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Knotweed (Fallopia spp.) is an herbaceous perennial from East Asia that was brought to Europe and North America and, despite control efforts, subsequently spread aggressively on both continents. Data is available on knotweed’s modes of sexual and asexual spread, historical spread, preferred habitat, and ploidy levels. Incomplete information is available on knotweed’s current global geographical distribution and genetic diversity. The chemical composition of knotweed leaves and rhizomes has been partially discovered as related to its ability to inhibit growth and germination of neighboring plant communities via phytochemicals. There is still critical information missing. There are currently no studies detailing knotweed male and female fertility. Specifically, information on pollen viability would be important for further understanding sexual reproduction as a vector of spread in knotweed. This information would help managers determine the potential magnitude of knotweed sexual reproduction and the continued spread of diverse hybrid swarms. The potential range of knotweed and its ability to spread into diverse habitats makes studies on knotweed seed and rhizome cold tolerance of utmost importance, yet to date no such studies have been conducted. There is also a lack of genetic information available on knotweed in the upper Midwest. Detailed genetic information, such as ploidy levels and levels of genetic diversity, would answer many questions about knotweed in Minnesota including understanding its means of spread, what species are present in what densities, and current levels of hybridization. This literature review summarizes current literature on knotweed to better understand its invasiveness and to highlight necessary future research that would benefit and inform knotweed management in the upper Midwest.
The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services.
We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases.
We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare.
Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.
We investigated whether the type of antipsychotic treatment has an impact on patients’ subjective quality of life (QoL).
In a prospective naturalistic long-term study, 374 patients meeting ICD-10 criteria for schizophrenia or schizoaffective disorder were examined biannually over a two-year period with regards to QoL, psychopathology, social functioning, use of medical and psychosocial services, compliance, side effects and current neuroleptic treatment. QoL was assessed by the Berliner Lebensqualitätsprofil (BeLP), an adaption of the Lancashire Quality of Life Profile. First examination took place two weeks around discharge from a psychiatric clinic. At study entry, all participants were receiving neuroleptic medication of either quetiapine, risperidone or olanzapine. Mixed regression analysis taking into account the unbalanced panel structure of the data and adjusted for selection bias by means of propensity scores were used for data analysis.
Overall quality of life improved continuously during the two years observed period regardless of the type of neuroleptic. A small, but significant difference emerged when comparing quetiapine monotherapy treatment with olanzapine monotherapy or with a combination treatment of conventional and atypical antipsychotics. QoL of patients treated with olanzapine was generally worse than that of patients treated with quetiapine but improved slightly more over the course of time. In total time and type of medication explained only small proportions of variance in QoL.
Type of neuroleptic had only marginal impact on the subjective QoL of our sample. In order to explain changes in quality of life, research on social and individual factors seems to be more promising.
Collecting prospective data on medication adherence, course of illness, course of treatment, cost effectiveness and quality of life among patients with schizophrenia under the German health system.
The ELAN study was conducted as a multi-centre, non-interventional observation study. 374 patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-10 F2) who had been discharged with a medication of quetiapine (N=183), olanzapine (N=91) or risperidone (N=100) were included. Follow-up interviews were conducted after 6,12,18 and 24 months. Applied instruments comprised PANSS, MARS-S, EPS-M, AIMS-S, GAF, ZST and a questionnaire for quality of life.
For each follow-up, at least 80% of the original sample could be included. After two years, between 39% and 43% of patients continued to take the drug prescribed at discharge. Only between 4% and 7% of patients received no neuroleptic treatment in the last 6 months, respectively. The variety of drugs used increased during the course. Only small differences could be found regarding the defined outcome measures (PANSS, GAF, rehospitalisation rate) and side effects. Changes in medication were mostly due to insufficient efficacy or side effects. Doctor's recommendations had an important influence on patients’ decisions.
Under conditions of routine treatment, medication adherence was much greater and differences between drugs were smaller than reported in randomised controlled clinical trials. Taking into account the low sample selection bias and the small percentage of lost-to-follow-up subjects, this study provides some new insight into routine clinical treatment and outcomes in patients with schizophrenia.
At the Psychiatric University Clinics (UPK) Basel a standardized psychoeducative group program with a diagnosis-independent, multimodal and bifocal conception for patients with severe mental disorders has been established.
Recent publications show that this strongly recommended intervention is highly underutilized in its traditional, disorder-specific form. E.g. an extensive survey in Germany, Switzerland and Austria revealed that 2003 only 21 % of all schizophrenic inpatients and 2 % of their relatives received psychoeducation, and probably the data for other diseases are even lower. Among other reasons difficulties concerning the availability of enough patients with the same diagnosis were accused for not offering this effective and cost-effective method. Clinical and theoretical considerations also support a diagnosis-independent modification, and it should promote the wider employment of psychoeducation.
Apart from that we expect a stronger effect on treatment-adherence by the integration of cognitive-behavioural modules and psychodynamic aspects. The findings of compliance research clearly indicate that a mere knowledge transfer has significantly less impact than a combination of different therapeutic elements. This is of crucial importance because compliance strongly influences course and outcome of the diseases, as well as relatives' burden and socio-economic costs.
Since 2006 e.g. participants' satisfaction is examined and the data show very good acceptance. Currently a randomized controlled trial is carried out to evaluate the efficacy of the intervention concerning relapse and rehospitalisation rates, social functioning, quality of life, compliance, insight into the disease and burden on family during a 1-year-follow-up-period.
The curriculum of the program and first results will be presented.
Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.
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.
Both schizophrenia and ultra high risk (UHR) patients show reduced neurocognitive performance compared to matched healthy control subjects. In the current study we compared neurocognitive performance at baseline and follow up between UHR patients who made the transition to psychosis and patients who did not.
Patients were eligible for the study when they met criteria for one or more of the following groups: Attenuated symptoms or brief limited intermitted psychotic symptoms or a first degree family member with a psychotic disorder and reduced functioning or basic symptoms. We assessed 216 UHR patients (166 males, mean age: 22,6 SD 5,2) with a neuropsychological test battery composed of the National adult reading test (premorbid IQ), California verbal memory test (verbal memory), spatial working memory test, verbal fluency first letter and categories (executive functioning), finger tapping test (motor speed) and continuous performance test (sustained attention). Data were collected in 7 participating centres of EPOS. Follow up was at 9 months.
37 UHR patients made the transition to psychosis (25 males, mean age 21,5 SD 4,8). The only test that showed a significant difference between the transition and non transition group at baseline was verbal fluency categories (t= 2.79, p = 0.006).
Patients who later make the transition to psychosis perform significantly worse on verbal fluency categories than patients who do not make the transition to psychosis. Verbal fluency may contribute to an improved prediction of psychosis in UHR patients. Follow up results will also be presented.
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.
Regional cerebral blood flow (rCBF) values were measured by single photon emission computed tomography (SPECT) in different regions of the brain in 27 patients with DAT. Significant correlations were found between rCBF in left parieto-temporooccipital regions and psychometric test scores. Patients with hemisphere asymmetry in SPECT performed worse on psychometric tests. SPECT did not permit prediction of or differentiation between depressive and psychotic symptoms.
Current clinical practice excludes placebo usage on ethical grounds. No attempt was made to clarify the viewpoint of the general population regarding the matter.
To evaluate the opinion of young-adults towards the use of Placebo in clinical practice.
1) Investigate the willingness of our study population to receive placebo for the treatment of depression or other general medical conditions, and
2) assess whether prescribing placebo would affect the study population's view regarding doctor-patient relationship or patient's autonomy.
We enrolled 344 students from five academic institutes in Israel, and briefed them thoroughly about the effects of placebo, its efficacy and limitations in treating depression. Understanding was verified and only then did the subjects complete a 32 item self-report questionnaire (include sociodemographic, health related data, past experience in medical encounters and willingness of subjects to be treated with Placebo medication).
In contrast to our main hypothesis 70% (N = 243) of the subjects expressed consent to be treated with placebo as a first line treatment had they suffered from depression, and 73% (N = 248) agreed to receive placebo for other general medical conditions. Eighty-eight percent of the subjects (N = 297) did not perceive a physician using placebo as a deceiver or the act of prescribing it a deceit.
The majority of our study population was willing to use placebo medication in general, and in particular, as first line treatment for depression. This study results should promote physicians to rethink and discuss the legitimacy of using placebo in clinical practice.
The ELAN study is a prospective multi centre observational trial on the effectiveness and safety of long-term antipsychotic treatment of people with schizophrenia or schizoaffective disorders with quetiapine in comparison to olanzapine and risperidone under real world treatment conditions.
374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine or risperidone were included at discharge from inpatient treatment. Psychotropic regimen, psychopathological symptoms, general and cognitive functioning, negative side-effects and quality of life were assessed before discharge and at 6, 12, 18 and 24 month follow-up assessments. Intention-to-treat analyses and crossover analyses were conducted by mixed-effects regression models including random linear time effects and time x treatment effects, controlling for baseline differences and additional psychotropic medication and using propensity scores to control for selection bias.
As indicated by significant linear time effects the patients improved with regard to psychopathological symptoms, general functioning, subjective quality of life and cognitive processing speed. No change of extrapyramidal motor side-effects, body mass index or waist circumference was obtained. The lack of any significant time x treatment interaction effects indicated no differences in the safety or effectiveness between the three antipsychotics. Nevertheless, the average hospital admission rate of patients receiving olanzapine was lower in comparison to patients receiving quetiapine or risperidone.
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.
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.
Individuals with schizophrenia suffer from deficits in social skills, lack of motivation and social rejection. Web-browsing seems to create opportunities to forge social ties, bypassing traditional social skills and rejection.
Assessing web-browsing habits and web based social interaction among individuals with schizophrenia.
1) Comparison of internet use for virtual relationships among patients suffering from psychotic spectrum disorders, non-psychotic patients and healthy subjects.
2) Examining correlation between creating virtual relationships and real-life social interactions among these groups.
The web-browsing habits, social skills and demographic data of 143 patients suffering from Psychotic spectrum disorders were evaluated via the use of self- administered questionnaires, clinical data and information from their computerized medical files. As control groups, similar data were collected from a group of Non-psychotic patients (n = 118) and healthy volunteers (n = 100).
When controlling the demographic data for the three groups, no difference was found in the extent of creating virtual and real-life social interactions via internet use. A trend association could be seen between the Psychotic group and creating virtual relationships. All groups exhibited significant correlations between creating virtual and real-life relationships through the internet. However, the Psychotic group exhibited a higher correlation (r = .76;p < 0.01) than the Non-psychotic group (r = .52;p < 0.01) and the Control group (r = .32;p < 0.01).
This study provides preliminary data regarding internet use for social interaction among individuals with schizophrenia. Our results suggest that these individuals do benefit from internet use, as it seems to enhance their social abilities.
The main aim of this guidance of the European Psychiatric Association is to provide evidence-based recommendations on the quality of mental health services in Europe. The recommendations were derived from a systematic search of the best available evidence in the scientific literature, supplemented by information from documents retrieved upon reviewing the identified articles. While most recommendations could be based on empirical studies (although of varying quality), some had to be based on expert opinion alone, but were deemed necessary as well. Another limitation was that the wide variety of service models and service traditions for the mentally ill worldwide often made generalisations difficult. In spite of these limitations, we arrived at 30 recommendations covering structure, process and outcome quality both on a generic and a setting-specific level. Operationalisations for each recommendation with measures to be considered as denominators and numerators are given as well to suggest quality indicators for future benchmarking across European countries. Further pan-European research will need to show whether the implementation of this guidance will lead to improved quality of mental healthcare, and may help to develop useful country-specific cutoffs for the suggested quality indicators.