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A hospital built environment can affect patients’ treatment satisfaction, which is, in turn, associated with crucial clinical outcomes. However, little research has explored which elements are specifically important for psychiatric in-patients. This study aims to identify which elements of the hospital environment are associated with higher patient satisfaction with psychiatric in-patient care.
The study was conducted in Italy and the United Kingdom. Data was collected through hospital visits and patient interviews. All hospitals were assessed for general characteristics, aspects specific to psychiatry (patient safety, mixed/single-sex wards, smoking on/off wards), and quality of hospital environment. Patients’ treatment satisfaction was assessed using the Client Assessment of Treatment Scale (CAT). Multi-level modelling was used to explore the role of environment in predicting the CAT scores adjusted for age, gender, education, diagnosis, and formal status.
The study included 18 psychiatric hospitals (7 in Italy and 11 in the United Kingdom) and 2130 patients. Healthcare systems in these countries share key characteristics (e.g. National Health Service, care organised on a geographical basis) and differ in policy regulation and governance. Two elements were associated with higher patient treatment satisfaction: being hospitalised on a mixed-sex ward (p = 0.003) and the availability of rooms to meet family off wards (p = 0.020).
As hospitals are among the most expensive facilities to build, their design should be guided by research evidence. Two design features can potentially improve patient satisfaction: family rooms off wards and mixed-sex wards. This evidence should be considered when designing or renovating psychiatric facilities.
One in every hundred Romani youth enters higher education in Europe. To justify this educational dearth, policymakers, scholars and practitioners have often reproduced the same racecraft about Roma: they form part of an inferior culture that does not value education. This racist ideology has not only fed a false moral justification but also buried any potential sense of concern and urgency among policymakers regarding the dramatic underrepresentation of Roma in higher education. In this chapter, we argue that public education has historically been an institution designed for gadje (non-Roma) (although less so for gadjo girls and the poor), while Romani children and youth, seen as ‘inferior and nomadic others’, have had no functional option for quality education and even less for higher education. We explore patterns of exclusion, fear, racism and racialised poverty. We show that schools and universities today remain highly unwelcoming for Romani children and youth, failing in large measure to address pervasive structural racism or to advance inclusion and equity. We conclude that education reform needs to start by dismantling the racecraft of ‘inferiority’ from ideology, policies and practice.
The Colorado potato beetle, Leptinotarsa decemlineata (Say), is one of the most destructive pest species to have developed resistance to most chemical insecticides. We determined the composition and evaluated the potential of Tanacetum parthenium L. and Tanacetum vulgare L. (Asteraceae family) essential oil (EO) application as an alternative eco-friendly control strategy against L. decemlineata. We assessed the antifeedant activity for L. decemlineata larvae and adults by estimating the damage to potato leaves treated with three concentrations of EOs dissolved in ethanol (0.125, 0.25 and 0.5%). Results showed that T. parthenium EO was more effective against larvae, and T. vulgare was more effective against adults. In an olfactometer assay, the time required to choose an untreated leaf disc did not depend on the Tanacetum species, or life stage examined. However, the concentration of EO exhibited a significant effect on the behaviour of both developmental stages. At higher EO concentrations, both third instar larvae and adults require less time to choose an untreated leaf disc. Additionally, T. parthenium EO provoked more rapid movement away from the treated leaf disc than T. vulgare, especially at the highest concentration. Successful modification of L. decemlineata behaviour by the two Tanacetum oils suggests that they possess the potential for use in potato protection.
With a special focus on the Republic of Serbia, this article will examine the macroeconomic performance of the external macroeconomic sector and its impact on the economic progress of developing countries. Our aim is to prove that economic development and the growth of the external macroeconomic sector are correlated. We will do so by analysing how macroeconomic parameters are conditioned. By analysing the macroeconomic and primarily dynamic indicators of countries in transition, including Serbia, it is possible to determine the situation and changes as well as potential causes of economic development. A macroeconomic analysis of developing countries can also determine the characteristics of economic development and mutual relations between macroeconomic indicators.
This paper analyzes suicides committed in Montenegro during the 2005-2008 period divided according to gender, age and the way these have been performed.In 2005 we have 25,02 suicides on 100000 habitans, and in next two years there is a growth in trend, thus in 1995, there are 16,3 suicides on 100000. Comparing to 1985 when suicide rate was 13,2/100000, and 2006 rate which was 31,87/100000, we can notice that period of social transition and big stress, lead to a rise in rate of suicides so average rate for period of 2005-2008 is 26,87/100000 which puts Montenegro into country with high suicide rate.The ratio of men and women who committed suicide is 1,7:1. The largest number of people who killed themselves are between 45 and 54 years old. The way that people use to perform suicide is mostly by hunging themselves 40% and firearm 31% which is near to average numbers in the world. This research shows that there is significant rise in suicide rate. As a conclusion, on the basis of cited literature, the authors lined up all risk factors which can explain significance rise in suicide rate.
Disulfiram is an aversive medication that works by making the drinking of alcohol an unpleasant experience (FDA approved since 1951) and most study of understanding alcohol abuse and dependence are based on it. Also, the combined Cognitive Behavioral Therapy (CBT) and disulfiram assurance treatment was substantially effective in patients with alcohol disorders.
We conducted 150 male patients range of age 20-60 and treated in Special Hospital on Addictions for 3 months period of time (inpatient setting).The recommended dose of disulfiram was 250 mg. All patients were diagnosis of alcohol dependence according the ICD-X, excluded psychosis and no one was unable to take disulfiram for medical reason. We used medical history of illness, psychiatric interview and semi structured CBT protocol for alcohol disorder and CBT sessions (2 sessions per week). Control group were 80 patients on disulfiram assurance therapy (alone).
CBT plus disulfiram assurance (N=150): 93(62%) maintaining sobriety and absence of drinking for 3 months; 44 (29,33%) maintaining sobriety for 2 months and 13 (8,66%) absence of drinking only 1 - 1,5 month.Disulfiram assurance therapy alone (control group) (N=80): 41 (51,25%) maintaining sobriety of drinking for 3 months; 22 (27,5%) less than 3 months; 10 (12,5%) for 1,5 - 2 months and 7 patients (8,75%) drop-out after a week without no relevant or medical reasons.
In this paper was shown the high level of effectiveness for the CBT combined with disulfiram assurance therapy according the maintaining sobriety and absence of drinking.
Many studies describing print media representations of mental illnesses have showed that these depictions are frequently negative and contribute to consequent stigmatization of people with mental illness. The main objective of this international study was to identify predictors of stigmatizing and nonstigmatizing articles on mental illness in Czech Republic, Croatia and Slovakia.
The study sample comprised all articles pertaining to the topic of mental illness (N=450) chosen from 6 most widely read newspapers and magazines identified during five weeklong periods in 2007. The presence of stigmatization and destigmatization statements was coded and articles were grouped in positive, neutral, mixed and negative clusters. Negative/positive ratio (NPR) was used to assess the predictor value of different features of the article regarding stigmatization.
61.8% of articles contained some stigmatizing statements towards persons with mental illness. The highest NPR was found in articles published in tabloids (6.8), on the front page (3.7) and in the articles where psychotic disorder was mentioned (7.4) and mentally ill person figured as a source of information (1.8). Lowest NPR was found in magazines (0.6), articles in later sections (1.7) that mentioned eating disorders (0.3) and scientific surveys (0.1).
There is a high level of stigmatizing statements in the studied articles. As the strongest predictors of stigmatizing content we have identified articles that are published in tabloids and articles with reference to psychosis. Contrary to this, eating disorders had the least stigmatizing depiction as well as articles containing scientific data.
There is little or no information comparing working experience, including burnout, amongst psychiatry residents internationally. We present preliminary findings from six of the first countries to complete data collection.
Objectives and aims
To obtain data from psychiatric residents in over twenty countries regarding rates of burnout, depression and suicidality and their associations with working conditions and personality traits.
An online survey incorporating the Maslach Burnout Inventory General Survey (MBI-GS), Areas of Work Life Survey (AWLS), Patient Health Questionnaire-9 (PHQ-9), Suicide Ideation and Behaviour Questionnaire (SIBQ), Big Five Inventory - 10 (BFI-10) and questions on demographics and working circumstances was designed, and checked by national co-ordinators for suitability in each participating country, prior to agreeing the final version. This was then translated and back-translated before being sent to participants. A stratified hierarchy sample methodology was developed and used to obtain the best possible study population in each country. This allowed us to maximise participation despite major differences in ease of access to residents across the study countries. The aim of studying the whole resident population was achieved in a large number of countries. Data was then analysed by the study statistician using SPSS. No funding was received for the study.
Results and conclusions
Data from Croatia (n=106), France (n=374), Hungary (n=81), Italy (n=180), Romania (n=52) and United Kingdom (n>2000) revealed marked differences between countries in the factors studied including in working circumstances, rates of burnout and suicidality. The associations discovered may help further improve psychiatric training experience internationally.
Longer DUP (duration of untreated psychosis) is associated with poorer outcome in schizophrenia. Factors unrelated to disease pathology (socioeconomic status, availability of care, recognition of illness and stigma) may contribute to DUP.
Investigating the relation between DUP and fear of stigma in patients and their family members.
Methods and instruments
38 patients(diagnosed by ICD X as F20-F29), treated at the Institute of Psychiatry,University Clinical Center in Belgrade and their family members(parents or siblings), were assessed through a questionnaire designed for the purpose of this cross sectional study. Data were obtained on fear of being stigmatized and first contact with psychiatrist (in patients) and stigmatization attitudes,estimated DUP,illness mode of onset,initial treatment mode,present evaluation of patients condition,adherence to therapy (in family members).
Patients included in this study were mostly female (68,42%), with high school education (84,2%), single(84,2%), with average age of 30 and 2,53 hospitalizations.
47,37% of family members,as well as 31,58%of patients were afraid of stigmatization by psychiatric treatment-which prolonged DUP. 42,10%of patients felt that they are presently stigmatized.100%of patients have never heard for antistigma programs.
Average period from first behavioral changes to first contact with psychiatrist was 16,34 weeks and 32,6 weeks until starting a continuous treatment (via hospitalization in 57,9%; abrupt illness onset in 42,10%)
Correlation found between DUP and fear of stigma in patients and their family members requires focused antistigma interventions in order to improve psychotic disorders treatment strategies.
Depression, malnutrition and inflammation are highly prevalent in hemodialysis (HD) patients, representing important predictors of morbidity and mortality.
The aim of the study was to screen for depression in HD patients and analyze, among other factors, its association with inflammatory and nutritional indices. C-reactive protein, Body Mass Index, albumin, cholesterol, phosphate and hemoglobin levels, dialysis adequacy, the presence of co-morbidities, stages of rehabilitation, education level and marital status were observed.
Thirty five patients (19F,16M) aged 53.1±9.4 years, on thrice-weekly HD for 77.7±57.1 months were studied. Depression was assessed via Beck Depression Inventory (BDI). The scores on the BDI ranged from 0 to 45 (16.9±11.1). 31.4% and 28.6% prevalences of inflammation and malnutrition were observed.
Patients were divided into two groups according to score obtained: 9 not depressed (NonD) subjects (2F, 7M, BDI 0-9) and 26 patients (17F, 9M) with depressive symptoms (D group, score of 10+). Depression was significantly more frequent in females (p=0.05). None of the patients working full or part time had depressive symptoms, as opposed to 3 without job and 13 who were retired (p=0.02). Insignificant diference in prevalence of inflammation, malnutrition and other analyzed parameters was found. Subdivision of D group revealed mild depressive patients (10-15) to be significantly younger than both nonD patients and subjects with moderate or severe depression (16 +); p= 0.02.
Depression, inflammation and malnutrition are common in HD patients. It is of great importance for long-term outcome of this population to identify them early and initiate treatment.
During and after the Civil War in former Yugoslavia many various social changes and migrations occured. One of their consequences is the increase of Gypsi-Roma population in Republic of Serbia. At the same time, the incidence of admissions and readmissions of Gypsi-Roma population into the psychiatric hospitals increased, in comparasion both with their participation in overall population and the incidence of admission before the war. Since the war led to economic exhaustion, especialy in social assistance resources, the vulnerability of this social group grew more dramatic. Difficulties in psychiatric treatment also have their origin in the particularites of this population. One of the most frequent demands of the representatives of this minority is the exclusively hospital treatment, on their own or on their families request, not always followed with clinical signs of relapse. This was verified despite the efforts of psychiatric reform and tendencies to reduce the psychiatric hospital treatments. Difficulties in diagnosis and consistent treatment were notified, therefore often psychopharmacotherapeutic resistance.
Variety of symptoms depend on ethnicity, and it is not consistant with diagnostic criteria due to possible pathoplastic moderators. Relaps and non compliance are more likely to occur. Somatic dissorders and illness are often reported and diagnostic by psychiatrist. Difficulties in treatment are sometimes based on the line between their social needs and abuse of psychiatry, since the patients and their families are more likely to show rental claims to illness. These request a complexed, multidisciplinary approach.
Psychiatric training is designed to educate psychiatrists to the highest standards of competence in prevention, diagnosis, treatment and rehabilitation of persons with mental disorders. At the same time, it may be an extremely stressful period characterized by intensive work demands, lack of job autonomy, poor salary, high degree of work-home interference and severe dilemmas regarding one's clinical skills. Trainees may be at increased risk of burnout syndrome and associated mental and physical health problems. Burnout syndrome is defined as a psychopathological reaction to prolonged occupational stress. Most recently, a unique international study - "The International Psychiatry Trainee Burnout Syndrome Study: Europe BOSS 2008” - was introduced across Europe in order to evaluate the prevalence and degree of burnout syndrome among psychiatry trainees. The aim is to use the study findings to improve the professional status and the working environment of young psychiatrists. The study itself is run through the national trainee associations in collaboration with the European Federation of Psychiatric Trainees. At this point, fifteen countries are engaged - Austria, Czech Republic, Croatia, Denmark, France, Germany, Greece, Hungary, Italy, Netherlands, Romania, Russia, Slovenia, Turkey and UK. The sample comprises all trainees in the country. They are asked to complete the questionnaire, translated into their native language, by entering data directly into anonymised online database. The study has already started in France and Croatia, and next two countries are Hungary and Romania. Results from the study, as well as detailed study design and methodology will be presented and discussed.
One million people worldwide commit suicide each year; the number of attempters is 20 times larger. The diathesis to suicidal behavior is inherited independently from mental disorders and is most often associated with depression. The importance of serotonergic genes in the genesis of suicidal behavior and depression is assumed. The link between depression and suicidal behavior is hopelessness.
Analyzing the link of certain serotonergic alleles and genotypes with suicidal behavior and depression, as well as with hopelessness.
To analyze the association of chosen serotonergic alleles and genotypes (5HTT LPR, LPR SNP, VNTR2; THP1 A218C, 5HTR1A C1019G; 5HTR2A T102C, C1354 T) with suicidal behavior, depression and hopelessness.
The study included 30 depressed suicide attempters, 30 depressed patients without attempt and 30 healthy controls. Polymerase Chain Reaction method was used to analyze serotonergic gene polymorphisms. Participants were tested with Beck Depression Inventory, Suicidal Intent Scale, Becks Hopelessness Scale.
Two analyzed polymorphisms are associated with depression, but not with suicidal behavior (5HTTintron 2 alele 10 and A218 of the TPH1 gene). Hopelessness is more prominent in depressed suicide attempters.
The results support the role of two serotonergic genes in the genesis of depression. Hopelessness is an important predictor of suicidal behavior. Further investigation of the role of serotonergic genes in various subtypes of suicidal behavior is suggested.
Michelangelo said "I saw angel in the marble and carved until I set him free.", as he didn’t see himself creating something new, but unwrapping beauty that was already there. Art and psychotherapy have many things in common - both are based on relationships and sincerity, communicate through interpretation, creativity and imagination. Experience of art - as mode of learning about reality and one's inner world - can be incorporated into psychotherapy. Our Day hospital program includes psychodynamic analytic oriented group psychotherapy, psychoeducation, sociotherapy and art workshop. the latter implies patients’ artistic creation and visits to museums. It stimulates patients’ relationships with art and brings back a need for esthetic experience which can have protective and reparative role. Here we present several clinical vignettes, thus showing specific relations between psychotherapy and patients’ experience of art; and give an overview of psychiatric patients’ works stored in artistic collections (from Prizhorn until now), as well as art brut, and new psychotherapeutical technique - art therapy. Taking into account analytic and iconographic interpretations, we discuss their similarities and ask - what does a patient achieve by interpreting unconscious contents and what does interpretation of art mean to a recipient? Art and psychotherapy undoubtedly have an impact on us - they cause not only a direct physical reaction, but a sense of pursuit of meaning and contemplation leading to cognition. Every work of art leaves empty space for recipient to fill in. We believe this encourages an integrative process which is also aim of psychotherapy.
Gender-based perspective is not systematically included across trauma studies and deeper insight into women's response to trauma is required. We explored how the type of trauma (military vs. civilian) is related to clinical characteristics of post-traumatic stress disorder (PTSD) female patients.
Out of 55 PTSD patients included in the study, 34 were military trauma victims (combat experience, witnessing family members being killed) and 21 experienced civilian trauma (rape, robbery, traffic accident). All patients were hospitalized at the Zagreb University Hospital. Data were gathered retrospectively from the medical charts.
Regardless to the type of trauma, examination of clinical characteristics indicate high rate of comorbid psychiatric disorders among PTSD patients with major depressive disorder being the most prominent one; others are personality disorder, anorexia nervosa and somatoform disorder. We found no significant inter-group differences in PTSD symptoms according to the DSM-IV criteria. Most pronounced PTSD symptoms in both groups were hyperarousal and social avoidance symptoms. Late first contact with psychiatrist was found to be a risk factor for PTSD diagnosis among the military group. Those patients were more likely to present first with somatic symptoms such as arterial hypertension, rheumatic pain and gastritis.
Study results suggest that both military and civilian traumas left polymorphous psychological consequences on the mental health of the victims. There is a need for sensitive and coordinated care for traumatized people in order to recognize psychological symptoms and provide optimal psychiatric interventions.