To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The involvement of informal carers (family and friends) in the care of people with severe mental illness (SMI) contributes to positive clinical outcomes, such as relapse prevention and symptom reduction. To date, the care pathway between inpatient and community care is not clearly defined impeding the smooth transition for patients, whilst carers are still barely involved in shared decision-making processes.
To investigate the views and experiences of patients with SMI, carers and clinicians regarding the transition from inpatient to community mental health services.
Four mixed focus groups were conducted with individuals with SMI (n=12), carers (n=10) and clinicians (n=9) across four different mental health catchment areas in England. Participants discussed their experiences and provided their views on facilitators, barriers and solutions for carer involvement during the transition between mental health services. Data were analysed using thematic analysis.
All stakeholders highlighted that factors that impede carer involvement are related to: confidentiality issues, unmet (structural and organisational) needs, and carer expectations. Patients with SMI, carers and clinicians agreed that carer involvement can be improved by providing psychoeducation to carers and training to staff, having accessible and transparent clinical procedures, and allocating specialised staff to carers.
The study findings emphasise that carer involvement is still overlooked, particularly when adults with SMI transition between services. The results provide guidance for practice emphasising the need for systematic involvement of carers across inpatient care, and for future research proposing effective ways of maximising carer involvement in mental health care.
Involving carers in the care of people with severe mental illness is known to bring positive treatment and psychosocial outcomes. However, evidence-based procedures to guide clinicians on how to involve carers in the acute care are lacking.
To provide an online training to clinicians working in the acute care regarding the organisation of a standardised meeting with the service user and their carer within the first week of hospitalisation, and explore their views after its implementation.
We trained six clinicians across four urban and rural sites in England, asked them to incorporate the meeting in their routine care provision and interviewed them to explore their experiences.
Clinicians reported training advantages such as ease of use, comprehensiveness and transferable skills, and meeting advantages such as shared goals development and acknowledgement of carer involvement value. They also mentioned challenges related to organisational/time constraints, expectations management, and distance to the hospital for carers. Clinicians suggested to further focus on carer motivation to engage, to use skills throughout admission rather than in a one-off session, and to provide a structured meeting summary. Those experiences were shared across sites, indicating similar benefits and challenges, not depending on the specific setting characteristics.
Providing structured training to clinicians may increase carer involvement in routine care in acute settings. Given the workload in such settings training endeavours should be brief and include skills that clinicians can apply to facilitate shared goal development and expectations management. The use of online meetings may allow increased carer participation in the acute care.
Guidelines produced for management of Bipolar Disorder illustrate change in evidence-base for treatment of acute and maintenance phases of illness. Our Pan-European Research Group assessed clinical practice and desired treatments amongst amongst Psychiatry trainees.
A semi-structured survey was piloted, and homogenous sample size (at least 50) agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, questioning preference of mood stabiliser for patients, trainees themselves and factors influencing choice.
Tables 1 summarise choices.
Lithium and Sodium Valproate
2nd Generation Atypical antipsychotics
[Choice of mood stabiliser for patient/themselves]
Factors influencing decision-making mapped onto cost, efficacy and side-effect profile (less than 4% other reasons). 66% (n=538) of respondents felt efficacy most important, 25% (n=202) felt side-effect profile most important and 3% (n=24) considered cost of most importance.
No clear difference exists in choice of mood stabiliser for European trainees and their patients, and decisions based on perceived efficacy are generally in keeping with established guidelines.
To provide a comprehensive review of past and current implementation of coercive measures in Italy.
Literature review (cross-referencing in PubMed, Embase, and Index Medicus) concerning the application of coercive measures in Italy. Description of the past and current regulations as well as of the routine implementation of coercive measures in Italy has been also empirically summarized.
The Italian 1978 reform law on mental health care clearly established that medical treatment and tests are mainly voluntary. Only under special circumstances, the medical authority can order a patient involuntary admission and the physician is obliged to provide necessary tests and medical treatment. However, even if coercive measures are usually placed without patient's consent, the first objective should remain to protect patient's interest and rights, in accordance to the Italian Constitution. In Italy, there are no officially recognised protocols on coercive measures for acute inpatient care and each psychiatric ward adopts its own rules and internal norms.
In Italy, patients with aggressive or dangerous behaviours are approached by the staff according to a “de-escalating” model, in which physical and mechanical restraint should be adopted only when any other therapeutic options previously failed. Proposals aimed to improve the implementation of coercive measures in clinical practice will be provided.
To assess trainees’ opinions on the quality of provided educational programs, as recently pointed out in several European countries.
The opinions of 198 Italian trainees in psychiatry on their training and their future career were assessed by means of the Questionnaire on Training in Psychiatry (QTP).
Recruited trainees were predominantly female (68%), with a mean age of 30.0 (± 3.0) years. Thirty-seven percent of them chose psychiatry because “it has always been a dream”, 20% by chance and 17% because they felt “keen on it”. Seventy-seven percent of residents interviewed would make the same choice again if they could turn back time.
Seventy percent of the respondents were “globally satisfied” with their training, especially in clinical psychiatry, psychopathology and psychopharmacology. Residents reported that training in psychotherapy, in psychiatric rehabilitation and in forensic psychiatry were the most neglected areas in their specialization course. Only 9% of them participated in exchange programs, finding them useful for their professional life and experience.
These results show that Italian psychiatric trainees are globally satisfied with the quality of their training. However, they feel that the training course in some neglected areas, such as psychotherapy, rehabilitation and forensic psychiatry, should be improved, and that exchange programs in other countries should be promoted.
a) the socio-demographic characteristics of patients with schizophrenia who were using cannabis at time of first appearing of psychotic symptoms;
b) the impact of cannabis on the duration of untreated psychosis (DUP) and on pathways to care;
c) the influence of cannabis on the clinical onset and on the first three years of the disorder.
Twenty-two patients with a recent onset (< 3 years) of schizophrenia were consequently recruited at the Department of Psychiatry of the University of Naples SUN. Socio-demographic characteristics, pathways to care and DUP were investigated by ad-hoc schedules.
About 60% of patients were using cannabis at onset of schizophrenia. All of them were male and did not have a job and with a lower education level. “Cannabis users” had a first contact with general practitioners earlier than “non cannabis users”, but their DUP was longer, as a consequence of significant delays in access to mental health care. Cannabis users showed higher rates of suicide attempts and relapses in the first three years, suggesting a more severe course of the disorder in the “critical period” of schizophrenia in this population.
The results of the study emphasize the need:
a) to carry out sensitization campaigns among young people in order to reduce the use of cannabis and other illicit drugs;
b) to promote information on schizophrenia for general practitioners.
There is growing concern about the influence of the pharmaceutical industry on psychiatric teaching and psychiatric professionalism as a whole. As a consequence, several national and international medical and psychiatric associations have issued guidelines to regulate the interactions between physicians and industry.
The EFPT-PRIRS study aims to provide the lacking data on the extent and nature of these interactions among psychiatric trainees across Europe.
Study objectives were determined by the EFPT research group (EFPT-RG), after discussion with national and international experts. A survey was then devised compiling previously published questionnaires extending them by questions with specific relevance to psychiatric trainees. The resulting questionnaire was piloted amongst members of the EFPT-RG, modified accordingly and subsequently distributed to the national study coordinators. All 24 EFPT member countries were invited to participate in the study and data collection is currently ongoing.
Preliminary analysis reveals the vast differences in industry - trainee relationships across European countries as well as major differences in personal attitudes towards these interactions.
EFPT-PRIRS will potentially have an impact on the regulation of the interactions between the pharmaceutical industry and psychiatric trainees.
There are significant differences in psychiatric training across Europe. In the light of the current direction of Europe (without borders with free movement of workforce) it is inevitable to harmonize at least basic standards of psychiatric education across Europe. Ideally by working in partnership with relevant national and international bodies (European Union of Medical Specialists, Board of Psychiatry - UEMS, European Psychiatric Association - EPA and European Federation of Psychiatric Trainees - EFPT). A qualitative data analysis on the most important challenges of psychiatric trainees across Europe, carried out by the EFPT in 2009, revealed several interesting findings which might be of interest not only for trainees, but for all involved in the process of psychiatric education. As the most important issue trainees reported the imperfect structure of the training programs and problems with implementation of new ones. That is why new training programs based on a competency based framework are being developed lately in number of countries (e.g. United Kingdom, Ireland, Netherlands). However, not only the structure of the training and its implementation remains an issue, trainees are concerned also with topics related to working conditions, insufficient training opportunities, lack of supervision, funding and availability of psychotherapy courses, etc. Based on these findings EFPT will undertake specific actions which in cooperation with other organizations shall lead in the future to better postgraduate training opportunities in Europe.
Views on the causes and psychosocial consequences of schizophrenia of the Italian population, patients’ relatives and mental health professionals can influence detection and outcome of these disorders.
To investigate the opinions on schizophrenia in a sample of 614 lay respondents, 465 mental health professionals and 709 key-relatives.
The survey was conducted in 30 randomly selected geographical areas with the Questionnaire about Opinions on mental illness (QO).
The results show significant differences among the three groups as regards opinions about patients’ civil rights and social competence of patients with schizophrenia. In particular, the belief that patients’ behaviors are unpredictable is maintained by 18% of mental health workers and by 35% of family members and the general public. As regards causes, 68% of relatives, 20% of mental health workers and 34% of general public believe that schizophrenia is caused by psychosocial factors only. Forty-eight percent of the relatives affirmed that they are fully convinced of the usefulness of pharmacological treatment compared to 28% of professionals and 25% of the Italian population. With respect to civil rights, about half of the relatives is fully convinced that patients with schizophrenia should not have children compared to 17% of mental health workers and to 19% of the general public.
These results underline the need to conduct sensitization campaigns about schizophrenia focused on specific aspects of the disease, such as unpredictability, civil rights and opportunities to recovery of patients, taking into account the target population to which they are addressed.
Even if technology and information are omnipresent, they rarely meet harmoniously. Either the lack of sufficient means prevents good information to reach its target or the technology is too complex to integrate flawlessly in the daily workflow.
The use and misuse of information technologies (internet, email, e-learning, social networks) has recently significantly increased among psychiatrists and patients and the changes in behavior of communication and seeking informations are real challenges.
Using the European Federation of Psychiatric Trainees network, the self-questionnaires concerning the usage of information technologies and the local patients-therapists communication were distributed among psychiatric trainees of 31 European countries.
A review of the results of this study, as well as recommendations about netiquette and useful websites for psychiatrists and scientists will be presented in detail.
While the efficacy of family psychoeducational interventions in the treatment of schizophrenia is now well documented, few data are available on its efficacy in major depression. This study aimed to verify the effectiveness of a family psychoeducational intervention according to the Falloon model on patients’ clinical status, social functioning and lifestyle and on relatives’ burden and social network.
The study was coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 7 Italian mental health centres. In each centre, 8 patients with major depression and their relatives were recruited if they fulfilled the following criteria: a) diagnosis of unipolar major depression according to the DSM-IV; b) aged between 18 and 65 years; c) in charge to the local mental health centre for at least 6 months; d) at least one depressive episode in the last two years; e) living with at least one relative aged between 18 and 70 years.
Recruited families have been randomly allocated to the experimental group, which received the psychoducational intervention for 6 months, or to the control group, which received the treatment as usual plus an informative brief intervention.
22 families have been treated with the experimental intervention and 22 with the control one. At the end of the intervention, patients’ clinical status and life-style significantly improved in the treated group, as well as family objective burden and social contacts.
Family psychoeducational intervention are useful in reducing personal and family difficulties caused by depression and in improving patients’ lifestyles.
Bipolar disorder is associated with high personal and social burden, impaired social functioning and high levels of disability. The psychoeducational family intervention, found to be effective in the treatment of schizophrenia, may be particularly useful for patients with bipolar disorder and their relatives.
Aims & methods
This study, funded by the Italian Ministry of Health, coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 11 randomly selected mental health centres, included the following phases
1) development of informative materials;
2) training of 2 mental health workers per center;
3) random selection of 16 families of patients with bipolar disorder for each center: 8 being randomly allocated to the experimental group and 8 to the control group.
62 families have been recruited. Mental health workers reported several advantages in conducting the intervention, in particular in the relationship with patients and families. Significant improvements have been reported in professional skills and relationships with colleagues. The advantages tend to increase over time. The main reported difficulties are lack of time to run the intervention, identification of appropriate families, excessive workload and the need to integrate this intervention with other work commitments.
It is possible to provide psychoeducational family intervention for patients with bipolar I disorder and their families, after a relatively short period of training. In order to facilitate the dissemination of this intervention in routine conditions, a better planning of the activities of the mental health centers may be useful.
The recent reforms of mental health legislation occurred in most European countries, together with the continuous advances of technologies and the development of research in all the domains of psychiatry have deeply modified the role of mental health professionals with consequent changes in training needs for early career psychiatrists. The competencies required to psychiatrists today include not only the knowledge of the advances in neuroscience, psychopharmacology, psychotherapy and social psychiatry, but also the ability to understand the different clinical and social needs of the patients. Young psychiatrists report a gap between their knowledge and the skills required during the first years of their job.
The European Psychiatric Association-Early Career Psychiatrists Committee, in cooperation with the European Federation of Psychiatric Trainees, conducted a survey among European young psychiatrists and psychiatric trainees, aimed at evaluating difficulties and perspectives related to psychiatric training residency.
86 respondents completed the Psychiatric Training Questionnaire, a multiple-choice and self-reported questionnaire, which evaluates: 1) satisfaction with training received; 2) self-confidence in theoretical and practical skills included in psychiatric training curriculum; 3) educational opportunities received during training.
Respondents were almost equally split between trainees (54%) and young psychiatrists (46%). Seventy per cent of them were completely or partially satisfied with training received. Early Career Psychiatrists reported higher levels of self-confidence in clinical psychiatry (98%), psychopharmacology (69%) and emergency psychiatry (61%), whereas the most problematic areas were forensic psychiatry (64%) psychotherapy (61%) and child and adolescent psychiatry (57%). 41% of respondents was not assigned a tutor for clinical activities, 73% of them could not rely on a dedicated supervisor for training in psychotherapy and 58% had not the possibility to use a log-book to record the competencies acquired during training. Only 37% participated in exchange programs; all early career psychiatrists who had this opportunity found this experience very useful for their professional growth.
Standards of training in psychiatry in Europe are generally satisfactory. However, our results highlight the need to:
1) upgrade training in some areas, such as psychotherapy, forensic psychiatry and child and adolescent psychiatry;
2) guarantee an adequate clinical supervision;
3) spread the use of log-book;
4) improve the opportunities for exchange programs.
Pathways to care and duration of untreated psychosis (DUP) strongly influence the long-term outcome of schizophrenia.
To investigate pathways to care, duration of untreated psychosis (DUP) and treatments received by a sample of individuals aged between 18 and 35 years meeting diagnostic criteria for psychosis.
Pathways to care and DUP were explored by an “ad-hoc” schedule administered to patients and caregivers.
The sample consists of 30 patients. The first episode of psychosis, which occurred at 19.7 (± 4.7) years, was characterized by negative symptoms and disorganized behaviours in more than half of the sample, suicide attempts (28%) and hospital admissions (26%). DUP was 41.6 ± 60.4 weeks, being longer than that reported in international literature. In 76% of cases patients’ relatives asked for a first contact with health professionals, referring the patients to psychiatrists (34% of cases), general practitioners (31%), neurologists (21%) or psychologists (13%). When professionals other than psychiatrists were contacted, the interval between the contact and receipt of appropriate psychiatric treatment (according to the current guidelines) was particularly long (15.2 ± 32.1 weeks). 34% of patients were treated with a monotherapy of psychotropic drugs: 24% with antipsychotics, 7% with anxiolytics and 3% with antidepressants; 48% received a poly-pharmacotherapy. 35% were treated with psychotherapy (in most of the cases cognitive-behavioural therapy), which was the only treatment for 18% of patients.
These results emphasize the need to train health professionals on diagnosis and treatment of first episode psychosis. DUP may be reduced by anti-stigma campaigns among general population.
Family burden, defined as the consequences for those in close contact with a severely disturbed psychiatric patient, is now well-documented in schizophrenia research, whereas very few data are available in affective disorders.
1) the levels of family burden in a sample of key-relatives of patients with major depression;
2) the professional and social support for relatives of patients with major depression disorder.
324 patients with major depression and their key-relatives were randomly recruited in 30 Italian mental health centres, randomly selected and stratified by geographical area and population density. Family burden was explored in relation to:
a) patient's clinical status and disability;
b) relatives’ social and professional support.
Reduction of leisure (53% of the sample) and social activities (44%) were the most frequently reported sources of practical burden, whereas psychological burden was mainly due to sense of loss (75%) and worries for the future (61%). Family burden is higher in key-relatives with a lower education level (p < .05), and when patients’ symptomatology and social functioning are more severe. Key-relatives who can rely on a stronger support from social network and from mental health professionals have lower levels of family burden (p < .05).
These results highlight the need to provide supportive interventions for patients with major depression and their key-relatives.
Training schemes in psychiatry are developed and evaluated by national education policy makers in the majority of European countries. However, the requirements that a training program in psychiatry should meet are also defined on the European level in a form of recommendations by the Board of Psychiatry - European Union of Medical Specialists (UEMS).
Recently, the European Federation of Psychiatric Trainees (EFPT) which represent trainees from more then 30 European countries, reported data pertaining to the structure of training programs and to the evaluation of training programs in 30 European countries. Whereas in the majority of European countries the structure of training programs and methods of assessment of trainees' competencies are partially compatible with one another and with the existing recommendations at the European level, the quality assurance of training programs varies significantly among countries. Regular evaluations of training programs and mentors, however, contribute to the proper implementation of training programs and help that the theoretical training principles are followed through in practice. As quality assurance of training schemes is an important mechanism how to improve the delivery of training programs, it should gain more focus by responsible authorities who structure the psychiatric training on the national and international European level.
The use of coercive measures in clinical practice represents a common, but understudied problem in Europe. In 2002–2005, the European Commission funded the study “European Evaluation of coercion in psychiatry and harmonization of best clinical practice” (EUNOMIA), coordinated by the Department of Psychiatry of the University of Dresden and carried out in 12 European countries.
This study, carried out on the Italian EUNOMIA sample, aims to:
1) assess the use of coercive measures in five Italian mental health inpatient units;
2) identify the patients’ socio-demographic and clinical characteristics associated with the use of coercive measures;
3) investigate the effect of coercive measures on the outcome of the patients.
The Italian sample included 294 admitted patients. Data were collected on coercive measures (physical restraint, seclusion and forced medication)
Almost 30% of the patients received coercive measures during their hospitalization; in particular, 22% received forced medication, 9% were restrained or fixed by mechanic devices, 7% were seclused. The most frequent reason for prescribing coercive measures was aggression against others. Patients who received coercive measures were more frequently male, with higher BPRS scores and a worse social functioning. At three months after discharge, they showed higher levels of positive symptoms, and reported more negative opinions on the need of hospital admission and on the appropriateness of psychiatric treatments.
In Italy coercive measures are in most of the cases applied to the patients affected by more severe psychopathology and disability.
The European Federation of Psychiatric Trainees (EFPT) is an independent federation of psychiatric trainees’ associations. Previous studies have shown that up to 1/3 of countries surveyed did not have separate CAP training We surveyed trainees to gain insights regarding current training within the member countries of the EFPT.
Ten item Survey of Trainee representatives from 32 countries- using surveymonkey questionnaire.
Industry standard encryption technology utilisied.
27 respondent countries. Response rate 84.4% In many countries CAP and General Adult Psychiatry training were not separate Variable availability of training posts (surplus posts 23%, no posts/ long waits 19.2%) Duration of training: 3 years (19.2%),4 years (23.1%), 5 years (26.9%). In 35% of countries CAP training was entirely separate from commencement of training. In 40%, entry to CAP training occurred after training in general adult psychiatry. Trainees in 61.5% of respondent countries indicate their intention to specialise in CAP before entering training in psychiatry; 15% of trainees can indicate this at any time.
This is a survey of trainee representatives to the EFPT of ten items related to CAP training experiences. It highlights significant differences in training experiences in 27 respondent countries. From 2010 the EFPT aims to record detailed information on CAP training yearly. CAP trainees are an integral part of EFPT, and there are specific areas of needs in CAP training.
Studies on the efficacy of psychoeducational family intervention in patients with depression and their relatives are scarce. the effectiveness of this intervention in major depression has not been adequately investigated, probably because it is considered to be less burdensome by mental health professionals compared to schizophrenia or bipolar disorder. This study aims to test the efficacy of a psychoeducational family intervention on: 1) clinical status and social functioning of patients with major depression; 2) family burden and social network. the study has been carried out in 7 Italian mental health centers; 8 families in each center were randomly recruited and allocated to receive a psychoeducational intervention or an informative one. Fourty-four families were examined: 22 from the experimental group and 22 from the control group. A significative reduction in symptoms (p < 0.05), social functioning (p < 0.05), practical burden (p < 0.01), psychological burden (p < 0.05), and an improvement of social contacts (p < 0.05) and of professional support (p < 0.01) have been observed in patients; a significant reduction of practical burden (p < 0,01) and an improvement of social contacts (p < 0.01) and professional support (p < 0.01) have been found in their relatives. the results of this study outline that psychoeducational family intervention is effective in reducing family burden, improving relationships between family members and alleviating family distress. This intervention should be included in the routine management of patients with depression and their relatives.
Research is one of the most attractive fields for young doctors training in psychiatry. The acquisition of research skills by all trainees has been recommended by recent consensus documents on standards of psychiatric training in Europe. However, not always trainees have adequate access to all the phases of a research project during their residencies. Joining professional associations provides opportunities for participating in research activities and establishing networks with other colleagues. In this respect, the European Federation of Psychiatric Trainees (EFPT) in 2008 started a research group with the aim of facilitating trainee-led collaborative studies. Over the years several international research projects on training-related areas have been conducted and published in international peer-reviewed journals. EFPT members can participate to all the phases of the projects as national coordinators and share with other colleagues their research competencies. Furthermore, many EFPT research projects have had the possibility to rely on supervision by internationally renowned experts.
Currently, the topics of the main ongoing studies are: 1) Early career psychiatrists views on psychiatric training (in collaboration with European Psychiatric Association - Early Career Psychiatric Committee); 2) Relationship between trainees and pharmaceutical industries; 3) Child and Adolescent psychiatric training; 4) Trainees’ views on the future of psychiatry and psychiatric training; 5) Trainees’ access to information and use of information technologies during training. In this presentation, issues in research training will be discussed, the EFPT cooperative trainee-led research network will be described and an overview of the results of the ongoing studies will be provided.