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The main aim of the current study was to present the abilities of widely used crop models to simulate four different field crops (winter wheat, spring barley, silage maize and winter oilseed rape). The 13 models were tested under Central European conditions represented by three locations in the Czech Republic, selected using temperature and precipitation gradients for the target crops in this region. Based on observed crop phenology and yield from 1991 to 2010, performances of individual models and their ensemble were analyzed. Modelling of anthesis and maturity was generally best simulated by the ensemble median (EnsMED) compared to the ensemble mean and individual models. The yield was better simulated by the best models than estimated by an ensemble. Higher accuracy was achieved for spring crops, with the best results for silage maize, while the lowest accuracy was for winter oilseed rape according to the index of agreement (IA). Based on EnsMED, the root mean square errors (RMSEs) for yield was 1365 kg/ha for winter wheat, 1105 kg/ha for spring barley, 1861 kg/ha for silage maize and 969 kg/ha for winter oilseed rape. The AQUACROP and EPIC models performed best in terms of spread around the line of best fit (RMSE, IA). In some cases, the individual models failed. For crop rotation simulations, only models with reasonable accuracy (i.e. without failures) across all included crops within the target environment should be selected. Application crop models ensemble is one way to increase the accuracy of predictions, but lower variability of ensemble outputs was confirmed.
This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention.
A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group—studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)—or to the active control group, who followed the 5 A’s intervention.
The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group.
In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A’s intervention.
The aim of this study is to test the psychometric properties of the Spanish validation of the Fear of COVID-19 Scale (FCV-19S) in a Paraguayan population.
Participants were recruited through an Internet-based survey. All participants whose scores in the Hospital Anxiety and Depression Scale (HADS) and The Fear Questionnaire (FQ) were greater than zero were included. 1245 subjects responded voluntarily: 1077 subjects, scoring >0, were considered.
To establish construct validity of the FCV-19S, an exploratory factor analysis was performed using the KMO test, which was adequate, and the Bartlett sphericity test, which was significant (p <.0001). The CFI, NFI, GFI, TLI and RMSEA indices were used to evaluate the model and showed good adjustment. Cronbach’s α showed valid internal consistency (α = 0.86). This validation was supported by significant correlation (p <.001) with the HADS scale for anxiety and depression and with the FQ scale for specific phobia.
The Spanish version of the FCV-19S is a 7-item scale with two dimensions, psychological symptoms and physiological symptoms, which demonstrated robust psychometric properties in a Paraguayan population.
The present study aimed to assess the associations of the stages of Fe deficiency (Fe deficiency without anaemia (ID) and Fe-deficiency anaemia (IDA)) and anaemia with metabolic syndrome (MetS) in Ecuadorian women. A cross-sectional study was conducted in 5894 women aged 20–59 years, based on data from the 2012 Ecuadorian National Health and Nutrition Survey. The sample was stratified by age. A χ2 test was used to assess the possible associations of ID, IDA and anaemia with MetS. The prevalence ratio (PR) for each stage of Fe deficiency and anaemia was estimated considering women without MetS as a reference. The total prevalence of MetS, ID, IDA and anaemia was 32⋅3 % (se 0⋅6), 6⋅2 % (se 0⋅3), 7⋅1 % (se 0⋅3) and 5⋅0 % (se 0⋅3), respectively. In women aged 20–29, 30–39 and 40–49 years, MetS was associated with a lower prevalence of ID (PR (95 % CI; P-value)): 0⋅17 (0⋅06, 0⋅46; P < 0⋅001), 0⋅69 (0⋅48, 0⋅99; P = 0⋅044) and 0⋅44 (0⋅29, 0⋅67; P < 0⋅001), respectively. In women aged 50–59 years, MetS was associated with IDA and anaemia (PR (95 % CI; P-value)): 0⋅12 (0⋅02, 0⋅96; P = 0⋅026) and 0⋅22 (0⋅07, 0⋅64; P = 0⋅002), respectively. In conclusion, Ecuadorian women of reproductive age with MetS have a lower prevalence of ID compared with those without MetS. Furthermore, the MetS and IDA coexist at the population level. These findings require an analysis from a dietary pattern approach, which could provide key elements for developing public policies that simultaneously address all forms of malnutrition.
Mixed Bipolar patients are those who have co-existing depressive symptoms during mania. These patients are supposed to have a worse evolution.
The objective of this study was to compare the long-term outcomes of patients who had at least one mixed episode with those who experienced only pure manic episodes.
169 outpatients diagnosed of Bipolar I disorder and treated at least during two years were included. 120 patients (71%) complited the follow-up over 10 years. Baseline demographic and clinical variables were included.
The patients with mixed episodes (37%) had a significantly younger mean age at onset comparing with those with manic episodes (25.3 years vs. 30.8 years; p=0.025) they also had more previous mood- incongruent psychotic symptoms χ2= 6.77, p=0.034), more number of hospitalizations (OR= 1.36, 95% CI = 1.14; -1.63; p< 0.001), and more number of episodes (OR= 1.21, 95% CI = 1.10-1.31; p< 0.001). There were no significant differences relating to depressive episodes, alcohol use, drug abuse, suicidal behaviour and suicide attempts.
Age at onset differed significantly between the mixed episode and pure mania groups, with mixed episode patients having a younger age of onset. This is interesting as one of the major results of the study we have found that age at onset mediates some of the factors classically related to outcome in mixed episodes like alcohol abuse and suicide attempts. However, independently of age at onset, these patients represent a especially severe type of bipolar disorder.
In Spain, consumption of psychotropic drugs is high and benzodiazepines represent 74% of the total. His prescription in primary care is very common and their use continues to grow. They are safe and effective drugs, but patients with prolonged use are elaborating the most adverse effects, particularly the dependency.
Descriptive ans cross-sectional.
Primary Health Care.
We seleted 202 patients treated with benzodiazepines, consecutive sample, belonging to the health center Los Barrio who were seen in consultation during 2009.
We conducted through a questionnaire that cointained the treatment and demographic characteristics.
We detect a frequency of use of benzodiazepines 9% (95% CI 4,7-12,1%). The profile of the consumer responds to middle-aged woman, with primary and housewives. Somatic diseases were associated in 72.6% (CI 67,2-77,5%) and had mental pathology at 59.7% (CI 53,9-65,3%). 35% (95% 29,6-40,6%) of prescribed benzodiazepines were clorazape dipotassium. Consumption was constant for over a year. The prescription from primary care represents 81% (95% 76,3-85,4%) and in 65% (CI 59,3-70,3%) is associated with other psychoactive drug.
In our area, highlights the prescription of benzodiazepines from primary care on demand and consumption during prolonged time. Interventions should be conducted on the prescription of benzodiazepines in medical and other interventions for patient support.
To evaluate the impact of the “Spanish Consensus on Physical Health in Patients with Schizophrenia” on psychiatrists’ evaluations of the physical health of patients with schizophrenia.
Epidemiological, non-interventional, national, multicentre study, with two retrospective, cross-sectional data collection stages in which 229 psychiatrists evaluated 1193 clinical records of patients with schizophrenia (ICD-10) seen in January and September of 2007.
Mean age of the patients was 39.7 ± 11.6 years, 65.5% were men, diagnosed for schizophrenia 14.0 ± 10.3 years ago. Forty percent of the patients suffer from a concomitant disease, the most prevalent being hypercholesterolemia (46.3%), hypertriglyceridaemia (33.5%) and arterial hypertension (26.0%). The difference in the number of patients who had all the physical measurements taken between the two cross-sectional evaluations was 13.8% (CI: 11.8%, 15.7%). The differences for each parameter were: weight 13.7% (CI: 11.7%, 15.6%), BMI 13.58% (CI: 11.6%, 15.5%), waist circumference 14.0% (CI: 12.0%, 15.39%), lipid profile 2.9% (CI: 1.9%, 3.9%) and glycaemia 2.6% (CI: 1.7%, 3.5%).
These results imply that the dissemination of the “Consensus on Physical Health in Schizophrenia Patients”, and possibly other actions, has made psychiatrists more aware of an integral approach to patients with schizophrenia, promoting increased monitoring of the physical health of these patients.
To describe validation process of the new apathy scale for institutionalized dementia patients (APADEM-NH).
100 elderly, institutionalized patients with diagnosis of probable Alzheimer Disease (AD) (57%), possible AD (13%), AD with cerebral vascular disease (CVD) (17%), Lewy Bodies Dementia (11%) and Parkinson associated to dementia (PDD) (2%). All stages of the disease severity according to the Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR) were assessed. The Apathy Inventory (AI), Neuropsychiatric Inventory (NPI), Cornell scale for depression, and the tested scale were applied. Re-test and inter-rater reliability was carried out in 50 patients. The feasibility and acceptability, reliability, validity, and measurement precision were analyzed.
APADEM-NH final version consists of 26 items and 3 dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. Mean application time was 9.56 minutes and 74% of applications were fully computable. All subscales showed floor and ceiling effect lower than 15%. Internal consistency was excellent for each dimension (Cronbach’s α DT = 0.88, α EB = 0.83, α CI= 0.88);Test-retest reliability for the items was kW=0,48-0,92; Inter-rater reliability reached kW values 0.84-1.00; The APADEM-NH total score showed a low/moderate correlation with apathy scales (Spearman ρ, AI =0.33; NPI-Apathy= 0,31), no correlation with depression scales (NPI-Dementia = -0.003; Cornell= 0,10), and high internal validity (ρ =0.69 0.80).
APADEM-NH is a brief, psychometrically acceptable, and valid scale to assess apathy in patients from mild to severe dementia and discerning between apathy and depression.
Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.
In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.
No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).
Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.
Involuntary admission of mentally ill patients tends to be related to clinical severity and worst therapeutic response.
To evaluate whether there is a relationship between involuntary admission and prescription of two or more antipsychotics (that is, polytherapy) among patients with schizophrenia and other psychosis.
A total of 241 patients (40.2% females, mean age 39.7+/−13.0 years) consecutively admitted during 2009 to a psychiatric inpatient ward with diagnosis of schizophrenia and other psychoses were assessed.
Out of the total sample, 150 (62.2%) patients were on polytherapy, and of the 241 patients 134 (55.6%) were involuntarily admitted. Involuntary admission was unrelated to age (p = 0.335), specific diagnosis (p = 0.452), or length of psychosis (p = 0.234). On the contrary, it was related to gender (61.8% of males vs. 46.4% of females were involuntary, p = 0.018) and to polytherapy/monotherapy prescription (62.0% of patients on polytherapy vs. 45.1% of patients on monotherapy were involuntarily admitted; and 53.3% of voluntary patients vs. 69.4% of involuntary were on polytherapy p = 0.010). After controlling for age, gender, specific diagnosis and length of psychosis the association between involuntary admission and being in polytherapy remained significant (p = 0.047).
Patients involuntarily admitted are more prone to be on antipsychotic polytherapy.
Adoption, twin and family studies suggest that suicide behavior is familial and heritable. Both completed and attempted suicide appear to be transmitted in a familial form. Genetics and environment influences had been detected in various studies. But suicidal behavior suggests to be inherited independently from the mental disorders usually associated with it. While traditional statistics emphasizes inference and estimations, data mining emphasizes the fulfillment of a task such as classification, estimation, or knowledge discovery.
The goal of this study was to determine in a large sample of suicide attempts which variables are associated with family history of attempted suicide.
In an emergency room, 539 adult suicide attempters were recruited. The two dichotomous dependent variables were family history of suicide attempt (10%) and of completed suicide (4%). Independent variables were 101 clinical variables explored with two data mining techniques: Random Forest and Forward Selection.
A model for family history of completed suicide could not be developed. A classificatory model for family history of attempted suicide included the use of alcohol in the intent and family history of completed suicide, provide a sensitivity of 78.4%, a specificity of 98.7% and accuracy of 96.6%.
A classificatory model for family history of completed suicide could not be developed using data mining techniques. But it suggested that the use of alcohol in the intent and family history of completed suicide may be associated with familial attempted suicide.
The objective of this study is to review work carried out over the last decade in the area of emotion recognition in persons diagnosed with schizophrenia. Emotion recognition is one of the areas included in the term social cognition. The MATRICS project looks at seven critical cognitive fields where patients with schizophrenia have difficulties. Social cognition is one of these fields. The reasons why social cognition has become so relevant include: empirical evidence associating social cognition with social functioning; its role as a mediator variable between basic social cognition or neuro cognition and social functioning; the appearance of studies showing a neuron substratum of social cognition; and the attention which has started to be given to the development of intervention programmes in schizophrenia focussed on social cognition and, more specifically, on the appropriate recognition of emotions. Emotion recognition or the processing of emotions refers to all those aspects related to perceiving and using emotions. Empirical knowledge in this aspect of social cognition has been basically amassed by studies on the perception of facial emotion. The tasks used in these studies tasks basically consist of showing photographs of human faces in order to identify six basic emotions (happiness, sadness, anger, fear, surprise and disgust or shame).
There is general consensus that social cognition is a key cognitive dysfunction in schizophrenia. At the same time, the hypothesis that social cognition is an aspect of cognition that determines social functioning has been receiving more and more empirical support since it was first proposed a few years ago.
However, the actual definition of “social cognition” can be a confounding factor in this framework. The definition has been a matter of debate in literature and only recently has some consensus emerged about the aspects that constitute “social cognition” (emotion perception, theory of mind, social perception, attributional style, social scheme). As a consequence, most of the time research in this area only considers some of these aspects, probably because the instruments available to measure social cognition measure these aspects individually and not social cognition globally.
The SCS (social cognition scale) is an instrument under development with the goal of measuring together some of the components of social cognition, specifically: identification of stimuli, emotion perception, and social perception. Results show that the social perception of the patients who participated in the social perception program has improved. Patients that have received training in social perception learn to gather more information from an image, and to make more adequate interpretations.
Insight in schizophrenia shows critical implications for adherence. Non-adherence is particularly relevant in first-episode patients. Few studies have examined insight in early schizophrenia. The aim of this study is to examine relationship between insight, adherence and outcome in patients with early schizophrenia.
Observational study in patients diagnosed for schizophrenia, schizophreniform, or schizoaffective disorder for less than 5 years. Data are collected retrospectively from first psychotic episode to study start, and prospectively (1 year). Association of demographic data, clinical measures, remission, relapses, and adherence with level of insight (Scale to Assess Unawareness of Mental Disorder and G12 item of PANSS) was evaluated. Adherence was assessed interviewing patients and family. Remission was defined according to Remission in Schizophrenia Working Group criteria. Preliminary data are shown.
575 patients have been analyzed. Duration of illness was 3.9±1.6 years. According to G12 item of PANSS, almost 50% of patients had moderate to extreme impairment in baseline insight, while this percentage was 15.8% at 12 mo. (N=291). At baseline, 50% of patients showed good adherence to medication (>80%), and adherence rose to 78% at 12 mo. (N=291). Remission (severity criteria) significantly increased from baseline (23.9%, N=574) to 12 mo. (59.5%, N=291; p<0.0001). A significant relationship between insight and remission at baseline (p<0.001) was found. Among patients who reached 12 mo. visit (N=289), hospitalization was more frequent in those with poor baseline insight.
Lack of insight is common in early schizophrenia and may be a relevant predictor of poor outcome.
The Eiffel study is a longitudinal, naturalistic study of patients with first episode psychosis (FEP) designed to evaluate the predictive value of defective insight on treatment adherence and global functioning.
Five hundred seventy-seven patients with FEP were assessed at baseline and at a 1-year follow-up. They were compared in terms of sociodemographic factors, psychopathology, insight, treatment adherence and functional outcome. Longitudinal functionality was prospectively assessed with the clinical global impression (CGI) and global assessment of functioning (GAF) rating scales.
At baseline, up to 50% of our sample presented with a lack of insight. Most clinical symptoms, including insight, improved over the follow-up period. Insight, education and social withdrawal significantly predicted CGI and GAF at follow-up. Insight and level of education were predictive of treatment adherence.
Insight significantly predicted the general clinical course, treatment adherence and functional outcome in our FEP sample after 1 year. Only education additionally accounted for the longitudinal course. Since our results suggest that better insight improves treatment adherence and consequently clinical course and functional outcome, insight could be a specific target of treatment in early intervention programs.
Brain-derived neurotrophic factor (BDNF) promotes growth and maintenance of connections and participates in plasticity mechanisms.The cognition an the functioning of patients with a first episode of psychotic (FEP) is altered.
We analyze the relation between the BDNF, the cognitive performance and prognosis in patients with FEP.
Design and Methods:
45 patients with a FEP from the Basque Country, diagnosed using the SCID-I and DSM-IV. Plasma BDNF levels were measured using the BDNF Sandwich ELISA Kit. All patients were assessed clinically three times over a year using PANSS, GAF and Strauss Carpenter scales. Battery of cognitive tests (Wechsler Memory Scale and WAIS-III) was applied six months after the acute episode.
Positive correlation between BDNF levels after six months of treatment and five cognitive domains: abstract verbal reasoning (r = 0.468), motor and processing speed (r = 0.397), learning capacity (r = 0.559), immediate memory (r = 0.409) and delayed memory (r = 0.382). Also, the patients with lower BDNF plasma levels at baseline, at 6 months follow-up had worse social activity (0.61 vs. 0.89; p = 0.041) and functioning (0.69 vs. 0.93; p = 0.044).The BDNF levels increased along the follow up, after the pharmacological treatment (basal-1 month: Z = −2.88; p ≤ 0.004 and 1–6 months: Z = −2.23; p ≤ 0.05).
Our results suggest that BDNF is associated with cognitive impairment seen after a FEP and their prognosis. After the pharmacological treatment, the BDNF levels increase significantly and at 6 moths of treatment there were normal levels. Further investigations of the role of this neurotrophin in the symptoms associated with onset of psychosis are warranted.
Impaired social functioning is a hallmark characteristic of several mental disorders including those characterized by paranoid ideation (P) and social anxiety (SA). Social deficits have been related to impaired social cognition.
To investigate the neurofunctional basis of social cognition in people with subclinical P and SA.
13 healthy participants with high paranoid ideation; 12 healthy participants with high social anxiety. Procedures and Instruments: Paranoid Thoughts Scale, Liebowitz Social Anxiety Scale, Cardiff Anomalous Perceptions Scale. Brain response to social stimuli was investigated with two event-related fMRI experiments with implicit processing of facial. expressions of happiness and anger in two different intensities, and with faces expressing no emotion.
People with P recruit differentially and positively the Left Lingual (p < 0,05 FWEcorr), and close to significant (p < 0,06 FWEcorr) the Right Caudate when processing neutral faces. People with SA only showed significant positive differences (p < 0,05 FWEcorr) in the Right Inferior frontal gyrus when processing anger stimuli at 100%. When comparing both groups, we did not find significant differences.
The preliminary results indicate a stronger recruitment of emotional and visual areas in P subjects when processing neutral faces and a stronger recruitment of cognitive processing areas in SA subjects when processing angry faces.
The relationship between neuropsychological and overall performance in people with schizophrenia is known. Smoking and stimulant drugs use can improve neuropsychological outcomes, however the existence of drugs use may be a more severe illness marker.
The purpose of this study is to investigate which clinical and epidemiological variables, including stimulant drugs use and smoking, influence on neuropsychological performance in patients with psychosis.
Material and methods
92 patients with different psychosis were assessed with a battery that included SCIP, to assess neuropsychological performance, PANSS, to evaluate psychotalogy, GAF and SIX as global performance measures. We also explore clinic and sociodemographic data. A binary logistic regresion model was applied on scores on the task ‘words’ of the SCIP (memory and learning), dichotomized at the median. The model included: sex, age, onset age, family history, negative scale, positive scale, global psychopatology and PANSS subtypes, estimated premorbid IQ using Barona Index, stimulant drugs use, smoking and funcionality.
The absence of stimulating drugs use and smoking (trials 2 and 3 of SCIP), was associated with better memory and learning in patients with psychosis. Younger age (trials 1-4 and total of words), higher functionality (trials 1,2 and total of words) and premorbid IQ (trials 2 and 4) were also positively associated with better neuropsychological performance.
Stimulant drugs use and smoking could be markers of poorer previous neuropsychological function in psychotic patients. It is necessary to do longitudinal studies evaluating these variables as markers, risk or protective factors of cognitive performance
numerous studies have shown higher rates of anxiety and depression, post-traumatic stress disorder (PTSD), chronic diseases and other physical symptoms in women exposed to intimate partner violence.
to analyze the relationships between duration and frequency of abuse and diverse health factors (mental health, physical complaints, post-traumatic stress disorder and self-perceived health) in a sample of battered women.
This study is composed of 274 battered women from Chile and Spain. The instruments used were: a semi-structured interview for victims of abuse, specifically designed for this research, which assesses sociodemographic characteristics of victims and circumstances of abuse; the General Health Questionnaire (GHQ-12) (Goldberg and Williams, 1988); Complaints Questionnaire, extracted from the National Health Survey of Spain (INE, 2006) and the Severity of Symptom Scale for PTSD (Echeburúa et al., 1997).
the results show that both the duration and frequency of intimate partner violence are associated to poorer health outcomes. For example, higher duration of violence leads to higher number of physical ailments and higher severity of PTSD symptomatology.
this results allow a better understanding of women health that suffer this kind of violence from their partners, and let us to develop treatment programs that best suit their specific needs, both in the private and public health field.
There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country.
Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration.
A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have ‘ever’ considered to move to a different country in their future, 53.5% were considering it ‘now’, at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (<500€) incomes (58.1%), whereas in those with higher (>2500€) incomes, personal reasons were paramount (44.5%).
A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.