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Professional attitudes and ethics skills of physicians are influenced in part by the lessons of medical training. Still, few medical schools and postgraduate training programs introduce a formal curriculum. There is also the hidden curriculum which is influenced by instructions that are implicitly learned by observation of others, the cultural climate, and the social norms. The hidden ethics curriculum in psychiatry resident programs was investigated with qualitative interviews. Patient autonomy (consent for admission, coercive treatments) and ethical problems that arise during the management of difficult patient populations (medical ills, substance users, and frequent fliers) were the most common themes. Psychiatric residents perceive a need for more education on ethical issues. The speaker will present the available knowledge on psychiatry residents’ perspectives and the current programs addressing ethics training. This talk is hoped to elicit discussion in preparation for future action and inform a roadmap for addressing ethics training and subsequent educational events during psychiatry undergraduate and postgraduate education.
Balancing career and family is a hard job for everyone. Academic life with multiple and conflicting demands on our time necessitates prioritizing among responsibilities. This resonates especially for a woman academic who takes care of a baby. The speaker will address specific challenges of mothers who are in both academia and clinical practice, give reflections and elaborate on patterns and ways of dealing with this challenge. The talk is hoped to promote awareness and discussion on addressing the inner and outer sources and planning one’s own way on a career path.
Psychiatry is still considerably ‘young’ compared to other positive sciences. Thus, it holds a huge potential for improvement of the current diagnostic and classification systems and modes of treatment particularly. For instance, the Research Domain Criteria Project will certainly generate novel research questions that will shed a light upon mechanisms, and processes for the expression of psychiatric phenomenology and develop psychiatric treatments. The new era of Digital Psychiatry/Telepsychiatry and real-time mobile monitoring are other approaches that have a lot to offer to advance the field of psychiatry. Despite these developments, the stigma around psychiatry is still a big obstacle to tackle with. Addressing and reducing stigma during medical education should benefit from training and experience co-facilitated by people living with mental illness ideally starting from the early years in medical school. Besides clinic rotations, student clubs, student scientific congresses, and clinical research that facilitate contact with the patients may be potential platforms to attract medical students’ attention to the work of psychiatry. The speaker will touch upon some examples and implementations from the medical schools in Turkey.
Women consistently fare worse than men in different professional metrics in terms of salary, promotions, grant money, and scholarly publishing. In clinical and management leadership roles, a similar trend of underrepresentation for women exists. It has been shown in academic publishing that women progressed to senior author positions at a slower pace, resulting in their ongoing underrepresentation as senior writers. Previous literature has shown that one of the most effective strategies for promoting women to leadership positions is the collaboration with men to identify attitudinal and institutional barriers, since gender equality is not only a “women’s concern.” To address this, a cross-sectional, multinational survey was disseminated in English (SurveyMonkey) to psychiatric trainees and psychiatrists across Europe. This study aims to explore the perspectives of female and male psychiatrists on the obstacles they face in their careers. The survey covered items on self-promotion, current institutional environment, and networking along with contextual information- age, gender, professional degree, current field, and years of professional experience in the current field. We hope that the presentation of these findings will serve as a springboard for future educational activities to address concerns connected to the gender gap. The speaker will present the comparison of female and male psychiatrists’ barriers and challenges they face during their professional development. This talk is hoped to elicit discussion in preparation for future action and inform a roadmap for addressing issues related to the gender gap with subsequent educational events.
Attention deficit and hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. Its primary clinical features include symptoms of inattention and hyperactivity/impulsivity, although young people often present with emotional dysregulation, excessive mind-wandering and executive dysfunction. Symptoms of ADHD often persist into adulthood together with high rates of comorbidity and significant psychosocial impairment across the lifespan. Berry, Shaywitz and Shaywitz proposed over 30 years ago that girls with ADHD form a ‘silent minority’ with greater internalized behavior which leads them to be under-identified. Even when referred for clinical assessment, their ADHD symptoms are missed or misdiagnosed for other conditions such as anxiety, depression and personality disorder. This means they will not receive the treatment they need. Compared with controls, they may be especially vulnerable to childhood adversities and health problems and they may cope with these difficulties with dysfunctional strategies (eg. with substance misuse and/or deliberate self-harming behaviours). If we are to enhance long-term outcomes in girls and women with ADHD, healthcare practitioners need to better understand the presentation of ADHD in females, improve detection and assessment of ADHD in order that they may access appropriate treatment. This workshop will focus on the differences in presentation and outcomes between males and females with ADHD.
ABSTRACT IMPACT: Current practice guidelines offer a variety of treatment options for sternal reconstruction but complications and infections remain a serious surgical problem. This work seeks to provide a comprehensive picture of the com-morbidities and reconstructive methods that lead to success and improve patient outcomes. OBJECTIVES/GOALS: Patients that undergo cardiac surgery via the median sternotomy approach are at risk of wound complications that require repair. We seek to evaluate how outcomes of sternal reconstruction are influenced by patient comorbidities, flap usage and internal mammary artery grafts and methods of sternal closure. METHODS/STUDY POPULATION: We identified patients between 2005 and 2020 who underwent sternotomy followed by debridement and flap coverage at our institution. Comorbidities, method of reconstruction, demographic data, surgical history, and other factors pertaining to mortality and morbidity were collected. The data will then be analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted multivariable measures of association with mortality. We present the pre-liminary data analyzed using chi-square and one-way anova in R. RESULTS/ANTICIPATED RESULTS: In this study we present a preliminary characterization of one institution’s sternal reconstruction patient outcomes with a variety of reconstruction methods including pectoralis advancement flaps, omental flaps and latissumus dorsi flaps. Notable preoperative comorbidities include 50% of patients > age 60, 18% with diabetes mellitus, 18 % with diagnosed hypertension, 18% with COPD, and 9% with a smoking history DISCUSSION/SIGNIFICANCE OF FINDINGS: In an evolving cardiothoracic landscape, clinical characteristics of patients being treated for sternal reconstructive surgery present a moving target. Understanding current risk factors, preoperative management and timing for aggressive surgical treatment offers an opportunity to update treatment protocol and maximize successful outcomes.
Severe mental disorders as bipolar disorder and schizophrenia often co-occur with chronic medical illnesses, especially cardiovascular disease and diabetes. Our aim was to estimate the prevalence of physical health problems in hospitalized patients and to determine the sociodemographic and clinical factors associated with physical comorbidity.
The medical records of all inpatients followed up between September 2007 and September 2009 were reviewed retrospectively.
144 patients were evaluted of which 59 (%41) had schizophrenia, 31(%21.5) had bipolar disorder and 54 (%37.5) had other disorders. 43 (%29.9) patients had at least one medical illness, hypertension being the most common (%30) followed by thyroid disorders (%16) and diabetes mellitus (%11). Diabetes Mellitus was detected only in bipolar patients (p=0.005). Females were affected more than males regarding physical comorbidity (p=0.009). Patients with physical comorbidity were older (42.9 vs 35.54 yrs) and had a longer duration of illness (16.2 vs 10.0 yrs). Their hemoglobin levels were lower, blood glucose, urea, thyroid stimulating hormone levels were higher than the patients with no physical illness and the differences were all statistically significant (p=0.05). There was no difference regarding length of hospital stay, drug compliance, previous neuroleptic use, family history for medical and mental illness.
Conclusions: Although it is generally accepted that many physical conditions have been associated with serious mental disorders, the exact nature of the relationship between them is still unclear. Further research is required to identify medical comorbidity risk factors in order to improve the physical health of these patients.
The contribution of childhood trauma and dissociation to the unknown pathophysiology of fibromyalgia has been the subject of considerable debate.
To assess and compare the relationship of childhood trauma and somatoform dissociation between patients with fibromyalgia and rheumatoid arthritis both of which are characterized by chronic pain and disability.
Early life and prolonged trauma may affect brain modulatory circuitry of pain and emotions. The findings of relationship between traumatic events, dissociation and fibromyalgia can lead to a better understanding of the etiology and suggest new treatment modalities.
Thirty-one patients with fibromyalgia and 19 patients with rheumatoid arthritis were enrolled in the study. All participants were asked to fill in the Childhood Trauma Questionnaire, Somatoform Dissociation Questionnaire and Dissociation Questionnaire.
Physical neglect score was higher in fibromyalgia group than rheumatoid arthritis group (p < 0.05) although there was no significant difference between two groups in other subscores of childhood trauma and the rest of the dissociation scores. Total trauma scores were positively correlated with dissociation scores in fibromyalgia group whereas this correlation was not seen in rheumatoid group.
Among childhood trauma types, physical neglect seems to have a more important role in fibromyalgia than rheumatoid arthritis. Fibromyalgia may be related to early life stress or prolonged trauma, affecting brain modulatory circuitry of pain and emotions in genetically susceptible individuals.
Depression and anxiety are frequently reported by MS patients. Studies examining the association between depression, anxiety and personality in MS patients is very limited.
Our objective is to compare temperament and character, depression and anxiety in Relapsing Remitting Multiple Sclerosis (RRMS) patients with healthy controls and inquire into the association between these entities.
The aim of this study is to investigate the possible presence of spesific temperament and character profiles in RRMS patients.
Seventy one RRMS patients and 50 age and gender matched healthy controls were enrolled in the study. Diagnostic neurological examination, sociodemographic and clinical data including the type of MS, duration of the disease, number of relapses, current treatment and the duration of treatment were recorded. SCID-I, Standardized Minimental State Examination, Temperament and Character Inventory, Beck Depression Inventory and Beck Anxiety Inventory were administered.
Patients scored significantly higher in Harm Avoidance and lower in Novelty Seeking, Persistence and Self-directedness than the healthy controls. Depression, anxiety, temperament and character scores were not correlated with disability and the number of relapses.
Temperament and character, depression and anxiety seems to be independent of the disability and the number of relapses in RRMS patients.
In the last decades, psychiatric training has undergone a major transformation due to the contribution of recent scientific developments in psychiatry. Nowadays, the information acquired during the Psychiatric training seems considerably variable in content and quality between different countries. However, data concerning access to information and also about the educational resources available to the trainees in Europe is very limited.
Objectives and aims
The ATIIPT survey aimed to evaluate Psychiatric trainees’ access to published, online, senior's or industry's information in Europe.
A short paper questionnaire constituted of 7 questions (Appendix 1) was created by the members of the EFPT Research Working Group and passed to each delegate of the 32 countries represented at the 19th EFPT Forum in Prague, Czech Republic, on the 2nd of July 2011.
According to the ATIIPT results, access to information among Psychiatric trainees in Europe is heterogeneous. The most available resources are books and websites, and the most preferable resource is journals. Most of the trainees find their resources sufficient, with the main obstacles being related to low availability of journals and books, lack of time and help from seniors.
Better access to information and more evidence in practice is warranted, since the introduction of novel approaches to access to information may create better psychiatrists in the future, encourage medical students to consider psychiatry as a potential career, and help reduce negative attitudes towards mental illness.
Most previous studies investigating the relationship between visual perception and anxiety have found that anxiety-provoking stimuli are perceived as relatively larger in size. Thus, the present study used neutral stimuli to investigate the relationships among anxiety, anxiety sensitivity (AS), and visual perception in a group of male and female university students.
The Visual Size Perception Assessment Test (V-SPAT), which requires subjects to define a neutral figure in a dichotomous manner (i.e., tall/short, large/small, wide/narrow, crowded/deserted) was administered to all participants (n = 76). Additionally, the anxiety level and AS of each participant was determined using the Beck Anxiety Inventory (BAI) and the Anxiety Sensitivity Index-3 (ASI-3), respectively.
The BAI and ASI-3 total and cognitive scores of female participants were correlated with perceptions of 'deserted”, whereas their ASI-3 social scores were correlated with perceptions of 'short”. The ASI-3 cognitive scores of male participants were correlated with perceptions of 'crowded”, and their ASI-3 physical scores were correlated with perceptions of 'tall”.
The present findings indicate that the visual perception of neutral objects is correlated with anxiety and AS. Furthermore, these data revealed sex differences in the relationship between AS and visual perception in that males perceived the objects as larger and females perceived them as smaller.
The influence of pharmaceutical industry (PI) on clinical practice and research in psychiatry has been considered a serious problem. Strict rules and guidelines were developed to regulate the interactions between doctors and PI. However, there is an ongoing debate whether these were thoroughly implemented in practice and internalized by physicians. The objective of our study was to assess the attitudes and behaviors of trainees in psychiatry and child & adolescent psychiatry toward PI across Europe. Methodologically, a validated questionnaire with additional items was administered to1444 trainees in 20 European countries. The minimum response rate was set at 60%. We found a high variation across countries in number of interactions between trainees and PI representatives; Portugal and Turkey had the highest number of interactions. The majority (59.76%) agreed that interactions with PI representatives have an impact on physicians’ prescribing behavior; whereas only 29.26% and 19.79% agreed interactions with PI representatives and gifts from PI have impact on their own prescribing behavior, respectively. Most of the gifts were considered appropriate by the majority, except tickets to vacation spot and social dinner at a restaurant. Of the sample, 70.76% think they have not been given sufficient training regarding how to interact with PI representatives. Only less than 20% indicated they have guidelines at institutional or national level. In conclusion, there is substantial interaction between trainees and PI across countries. The majority feel inadequately trained regarding professional interaction with PI, and believes they are immune to the influence of PI.
Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees.
One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire.
The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37).
There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.
Migration of mental health professionals is an important phenomenon influencing mental health services of host and donor countries. Data on medical migration in Europe is very limited, particularly in the field of young doctors and psychiatry. To research this hot topic, the European Federation of Psychiatric Trainees (EFPT) conducted the EFPT Brain Drain Survey.
To identify the impact of previous short-term mobility on international migration and to understand characteristics, patterns and reasons of migration.
In this cross-sectional European multicentre study, data were collected from 2281 psychiatric trainees across 33 countries. All participants answered to the EFPT Brain Drain Survey reporting their attitudes and experiences on migration.
Two-thirds of the trainees had not had a short-mobility experience in their lifetime, but those that went abroad were satisfied with their experiences, reporting that these influenced their attitude towards migration positively. However, the majority of the trainees had not had a migratory experience of more than 1 year. Flows showed that Switzerland and United Kingdom have the greatest number of immigrant trainees, whereas Germany and Greece have the greatest number of trainees leaving. ‘'Pull factors'’ were mostly academic and personal reasons, whereas ‘'push factors'’ were mainly: academic and financial reasons. Trainees that wanted to leave the country were significantly more dissatisfied with their income.
The majority of the trainees has considered leaving the country they currently lived in, but a lower percentage has taken steps towards migration.
Research is one of the most appealing fields for trainees in psychiatry and is an essential competency within curricula. Skills gained through research impact on clinical care and can be developed throughout the training of young psychiatrists. Since mobility is growing at different levels within psychiatry, giving rise to new challenges while requiring the exchange of visions and know-how, international collaborative research becomes crucial and should be promoted since the training.
To share the experience of joint work and collaborative research done through joining professional associations, such as the European Federation of Psychiatric Trainees (EFPT) that provide opportunities for participating in research activities and establishing networks with others.
The interest for academic background and investigational activities are essential in psychiatry, being therefore crucial to share and promote discussion on the international research projects done in an international meeting point like this.
Assess the research projects done through time by the EFPT research group with special focus on the most recent ones.
Since 2008 the EFPT 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.
The research projects done will be briefly presented, showing that trainees can have the possibility to participate in all the phases of the projects as national coordinators and share with other colleagues their research competencies, having the possibility at times to rely on supervision by internationally renowned experts.
Clozapine-induced sialorrhea (CIS) is a common, treatment-limiting and stigmatizing side effect. All systemic agents that are used for hypersalivation may increase clozapine side effects such as blood pressure changes, constipation, or arrythmias. Oral application of topical anti-muscarinic agents may be a low side effect option for treatment of CIS.
The aim of this case report was to propose an off-label treatment of tropicamide drops to CIS and to stimulate further investigation.
A 33-year-old male inpatient with schizophrenia has been on clozapine 800 mg and amisulpride 600 mg/day. His drooling was occasional and severe as drool drips off his chin during the day and night. Wet area over the pillow, visual analog scale (VAS), the short form of health survey (SF-36), UKU side effect rating scale, scale for the assessment of negative symptoms (SANS), scale for the assessment of positive symptoms (SAPS) were applied at baseline and in one-week intervals. Oral application of one drop of tropicamide % 0.5 (5 mg/mL) to left and one drop to right side before going to bed in the first week and two drops to each side were administered subsequently. Informed consent was given by the patient.
No psychological, neurological, autonomic and other side effects were observed associated with tropicamide. On VAS, the patient rated hypersalivation 5/7 at baseline, 4/7 after one drop each, 3/7 after two drops each.
The reduction of CIS by oral use of tropicamide eye drops is promising and should be explored with randomized controlled trials.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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.
Disruptive mood dysregulation disorder (DMDD) defined by DSM-V is characterized by severe and recurrent temper outbursts and persistently irritable or angry mood.
Our aim is to attract attention to an adult case with DMDD since the literature is lacking adult manifestations.
A 18-year-old boy have been on follow-up in our outpatient clinic since he was 12 with complaints of being increasingly irritable and angry during most of the day. He had temper tantrums six or seven times per week involving verbal rages, physical aggression and throwing things to friends and family members. There had never been a distinct period lasting more than one day during which the full symptom criteria, for a manic, hypomanic or a depressive episode had been met. He was also reported to be hyperactive, impulsive, and had difficulty concentrating and focusing since he was seven. Laboratory evaluations were within normal limits. Results of screening forms provided by parents and teachers supported the presence of attention deficit and hyperactivity disorder (ADHD). ASRS, YMRS, STAXI, SCID-I, Diagnostic Interview for Adult ADHD (DIVA) were the psychometric evaluations carried out in order better to characterize the clinical situation.
He was considered as fulfilling DSM-5 criteria for ADHD and DMDD, and started on sertraline 50 mg/day and OROS methylphenidate 36 mg/day. At the following visits, temper tantrums were much reduced and there were moderate improvement in ADHD symptoms.
By defining the adult manifestations of DMDD accurately, clinicians will be able to improve diagnosis and care.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Workforce migration of mental health professionals seems to have a significant impact on mental health services, both in the donor and host countries. Nevertheless, information on migration in junior doctors within Europe is very limited. Therefore, the European Federation of Psychiatric Trainees (EFPT) has conducted the Brain Drain Survey.
To identify, in junior doctors training in psychiatry, the impact of international short-term mobility experiences, towards a future workforce migration across countries, exploring its patterns and reasons.
In this cross-sectional international study, data were collected from 2281 psychiatric trainees in 33 countries. All participants answered to the EFPT Brain Drain Survey reporting their attitudes and experiences on mobility and migration.
Only one-third of the trainees had a short-mobility experience in their lifetime, being education the main purpose for these experiences. Interestingly, the main predictors for future migratory tendency were not only the having a income and being dissatisfied with this income, but having a short-mobility experience. In fact, people that had short-mobility experiences were two times more likely to express a migratory tendency. Trainees that went abroad were predominantly satisfied with their experiences, reporting that these influenced their attitudes towards migration, positively.
These findings show that short-term mobility has a positive impact into future long-term migration, increasing its probability.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The brain drain of mental health professionals is an important issue especially for developing countries with inadequate recruitment rates. The European Federation of Psychiatric Trainees (EFPT) investigated the extent of migration among trainees across Europe by Brain Drain research project. Results from a non-EU country, with the lowest number of mental health professionals per 100 000 population across OECD countries might provide important clues.
To identify attitudes towards and behaviors towards international migration among psychiatry trainees from Turkey.
An online survey was conducted among psychiatry trainees from Turkey in 2013, as part of the EFPT Brain Drain Research Project.
Of 107 trainees surveyed, 74% considered living abroad. However, the rate of having even short mobility experience was just 13%, and these were mainly educational visits. More than half of those who visited a foreign country reported to have a satisfactory experience, which might explain the positive influence of these visits on attitudes towards migration. Responders perceived academic conditions as the most important aspect of training that needs to be improved, in line with the fact that inadequate training programs were important reasons for migrating.
Overall, psychiatry trainees in Turkey tend to remain in their country of origin, which may protect healthcare system against the detriment of workforce loss. The relatively low rate of migration may also reflect the legislative barriers (e.g. being o non-EU country) impeding migrating. Our findings also suggest that the unmet educational needs of trainees require immediate attention.
Disclosure of interest
The authors have not supplied their declaration of competing interest.