War and peace in public health education and training: a scoping review.

BACKGROUND: Armed conflict and war are public health disasters. Public health action has a crucial role in conflict-related emergencies and rehabilitation but also in war prevention and peace promotion. Translating this into public health training and competencies has just started to emerge, especially in Europe. METHODS: We conducted a Scoping Review to map and identify the role of public health education and training of public health workforce relating to the prevention of war and promoting peace, as reflected in the scientific literature. We searched in PubMed, CINAHL, PsycINFO, Embase, Web of Science Core Collections as well as the reference list of included material in English, German and Polish. Focusing initially on the European region, we later expanded the search outside of Europe. RESULTS: We included 7 publications from opinion pieces to an empirical assessment of curricula and training. The educational programs were predominantly short-term and extra-curricular in postgraduate courses addressing both public health professionals in conflict-affected countries as well as countries not directly affected by war. Publications focused on public health action in times of war, without specifying the context and type of war or armed conflict. Competencies taught focused on emergency response and multi-disciplinary collaboration during emergencies, frequently drawing on experience and examples from natural disaster and disease outbreak management. CONCLUSIONS: The scientific discourse on competences in public health education for times of war and for the promotion of peace, predominately focuses on immediate emergency response actions. The prevention of war and the promotion of peace are missing foci, that need to feature more prominently in public health training. Public Health Education and training should ensure that war prevention and peace promotion, as well as public health action in times of war, are included in their competencies for public health professionals.

Broad spectrum psychiatric comorbidity is associated with better executive functioning in an inpatient sample of individuals with schizophrenia.

BACKGROUND: Individuals with schizophrenia exhibit cognitive deficits but whether these deficits are exacerbated by broad spectrum psychiatric comorbidity (i.e., comorbidity that is inclusive of disorders from different diagnostic categories) is unclear. A broad spectrum approach to psychiatric comorbidity is an ecologically valid way to capture the diagnostic heterogeneity inherent in psychiatric presentations. OBJECTIVE: This study compared the attention, working memory, processing speed, and executive functioning of individuals with schizophrenia only relative to individuals with schizophrenia and broad spectrum psychiatric comorbidity. METHOD: Archival patient neuropsychological test data were obtained for a sample of patients with schizophrenia only (n=30) and a sample of patients with schizophrenia and psychiatric comorbidity (n=33). Relevant tests were used to form composite indices for the cognitive domains of attention, working memory, speed of processing, and executive functioning. RESULTS: Unexpectedly, individuals with schizophrenia and psychiatric comorbidity had significantly better executive functioning than individuals with schizophrenia only. There were no other significant differences. CONCLUSIONS: A broad spectrum approach to psychiatric comorbidity can help to account for differences in the executive functioning of individuals with schizophrenia. In clinical settings, individuals with schizophrenia and psychiatric comorbidity may benefit from intervention strategies that capitalize on their relatively higher executive functioning.

A snapshot of cognitive functioning: deriving a tool for the efficient assessment of cognition in schizophrenia and other chronic psychiatric disorders in a real-world inpatient setting.

Previous research has led to the development of short batteries of tests that efficiently measure the cognitive functioning of individuals with schizophrenia. To attempt to replicate previous findings, we applied an empirical test selection strategy to archival cognitive test data of two non-overlapping inpatient samples of individuals with schizophrenia or schizoaffective disorder (total N=110). We then extended previous findings by applying the empirical test selection strategy to the archival data of two non-overlapping inpatient samples of individuals with various psychiatric disorders (total N=149). For each sample, tests were selected by examining the relationships between individual test scores and averaged test scores representing global cognitive functioning while taking into account test administration times. Across patient samples, digit symbol coding tasks, verbal fluency tasks, and tests with a processing speed component (Trail Making Test Part A and Stroop) emerged as efficient and effective indicators of overall cognitive functioning. A brief cognitive assessment tool incorporating coding, fluency, and processing speed tasks would provide a valid and clinically useful snapshot of a patient's level of cognitive functioning if more comprehensive testing cannot be completed.

Time to 'get real': preliminary insights into the long-term management of schizophrenia.

OBJECTIVE: A brief file and medication chart review was undertaken to examine the 'real world' treatment of schizophrenia, with a particular focus on long-term treatment strategies that extend beyond existing evidence-based guidelines. METHOD: Treatment strategies were identified through an audit of patient files and their medication charts for patients admitted 2-5 years in a non-acute psychiatric hospital. RESULTS: Twenty-nine file reviews and 20 medication chart audits were conducted. High levels of diagnostic heterogeneity were identified with the presence of psychosis and mood-related diagnoses (primarily schizophrenia and schizoaffective disorder) and high rates of comorbidity (86%). Functional impairment, poor insight and high levels of risk were present in most patients. Treatments largely consisted of combination strategies with 75% of patients prescribed two or more antipsychotics and an average of 3.4 psychotropic medications in total. While clozapine was commonly prescribed (65%), this was often in combination with, on average, two other psychotropic agents. CONCLUSIONS: Notwithstanding the limited sample, these findings provide a valuable glimpse into the management strategies employed in the long-term management of schizophrenia. Evidence-based guidelines are largely of limited value for this cohort that often has complex presentations and further research is urgently needed to provide guidance into management strategies that extend beyond 5 years, with particular emphasis on the utility of medication combinations.