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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.
Unipolar depression is mostly recurrent disorder, frequency of depressive episodes increases with subsequent episodes, duration of fourth episode is half of the second episode. There are several reasons for long-term treatment of depression. To avoid recurrence, to decrease severity of subsequent episode, to avoid resistance, to decrease possibility of suicide, to maintain functional and social functioning of patients with depression.
We prospectively examined patients with diagnosis of recurrent depression in naturalistic settings. Patients we treated according the severity of the disorder and according to previous number of episodes.
Two groups of patients were compared, those treated for MDD in 2000 and those treated for MDD in 2006.
Total number of patients was (2000 n =85 2006 n = 100). We did not find any significant difference between patient who have been on monotherapy vs combinations according to age, gender, psychiatric comorbidity. The only sifnificant difference (p<0.01) was in the duration of MDD. The longer duration of the disorder had been a predisposing factor for the significantly higher combinations in the treatment of MDD.Monotherapy is preferentially used in patients with shorter duration of the disorder.
The relationship of the serotonin transporter gene promoter region polymorphism (5-HTTLPR) to antidepressant response was examined in 50 patients receiving protocolized treatment for depression with citalopram. Patients were treated for up to 12 weeks assessed weekly with clinical ratings and measurements (HAMD-17, MADRS, CGI).
Samples from 50 subjects with Major depressive disorder - recurrent episode (DSM-IV) were analyzed for 5-HTT-promotor polymorphism.
Patients with genotype II responded more rapidly and better to treatment with citalopram in comparison to those who did not responded or were only partial responders.
Allelic variation of 5-HTTLPR may contribute to the variable response of patients treated with selective serotonin reuptake inhibitor.
As a result of the globalization process that is taking place all over the world during the last two or three decades, a strong pattern of migration is being observed in all regions of the world. This pattern usually is observed from emerging countries toward industrialized nations. Needless-to-say, this migration process is making a big impact in many nations of the European Union such as Spain, Germany, Sweden, and the United Kingdom.
In general, migrants go to industrialized nations with the hope of improving their socioeconomic conditions; however, they also bring with them language, religion, norms and heritage, that is their culture. Additionally, the migration process produces "acculturation stress", and this stress could lead to development of psychiatric conditions such as posttraumatic stress disorder, depression, substances use and abuse, alcoholism, suicide, etc. At times, however, migrants are capable to adjust well and, thus, to integrate with the host society.
It is, therefore, important for psychiatrists and other mental health professionals to understand the impact of migration vis-à-vis the development of "acculturative stress" as well as psychiatric disorders. This knowledge will permit psychiatrists and other mental health professional to more appropriately and effectively diagnose and treat psychiatric disorders in these migrant groups.
1. Understand the process of migration from a mental health point of view.
2. Learn the role of acculturative stress vis-à-vis mental illness.
The likelyhood of a good symptomatic and functional outcome has varied over time and across place. The most likely explanation is that genetic and environmental factors that influence prognosis vary in a given population at a given time and thus affect disease outcome in that population. Some evidence suggests that outcome may have improved with the introduction of antipsychotics. In some studies better outcome is consistently found in developing compared to developed countries. It has been documented by the WHO International Pilot Study on Schizophrenia. Social-, cultural-, or biologically based differences between countries or even regions may significantly affect the severity of schizophrenia and in a certain way also the level of social functioning of schizophrenic patients.
There are several variables of the outcome of psychosis severity of clinical features, environmental factors (substance use disorders, pre and postnatal factors, etc.), genetic factors, death and disability.
Social functioning (social adaptation) can be measured by various tools - Global Assessment of Functioning Scale or by the level of employment, or the level of employment adequate to education of the patient.
We present a study on first episode patients (N=99) treated either with first or second generation antipsychotics during the period of 12 months after they were discharged from the hospital. All the patients were assessed regularly (0, 3, 6, 9, 12 month) with PANSS, CGI, GAF and the lever of their employment was also taken into account.
Problems with antipsychotic medication is well known problem. We however looked for patients who, inspite of suffering with psychotic disorder, do all the best to be compliant with the medication.
In our settings Within 3 month period we delivered DAI-10 inventory to all 183 psychotic patients who were supposed to be antipsychotics – oral or long-acting injections. 9 patients refused to fill in the forms. We allso looked for other characteristics of patients who were regularly comming for treatment.
We used simple statistic methods to define the major characteristis of compliant patients.
The protective factors which help patients to comply with antipsychotic medication in our sample were: 1, acceptance of the disorder (72%), 2, acceptance of the need of life long treatment (75%), 3, strong family support (68%), 4, being employed (68%), 5, 2,5 prior relapses of psychosis (56%), 6, having children (55%), 7, having family member with psychiatric disorder (43%).
Patients on long-acting injections (64%) were: 1, employed (62%), 2, having children (61%), 3, accepted the disorder (60%), 4, had 3,2 prior relapses of the disorder (56%), had strong familly support (54%).
More attention shoud be payed to variables which lead to high compliance with antipsychotic medication to understand and improove our attitude in educational processes with patients and psychiatrist as well.
Anxiety disorders are highly prevalent clinical conditions (25%) causing high number of hospital admissions and utilization of health care. Recent clinical trials indicate that gender differences in responsiveness to drug therapy also occur. Several lines of inquiry have focused on explaining this gender-related difference due to the higher prevalence of these disorders in women. There is a pile of evidence of a physiologic component is based on gender differences in gastrointestinal transit time, visceral sensitivity, central nervous system pain processing, and specific effects of estrogen and progesterone on gut function as well as on hypothalamic-pituitary-adrenal (HPA) circuitry in adult women., differences in autonomic nervous system, and reactivity. Decreased activity of HPA was observed in trait anxiety and anxiety disorders like panic disoerder or posttraumatic stress disorder. Twenty four patients high level of anxiety in general anxiety disorder participated in the study. ACTH and cortisol plasma concentrations were followed in regular intervals in patients who did not respond to 8 weeks of antidepressant treatment. Our findings show that highly anxious females exhibited lower cortisol release than highly anxious males, suggesting that high-anxiety in females may be associated with inability to respond to antidepressant treatment.
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