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Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Memory impairment has been acknowledged as a core cognitive deficit in schizophrenia, however distinct functional subtypes of memory are differently impaired in these patients.
To assess working memory in schizophrenia patients.
Forty schizophrenia inpatients, mean age 29.1 years from the 3rd Psychiatric Clinic Cluj-Napoca, Romania, were included. Exclusion criteria were mental retardation, history of drug or alcohol use, neurological or systemic conditions, recent electroconvulsive therapy. The control group consisted of 30 healthy subjects (mean age = 29.6). The Word List Memory Test (WLM), the Face Memory Test and the Spatial Working Memory Test on a Cogtest Console were used in the assessment of the 2 groups.
Schizophrenia patients displayed specific impairments of working memory, such as lower learning (42.65 ± 12.87 vs. 51.80 ± 14.31, p = 0.006) and trial-to-trial transfer capabilities (54.82 ± 25.29 vs. 87.21 ± 8.99, p < 0.001), impaired face recognition abilities reflected in lower correct answer proportion (0.66 ± 0.13 vs. 0.83 ± 0.09, p < 0.001), and impaired visuo-spatial memory, when compared to controls (89.42 ± 55.42 vs. 49.37 ± 16.57, p < 0.001). It was specifically observed that higher rates of non-list words were recorded in WLM in the schizophrenia patients group.
The study supports the current data which state that working memory deficits in schizophrenia are consistent, stable and comprehensive, which is particularly relevant for the social functioning of schizophrenia patients. Occurrence of non-list words in auditory memory may explain the mechanism of paranoid delusions.
The Suicide Rate of Romania (12, 7/100,000 inhabitants) presents significant lower figures than those of surrounding countries: Hungary, Ukraine, Republic of Moldavia, Bulgaria, and Serbia. Inside Romania the regional suicide ratio varies enormously (from 33 to 5/100,000 inhabitants).
To compare the influence of psychopathology and cultural patterns on the model of suicidal behaviour in different ethic population of Romania.
The researchers collected the data on demography, psychopathology and quality of life of suicidal persons in the last 2 years, in 44 counties of Romania. The Beck Hopelessness Scale, SAD PERSONS scale (1), and The Multicultural Quality of Life Index (2), were applied to persons belonging to different ethnic groups.
It was found out the relation between the highest suicide rate and the prevalence of Hungarian population in Harghita, Covasna counties and of Slavic population in Salaj, Suceava and Tulcea counties. The lowest suicide ratio was registered in the counties with a Romanian non-mixed population. The morbidity by psychiatric disorders didn't explain the significant differences between suicide ratio among the Romanian and Hungarian, Slavic population. The cultural identity among Hungarian and Slavic ethnic groups was significantly correlated with the behavioural pattern of deliberate self-harm.
The behavioural pattern of deliberate self harm has a strong correlation with the culturally learned assumptions.
Recent data suggest that schizophrenia is a complex disorder with intricate patterns of neurocognitive impairment supported by specific neurobiological systems, present in schizophrenia patients, regardless of individual or clinical variables. the neurodevelopmental model of schizophrenia states that early insults (pre-, perinatal), late environmental, early and late genetic factors interact in various developmental stages, leading to various individual expressions of the disorder.
To assess specific developmental risk factors in connection with the level of neurocognitive dysfunction in schizophrenia.
Material and methods:
Issues concerning family history, parenting style, attachment and early life stress were investigated in correlation with general intellectual functioning, working memory and executive functions in a set of young schizophrenia patients and a control group.
The authors found that certain prenatal insults, complications of delivery and early development, along with the quality of attachment and parenting style, were strongly correlated with the patterns of cognitive dysfunction in schizophrenia patients.
Cognitive impairment might be a trait-like feature, stable throughout the lifetime, occurring years before the onset of the illness. Extending the concept of development to the entire life span could entail that factors with limited timeframe of action may play a role in the epigenetic regulation of certain genes and proteins expressed in specific areas of the brain, in specific developmental stages, which in turn may lead to overt and definitive changes much later in life.
Suicide is one of the leading causes of death for schizophrenia patients: 9-13% of these patients eventually commit suicide, at least 20-40% make suicide attempts and 1-2% go on to complete in their attempt within the next 12 months. Therefore, suicide in schizophrenia has long been a major area of concern and research efforts. Although neurocognitive deficits are seen as core to schizophrenia, the association between suicidality and neurocognition has received little attention. People with schizophrenia often have impaired working memory and lower IQ. in particular, deficits in long-term memory, working verbal memory, executive functioning, and vigilance have been consistently associated with poor functional outcome in this patient population.
To evaluate the effect of depression in schizophrenia suicidal patients from the point of view of neuropsychological functions.
A clinical sample of 60 patients with schizophrenia was assessed. among them, 30 patients presented a life long history of deliberate self-harm. We performed the assessment of schizophrenia (PANSS, GAS), depression (MADRS), suicidal risk (SIS, BHS), and neuropsychological markers with CogTest battery.
Suicidal behaviour in schizophrenia patients was significantly correlated with negative symptoms (anhedonia) accompanied by poor global functioning and positive symptoms (delusions). Some neuropsychological markers (abstract thinking, reduced capacity to maintain information on-line, working memory, facial emotions discrimination) were significantly correlated with hopelessness.
The most significant neuropsychological dysfunction is represented by working memory impairment which is present in schizophrenia patients with self-harm behaviour even if they have an intact IQ.
Social intolerance is one major topic in every modern society, but although it receives much attention in the public space, there is relatively little information related to the behavioral correlates of such attitudes.
To investigate the relation between social intolerance and risk-taking behaviors in European adolescents.
Adolescents from the SEYLE and WE-STAY cohorts were included. The questions evaluating social intolerance, sensation-seeking and delinquent behavior, alcohol, tobacco and illegal drugs use were extracted from the baseline questionnaire.
Adolescents positive for at-risk tobacco, alcohol and illegal drugs use showed significantly lower levels of social intolerance. This observation might be explained by the social factors associated with substance use at this age group. No relationship was observed with sensation-seeking and delinquent behavior.
Social intolerance is not associated with risk-taking behaviors in adolescents.
Recent evidence suggests that electrodermal reactivity could be useful in identifying individuals with high suicide risk.
To evaluate the relevance of electrodermal oriented reactivity for the discrimination of high suicide risk cases among major depressive disorder patients.
Material and Methods
60 adult major depressive disorder patients (as diagnosed by using the ICD-10 criteria) were included, of which 30 were identified as having a significant suicide risk by using the Paykel Suicide Scale. Electrodermal reactivity was tested by using the EDOR test.
No statistical significant difference was identified, although a certain tendency was obvious.
The use of electrodermal reactivity tests seems promising in identifying individuals with high suicide risk.
Cognitive impairment is a major factor influencing the severity and prognosis of major depression. On the other hand, the impossibility of finding solutions and support is characteristic for individuals with suicidal behavior. Therefore, the comparative investigation of cognitive functioning in suicidal and non-suicidal major depression disorder patients seems to be justified.
To evaluate weather suicidal major depressive disorder patients show a specific pattern of cognitive impairment as compared to non-suicidal major depressive disorder patients.
Material and Methods
60 adult major depressive disorder patients (as diagnosed by using the ICD-10 criteria) were included, of which 30 were identified as having a significant suicide risk by using the Paykel Suicide Scale. Cognitive functioning (working memory and executive functions) was assessed by using the CogTest battery.
Both working memory and executive function performance were lower in suicidal patients, with problem solving being the most prominent marker related to suicide risk.
Severe problem solving deficiency might be a marker of suicide risk in major depressive disorder patients.
Stress has been associated with depression in the past, but large enough, prospective studies to demonstrate this relationship still have to be produced.
To investigate the relationship between stressful life events and depressive symptomatology in a large sample of adolescents, in a prospective setting.
Material and method:
9032 adolescents that participated in all the waves of the SEYLE project were included. Mean age of our study group was 14.84 ± 0.88 years. 56.5% of the participants were females. We used the Beck Depression Inventory (BDI) to assess the depressive symptomatology and Kendler's Life Events Checklist to assess the life events. We build several multivariate linear regression models controlling for age, sex and baseline depressive symptomatology.
Total number of life events occurred in the previous 12 months seems to be significantly related to the intensity of the depressive symptomatology. Personal life events seem more closely related to depressive symptomatology than network life events. Out of the personal life events, the ones in the Interpersonal, Work (School), Marriage (Intimate relationship), and Financial categories seem to be the most important for this relationship.
Our study supports the hypothesis that life events can lead to depression in adolescents and draws attention on the most important categories of life events for this relationship.
The exposure to occupational stress is an important cause for the occurrence of the burnout syndrome (Schaufeli, W. B., Maslach, C., Marek,1993; Maslach, C., Leiter, M. P., 1997).
The research objectives are identifying the level of stress in psychiatric nurses and analyzing the relationship between stress and the classifying variables: age, gender and length of service.
The research group consists of 33 nurses with a minimal length of service of 24 months. Each nurse was assessed with two tests: the Perception of Stress test (T. Hindle 2001), containing a total of 32 items with answers given on a scale from 1 to 4, and the Psychological Symptoms Scale” (V. Birkhenbil, 2000), including 29 symptoms that occur often, regularly or constantly in a person under stress.
The perceived level of stress and its psychological symptoms are emphasized with growing age, due to life events and increased responsibilities. The female gender is more often affected by stress, coping mechanisms having a special role in the differences between the two genders. The length of service is also a factor that increases stress levels in psychiatric healthcare; professional dissatisfaction, routine and increased demands being a major source of stress.
The predictors for the onset of the burnout syndrome revealed by our research were: the age and length of service in the field, as well as the female gender of the psychiatric staff nurses. These results have served as the basis for developing an occupational stress intervention protocol.
School-based prevention programs, especially depression and suicidal behavior screenings, performed on highschool pupils, proved their validity and efficiency in identifying high suicidal risk individuals.
This research aimed to perform an evaluation of adolescent mental health and of the risk factors for the psychiatric pathology that generates suicidal behavior.
The study sample was collected by randomizing 16 highschools in Cluj and Maramureş counties. 1470 pupils were contacted. Informed consents were signed for 1143 pupils. These pupils were evaluated at baseline and 3 and 12 months after baseline.
The initial evaluation identified 151 pupils showing high risk for mental health problems, out of the 1143 pupils included. Also, the initial evaluation identified 50 pupils (4,37% of the study group) showing high suicidal risk. The second evaluation (3 months from baseline) identified 42 pupils showing high suicidal risk, out of a total of 990 pupils re-evaluated. The third evaluation (12 months from baseline) identified 27 pupils showing high suicidal risk, out of 991 pupils re-evaluated. More maladaptive behaviors were identified in pupils with suicidal risk.
Our results confirm the hypothesis of the interdependence of suicidal risk and maladaptive behaviors. There is no evidence supporting the hypothesis that suicide screening might lead individuals to suicidal behavior.
Family disintegration due to workforce migration is a relatively new phenomenon affecting quite a large number of families in developing countries around the world that raised a lot of concerns regarding the mental health of children and adolescents left behind.
To investigate weather family disintegration is associated with suicide risk in adolescents.
Material and method:
The 12395 adolescents from the SEYLE baseline evaluation were included. Mean age in this group was 14.91 ± 0.90. 55.2% of the participants were females. We used the direct questions in the SEYLE baseline questionnaire to assess for families in which at least one parent was working abroad and for suicide attempt history. A binary logistic regression model was used to test this hypothesis, controlling for significant depressive symptomatology (assessed using the Beck Depression Inventory), substance misuse, the presence of a physical disability or chronic illness and the number of life events.
Our data revealed that parental migration, along with depressive symptomatology, substance misuse and the total number of life events reported in the previous 6 months were the items most closely associated with suicide attempt history.
Family disintegration due to workforce migration is associated with a higher risk for suicide in adolescents.
Secondary mania is still an under-recognized pathology even if nowadays psychiatrist benefit from a wide range of imagistic and laboratory tools. The following case study illustrates bipolar affective disorder, manic episode with psychotic symptoms in a 36 years old female which had an abrupt beginning. At the moment of examination in the office at the medical centre she presented tachypsychia, grandiosity and interpretative delusions, positive hyperthymia, sterile hyperactivity, elevated appetency, hyperbulia, low sleep need.
The importance of having in mind the 5 most frequent causes of mania caused by generalized medical condition when presented with an atypical manic episode.
Our aim is to increase the acknowledgement of a more elaborate paraclinic approach for psychiatrists whom find themselves in front of bipolar disease case that also have somatic issues attached.
For this type of cases the laboratory and imagistic exploration are the key to an accurate diagnosis and therefore for an aimed treatment. In our case the imagistic exploration and blood tests revealed a well defined tumor in the left suprarenal gland.
The psychiatric diagnosis was bipolar affective mood disorder due to a general medical condition and the patient was transferred to the Endocrinology Clinic.
After the surgery of the tumor both the psychiatric symptoms and the secondary Cushing syndrome disappeared completely.
Assessment of posttraumatic cognitions after accidents, paired with active identification of suicide risk and reasons to stay alive, can generate more effective management strategies of traumatic events. Aim. To comparatively assess posttraumatic cognitions in survivors of accidents with and without suicide risk. Participants and method. Authors assessed a sample of persons exposed to motor vehicle accidents, work – related accidents or burns, treated in the Rehabilitation Hospital Cluj – Napoca. Suicidal risk after trauma and in the 2 weeks prior to assessment were evaluated through Paykel Suicide Scale. Posttraumatic Cognitions Inventory was employed in order to assess various types of catastrophic cognitions. Results. Most patients included in the study did not exhibit suicidal risk after the exposure to trauma. Nevertheless, specific differences between the samples with and without suicide risk were ascertained, regarding the types of posttraumatic cognitions mostly endorsed. Discussion. Excessive suppression and excessive expression may prove equally detrimental after exposure to specific types of trauma, generating increased suicide risk. Conclusions. Certain catastrophic cognitions can be considered risk factors for suicide after trauma and addressing them in therapy can be beneficial for individualized short- and long-term trauma management.
Suicide behavior is an important and preventable cause of injury, disability and death in the world, and, at the same time, a major economic and social burden for modern societies. The majority of suicide attempts and completions are associated with psychiatric disorders, especially major depressive episode. Impulsivity has been associated with suicidality in major depressive disorder patients.
The current study aims to evaluate impulsivity in major depressive disorder patients with a history of suicide attempts as compared to major depressive disorder patients without a history of suicide attempts.
One hundred and twelve patients with major depressive disorder, aged 51.91 ± 10.72 (70% females) were included through convenient sampling procedure from the patient population of the 3rd Psychiatry Clinic of the Cluj County Emergency Hospital. Impulsivity was assessed through Barratt Impulsiveness Scale (BIS-11).
In total, 27.8% of the patients had a history of suicide attempts. Significant differences between the two groups were obtained only for the Perseverance subscale of the BIS-11. (12.7 ± 1.8 vs. 7.13 ± 2.1, P = 0.005–Mann Whitney U-test).
Perseverance might be a discriminating element between patients that eventually commit a suicide attempt and those that do not.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A better understanding of the genomics of mental illnesses allowed genetic counselling to be provided to individuals with severe mental illness and their families.
The present study was aimed at assessing the efficacy of genetic counselling for severe mental illnesses with high suicide risk.
Assessment was performed before and after genetic counselling session. Measures used were evaluation of traumatic events in childhood, multidimensional scale for perception of social support (SMSSP), positive and negative affect schedule (PANAS-X), Brief Psychiatric Rating Scale (BPRS), Paykel questionnaire and Genetic Counselling Outcome Scale (GCOS). Paykel's questionnaire consists of five questions about suicidal thoughts and attempts, including: life-weariness, death wishes, suicidal ideation, suicidal plans and suicide attempts. Intervention and assessment lasted approximately one and a half hour. Data from 48 patients was analysed.
Mean age of participants was M = 38.4, SD = 9.7, and the group was batter represented by females (57%). The participants had various diagnoses, 22% had schizophrenia, 36% bipolar disorder and 42% recurrent depressive disorder. Forty percent of participants reported suicidal ideation and 22,5% had a past history of suicide attempt. Genetic counselling had a direct positive influence upon GCOS specific items and reduced the Paykel scores among participants presenting with suicidal ideation.
Genetic counselling offers information about the disorder, the role of genetics and the impact of environmental factors. Preliminary data suggest that providing genetic counselling decreases the suicidal ideation frequency.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Currently available data on the aetiology of schizophrenia suggests a major involvement of epigenetic mechanisms. One such mechanism could be the alteration of activation and silencing of genes, which involves DNA methylation and de-methylation. The main limiting enzyme involved in the methyl-donor cycle is methylene-tetra-hydro-folate-reductase (MTHFR), and the most frequently observed mutation in the MTHFR gene, altering its activity, is the C677 T mutation.
In the present study, we investigated the frequency of MTHFR C677 T mutation and total plasma homocysteine (tHcy) concentrations in a sample of Romanian schizophrenia patients as compared to healthy controls.
Seventy schizophrenia patients (35% females) with a mean age of 38.8 ± 20.5 years and 50 healthy controls (50% females) with a mean age of 36.3 ± 11.6 years were included. MTHFR genotype was determined through polymerase chain reaction and tHcy levels were determined through reversed phase high-pressure liquid chromatography.
Schizophrenia patients, registered higher frequency of the T allele, with the CC genotype observed in 39.4% of them, as compared to a frequency of 60.6% in the control group (P = 0.002–Fisher's exact test). tHcy concentrations did not differ between the two groups (10.7 ± 4.2 vs. 11.2 ± 4.1, P > 0.005–Mann–Whitney U test).
Romanian schizophrenia patients have a significantly higher frequency of the MTHFR C677 T mutation, but without significant effect on tHcy concentrations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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