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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.
Beside psychological distress of breast cancer diagnosis and patophysiological characteristics of breast cancer it is also known that different treatments could have influence on mental well-being. The aim of this study was to investigate treatment of depression, anxiety and breast cancer in Slovenian female patients.
In the study were included 314 female patients with breast cancer treated at the Institute of Oncology Ljubljana between September 2004 and July 2005. Only 18 patients were not surgically treated. Majority (80%) of all patients were treated also with chemotherapy. In combination with chemotherapy 43% of all patients received also radiotherapy and 50% received also hormonal therapy. Altogether 72 (22,9%) patients expressed clinically important serious anxiety (Hospital Anxiety and Depression (HAD) score of 11 or more on anxiety subscale), 39 (12,4%) clinically significant serious depression (HAD score of 11 or more on depression subscale) and 51 (16,2%) clinically significant depression and anxiety combined (HAD score of 11 or more on both subscales). Among patients with clinically significant serious anxiety 19 (26,4%) patients were psychiatrically treated before inclusion into study. Among patients with clinically significant serious depression 13 (33,3%) patients were psychiatrically treated before inclusion into study and among patients with clinically significant serious anxiety and depression 24 (47,0%) patients were psychiatrically treated before inclusion into study.
Less then half of patients with breast cancer with comorbid clinically significant expressed serious anxiety and/or depression has been psychiatrically treated before the inclusion in the study.
Antipsychotic medications are registered for the use in psychosis, mania and agitation. the aim of our study was to assess the off-label use of atypical antipsychotics (AA) at the Crisis Intervention Unit (CIU).
Hospital records of 280 patients that were treated at the CIU in year 2007 were included to the observational study. Patients were screened for diagnosis (ICD-10), gender, age, suicidal behaviour and for prescribed psychotropic medications. Off-label use of atypical antipsychotics for diagnoses other than psychosis was evaluated.
Most hospitalised patients suffered for stress related disorders: adjustment disorder F43.2 (34%), acute stress disorder F 43.0 (2%), mixed anxiety-depression disorder F41.2 (19%), depression (24%), anxiety disorders (4%) and other disorders (17%). Patients were treated with antidepressants (92%), benzodiazepines (55%), hypnotics (44%) and mood stabilising drugs (9%) during their stay at the CIU. at discharge from hospital benzodiazepines (31%) and hypnotics (12%) were prescribed in lower percentages. 51% of patients received AA at least once during their stay at the CIU, 49% received AA for off-label use and it was prescribed for most of the hospital stay (for 87% of the time). Average daily CPU at admission to the hospital was 107.52 and at the discharge it was 100.33. No significant differences were noted among the different diagnoses for off-label AA use.
Atypical antipsychotics are widely used for indications other than psychosis, even though the long-term effects of their use are not yet known and safety issues remain to be examined further.
The present study describes the translation process of the Hospital Anxiety and Depression Scale (HADS) into Slovenian language and testing its reliability and validity on psychological morbidity in female cancer patients.
The HADS consists of 14 items to assess anxiety (7 items) and depression (7 items). Each item is rated from 0 to 3. The maximum score on either subscale is 21. Scores of 11 or more on either subscales are considered to be a significant 'case' of psychological morbidity (clinical caseness), while scores of 8-10 represent ‘mood disorder’ (‘borderline’). A score of 7 or below is considered as normal.
The English version of the HADS was translated into Slovene language using the 'forward-backward' procedure. The questionnaire was used in a study of 202 female cancer patients together with a clinical structured interview (CSI) to measure psychological state. A biserial correlation coefficient was calculated.
The mean score of participants rating on the HADS-A was 11,6 (sd 4,49) and on the HADS-D was 9,2 (sd 4,46). The value of biserial correlation coefficient was 0.81 for the depression scale and 0.91 for the anxiety scale.
The validation process of the Slovenian HADS score version shows metric properties similar to those in international studies, suggesting that it measures the same constructs, in the same way, as the original HADS score form. This validation study of the Slovenian version of the HADS proved that it is an acceptable and valid measure of psychological distress among female cancer patients.
Prolongation of myocardial repolarization, i.e. lengthening of the QTc interval on surface electrocardiogram, with increased risk of cardiac arrhythmias, has been recognized as a side effect of many drugs. Most conventional and atypical antipsychotic drugs can cause dose-related prolongation of QTc, although there are important differences in the potency of individual agents. Antipsychotic polipharmacy increases the risk for sever cardiac side effects.
Subjects and methods:
In this prospective clinical investigation, we analyzed ECGs in 46 patients suffering from schizophrenic disorder who were treated with different antipsychotic drugs one week after the admission to the psychiatric hospital. Hearth rate, QT interval and QTc interval were assessed. the average daily dose of prescribed antipsychotic drugs was calculated and transformed to chlorpromazine units.
Average QTc interval in patients undergoing our clinical investigation was 417 msec, only 3 out of 46 (6,5%) patients had QTc over 450 msec and only one patient (2,2%) had QTc over 500 msec.
We found no differences in QTc interval between patients who were treated either with conventional or atypical antipsychotic or with combination of both, and no gender differences for QTc interval were found.
Our results raise the question of the clinical relevance of a single ECG for diagnostics of cardiac complications in schizophrenia patients and suggest the need to conduct ECG monitoring in patients with high risk for cardiac complications during antipsychotic treatment.
Substantial evidence from family, twin, and adoption studies corroborates implication of genetic and environmental factors, as well as their interactions, on suicidal behavior and alcoholism risk. Serotonergic disfunction seems to be involved in the pathophysiology of substance abuse, and has also an important role in suicidal behavior.
Recent studies of the tryptophan hydroxylase 2 (TPH2) showed mild or no association with suicide and alcohol-related suicide.
Investigation of the role of five single nucleotide polymorphisms (SNPs), one functional (p.Arg441His), two in intron 5 (Rs1843809, Rs1386493), and two in the 5’ regulatory promoter region (Rs4131348, Rs11178997) of TPH2, in association with suicide and alcohol-related suicide on a population with one of the highest suicide rates in the world.
We performed qRT-PCR (Real-Time Polymerase Chain Reaction) genotyping analysis of SNPs and alcohol analysis on 388 suicide victims and 227 controls.
The results showed association between suicide (P(X2) = 0.043) and alcohol-related suicide (P(X2) = 0.021) for SNP Rs1843809. A tendency for association was determined also for polymorphism Rs1386493 (P(X2) = 0.055) and alcohol-related suicide. Data acquired from psychological autopsies in a subsample of suicide victims (n = 79) determined more impulsive behavior (P(X2) = 0.016) and verbal aggressive behavior (P(X2) = 0.025) in the subgroup with alcohol misuse or dependency.
Our results suggest implication of polymorphisms in suicide and alcohol-related suicide, but further studies are needed to clarify the interplay among serotonergic system disfunction, suicide, alcohol dependence, impulsivity and the role of TPH2 enzyme.
According to recent knowledge there are probably multiple susceptibility genes involved in patophysiology of schizophrenia and bipolar disorder, each of small effect, which act in conjunction with environmental factors. These genes could influence synaptic plasticity, neurodevelopment and neurotransmission. There are an estimated 4,000 genes involved in the complicated communication between brain cells. However, overlapping of candidate genes between both disorders was reported.
Recent studies revealed that random mutations not inherited from either parent play a role in schizophrenia. The relation between psychopathological events, the phenomenology of the trauma and neurobiological changes related to schizophrenia and bipolar disorder is not totally understood.
The symptoms of schizophrenia are believed to be triggered by stress-induced changes in neurobiological systems representing an inadequate adaptation of neurobiological systems to exposure to stressors. Recent studies suggest that epigenetic mechanisms may play an important role in the interplay between stress exposure and genetic vulnerability also in humans. In preclinical studies it was first suggested that epigenetic mechanisms may be involved in the modulation of gene expression in response to stressful stimuli. Recently, epigenetic differences in a neuron-specific glucocorticoid receptor (NR3C1) promoter between postmortem hippocampus obtained from suicide victims with a history of childhood abuse and those from either suicide victims with no childhood abuse or controls were found, indicating the involvement of these mechanisms in human adaptation to stress. Future research could lead to prenatal screening for both disorders, and for new, more personalized approaches to treating people depending upon their genetic profile.
In retrospective study we characterize the suicidal behavior in 413 patients with stress related disorders as assessed by psychiatrists in Psychiatric Emergency Clinic at University Psychiatric Hospital. These patients were compared with 482 patients with anxiety disorders attending the same institution. We observed that 76 patients (18,4%) with stress related disorders had suicidal thoughts at the time of their evaluation and 21 patients (5.1%) had documented suicide attempts just before the evaluation. In the group of patients with anxiety disorders we observed that 50 patients (10,4%) had suicidal thoughts at the time of their evaluation and only 4 patients (0,8%) had been referred to UPOC after suicide attempt. Difference was significant (p<0.05). The aim of our next study was to evaluate negative life of suicide victims in a month before suicide. On the other hand aggression and impulsivity of suicide victims was evaluated. In the tree-year period 90 suicide victims (28 women and 62 men) in the central region of Slovenia were examined using the method of psychological autopsy. We compared subgroups of suicide victims with or without previous aggressive behaviour. We observed that suicide victims with previous aggressive behaviour have higher number of negative life events in a month before suicide and have expresses higher impulsivity then others. We also observed that suicide victims with previous aggressive behaviour directed toward others have more often previous suicide attempts than suicide victims without previous aggressive behaviour. These data support the hypothesis that suicidal behaviour is also influenced by previous stress events.
The Selective Serotonin Reuptake Inhibitors (SSRIs) act on a serotoninergic system. Serotonin is involved in mood regulation, however it also plays a role in digestion, pain, sleep, mental clarity, and other bodily functions. As a result, the SSRI antidepressants cause a wide range of side effects. It was reported that in some cases, a high serum concentration of citalopram in elderly patients has been associated with increased somnolence and movement difficulties but not with delirium.
We report the case of a 65-years-old depressive man in whom i.v. citalopram in monotherapy induced delirium.
Our patient was admitted to a closed geriatric ward as a psychotically depressed with somatic and depressive delusions and suicidal thoughts. Because he rejected all per os drugs we started only with citalopram i.v. (1 ampoule of citalopram in 500 ml NS) and after 3 days he became delirious and physically aggressive because of what he was restrained. We stopped citalopram. Next day he was alert and oriented, there was no evidence of psychotic symptoms, hallucinations, or delusions. Patient was euthymic. He was not suicidal at the time of evaluation. In few days he became depressed again with depressive and nihilistic delusions. We started with dual-acting antidepressant and atypical antipsychotic what led to remission. Depressive episodes were not observed in four-year follow up.
In this report, we described a patient with acute hyperkinetic delirium associated with a i.v. citalopram what is the first description of this kind of sideects of i.v. citalopram.
In the field of drug abuse treatment, noncompletion and negative outcome is a general problem.
Outcome of hospital treatment of opioid dependence was examined.
The purpose of the present study was examination of a cohort of patients treated at Centre for treatment of drug addiction at the beginning of the treatment, after three and six months.
A group of 113 patients consecutively admitted to a closed detoxification unit between October 2011 and September 2012 were assessed. Positive outcome of the treatment is defined as complete abstinence in the 28 days before review. Baseline data were obtained using The Treatment Outcomes Profile (TOP), The Drug Addiction Treatment Efficacy Scale (DATES), and a semistructured research interview for obtaining information on patient's sociodemographic characteristics. Follow up scores of TOP and DATES have been recorded after three and six months.
Fifty-two patients completed 6 weeks of detoxification program. After 3 months 45 of 84 evaluated subjects (53%) had a positive outcome, 14 patients (12%) abused heroin and 36 patients (32%) abused other drugs. After 6 months 14 of 52 evaluated patients (27%) had a positive outcome and 9 patients (8%) used heroin.
The share of patients with positive outcome peaked at 3 months, however the decreased use of heroin was sustained throughout the observation period.
The most prevalent mental disorders among suicide victims are depressive syndromes. Beside depression, research relates a wide range of psychosocial characteristics and stressors to suicide behaviour. Increasing amount of data about suicidal behaviour indicates that suicide is familial and that familial transmission of suicidal behaviour cannot be explained by the transmission of psychiatric disorder alone. Genetic and epigenetic effects are involved on suicidal behaviour beside environmental factors. Aberrant genes regulating serotoninergic, dopaminergic and noradrenergic systems could increase suicidal risk. Associations between catechol-O-methyltransferase (COMT) and tryptophan hydroxylase 2 (TPH2) polymorphisms, the rate-limiting enzyme for brain serotonin, and completed suicide were observed in suicide victims in populations with high suicide risk. On the other hand, it is also known that brain-derived neurotrophic factor (BDNF) influences a variety of neural processes during the development like neurogenesis, neuronal survival, and maturation of neural development pathways and it seems that BDNF plays a central role in neurobiology of suicidal behaviour and depression. The Met-carrying genotypes and Met allele seems to be connected with increased risk for suicide. The dynamic nature of the epigenetic mechanisms could be involved in the predominant episodic clinical picture of depression. The potential reversibility of epigenetic modifications could be important for management of patients with bipolar disorder offering the opportunity to influence aberrant gene expression by modifying environmental factors with the methods such as psychotherapy.
Different psychosocial factors could serve as a predictor of drug addiction treatment outcome. However the interplay of those factors is still poorly understood and further research is needed. Attempts were made to improve outcomes of addiction treatment by addressing patient characteristics that predict continued drug use.
The purpose of the study was examination of the relationships that exist among hypothesised variables and outcome of hospital treatment of opioid dependence. Positive outcome was defined as abstinence of illicit drugs in the 28 days before review.
A group of 151 patients consecutively admitted to a closed detoxification unit between October 2011 and May 2013 were assessed. Data about age, gender, psychiatric disorders, sexual abuse, criminal activity, drug use after three months and i.v. drug use were collected. A multivariate logistic regression was used.
The results of multivariate logistic regression indicated that negative treatment outcome was associated with age of patients.
Our model showed that older patients had negative outcome more often. The further research is needed to find out if older patients have more drug related problems.
Despite different treatment approaches many drug addicted patients continue to use drugs during and after treatment.
Personality traits are considered risk factors for drug use, and, in turn, the psychoactive substances impact individuals’ traits.
To describe the sample of 186 opioid addicted patients entered hospital treatment and assessing the differences in personality traits between abstinent and non-abstinent after one year.
A cohort of 186 patients consecutively admitted to the detoxification unit was investigated. The research interview, the Big Five Inventory (BFI), the Treatment Outcomes Profile (TOP) were administered during the first week of admission to the detoxification unit. Urine test was administered on the day of admission and at each follow-up point in combination with the TOP (after three, six and twelve months). Illicit drugs abstinence during one year after intake was selected as a treatment outcome measure.
Twelve months after admission 82 (44.9%) patients abstained completely. Agreeable patients remain in treatment longer (r = 0.20, P = 0.07). Extraversion and openness are negatively correlated with abstinence after six and twelve months (r = –0.15, P = 0.041; r = –0.15, P = 0.044). Neuroticism is in negative correlation with duration of treatment (r = –0.20, P = 0.006). Patients who are less open to new experiences are more likely to abstain from drugs 6 months after admission (r = –0.17, P = 0.021).
Personality measured with BFI correlates with treatment outcome poorly. At the same time personality could have an important role in responding to treatment, but personality traits could be at the same time protective as well as risk factors.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
According to the available data, treatment motivation and readiness are closely linked to retention. There are instruments for measuring the stages of motivation and readiness, and predicting treatment retention and outcome.
This study describes psychometric properties, while focusing on the reliability of the Slovenian version of the Circumstances, Motivation and Readiness (CMR) scales.
We included 109 male and female patients with opioid addiction at the Centre for Treatment of Drug Addiction, Ljubljana. The CMR was translated into Slovenian by using the “forward-backward” procedure by our team and its author. Data analysis addressed psychometric properties of the CMR. Internal consistency was examined by applying exploratory and confirmatory factor analysis, while reliability was examined with Cronbach's coefficient alpha.
Cronbach alpha coefficients of reliability were calculated for each of the three CMR subscales and for the total score. The total alpha was 0.842. Alpha for Motivation was 0.860, for Circumstances 0.372 and for Readiness 0.818. Exploratory factor analysis extracted a 3-factor solution with 56% explained total variance. The factors do not provide an exact match with the dimensions C, M and R.
On the basis of these results we can conclude that the Slovenian translation of the CMR is a valid instrument for evaluating patients’ motivation and readiness for treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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