and bipolar disorder. Copy number variants do not seem to have an important role in susceptibility to bipolar disorder, they may, however, still represent a rare cause of the disease, although the evidence for this is far from clear.

International medical graduates in the National Health Service.

The UK's National Health Service (NHS) has benefited from the skills of foreign qualified doctors for many years. International medical graduates (IMGs) - that is, those doctors with primary medical qualifications outside the European Economic Area (EEA) - have come to the UK despite the significant personal and financial costs, alongside the burden of taking the Professional and Linguistic Assessment Board (PLAB) examination. Despite the costs and increasing indications that the UK job market was becoming saturated with the increased indigenous medical school output and expansion of the EEA, doctors still migrate to the UK in their thousands (McGinn, 2005). The government's active international recruitment policy, which continued until very recently despite the significant increase in places in UK medical schools, was partially responsible for this trend. Until last year, once registered to practise in the UK, access to specialty training was facilitated by the permit-free training visa (PFTV) system, which allowed IMGs to work and train simultaneously, without the need for a work permit. This meant that they could compete on an equal footing with UK graduates for training opportunities in the UK. The implementation and potential impact of some of the recent policy changes in the NHS specifically with regard to IMGs is discussed here briefly.