Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries.

PURPOSE: There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. METHODS: This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models. RESULTS: A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. CONCLUSION: Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.

Can medical students recognize depression? A survey at the Zagreb School of Medicine.

OBJECTIVE: The objective of this study was to investigate medical students' knowledge and attitudes towards depression. METHODS: Students attending their final year at Zagreb School of Medicine completed a set of standardized questionnaires, including attitudes towards psychiatric medication, attitudes towards depression, and personality inventory. RESULTS: In total, 199 students completed the questionnaire (response rate 77 %). Most medical students were only partially able to correctly identify major symptoms of depression, but did suggest referral to mental health specialists as the most appropriate course of action. They recognized social and biological causes of depression. Degree of correct identification of symptoms of depression correlated positively with non-stigmatizing attitudes towards depression and negatively with stigmatizing attitudes towards depression. CONCLUSION: Students' attitudes toward depression may influence their recognition of symptoms of depression. Incorporation of these findings in development of undergraduate medical curricula may improve students' recognition of depression.

Premorbid combat related ptsd in Huntington's disease - Case report.

Huntington's disease (HD) is a neurodegenerative, autosomal dominant disease that manifests with a triad of symptom clusters including movement disorder, cognitive impairment and psychiatric symptoms. We present a patient with HD who, prior to developing neurological signs and symptoms, had been exposed to war trauma and had developed posttraumatic stress disorder. Fifteen years later he manifested with dysarthria, difficulties with swallowing and involuntary movement. What brought him to psychiatrist was a heteroanamnestically noticed change in personality with irritable mood, impulsivity, aggressive outbursts in behavior and delusional ideation. Therapy was stared with haloperidol, but patient developed severe extrapiramidal side effects. Subsequent treatment with olanzapine, diazepam and omega 3 fatty acids lead to mood stabilization and better impulse control with even some improvement in motoric symptoms. To our knowledge, this is the first case report on combat related PTSD as psychiatric disorder manifested prior to HD. We discuss a possible influence of psychological stress disorder on severity of psychiatric symptoms in the HD. The importance of personalized approach in both psychopharmacological and psychotherapeutical treatment of patients with HD is emphasized. If the influence of environmental stress on the psychiatric phenotype of the disease should be confirmed by clinical trials and further studies, both screening methods and interventions aimed to reduce psychological stress in carriers of Huntington gene could be considered.

Retention of basic sciences knowledge at clinical years of medical curriculum.

AIM: To explore the association between the knowledge of basic (physiology and biochemistry) and clinical sciences (internal medicine) among medical students, and determine the level of retained basic science knowledge at the fifth year of medical studies. METHODS: Medical students attending the second (n=145, response rate 60%) or the fifth year (n=176, response rate 73%) of medical studies at the Zagreb University School of Medicine in Croatia were given an anonymous knowledge test with 15 pairs of questions developed specifically for this purpose. Each pair consisted of a basic and clinical question, with the correct answer to the basic question explaining the physiological or biochemical background of the clinical question. Three pairs of questions were excludes from the analysis due to poor psychometric characteristics. RESULTS: We found statistically significant correlation between basic and clinical tests scores for both groups of students (r=0.47, P<0.001 for the second year and r=0.45, P<0.001 for the fifth year). 2x2 within-between measures ANOVA revealed a significant interaction effect for knowledge test and study year (Wilks lambda=0.55, F(1, 319)=262.7, P<0.001; effect size=0.45), showing that fifth year students scored lower on the basic test than second year students but obtained higher scores on the clinical test. CONCLUSION: The core basic science knowledge is lost during the clinical years of medical studies. Although remembering and understanding basic science concepts as a background of clinical statements at the clinical years does not directly affect clinical knowledge, there is a positive correlation between retained basic science concepts and clinical knowledge.