Mental health related stigma in Romania: systematic review and narrative synthesis.

BACKGROUND: Stigma related to mental illness is increasingly and more effectively addressed. Although more research is being conducted, there is relatively little from low and middle-income countries, with former Soviet bloc countries identified as a particular contributor to this evidence gap. Romania struggles with mental health stigma at many levels. The aim of this review was to bring together all relevant data regarding stigma and discrimination related to mental illness as well as actions to address these problems in Romania in order to prioritise further stigma research and identify priority targets for stigma reduction. METHODS: A systematic literature search was conducted in three online databases and grey literature. After the analysis of full manuscripts, four were excluded based on lack of relevance or incomplete data reporting. Quality assessment was performed for included studies using the Mixed Methods Appraisal Tool (MMAT) and the narrative was synthesized based on the research questions. RESULTS: The review included fifteen studies, the majority having a cross-sectional design. Stigma related to mental illness in Romania, has an impact on help-seeking attitudes and behaviours, workplace environment and social relationships of people with mental health problems. Negative stereotypes are maintained and validated by mass media reports. Significant stigma in healthcare and mental care settings has also been observed. Self-stigma was less frequently reported than public stigma. Despite a few stigma reduction actions, no rigorous evaluation of content, delivery and effectiveness has been conducted and no empirical evidence has been published. CONCLUSIONS: Based on this review, three lines of action are recommended in Romania. Increase research concerning stigma in healthcare and mental care settings and use behavioural outcomes. Develop and deliver evidence-based tailored interventions to reduce stigma in identified priority subgroups of the population and ensure rigorous evaluation and scientific dissemination. Elaborate guidelines for working with community stigma and advocate for structural changes.

The Implication of Misinformation and Stigma in Age-Related Quality of Life, Depression, and Coping Mechanisms of Adult Patients with Psoriasis.

Background and Objectives: Stigma and lack of acceptance in society might have detrimental effects on the quality of life of patients with psoriasis, sometimes being comparable with other chronic diseases and conditions that affect the appearance of a patient, such as burns. Therefore, we surveyed our patients diagnosed with psoriasis to determine the implications of misinformation and stigma for their quality of life, depression, and coping strategies stratified by different age categories. Materials and Methods: A cross-sectional study was designed for a sample size of a minimum of 45 patients considering a prevalence of psoriasis of 2-3% in the general population. The study participants (patients and controls) were given both a paper-based unstandardized questionnaire and an online version of three standardized surveys. The cohort of patients was further split into three age groups to determine their age-related quality of life and coping mechanisms. Results: The proportion of patients with a history of depression and depressive symptoms among patients with psoriasis was significantly higher. Multiple discrepancies were observed between patients and controls regarding questions that targeted stigma and misinformation. On the Coping Orientation to Problems Experienced Inventory (COPE-60) questionnaire, older patients were more likely to use positive coping mechanisms such as engagement and problem-focused coping, while the young patients were using more emotion-focused coping mechanisms. However, patients in the 30-50 age range group scored the highest on physical and mental health among all participants who filled the 12-Item Short Form Survey (SF-12) survey. The Dermatology Life Quality Index (DLQI) results showed significantly more patients answering "a lot and very much" concerning embarrassment and social activities, while sexual difficulties affected the older patients. The strongest correlations with depression were observed in the young patient group, who believed that psoriasis can cause skin cancer (rho = 0.418) and who had sexual difficulties (rho = 0.414) and embarrassment (rho = 0.359) as evaluated by the DLQI survey. In the 30- to 50-year-old group, the strongest correlations were with the feeling of being stigmatized (rho = 0.376), having sexual difficulties (rho = 0.367) and disengagement coping style (rho = 273). Conclusions: While the respondents are reasonably well-informed regarding psoriasis, a degree of stigma remains, likely due to involuntary emotional responses such as repulsion and embarrassment. It is essential to establish initiatives aimed at educating the general public, raising awareness, and establishing a more tolerant social environment for psoriasis patients.

Pathways to care for people with dementia: An international multicentre study.

OBJECTIVE: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. METHODS: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant. RESULTS: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care. CONCLUSIONS: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.

A risk-based decision framework for policy analysis of societal pandemic effects.

Introduction: In this article, we summarize our findings from an EU-supported project for policy analyses applied to pandemics such as Covid-19 (with the potential to be applied as well to other, similar hazards) while considering various mitigation levels and consequence sets under several criteria. Methods: It is based on our former development for handling imprecise information in risk trees and multi-criteria hierarchies using intervals and qualitative estimates. We shortly present the theoretical background and demonstrate how it can be used for systematic policy analyses. In our model, we use decision trees and multi-criteria hierarchies extended by belief distributions for weights, probabilities and values as well as combination rules to aggregate the background information in an extended expected value model, taking into criteria weights as well as probabilities and outcome values. We used the computer-supported tool DecideIT for the aggregate decision analysis under uncertainty. Results: The framework has been applied in three countries: Botswana, Romania and Jordan, and extended for scenario-building during the third wave of the pandemic in Sweden, proving its feasibility in real-time policy-making for pandemic mitigation measures. Discussion: This work resulted in a more fine-grained model for policy decision that is much more aligned to the societal needs in the future, either if the Covid-19 pandemic prevails or for the next pandemic or other society-wide hazardous emergencies.

The family in Romania: cultural and economic context and implications for treatment.

The study of family structures, functioning, roles and values is fundamental in family therapist's activities for better understanding the psychological, cultural and social specificity of different clients and interventions. In this paper we describe the Romanian family and the family therapies which are available in Romania. We illustrate basic needs using demographic data and research available from Romania. The nuclear family remains dominant instead of other alternatives, the age of marriage is earlier than in western European countries and celibate and consensual living are exceptions or only for the transitional period before marriage. The role of marriage and childbirth within the marital setting is still important. The model of a single child appears increasingly common due to an improvement in financial resources and better living conditions. Relations with family of origin remain close. The difficulties for children with parents working in different countries raise problems and have implications for the extended family, educators and psychotherapists as well as mental health service providers. Family therapists should keep in mind the structure, function, role and values of the Romanian family for better understanding the issues and resources and use these accordingly in therapy. Policy-makers should be aware of the difficulties concerning availability and access to this therapeutic approach.

Influence of Water, NaCl and Citric Acid Soaking Pre-Treatments on Acrylamide Content in French Fries Prepared in Domestic Conditions.

The aim of this study was to investigate the influence of some pre-treatment applications toward acrylamide mitigation in potatoes fried in domestic conditions modeled after those found in Romania, by using a pan and a fryer. Before being fried in a pan, potato strips were treated in one of the following ways: soaked in cold water for 15, 60, and 120 min (a); soaked in hot water at different combinations of temperatures and durations (60, 70, 80 °C for 5, 10, 15 min) (b); soaked in a NaCl solution (c), and; in a citric acid solution (d) both solutions of 0.05% and 1% concentration for 30 min. For potatoes fried in a fryer, the (a) pre-treatment and soaking in water at 80 °C for 5, 10, and 15 min were applied. Untreated samples were used as a control. French fries were analyzed in terms of moisture and acrylamide content, color, and texture parameters. The pre-treatments applied reduced the acrylamide content in French fries by 4-97% when fried in the pan and by 25-47% when fried in the fryer. Acrylamide content of French fries was negatively correlated with L* parameter and moisture content and positively correlated with a* parameter. The pre-treatments applied can be used successfully by consumers to reduce acrylamide content.

A Multi-Criteria Framework for Pandemic Response Measures.

In managing the COVID-19 pandemic, several compelling narratives seem to have played a significant role in the decision-making processes regarding which risk mitigation and management measures to implement. Many countries were to a large extent unprepared for such a situation, even though predictions about a significant probability for a pandemic to occur existed, and national governments of several countries often acted in an uncoordinated manner, which resulted in many inconsistencies in the disaster risk reduction processes. Limited evidence has also made room for strategic narratives meant to persuade the public of the chosen set of actions, even though the degree of uncertainty regarding the outcomes of these was high, further complicating the situation. In this article, we assume a normative standpoint regarding rhapsodic decision making and suggest an integrated framework for a more elaborated decision analysis under the ambiguity of how to contain the virus spread from a policy point of view, while considering epidemiologic estimations and socioeconomic factors in a multi-stakeholder-multi-criteria context based on a co-creative work process for eliciting attitudes, perceptions, as well as preferences amongst relevant stakeholder groups. The framework, applied in our paper on Romania for demonstrative purposes, is used for evaluating mitigation measures for catastrophic events such as the COVID-19 situation, to mobilize better response strategies for future scenarios related to pandemics and other hazardous events, as well as to structure the production and analysis of narratives on the current pandemic effects.

The role of coping strategies, depression and anxiety in thyroid disease / A megküzdési stratégiák, a depresszió és a szorongás szerepe a pajzsmirigybetegségekben.

Összefoglaló. Bevezetés: A tudományos szakirodalomban számos kérdés fogalmazódik meg a pajzsmirigybetegségeket befolyásoló pszichológiai tényezokrol. Kevés tanulmány készült a pajzsmirigybetegségek és a megküzdési stratégiák kapcsolatáról. Célkituzés: Jelen tanulmányunk célja felmérni a megküzdési stratégiák, a depresszió és a szorongás szintjének változásait a pajzsmirigybetegek (hyperthyreosis és hypothyreosis) esetében a gyógyszeres kezelés (Thyrozol és Euthyrox) hatására. Módszer: A betegeket a szakorvos diagnózisa, illetve a TSH- és fT4-szint alapján hyperthyreosis- (n = 10) és hypothyreosis- (n = 21) csoportba soroltuk. Mindkét csoport tagjait az endokrinológiai kezelés elott és után pszichológiai felmérésnek vetettük alá. A felmérés során a megküzdési stratégiák felméréséhez a következo skálákat alkalmaztuk: Kognitív Érzelem Szabályozás Kérdoív (Cognitive Emotion Regulation Questionnaire - CERQ), Hobfoll-féle Megküzdési Stratégia Kérdoív (Strategic Approach to Coping Scale - SACS). A Beck Depresszió Kérdoívet (Beck Depression Inventory - BDI-II) alkalmaztuk a depresszió felmérésére, az Állapot- és Vonásszorongás Kérdoívet (State-Trait Anxiety Inventory, Form Y - STAI-Y) a szorongás szintjének felmérésére. Eredmények: A két csoport pszichológiai és laboreredményeit összehasonlítottuk a gyógyszeres kezelés elott és után. Mind a hyperthyreosisban, mind a hypothyreosisban szenvedo betegeknél magas volt a depresszió és a szorongás szintje. A hyperthyreosisban szenvedo betegeknél a depresszió magasabb. A gyógyszeres kezelés után a depresszió és a szorongás szintje csökkent mindkét csoportban, a megküzdési stratégiák többnyire változatlanok maradtak. Következtetések: Pajzsmirigybetegeknél a kognitív viselkedésbeli pszichoterápiás beavatkozás a gyógyszeres kezelés kiegészíto alternatívája lehet a szorongás és a depresszió szintjének csökkentése és a diszfunkcionális megküzdési stratégiák módosítása szempontjából. Orv Hetil. 2021; 162(7): 262-268. INTRODUCTION: There is a high interest in the scientific literature in psychological factors that influence the course of thyroid disease. There are a few studies on the link between thyroid disease and coping strategies. OBJECTIVE: In the present study, we aimed to evaluate the manifestation of depression, anxiety and coping strategies in people with thyroid disease and the impact of endocrinological medication on these psychologic items. METHOD: The patients were grouped into two groups, hyperthyroid (n = 10) and hypothyroid (n = 21), according to the diagnosis established by the attending physician, TSH and fT4 level. Patients with hyperthyroidism and hypothyroidism were evaluated before and after endocrinological treatment with the Cognitive Emotion Regulation Questionnaire (CERQ), Strategic Approach to Coping Scale (SACS) for the evaluation of coping strategies, Beck Depression Inventory (BDI-II) for assessing the level of depression, State-Trait Anxiety Inventory, Form Y (STAI-Y) for assessing anxiety. These two groups have been compared. RESULTS: The psychological and laboratory results of the two groups were compared before and after drug treatment. Both patients with hyperthyroidism and with hypothyroidism had high levels of depression and anxiety. In hyperthyroidism, depression is more severe. Following treatment with Thyrozol and Euthyrox, the level of depression and anxiety decreases in patients with hyper- and hypothyroidism; the coping strategies remained almost unchanged. CONCLUSION: Cognitive-behavioral psychotherapeutic intervention could be supplementary to drug treatment in terms of reducing anxiety, depression, and modifying dysfunctional coping strategies for patients with thyroid diseases. Orv Hetil. 2021; 162(7): 262-268.

Assessment of Psychopathology in Adolescents with Insulin-Dependent Diabetes (IDD) and the Impact on Treatment Management.

Assessing mental health in children and adolescents with insulin-dependent diabetes (IDD) is an issue that is underperformed in clinical practice and outpatient clinics. The evaluation of their thoughts, emotions and behaviors has an important role in understanding the interaction between the individual and the disease, the factors that can influence this interaction, as well as the effective methods of intervention. The aim of this study is to identify psychopathology in adolescents with diabetes and the impact on treatment management. A total of 54 adolescents with IDD and 52 adolescents without diabetes, aged 12-18 years, completed APS-SF (Adolescent Psychopathology Scale-Short Form) for the evaluation of psychopathology and adjustment problems. There were no significant differences between adolescents with diabetes and control group regarding psychopathology. Between adolescents with good treatment adherence (HbA1c < 7.6) and those with low treatment adherence (HbA1c > 7.6), significant differences were found. In addition, results showed higher scores in girls compared with boys with IDD with regard to anxiety (GAD), Major Depression (DEP), Post-Traumatic Stress Disorder (PTSD), Eating Disturbance (EAT), Suicide (SUI) and Interpersonal Problems (IPP). No significant differences were found regarding the duration of the disease. Strategies such as maladaptive coping, passivity, distorted conception of the self and the surrounding world and using the negative problem-solving strategies of non-involvement and abandonment had positive correlation with poor glycemic control (bad management of the disease). The study highlighted the importance of promoting mental health in insulin-dependent diabetes management.

Romanian psychiatric residents' opinions on factors that influence their decision to emigrate: A 5-year follow-up study.

INTRODUCTION: To evaluate the situation of migration of psychiatrists from Romania and a prioritization exercise of main factors related with psychiatric residents' decision to emigrate could be a starting point of elaboration of a strategy of reforms. Important changes have been done in economic status of residents in 2018. The impact of these measures in changing opinions was checked. METHODS: This is a cross sectional evaluation study on a randomized selected sample of Romanian psychiatric residents' opinions on factors that influence decision of migration in EU countries in two time points, 2015 and 2020. RESULTS: Thirty-eight percent of residents intend to work abroad comparing with 78% before the economic changes (25.8% vs. 71.7% for a limited period of time and 15.7% vs. 28.3% intend to emigrate) and 2% vs. 5% intend to leave the specialty. The important factors for decision to emigrate changed from "Better working conditions" (15.7% vs. 37.3% residents) to "Better training"; the factor "respect and appreciation by colleagues" remained important for 19.1% versus 17.9%. "Lack of working place for partner" was considered by 26.7% of responders as an important disadvantage of working abroad. "Being far from family members", which was considered 5 years ago by 64.2% of responders as an important disadvantage of working abroad, nowadays concerns only 6.7%, probably because it seems easier to go abroad together with the family members. CONCLUSIONS: The factors (better training in psychiatry and psychotherapy, better supervision, more involvement in research) that influence the residents' decision to emigrate represent the starting points for future reforms in educational and medical system in psychiatry.

Prevalence, New Incidence, Course, and Risk Factors of PTSD, Depression, Anxiety, and Panic Disorder during the Covid-19 Pandemic in 11 Countries.

We aimed to evaluate the prevalence and incidence of post-traumatic stress disorder (PTSD), depression, anxiety, and panic disorder (PD) among citizens in 11 countries during the Covid-19 pandemic. We explored risks and protective factors most associated with the development of these mental health disorders and their course at 68 days follow up. We acquired 9543 unique responses via an online survey that was disseminated in UK, Belgium, Netherlands, Bulgaria, Czech Republic, Finland, India, Latvia, Poland, Romania, and Sweden. The prevalence and new incidence during the pandemic for at least one disorder was 48.6% and 17.6%, with the new incidence of PTSD, anxiety, depression, and panic disorder being 11.4%, 8.4%, 9.3%, and 3%, respectively. Higher resilience was associated with lower mental health burden for all disorders. Ten to thirteen associated factors explained 79% of the variance in PTSD, 80% in anxiety, 78% in depression, and 89% in PD. To reduce the mental health burden, governments should refrain from implementing many highly restrictive and lasting containment measures. Public health campaigns should focus their effort on alleviating stress and fear, promoting resilience, building public trust in government and medical care, and persuading the population of the measures' effectiveness. Psychosocial services and resources should be allocated to facilitate individual and community-level recovery from the pandemic.

Perceived Effectiveness, Restrictiveness, and Compliance with Containment Measures against the Covid-19 Pandemic: An International Comparative Study in 11 Countries.

National governments took action to delay the transmission of the coronavirus (SARS-CoV-2) by implementing different containment measures. We developed an online survey that included 44 different containment measures. We aimed to assess how effective citizens perceive these measures, which measures are perceived as violation of citizens' personal freedoms, which opinions and demographic factors have an effect on compliance with the measures, and what governments can do to most effectively improve citizens' compliance. The survey was disseminated in 11 countries: UK, Belgium, Netherlands, Bulgaria, Czech Republic, Finland, India, Latvia, Poland, Romania, and Sweden. We acquired 9543 unique responses. Our findings show significant differences across countries in perceived effectiveness, restrictiveness, and compliance. Governments that suffer low levels of trust should put more effort into persuading citizens, especially men, in the effectiveness of the proposed measures. They should provide financial compensation to citizens who have lost their job or income due to the containment measures to improve measure compliance. Policymakers should implement the least restrictive and most effective public health measures first during pandemic emergencies instead of implementing a combination of many restrictive measures, which has the opposite effect on citizens' adherence and undermines human rights.

Are female psychiatry residents better to propose in emergency a voluntary hospitalization?

This study analyses assessment, intervention and admission decisions made by emergency psychiatry residents, to determine whether these differ depending on the gender of the resident. Data from all patients presenting to a psychiatric emergency room were collected prospectively for a 3 months period as part of a local quality check project. A questionnaire was used to collect patient demographic data, diagnosis, treatment decisions and the personal and professional characteristics of the residents who performed the assessments. During the 3 months of the study period we obtained data on all 251 emergency assessments carried out by all six residents working in the service. These were 3 female and 3 male 3rd year residents in psychiatry. There was no difference between male and female residents concerning ICD-10 diagnostic assessment, adherence to local hospitalization criteria guidelines, psychotherapeutical and pharmacological treatments administered. A similar distribution between male and female residents was found for diagnoses. No difference was found in the rate of hospitalization decisions between male and female residents. However, surprisingly, there were more voluntary hospitalizations by the women residents (P = 0.035; χ2 = 4.443) and more involuntary admissions by the men residents (P = 0.005; χ2 = 7.643). There was no correlation between the gender of the patient and the assessment or hospitalization decision of either male or female residents. Although this study has methodological limitations, it suggests that female emergency psychiatry residents are more likely to propose voluntary hospitalizations.

[Analysis of inter-judge concordance for the realization of psychiatric expertise in the use of guidelines]. / L'analyse de la fidélité inter-juge d'expertises psychiatriques d'assurance invalidité suggère l'intérêt de l'utilisation de guidelines.

OBJECTIVES: The aim of this work is to measure the inter-judge concordance in thirteen psychiatric expertises for invalidity insurance. METHOD: We analyzed thirteen interdisciplinary (somatic and psychiatric) expertise files, blinded for the patient identity. The patients had a first opinion of a "classic" psychiatric expertise and then a second opinion of other experts, from a center specialized for interdisciplinary expertises in Switzerland. The inter-experts' judgments were compared according to the complexity of every file, due to the intervention of four foreign independent experts with regard to the expertise process (France, Belgium, United States, Switzerland, Romania). RESULTS: A satisfactory inter-judge concordance in terms of diagnoses and to incapacities was observed in nine files out of thirteen, with a better consensus for the male patients (chi2 = 4.95; p = 0.026). Divergent opinions seem to be in relation with the lack of explicit expertise guidelines used by the first psychiatric experts. We highlight some general principles issued from guidelines of the Swiss Insurance Psychiatric Society for medical expertise of psychiatric disorders. In our opinion these principles would have been able to improve the inter-judge concordance in the thirteen analyzed expertises. DISCUSSION: In spite of his methodological limits, especially the reduced number of analyzed expertises, this work underlines the interest to use of certain guidelines for the realization of psychiatric expertises in terms of invalidity insurance. CONCLUSION: The use of guidelines could improve the inter-judge concordance for the realization of psychiatric expertises about invalidity insurance.

General practitioners' views towards diagnosing and treating depression in five southeastern European countries.

AIM: To assess and compare general practitioners' (GPs') views of diagnosing and treating depression in five southeastern European countries. METHODS: A cross-sectional study was conducted in Albania, Bulgaria, Moldova, Romania, and Serbia. The sample included 467 GPs who completed a hard-copy self-administered questionnaire, consisting of self-assessment questions related to diagnosing and treating depression. RESULTS: The most common barriers to managing depression in general practice reported by GPs were: patients' unwillingness to discuss depressive symptoms (92.3%); appointment time too short to take an adequate history (91.9%), barriers for prescribing appropriate treatment (90.6%); and patients' reluctance to be referred to a psychiatrist (89.1%). Most GPs (78.4%) agreed that recognizing depression was their responsibility, 71.7% were confident in diagnosing depression, but less than one-third (29.6%) considered that they should treat it. CONCLUSIONS: Improvements to the organization of mental healthcare in all five countries should consider better training for GPs in depression diagnosis and treatment; the availability of mental healthcare specialists at primary care level, with ensured equal and easy access for all patients; and the removal of potential legal barriers for diagnosis and treatment of depression.

International variations in mental-health law regulating involuntary commitment of psychiatric patients as measured by the Mental Health Legislation Attitudes Scale.

Previous research illustrated that the laws regulating involuntary placement and treatment of people with mental-health problems are diverse across countries. International studies comparing satisfaction levels between countries are rare. We compared the opinions of professionals and family members about the operation of the national mental-health law regulating forcibly admission and treatment of psychiatric patients in 11 countries: Ireland, Iceland, England and Wales, Romania, Slovenia, Denmark, Germany, Sweden, Norway and India. An online survey design was adopted using a Mental Health Legislation Attitudes Scale (MHLAS). This brief nine-item questionnaire was distributed via email to psychiatrists, general practitioners, acute and community mental-health nurses, tribunal members, police officers and family members in each collaborating country. The levels of agreement/disagreement were measured on a Likert scale. Data were analysed both per question and with regard to a total MHLAS 'approval' score computed as a sum of the nine questions. We found that respondents in England and Wales and Denmark expressed the highest approval for their national legislation (76% and 74%, respectively), with those in India and Ireland expressing the lowest approval (65% and 64%, respectively). Almost all countries had a more positive attitude in comparison to Ireland on the admission criteria for involuntary placement and the way people are transferred to psychiatric hospitals. There are significant variations across Europe and beyond in terms of approval for how the national mental-health law framework operates in each country.

Depression and suicidality among psychiatric residents - results from a multi-country study.

BACKGROUND: Previous studies have highlighted risks for depression and suicide in medical cohorts, but evidence regarding psychiatric residents is missing. This study aimed to determine rates of depression, suicide ideation and suicide attempt among psychiatric residents and to identify associated individual, educational and work-related risk factors. METHODS: A total of 1980 residents from 22 countries completed the online survey which collected data on depression (PHQ-9), suicidality (SIBQ), socio-demographic profiles, training, and education. Generalized linear modeling and logistic regression analysis were used to predict depression and suicide ideation, respectively. RESULTS: The vast majority of residents did not report depression, suicide ideation or attempting suicide during psychiatric training. Approximately 15% (n = 280) of residents met criteria for depression, 12.3% (n = 225) reported active suicide ideation, and 0.7% (n = 12) attempted suicide during the training. Long working hours and no clinical supervision were associated with depression, while more completed years of training and lack of other postgraduate education (e.g. PhD or psychotherapy training) were associated with increased risk for suicide ideation during psychiatric training. Being single and female was associated with worse mental health during training. LIMITATIONS: Due to the cross-sectional nature of the study, results should be confirmed by longitudinal studies. Response rate was variable but the outcome variables did not statistically significantly differ between countries with response rates of more or less than 50%. CONCLUSION: Depression rates among psychiatric residents in this study were lower than previously reported data, while suicide ideation rates were similar to previous reports. Poor working and training conditions were associated with worse outcomes. Training programmes should include effective help for residents experiencing mental health problems so that they could progress through their career to the benefit of their patients and wider society.

Attitudes of patients and family members towards implantable psychiatric medication.

INTRODUCTION: Medication is a necessary part of treatment for severe psychiatric illnesses such as schizophrenia and nonadherence to prescribed medication is one of the most important public health issues in psychiatry today. The devastating consequences of nonadherence have motivated the development of novel therapeutic strategies, including a new long-term implantable medication delivery system. METHODS: The current study assesses attitudes towards implantable medication in psychiatric patients and their family members. Patients included in the study had diagnoses of Schizophrenia, Schizoaffective Disorder, Mood or Anxiety related disorders. RESULTS: 49.62% of patients and 74.47% of family members endorse support for implantable medication. CONCLUSIONS: This study demonstrates that implants may be an acceptable alternative to oral and injectable medication for a subset of psychiatric patients and their families.

Intramuscular olanzapine in patients with schizophrenia: an observational study in an emergency room.

BACKGROUND: Between 2001 and 2005 important changes were observed in expert opinion about the clinical management of patients with schizophrenia (SCZ) and agitation requiring an IM psychotropic, with a growing interest for IM atypical antipsychotics. STUDY OBJECTIVES: In an effort to acquire a typical, medically and psychiatrically unselected population of severely agitated patients with SCZ, we conducted a naturalistic study in an emergency setting, consecutively enrolling agitated patients who refused oral treatment. METHOD: Measures were collected prospectively for patients with acute agitation and schizophrenia (DSM IV diagnosis criteria) who consulted consecutively two ED: one in Belgium and the other one in Switzerland. Consent was obtained subsequently. A group of 40 patients with severe agitation and SCZ received olanzapine 10 mg IM. Efficacy and safety data (blood pressure, pulse, extrapyramidal symptoms) were assessed at baseline, two hours post-injection and at discharge. RESULTS: Significant reductions of agitation associated with good tolerance were observed two hours after the first IM olanzapine (PANSS EC declined from 28.6 +/- 4.13 to 16.8 +/- 4.8). Only 5% of patients required a second IM olanzapine. The absence of clinically significant extrapyramidal and cardiovascular side effects is promising, but considering the statistically significant reduction of systolic and diastolic blood pressure and pulse, vital signs should be checked especially in the first 2 hours post injection. CONCLUSIONS: This naturalistic study suggest a promising efficacy and safety balance of intramuscular olanzapine in patients with acute agitation and schizophrenia in emergency.

[Panic disorders: differential diagnosis and care in emergencies]. / Troubles paniques: du diagnostic différentiel vers une prise en charge urgente.

Despite the high prevalence of panic disorders in patients in primary-care settings, this condition is frequently under-recognised and under-treated. After the description of DSM-IV diagnosis criteria of panic disorders, this paper underline the importance of an adequate somatic and psychiatric differential diagnosis. Even if cognitive-behavioural therapy is the best studied psychotherapeutical approach, several efficacious psychodynamic psychotherapies were also described. High-potency benzodiazepines provide a rapid efficacy with beneficial effects during the first days of treatment. However, benzodiazepines should be avoided in the long term, because of the development of tolerance and dependence. Antidepressants (SSRI, venlafaxine) are effective in preventing panic attacks, especially in improving anticipatory anxiety and avoidance behaviour.