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Numerous researches show significant presence of cardiovascular disorders, especially hypertension in depressed patients that show up several years after first depressive episode.
Mortality caused by cardiovascular disorders in depressed patients is 50% higher than in general population. Comorbid depression and cardiovascular disorders is making worse health condition, increasing suffering, making hard treatment, and outcome is not good.
The goal is to confirm presence of hypertension in depressed patients as the most common comorbid cardiovascular diseases.
A retrospective study has been conducted using data from medical history of 274 depressed patients hospitalized and treated at the Psychiatric Clinic, Clinical Center Banjaluka. These parameters were assessed: sex, age, number of hospitalizations, marital and employer status, comorbid disease, BMI, presence of hypertension, lipid status and glicemia's level. Data were presented using tables and graphs.
Results obtained in our study were:
Hypertension in comorbidity with depression was found in 106 patients (38,5%), 75 of them were males and 31 of them were females. The majority were at age 40-60 years. Obesity was found in 21% of them. High lipid's level was found in 20% of them. 11% of patients had high level of glicemia. More than half of the patients had lower socio-economic status.
Depression is often accompanied by cardiovascular disorders. It is very important to recognize this comorbidity in order to treat it successfully and to make better treatment's outcome.
IDEA project is the outcome of Association for the Improvement of Mental Health programme and coordinated at Institute of Psychiatry, King's College London.
Are to explore experience of people treated in a mental health setting across nations, determine how inpatient experiences can be improved. Experience gained from interviews will be used to propose questionnaire for routine use, develop versions of interview for other services, inform a possible follow-up study.
30 consecutive patients are interviewed on day of discharge in own language. Semi-structured interview covers physical condition in institutions, experiences of treatments like medication, satisfaction with staff, privacy, dignity and whether rights were respected. Responses are summarized on several visual analogue scales and quantitative analysis will be performed. The scale will also be analysed by demographic indices within centres to see whether different groups have different experiences.
Qualitative responses will be analysed thematically, both within and between centres, identifying core themes for each domain and core themes for the protocol as a whole.
10 countries are participating, 577 interviews are completed. It is noticed a large disparity between institutions in regards to the amount of contact patients have with family, access to phone, quality of food, surroundings and view of medication and therapy.
It will be a better understanding of the size, structure and staffing of the institutions included in the study, which will help us with our observations about inpatient experiences by putting them in context and make recommendations to institutions.
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.
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.
Patient G. D. born in 1975, trained as a textile worker, unemployed, married, mother of three children. The current hospitalization was due to suicide attempts and manifestation of depressive symptoms after a stressful event.
Our diagnostic dilemma was whether it concerns:
- depressive disorder with psychotic symptoms
- adjustment disorder in people with personality disorder
After applying diagnostic procedures and observations during individual psychotherapy sessions, as well as the response to a given therapy, psychotic depression is excluded. The stories provided from the patient were in conflict since they have changed in contact with different therapists in the same department, why we decided to consult other professionals from other departments at which the patient apparently was treated.
In this disorder the patient is aware that he is exaggerating and faking illness, but in core of the disease is irresistible urge for pointing attention, and the cause is most likely a lack of love and affection in childhood.
In psychoterapic process was included family therapist also. Family therapist confronted patient with family members, which resulted in a real insight into the mental state and allowed us to confirm a diagnose of histionic personality disorder with tendency to pathological lying- Munchausen syndrome.
In this presentation, we wanted to point out the necessity of cooperation of a psychiatrist with other specialists, considering that patients with this disorder are prone to change therapists, hospitals and faking the results of diagnostic tests.
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.
Although psychoactive substance use disorders (PSUD) belong to the domain of mental health, their management varies greatly among European countries. Furthermore, both the role of psychiatrists and trainees in the treatment of PSUD is not the same for each European country.
Among the context of the European Federation of Psychiatric Trainees (EFPT), the PSUD Working Group has developed a survey that has been spread out between the 15th of august 2015 and 15th of October 2016, at the aim of gathering information about the training in PSUD in Europe, both from Child and Adolescent, and General Adult Psychiatric (CAP and GAP) trainees.
The survey investigated, at European level, the organisation of the PSUD training, trainees satisfaction, attitudes towards people who use psychoactive substances, management of pharmacologic and involvement in common clinical situations.
A 70-items questionnaire regarding the aforementioned objectives was developed, and shared trough an online data-collecting system among European CAP and GAP trainees, with 40 trainees per country filling the survey in at least 25 countries. One national coordinator per country facilitated the delivering of the survey.
A total of 1250 surveys were filled from more than 25 European countries.
Data from the survey will be promptly analysed.
The survey will be the first to explore European psychiatric trainees attitudes and practices about PSUD. Findings from this independent survey may serve in understanding the needs of trainees in the field of substance misuse psychiatry.
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.
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.
Cerebrovascular disease include all disorders in which a part of brain is transiently or persistently damaged by ischemia or bleeding and/or where one or more blood vessels of brain are primarily damaged by pathological processes. The research confirmed the influence of risk factors.
The primary objective was to measure frequency of patients with cerebrovascular diseases in the Emergency Service during the period from September 1, 2008 to March 1, 2009. The secondary objective was to prove co-morbidity between the risk factors and cerebrovascular diseases.
Numerical indicators for patients with cerebrovascular diseases are extracted retrospectively by statistical work-up for the six-month period. The data indicating the risk factors predisposing cerebrovascular diseases are obtained through the (hetero)anamnesis.
From the overall number of 24,600 patients, 127 patients had a diagnosis of cerebrovascular diseases. The frequency of cerebrovascular diseases is linearly increasing with age; after the age of 50, frequency is doubled. The frequency of cerebrovascular diseases is higher in women than in men, the role of heredity is significant, and risk factors influenced development of cerebrovascular diseases as follows: 50.40% of patients had hypertension, 16.54% diabetes mellitus, 48.82% smoking cigarettes, 40.94% obesity, 20.47% alcohol abuse, 11.02% migraine-like headaches, 30.71% cardiovascular diseases and 22.05% hyperlipidemias.
Cerebrovascular diseases are increasing in developing countries. The main reason is poor control of risk factors. In the majority of cases it is possible to produce decrease of frequency of cerebrovascular diseases by elimination and reduction of risk factors through the change of life style. Pre-hospital urgent concept of therapy and improving of organization of emergency service will contribute to decreasing mortality and morbidity of cerebrovascular diseases.
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