[Undersupply of child and adolescent psychiatric outpatient clinics in Austria that can meet minimum requirements]. / Unterversorgung mit Kinder- und jugendpsychiatrischen Fachambulatorien in Österreich, die Mindestanforderungen erfüllen können.

This article is intended to provide an overview of the supply situation with independent outpatient clinics and dislocated Hospital ambulances for Child and Adolescent Psychiatry, taking into account minimum professional standards. The level of care, the mandate to provide care, requirements, structural quality criteria and implementation recommendations are described. 13 outpatient clinics and dislocated Hospital ambulances are described in a data matrix.A comprehensive Austria-wide survey of the staffing and care offerings identified 13 outpatient clinics and outpatient clinics that meet minimum standards. This proves a difference between the current situation and the number of outpatient clinics required nationwide of 26 to 36 (depending on the assessment 1/350k or 1/250k)Thus, the findings provided here, lead us to the conclusion that the patient care in Austria's child and adolescent psychiatric outpatient clinics is not sufficiently guaranteed due to the largely tolerated but technically incorrect interpretation of the legally valid minimum standards.If the current deficiencies are retained, a central child and adolescent psychiatric care level remains with an effectiveness of less than 50% of the Austrian health structure plan (OSG).

Psychiatry training in 42 European countries: A comparative analysis.

Psychiatry qualifications are automatically recognized among European Union (EU) countries despite differences in national training programs. A widening gap between the number of psychiatrists, their competencies and the growing burden of mental illnesses in Europe has renewed calls for international standardization of training. Comprehensive information about training programs is missing, which limits thorough comparisons and undermines development of an actionable strategy to improve and harmonize psychiatry training. This study describes and compares the existing postgraduate psychiatry programs in 42 countries in the European region. Representatives of national psychiatry associations completed a semi-structured, 58-item questionnaire. Training structure and working conditions of each country were compared with population needs calculated by the World Health Organization to determine the European mean and contrasted among pre-2004 and post-2004 EU members and countries with unrecognized qualifications. Differences were tested with nonparametric (Wilcoxon) and parametric (Anova) tests. Median training duration was 60 months, significantly shorter in countries with unrecognized qualifications (48 months, χ²16.5, p < 0.001). In 80% of the countries, placement in a non-psychiatric specialty such as neurology or internal medicine was mandatory. Only 17 countries (40%) stipulated a one-month rotation in substance abuse and 11 (26%) in old-age psychiatry. The overall deficit of training versus population need was 22% for substance abuse and 15% for old-age psychiatry. Salaries were significantly higher in pre-2004 EU members (χ²22.9, p < 0.001) with the highest in Switzerland (€5,000). Significant variations in curricula, training structure and salaries exist in Europe. Harmonization of training standards could offer significant benefits for improving mental healthcare.

Diffusion-weighted MRI in transient global amnesia and its diagnostic implications.

OBJECTIVE: To analyze how the evidence of hippocampal diffusion-weighted imaging (DWI) lesions may support the clinical diagnosis of transient global amnesia (TGA). METHODS: In this retrospective observational study, 390 consecutive patients with isolated TGA were analyzed, who were evaluated at our institution between July 1999 and August 2018. The size, location, and number of lesions and time-dependent lesion detectability were examined. The incidence of DWI lesions was reviewed with regard to different levels of clinical diagnostic certainty upon presentation to the emergency department. RESULTS: Hippocampal DWI lesions were detected in 272 (70.6%) patients with TGA, with a mean of 1.05 ± 0.98 (range 0-6) and a mean lesion size of 4.01 ± 1.22 mm (range 1.7-8.6 mm). In the subgroups of lower diagnostic certainty (amnesia witnessed by layperson or self-reported amnestic gap), DWI was helpful in supporting the diagnosis of TGA in 76 (69.1%) patients. In 187 patients with information about the exact onset, DWI lesions were analyzed in relation to latency between onset and MRI. Lesions could be detected at all time points and up to 6 days after symptom onset in individual patients; the highest rate of DWI-positive MRI (93%) was in the 12-24 hours time window. CONCLUSION: MRI findings can support the diagnosis of TGA and may be particularly valuable in situations of low clinical certainty. DWI-ideally performed with a minimum delay of 20 hours after onset-should therefore be considered a useful adjunct to the diagnosis of TGA.

Psychiatrists' emotional reactions: Useful for precise diagnosis in adolescence?

Therapist response (countertransference) can be defined as the range of emotions a clinician experiences when interacting with a patient. Previous research has shown that this reaction plays an important role in the establishment of the therapeutic relationship, and that certain psychiatric disorders are systematically related to strong countertransference reactions in clinicians. For this study, 30 videotaped sessions were retrospectively analyzed by one observer using the Therapist Response Questionnaire (TRQ). The authors aimed to investigate the differences in therapist response between an adolescent case group consisting of 19 patients diagnosed with a cluster B personality disorder (PD), and a control group composed of 11 adolescents diagnosed with anorexia nervosa. The PD group scored significantly higher on the hostile/mistreated, helpless/inadequate, disengaged and overwhelmed/disorganized factors. This study adds evidence to the preexisting empirical literature on therapist response in regard to personality disorders and emphasizes the continuing need for recognition of countertransference across all psychotherapy orientations.

Efficacy and tolerability of the ketogenic diet in Dravet syndrome - Comparison with various standard antiepileptic drug regimen.

UNLABELLED: There is strong evidence for the use of the ketogenic diet (KD) in Dravet syndrome (DS). The purpose of this study was to evaluate both effectiveness and tolerability in comparison with various antiepileptic drugs (AEDs). METHODS: 32 children (19 males) with genetically confirmed DS treated at our center since 1999 were analyzed retrospectively. Data collected from patients' files included type of mutation, age at treatment initiation and treatment lag, overall seizure frequency and frequency of different seizure types, especially prolonged seizures and status epilepticus (SE). Efficacy and safety of the KD were evaluated. In addition, the effect on seizure count was compared with that of various AED regimen and the vagus nerve stimulation (VNS). RESULTS: Overall response to the KD was 70% at 3 months and 60% at 12 months. No SE occurred while patients were on the diet, and the frequencies of prolonged generalized and myoclonic seizures were reduced. No severe side effects requiring withdrawal of the KD were observed. Although the effect of the KD was independent of age at initiation, it had to be withdrawn due to noncompliance more frequently in solid fed older children compared with infants treated with the liquid ketogenic formula. The KD was not significantly inferior to the current gold standard AED triple combination of Stiripentol+Valproate+Clobazam (89%), Bromides (78%), Valproate alone (48%), Topiramate (35%) and VNS (37%) and significantly more effective than Levetiracetam (30%; p=0.037, Pearson's Chi-square). SIGNIFICANCE: These data suggest that the KD ranks among currently used AEDs as an effective treatment for seizures in DS. According to our results (good effect on SE and prolonged seizures, good tolerability, less compliance problems due to formula treatment) the KD should be considered as an early treatment option in infants with DS.