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The COVID-19 pandemics brought numerus changes in the European mental health systems. One of the major, was the widespread introduction of digital psychiatry across the globe, as the only possible option to maintain the psychiatric care. On February 28th 2022, the European Psychiatric Association has started a network of solidarity for Ukraine to respond to the needs of people in Ukraine as verbalized by the Ukrainian mental health professionals, but also to the need of surrounding countries where people from Ukraine fled to. As verbalized by the colleagues from Ukraine and surrounding countries, one of the unmet educational needs was the education for first line helpers and volunteers from Ukraine and countries surrounding Ukraine where displaced persons fled to. This resulted in the series of webinars on the topics detected as unmet needs (what is normal response to trauma, how to triage dispaced persons in need of help, how to provide first psychological help, how to approach to children of different ages, how to take care of one-self and what is the role of supervision). The webinars were delivered by experienced clincians, trauma experts and experts with lived experince in the war zones, incliding the ones from Ukraine. These are available freely at the EPA website https://www.europsy.net/resource-page/, in several languages.
After two years of pandemic with COVID-19 Europe is facing a war, which has already caused numerous death and injuries, mass displacement, and aggravated the economic and energy crisis and has left most countries completely unprepared and created a humanitarian crisis. The COVID-19 pandemics crisis pointed out the unpreparedness of the health (including mental health) sectors for the emergency situations. However, we also learnt some of the practices that proved effective – including the fast creation of collaborative networks on a larger scale that also allowed fast spread of good practices and practical organisation of help. The European Psychiatric Association as well as individual national psychiatric association have started an informal network of solidarity for Ukraine on February 28th, 2022 to respond to the needs of people in Ukraine as verbalized by the Ukrainian mental health professionals, but also to the need of surrounding countries where people from Ukraine fled to. Through this network several actions, including financial support, medical donations and education. The Croatian Psychiatric Association took the lead in the organisation of education for first line helpers and volunteers from Ukraine and countries surrounding Ukraine where displaced persons fled to, in collaboration with many partners.
The COVID-19 pandemic has disrupted mental healthcare delivery in many countries. The restricted access to psychiatric services and double disasters (pandemic and earthquakes) coincided in Croatia, potentially placing people with severe mental illness (SMI) in a very vulnerable position.
The aim of this study was to examine the changes in substance use in people with SMI in the first and the second COVID-19 wave and co-occurring earthquakes. The secondary aim was to explore whether the type of treatment (community mental health teams (CMHT) vs. treatment as usual) influenced those changes.
This study was nested within the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE, Horizon 2020 research and innovation programme, grant agreement No 779362). The study involved 90 participants with SMI assessed at two time points: in May/June 2020 (during the first COVID-19 wave and after Zagreb earthquake) and in December 2020/January 2021 (during the second COVID-19 wave and after Petrinja earthquake). The changes in the use of psychoactive substances (alcohol, cannabis, other drugs, sedatives) were assessed using self-reported survey.
The increase in tobacco smoking behavior and the use of sedatives was observed in both COVID-19 waves in people with SMI. No increase was reported in cannabis and other drugs use, while less than 5% of participants reported increase in alcohol consumption. Not receiving CMHT service predicted the increase in sedative use.
Ensuring accessible mental health care provided by CMHT is recommended for counteracting the negative effect of external stressors (such as pandemic and co-occurring earthquakes) on the increased substance use among people with SMI.
Disclosure of Interest
S. Levaj Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., S. Medved Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., J. Gerlach: None Declared, L. Shields-Zeeman Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., F. Bolinski Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., Z. Bradaš Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., Z. Madžarac Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., I. Rojnić Palavra: None Declared, M. Rojnić Kuzman Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362.
In most academic settings, mentoring students is a part of the activities of the academic staff. Usually, associate professors, assistant professors and professors are required to mentor graduate and postgraduate students, and in some academic settings postgraduate students are required to mentor junior students. In psychiatric clinical settings, mentoring also extends to the supervision and evaluation of clinical work of postgraduate psychiatric trainees, usually for different parts of the psychiatric training. Depending on the local organisation of academic and clinical work, numbers of mentees per one mentor as well as description of activities may vary greatly across regions. Nevertheless, “mentoring” is not systematically taught and evaluated in the majority of systems but is infrequently self-taught. The situation of COVID-19 pandemic, especially in the first wave, has created a new situation which needed quick adaptations in many of the fields of the academic work, mentoring included. In this presentation, these new situations and lessons learnt will be presented and discussed from the point of the academic centre in Croatia.
During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams’ contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.1
Prevention of the First Episode of Psychosis: What Have we Reached by 2021? The first episode of psychosis is usually preceded by a prodromal period or stage of psychosis, where early signs of symptoms indicating onset of first episode psychosis (FEP) occur. In the last twenty years, enormous progress was made in the tretment of FEP and subsequently schizophrenia, as the focus of treatment of FEP shifted to this prodromal period with the aim of preventing the first episode of psychosis in people at risk.Treatment for the prodromal stage of psychosis is provided within specialized early intervention services, which are somtimes part of the services for the treatment of FEP. Early intervention services, which have been gradually developed in many countries worldwide, usually incorporate multimodal treatment approaches (pharmacotherapy, psychotherapy and psychosocial interventions). However, there are still many differences in the treatment of prodromes across early intervention services, even within one country, leaving open the questions on what kind or combinations of treatments really work in the prevention of FEP. The methods of studies in the scientific psychiatric literature do not allow easy translation of scientific data to clinical practice. In the presentation, an up-to-date overview of the available treatments offered witin early intervention services for prevention of FEP is given.
Croatian healthcare faced dramatic changes as a response to the ongoing pandemic, which further pressured financially loaded system. Besides, the capital of Croatia was hit by an earthquake that caused material damage and organizational difficulties. Contrary to the World Health Organization’s recommendations that mental health services are essential services to be maintained during the pandemic, there was severe disruption of utilization and accessibility to mental health services during the pandemic. In the beginning, the only services maintained were in-hospital and emergency services, while daily hospitals and ambulatory visits were disrupted. Psychiatric resources were not formally implemented in the treatment and management of COVID-19 and majority of mental health workers remained within the boundaries of psychiatric services. In the following period, some of the services reopened, with reorientation to online provision. However, the interference of services gradually occurred as the second wave started, with some psychiatric departments being repurposed for non-psychiatric use. Psychiatric care was organized in some of the COVID-19 departments as liaison service. Some of the psychiatric services offered consultation and prevention of burn-out for frontline personnel. Lastly, as the University hospital centre Zagreb was implementing the flexible assertive community treatment teams for persons with severe mental illness through the Large-scale implementation of community based mental health care for people with severe and enduring mental ill health in Europe (RECOVER-E) project in the period from 2018-2022, we investigated the effect of this service on the health outcomes during the pandemic and found it superior compared with the standard treatment.
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.
Many studies describing print media representations of mental illnesses have showed that these depictions are frequently negative and contribute to consequent stigmatization of people with mental illness. The main objective of this international study was to identify predictors of stigmatizing and nonstigmatizing articles on mental illness in Czech Republic, Croatia and Slovakia.
The study sample comprised all articles pertaining to the topic of mental illness (N=450) chosen from 6 most widely read newspapers and magazines identified during five weeklong periods in 2007. The presence of stigmatization and destigmatization statements was coded and articles were grouped in positive, neutral, mixed and negative clusters. Negative/positive ratio (NPR) was used to assess the predictor value of different features of the article regarding stigmatization.
61.8% of articles contained some stigmatizing statements towards persons with mental illness. The highest NPR was found in articles published in tabloids (6.8), on the front page (3.7) and in the articles where psychotic disorder was mentioned (7.4) and mentally ill person figured as a source of information (1.8). Lowest NPR was found in magazines (0.6), articles in later sections (1.7) that mentioned eating disorders (0.3) and scientific surveys (0.1).
There is a high level of stigmatizing statements in the studied articles. As the strongest predictors of stigmatizing content we have identified articles that are published in tabloids and articles with reference to psychosis. Contrary to this, eating disorders had the least stigmatizing depiction as well as articles containing scientific data.
Antipsychotic medications are used to treat a significant number of psychiatric disorders, such as schizophrenia or bipolar disorder, which have a significant impact on overall disability in Europe. Although these drugs have documented efficacy, they are also associated with side-effects such as drowsiness, weight gain, type 2 diabetes, or extrapyramidal symptoms . These contribute to increasing overall morbidity and mortality , reduced quality of life, and can push patients to stop their medications. This often leads to relapse, and the need for a new hospital admission, which is detrimental to the patient, and create extra costs for the society. However, the monitoring of side-effects is rarely carried out in a standardized way in daily clinical practice. Smartphones are an acceptable and easy to use tool available to patients with schizophrenia . The aim of the mPIVAS (mHealth psychoeducational intervention versus antipsychotic-induced side effects) project is to develop an effective and innovative smartphone application that can be used by psychiatrists and patients in order to monitor medications’ side-effects. The European Psychiatric Association (EPA) is involved in this project with the objective to develop this application in 6 languages. Part of the project includes training European early careers psychiatrists to the use Psylog and helping them to spread information about this new project in their own country, by organising local and national cascade courses. We expect an improvement in psychiatric care in all involved institutions through the education of employees, a better implication of patients in their disease, and an improved monitoring of antipsychotic side-effects.
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.
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.
Gender-based perspective is not systematically included across trauma studies and deeper insight into women's response to trauma is required. We explored how the type of trauma (military vs. civilian) is related to clinical characteristics of post-traumatic stress disorder (PTSD) female patients.
Out of 55 PTSD patients included in the study, 34 were military trauma victims (combat experience, witnessing family members being killed) and 21 experienced civilian trauma (rape, robbery, traffic accident). All patients were hospitalized at the Zagreb University Hospital. Data were gathered retrospectively from the medical charts.
Regardless to the type of trauma, examination of clinical characteristics indicate high rate of comorbid psychiatric disorders among PTSD patients with major depressive disorder being the most prominent one; others are personality disorder, anorexia nervosa and somatoform disorder. We found no significant inter-group differences in PTSD symptoms according to the DSM-IV criteria. Most pronounced PTSD symptoms in both groups were hyperarousal and social avoidance symptoms. Late first contact with psychiatrist was found to be a risk factor for PTSD diagnosis among the military group. Those patients were more likely to present first with somatic symptoms such as arterial hypertension, rheumatic pain and gastritis.
Study results suggest that both military and civilian traumas left polymorphous psychological consequences on the mental health of the victims. There is a need for sensitive and coordinated care for traumatized people in order to recognize psychological symptoms and provide optimal psychiatric interventions.
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.
Croatian Young Psychiatrists and Psychiatric Trainees Section was founded on December 15, 2005. as part of Croatian Psychiatric Association, established to promote different activities using network of young psychiatrists accros the world. In order to indicate activities that could fulfill possible gaps in our educational system, we performed a study among psychiatry residents and young specialists from different Croatian psychiatric centers.
91 participants answered the questionnaire constructed to obtain information about profile of young psychiatrist in Croatia, objective parameters of educational quality to produce competent psychiatrist, evaluation of residency training and suggestions of how to improve the current educational system.
Study results indicate that Croatian psychiatry residents are derived from a pool of average to above average medical students and majority is engaged in postgraduate studies and research acitivities and shows high interest in specific psychiatric fields such as psychotherapy and clinical psychiatry, but low interest in community psychiatry and mental health. Most of participants are only partially satisfied with the current residency training and feel that most problems reside from the lack of practical psychotherapy, the inefficiency of the mentorship system and the lack of opportunities for student's exchanges with other countries.
The results of this study revealed the major problems of psychiatry residents in Croatia. Following those results, we will perform the study that would include mentors and supervizors from different Croatian psychiatric centers. That could enable the developement of specific interventions with aim to improve current residency training in Croatia.
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.
Modern technology and globalization dramatically changed our perception of how research in psychiatry should be done. On one hand, research topics in modern psychiatry considerably broadened over the years, and opportunities for collaboration as well as dissemination of results dramatically increased. On the other hand, research in psychiatry has become highly demanding, requiring the use of the most modern methodologies, large numbers of participants and fast publications of the results in highly competitive journals. Inevitably, it has become very costly in terms of time, money and human resources.
These changes brought more opportunities for research to the new generations of European early career psychiatrists. Nevertheless, they also increased the inequality in opportunities for research among them, due to relative centralization of the most “exclusive” psychiatric research sites. Indeed, the majority of European early career psychiatrists miss real opportunities to get involved in research due to a lack of mentorship, psychiatric research groups and research facilities in their countries.
Within this scenario, choosing the right kind of research for early career psychiatrists might be confusing and somewhat discouraging. To support the involvement of young colleagues in research, the Early Career Psychiatrists Committee has formed the Task Force on Research. We will present several projects run by our task force, each relying on a different approach of research in psychiatry. We think that the proposed approaches would be useful for early career psychiatrists, since they take into account both the strengths and limitations inherent to the role/position of early career psychiatrists.
Ways of travelling and means of communication have exponentially developed, while their price has dropped. It is now relatively easy for a psychiatrist to travel in different countries in the early stages of his career. The development of European programs such as Erasmus has increased exchanges during medical school. After graduation, it is possible to travel abroad for a few weeks as an observer, months a researcher, but also for one’s entire life, as European legislation has made it possible for doctors to register and permanently work in many countries. The crisis in recruitment of psychiatrists that many countries face has put junior doctors in a position of finding a job almost wherever they want.
On the one hand, this phenomenon tends to drain resources in less favoured countries, and psychiatrists travelling the world might become mercenaries, looking for the best opportunities and not being able to maintain consistency in service provision. This would ultimately lead to psychiatrists only becoming technicians, providing a service for a fixed period of time, and being replaced as leaders by managers in charge of running services.
On the other hand, this constitutes a unique chance from a personal point of view, as a way to gain experience and discover other cultures. From a professional point of view, working in a different system is also a valuable experience, and the travelling doctor can bring his own culture and tend to naturally ‘think outside the box”, benefiting the service and the patients. In addition, a growing number of patients migrating themselves and coming from diverse backgrounds will benefit from a psychiatrist with a personal experience of migration.
Continuous advances in psychiatric research and increased service users’ expectations led to the need to develop a new international framework for psychiatric training. The assessment of early career psychiatrists’ (ECPs) views has been emphasized as an important step of this process. However, at the moment, only few national studies have investigated ECPs’ opinions on received training.
1) ECPs’ satisfaction with training and self-confidence in different psychiatric domains;
2) availability of clinical supervision and educational opportunities during training.
The Early Career Psychiatrists Committee of the European Psychiatric Association - in collaboration with the European Federation of Psychiatric Trainees, conducted an online survey among European ECPs. The Psychiatric Training Questionnaire, a multiple choice-answer self-reported instrument developed for this occasion, was completed by 194 respondents from 34 European countries.
Most respondents (73%) were completely or partially satisfied with the received training. Highest levels of self-confidence were reported in clinical psychiatry (93%), pharmacotherapy (68%) and emergency psychiatry (67%); the most problematic areas for ECPs were forensic psychiatry (68%), psychotherapy (63%) and child and adolescent psychiatry (57%). Thirty percent of ECPs were not assigned to a tutor for clinical activities, 67% did not receive any psychotherapeutic supervision and only 19% participated in exchange programs.
ECPs are globally satisfied with the training received; however, they report the need to enhance training in psychotherapy, forensic psychiatry and child and adolescent psychiatry, to ensure adequate supervision to all trainees and to improve the opportunities for international exchange programmes.
In the last two decades, both early detection (ED) and early intervention (EI) programs and services have gradually become important and innovative components of contemporary mental health care. However, it is unclear whether ED/EI programs have consistently been implemented throughout Europe.
Here, we report results of the EPA Survey on ED/EI Programs in Europe in 2016.
A 16 item questionnaire was sent to representatives (presidents and secretariats) of 40 EPA National Societies/Associations (NPAs), representing 37 countries. The representatives were also invited to recommend a person for additional information about ED/EI services/programs in the country.
The response rate was 59.4% (22 NPAs). Fifteen out of 28 NPAs were from developed, and 7 out of 8 from economies in transition. ED/EI services have been implemented in 54.5% of the included countries, mean duration 10.0 ± 4.9 yrs. Mostly, neither ED were separated from EI, not the adults from adolescents. National plans to develop ED/EI were reported in four countries. Although national guidelines for schizophrenia exist in most of the countries (73.9%), specific chapters focusing on ED/EI and/or at-risk mental states were not included in the majority of them. Duration of untreated psychosis was unknown in 63.6%. In those who gave the estimation it was 12–100 weeks (median in weeks: 33 developed economies; 44 economies in transition).
The fields of ED/EI have been unequally developed across Europe. Still, many NPAs are without the development plans. EPA and its Sections should address the identified gaps and suggest how to harmonize services for the full range of assessments and interventions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.