Volume 33 - March 2016
PL01
Adversities in childhood and their impact on mental health across thelife course
- S. Pollak
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- 23 March 2020, p. S1
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How is the brain shaped and refined by children's early social and emotionalexperiences? In this colloquium, I will focus on the development of children whohave endured environments marked by toxic levels of stress early in theirdevelopment. These children are known to be at increased risk for a variety ofhealth, academic, and social problems. Some of these problems appearimmediately, but others may not manifest themselves until much later indevelopment. I will highlight ways in which we can address central issues inhuman development by studying the quality and timing of children's socialexperiences. To do so, I will describe recent research involving children whohave experienced child abuse and neglect, children raised in poverty, childrenraised in institutional settings, children who have endured traumatic lifeexperiences, and typically developing children. Through these studies, I willhighlight new insights about the developmental processes underlying children'ssensitivity to their social environments as a way to understand the emergence ofboth adaptive and maladaptive human emotional behavior. Defining and specifyingways in which the environment creates long-term effects on brain and behaviorholds tremendous promise for improving the health and well-being ofchildren.
Disclosure of interestThe author has not supplied his declaration of competing interest.
Original article
Response style and severity and chronicity of depressive disorders in primary health care
- K. Riihimäki, M. Vuorilehto, P. Jylhä, E. Isometsä
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- 23 March 2020, pp. 1-8
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Background
Response styles theory of depression postulates that rumination is a central factor in occurrence, severity and maintaining of depression. High neuroticism has been associated with tendency to ruminate. We investigated associations of response styles and neuroticism with severity and chronicity of depression in a primary care cohort study.
MethodsIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up with a graphic life chart enabling evaluation of the longitudinal course of episodes. Neuroticism was measured with the Eysenck Personality Inventory (EPI-Q). Response styles were investigated at five years using the Response Styles Questionnaire (RSQ-43).
ResultsAt five years, rumination correlated significantly with scores of Hamilton Depression Rating Scale (r = 0.54), Beck Depression Inventory (r = 0.61), Beck Anxiety Inventory (r = 0.50), Beck Hopelessness Scale (r = 0.51) and Neuroticism (r = 0.58). Rumination correlated also with proportion of follow-up time spent depressed (r = 0.38). In multivariate regression, high rumination was significantly predicted by current depressive symptoms and neuroticism, but not by anxiety symptoms or preceding duration of depressive episodes.
ConclusionsAmong primary care patients with depression, rumination correlated with current severity of depressive symptoms, but the association with preceding episode duration remained uncertain. The association between neuroticism and rumination was strong. The findings are consistent with rumination as a state-related phenomenon, which is also strongly intertwined with traits predisposing to depression.
D01
Debate: Can suicide be prevented?
- D. Wasserman
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- 23 March 2020, p. S2
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Suicidal behaviour is the most common life-threatening psychiatric emergency. Reliable and precise tools to predict suicidal behaviours and to get support in the clinical practice are frequently requested.
Several measurement tools for suicide risk assessment, both psychometric and biological have been studied. However, the low precision of the predictions make these tools insufficient from the clinical perspective. To date, the same applies to the search of genetic predictors. The best information is gained in a standard clinical evaluation, which puts focus on the need of acquiring the best possible knowledge and skills by practicing clinicians.
The European Psychiatric Association (EPA) issued a guidance paper on suicide treatment and prevention, which was published in the European Psychiatry in 2012 [1]. This guidance paper elucidates the process of systematic evaluation of suicidal risks in the clinical interview, an overview of the best treatment possibilities and strategies for follow-up. As psychiatric patients constitute the majority of people who commit suicide, the adequate treatment of depression, substance use disorders, schizophrenia and other psychiatric diseases is a must.
We will probably never be able to have perfect measurements to predict if an individual will or will not commit suicide, due to the complexities of human behaviour. However, with a good clinical praxis, suicide is an unnecessary death [2].
Disclosure of interestThe author has not supplied his declaration of competing interest.
Original article
A randomized trial to assess the efficacy of a psychoeducational intervention on caregiver burden in schizophrenia
- M. Martín-Carrasco, P. Fernández-Catalina, A.I. Domínguez-Panchón, M. Gonçalves-Pereira, E. González-Fraile, P. Muñoz-Hermoso, J. Ballesteros, the EDUCA-III group
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- 23 March 2020, pp. 9-17
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Background
Patient's relatives usually care for patients with schizophrenia, and as informal caregivers they experience negative consequences. The aim of the EDUCA-III trial is to test the efficacy of a psychoeducational intervention program (PIP) versus standard care to reduce the caregiver burden at post-intervention (4 months), and at follow-up (8 months).
MethodA two-arm, evaluator blind, multicentre, randomized controlled trial. The PIP group had 12 weekly group sessions. The control intervention group had the usual support and standard care. Primary outcomes were change scores since baseline on the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ).
ResultsOne hundred and nine caregivers were randomized to PIP and 114 to control condition from 23 research sites. The decrease of ZBI scores was significantly higher on the PIP arm at 4 months (mean difference [MD] = −4.33; 95% CI −7.96, −0.71), and at 8 months (MD = −4.46; 95% CI −7.79, −1.13). There were no significant decreases in the IEQ scores (MD at 4 months = −2.80; 95% CI −6.27, 0.67; MD at 8 months = −2.85; 95% CI −6.51, 0.81).
ConclusionsThe PIP condition seems to reduce caregiver burden.
Trial registrationISRCTN32545295.
EF01
21st century psychiatry: The need for a unitary framework
- M. Maj
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- 23 March 2020, p. S3
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While the plurality of approaches is a richness of psychiatry, we need today a unitary framework in which the vast majority of psychiatrists are able to place and recognize themselves. An essential component of this framework should be the awareness that a major outcome of research efforts of the past thirty years is the notion that a simple deterministic etiological model cannot be applied to mental disorders, which instead represent the product of the complex interaction of a multiplicity of vulnerability and protective factors of different nature (biological, intrapsychic, interpersonal, psychosocial). Most current significant etiological research in psychiatry can be accommodated within this framework, thus appearing much less chaotic, inconsistent and fragmentary. This first level of the framework affects in a probabilistic, not a deterministic, way the second one, that of neurobiological, cognitive and psychological intermediate processes. It is unavoidable that different languages be used to describe these processes, but these languages may be translatable into each other to some extent. Furthermore, comprehensive pathogenetic models usually require the integration of different languages. This second level leads, again in a probabilistic way, to the third level, that of symptoms, signs, cognitive dysfunctions and psychopathological dimensions. These are the elements composing the fourth level, the syndromal one. The ICD/DSM formulation of this fourth level is not optimal, but it is the best we have at the moment. Certainly, the fact that two major diagnostic systems exist in psychiatry adds to the confusion and the uncertainty, and should be overcome in the future.
Disclosure of interestThe author has not supplied his declaration of competing interest.
Original article
European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe
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- A. Jobst, E.-L. Brakemeier, A. Buchheim, F. Caspar, P. Cuijpers, K.P. Ebmeier, P. Falkai, Gaag R. Jan van der, W. Gaebel, S. Herpertz, T. Kurimay, L. Sabaß, K. Schnell, E. Schramm, C. Torrent, D. Wasserman, J. Wiersma, F. Padberg
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- 23 March 2020, pp. 18-36
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Purpose
Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.
MethodsWe performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.
ResultsWe developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.
DiscussionThe DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.
ConclusionPatients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
EF02
Outcomes of promotion, prevention, treatment and care
- M. Muijen
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- 23 March 2020, p. S3
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The WHO European Mental Health Action Plan encompasses promotion, prevention, treatment and recovery, within the context of a model of mental health that proposes a set of socio-economic and biological determinants that predispose to vulnerabilities and increase the risk of disorders. These determinants also negatively affect access to and quality of care. Such risk factors are shared with common non-communicable disorders, increasing the risk of morbidity and early mortality for people with mental disorders.
Mental health promotion and prevention actions should therefore be addressing determinants such as alcohol and smoking. However, such determinants are not equally distributed in the population, but cluster among vulnerable groups, such as those with a low income, the unemployed and minority groups. These groups overlap with the populations services struggle to reach. In addition, both primary care and specialist mental health services struggle to identify and treat people with co-morbidities. This suggests that connections need to be established between public health, primary care and specialist mental health services.
WHO is focussing on the strengthening of primary care and the interface with mental health services. In particular, there is an urgent need to screen people who present with symptoms of NCDs or mental disorders for common determinants and co-morbidities. Effective health promotion activities need to be offered to populations at risk, in addition to universal health promotion interventions such as taxation or advertising bans. Some examples will be presented.
Disclosure of interestThe author has not supplied his declaration of competing interest.
Original article
Self-reported symptoms of schizotypal and borderline personality disorder in patients with mood disorders
- I. Baryshnikov, J. Suvisaari, K. Aaltonen, M. Koivisto, P. Näätänen, B. Karpov, T. Melartin, J. Oksanen, K. Suominen, M. Heikkinen, T. Paunio, G. Joffe, E. Isometsä
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- 23 March 2020, pp. 37-44
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Background
Distinguishing between symptoms of schizotypal (SPD) and borderline personality disorders (BPD) is often difficult due to their partial overlap and frequent co-occurrence. We investigated correlations in self-reported symptoms of SPD and BPD in questionnaires at the levels of both total scores and individual items, examining overlapping dimensions.
MethodsTwo questionnaires, the McLean Screening Instrument (MSI) for BPD and the Schizotypal Personality Questionnaire Brief (SPQ-B) for SPD, were filled in by patients with mood disorders (n = 282) from specialized psychiatric care in a study of the Helsinki University Psychiatric Consortium. Correlation coefficients between total scores and individual items of the MSI and SPQ-B were estimated. Multivariate regression analysis (MRA) was conducted to examine the relationships between SPQ-B and MSI.
ResultsThe Spearman's correlation between total scores of the MSI and SPQ-B was strong (rho = 0.616, P < 0.005). Items of MSI reflecting disrupted relatedness and affective dysregulation correlated moderately (rφ varied between 0.2 and 0.4, P < 0.005) with items of SPQ. Items of MSI reflecting behavioural dysregulation correlated only weakly with items of SPQ. In MRA, depressive symptoms, sex and MSI were significant predictors of SPQ-B score, whereas symptoms of anxiety, age and SPQ-B were significant predictors of MSI score.
ConclusionsItems reflecting cognitive-perceptual distortions and affective symptoms of BPD appear to overlap with disorganized and cognitive-perceptual symptoms of SPD. Symptoms of depression may aggravate self-reported features of SPQ-B, and symptoms of anxiety features of MSI. Symptoms of behavioural dysregulation of BPD and interpersonal deficits of SPQ appear to be non-overlapping.
Review
BDNF Val66Met and clinical response to antipsychotic drugs: A systematic review and meta-analysis
- S. Cargnin, A. Massarotti, S. Terrazzino
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- 23 March 2020, pp. 45-53
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Background
The polymorphic brain-derived neurotrophic factor (BDNF) gene has been postulated to be involved in inter-individual variability response to antipsychotic drugs.
PurposeTo perform a qualitative and quantitative synthesis of studies evaluating the influence of BDNF genetic variation on clinical response to antipsychotics.
MethodsThe review protocol was published in the PROSPERO database (Reg. no CRD42015024614). A comprehensive search was performed through PubMed, Web of Knowledge and Cochrane databases up to July 2015. The methodological quality of identified studies was assessed using the MINORS criteria. Publication bias was estimated and potential sources of heterogeneity were investigated via meta-regression, subgroup and sensitivity analyses.
ResultsNine studies including a total of 2461 antipsychotic-treated patients fulfilled inclusion criteria for meta-analysis of BDNF Val66Met. Using the random-effects model, the pooled results showed no significant association with antipsychotic response for the dominant (Met carriers vs Val/Val, OR: 0.93, 95% CI: 0.72–1.19, P = 0.55), codominant (Met/Met vs Val/Val, OR: 0.82, 95% CI: 0.59–1.15, P = 0.25), recessive (Met/Met vs Val carriers, OR: 0.81, 95% CI 0.60–1.10, P = 0.18) or the allelic contrast (Met vs Val, OR: 0.92, 95% CI 0.76–1.10, P = 0.34). Visual inspection of funnel plots and further evaluation with Egger's test did not suggest evidence of publication bias. Despite lack of significant heterogeneity in most comparisons, no evidence of association also emerged in the subgroup and sensitivity analyses conducted.
ConclusionThe present meta-analysis excludes a clinically relevant effect of BDNF Val66Met on antipsychotic drug response per se. Nevertheless, further investigation is still needed to clarify in well-designed, large sample-based studies, the impact of BDNF haplotypes containing the Val66Met polymorphism.
EF03
Human rights and mental health care – Can we find a common ground?
- D. Pūras
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- 23 March 2020, pp. S3-S4
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Future of psychiatry is discussed in the context of modern human rights principles, evidence-based policies and sustainable development goals.
After international community agreed on sustainable development goals to be reached by 2030, there is a good opportunity to address mental health as a priority and to substantially invest in promotion of mental health and emotional well-being.
Psychiatry, as an influential specialty, needs to reconsider its strategy in this context, and to rethink strengths and weaknesses of its role and image.
Protection of dignity and human rights of persons with psychosocial disabilities, in the post-CRPD framework, should become a priority for psychiatry. Common ground for search of a new consensus between different views on non-consensual treatment in psychiatry could be equilibrium within the principles of “first, do no harm”, “right to treatment” and “no hierarchy within human rights”. For mental healthcare practice, this would mean that good intentions to provide evidence-based interventions do not justify the use of force and deprivation of liberty which threatens dignity and universal human rights principles.
Psychiatry, while rethinking future directions, should critically reconsider its current focus on neurobiological paradigm and tradition of using force in the name of medicine and social control. These two paradigms, traditionally perceived as strengths of psychiatry and sources of its power, are now too often misused and increasingly discussed as lacking evidence, ignoring human rights and thus threatening image of psychiatry. Instead, psychiatry could consider accepting post-CRPD challenge as a unique opportunity for change, through strengthening strategic alliance with human rights mechanisms, social sciences, general and community medicine, modern public health approach and users’ perspective.
Disclosure of interestThe author has not supplied his declaration of competing interest.
Original article
Exploratory study of once-daily transcranial direct current stimulation (tDCS) as a treatment for auditory hallucinations in schizophrenia
- F. Fröhlich, T.N. Burrello, J.M. Mellin, A.L. Cordle, C.M. Lustenberger, J.H. Gilmore, L.F. Jarskog
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- 23 March 2020, pp. 54-60
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Background
Auditory hallucinations are resistant to pharmacotherapy in about 25% of adults with schizophrenia. Treatment with noninvasive brain stimulation would provide a welcomed additional tool for the clinical management of auditory hallucinations. A recent study found a significant reduction in auditory hallucinations in people with schizophrenia after five days of twice-daily transcranial direct current stimulation (tDCS) that simultaneously targeted left dorsolateral prefrontal cortex and left temporo-parietal cortex.
HypothesisWe hypothesized that once-daily tDCS with stimulation electrodes over left frontal and temporo-parietal areas reduces auditory hallucinations in patients with schizophrenia.
MethodsWe performed a randomized, double-blind, sham-controlled study that evaluated five days of daily tDCS of the same cortical targets in 26 outpatients with schizophrenia and schizoaffective disorder with auditory hallucinations.
ResultsWe found a significant reduction in auditory hallucinations measured by the Auditory Hallucination Rating Scale (F2,50 = 12.22, P < 0.0001) that was not specific to the treatment group (F2,48 = 0.43, P = 0.65). No significant change of overall schizophrenia symptom severity measured by the Positive and Negative Syndrome Scale was observed.
ConclusionsThe lack of efficacy of tDCS for treatment of auditory hallucinations and the pronounced response in the sham-treated group in this study contrasts with the previous finding and demonstrates the need for further optimization and evaluation of noninvasive brain stimulation strategies. In particular, higher cumulative doses and higher treatment frequencies of tDCS together with strategies to reduce placebo responses should be investigated. Additionally, consideration of more targeted stimulation to engage specific deficits in temporal organization of brain activity in patients with auditory hallucinations may be warranted.
CS01
Making mental health part of the solution for reducing the negative impact of austerity – a perspective from England
- S. Bailey
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- 23 March 2020, p. S5
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This paper will describe four initiatives in England to protect the mental health of the population.
1. Lobbying government – presenting the evidence about how mental health services can reduce the impact of austerity on families and communities.
2. Building psychosocial resilience in schools through well being programmes and through “enabling environments” in the workplace.
3. Delivering sustainability in mental and physical healthcare:
– prevention – don’t get ill in the first place;
– patient empowerment – if unwell patient to self manage where possible;
– lean service design – if healthcare services necessary, these should be efficient and high value;
– low carbon – reducing carbon footprint and waste.
4. Working across medicine – choosing wisely:
– promoting conversations between doctors and patients to choose care that is:
– supported by evidence,
– not duplicative of other tests of procedures already received,
– free from harm,
– truly necessary.
Disclosure of interestThe author has not supplied his declaration of competing interest.
Original article
Utilisation of extended release quetiapine (Seroquel XL™): Results from an observational cohort study in England
- V. Osborne, M. Davies, D. Layton, S.A.W. Shakir
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- 23 March 2020, pp. 61-67
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Background
A post-authorisation safety study was carried out as part of the EU Risk Management Plan to examine the long-term (up to 12 months) use of quetiapine XL as prescribed in general practice in England.
AimTo present a description of the drug utilisation characteristics of quetiapine XL.
MethodsAn observational, population-based cohort design using the technique of Modified Prescription-Event Monitoring (M-PEM). Patients were identified from dispensed prescriptions issued by general practitioners (GPs) for quetiapine XL between September 2008 and February 2013. Questionnaires were sent to GPs 12 months following the 1st prescription for each individual patient, requesting drug utilisation information. Cohort accrual was extended to recruit additional elderly patients (special population of interest). Summary descriptive statistics were calculated.
ResultsThe final M-PEM cohort consisted of 13,276 patients; median age 43 years (IQR: 33, 55) and 59.0% females. Indications for prescribing included bipolar disorder (n = 3820), MDD (n = 2844), schizophrenia (n = 2373) and other (non-licensed) indications (n = 3750). Where specified, 59.3% (7869/13,276) were reported to have used quetiapine IR (immediate release formulation) previously at any time. The median start dose was highest for patients with schizophrenia (300 mg/day [IQR 150, 450]). The final elderly cohort consisted of 3127 patients and 28.5% had indications associated with dementia. The median start dose for elderly patients was highest for patients with schizophrenia or BD (both 100 mg/day [IQR 50, 300]).
ConclusionsThe prevalence of off-label prescribing in terms of indication and high doses was common, as was use in special populations such as the very elderly. Whilst off-label use may be unavoidable in certain situations, GPs may need to re-evaluate prescribing in circumstances where there may be safety concerns. This study demonstrates the ongoing importance of observational studies such as M-PEM to gather real-world clinical data to support the post-marketing benefit:risk management of new medications, or existing medications for which license extensions have been approved.
CS02
Choosing wisely in Germany – adapting an international initiative to a national healthcare agenda
- D. Klemperer
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- 23 March 2020, p. S5
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Overuse and underuse in healthcare is a chronic problem in most healthcare systems. Inspired by the North American Choosing Wisely Initiative, the Association of Scientific Medical Societies in Germany (AWMF), which actually counts 173 member organisations, decided to address the problem. The aim of the German “Gemeinsam klug entscheiden” (deciding together wisely)-initiative is to reduce overuse, underuse and misuse of health interventions in areas where recommendations of clinical practice guidelines (CPG) are not adequately implemented or missing. Starting point are the positive and negative recommendations of the CPGs, which the AWMF-member societies have developed for more than 20 years, following the manual and rules set up by AWMF. To identify and select recommendations methodological criteria have been developed by a working group in a consensus-based process. The development of AWMF-CPGs follows a methodology that aims to ensure the full integration of evidence, an interdisciplinary and interprofessional perspective, the prevention of bias as a consequence of conflicts of interest and full transparency of the development process.
Disclosure of interestThe author has not supplied his declaration of competing interest.
CS03
Choosing wisely – the viewpoint and experiences of the American Psychiatric Association
- J. McIntyre
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- 23 March 2020, p. S5
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Choosing wisely, a program developed by the American Board of Internal Medicine in 2012, is advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments or procedures. Recommendations are chosen that have a strong evidence base. There are now over seventy specialty society partners including the American Psychiatric Association. The program attempts to involve patients in the dialogue and an important partner in the program is consumer reports. In this presentation, information about the origins of the program, its development and the impact it has on the practice of medicine will be reviewed. Also the measures developed and submitted by the American Psychiatric Association will be discussed and potential additional psychiatric measures will be discussed. The strengths and weaknesses of the program will be identified.
Disclosure of interestThe author has not supplied his declaration of competing interest.
CS04
Prioritization in medicine – a special role for mental healthcare?
- T. Meyer
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- 23 March 2020, p. S6
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The international debate on priority setting in health care has been around for more than 30 years now, Denmark, Norway, the US state of Oregon, Sweden, UK and the Netherlands being among their vanguards. From the beginning, the debate has been related to – or was even seen as identical to – the discourse on rationing in health care. Based on these international debates, the presentation will introduce different understandings and characteristics of the priority-setting concept in health care and will argue for a clear distinction between priority setting and rationing. Different ways of implementing priority setting, i.e., by means of guidelines or ethical frameworks, will be introduced to set the frame for the current choosing-wisely initiative. It will be argued that priority setting is important for the organisation of mental health care, as it is for health and social care of different chronic disorders.
Disclosure of interestThe author has not supplied his declaration of competing interest.
CS05
Evidence-based psychosocial measures in rehabilitation
- T. Becker, U. Guehne, S. Riedel-Heller
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- Published online by Cambridge University Press:
- 23 March 2020, p. S6
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Background
Psychosocial interventions are essential tools in mental health care and rehabilitation. A range of interventions relevant to rehabilitation that are covered in a German DGPPN S3 guideline on psychosocial interventions are discussed.
MethodsLiterature search and (mostly) systematic reviews were performed for a range of psychosocial interventions.
FindingsMilieu therapy (MT) includes measures that impinge on therapeutic milieu/atmosphere in joint professional/user groups in the course of treatment. MT provides a context in which psychosocial interventions can be implemented. There is evidence of its effectiveness in improving mental health outcomes. Peer involvement (PI) and peer support are supported by promising evidence as innovative interventions in mental health care. Findings on case management (CM) are inconsistent. There are difficulties in defining CM. CM strengths include treatment satisfaction and continuity of care. With respect to integration in the labour market for people with severe mental illness supported employment (SE) has been shown to be more effective in achieving job placement. A proportion of SE users fail to find jobs on the general labour market. Other types of work rehabilitation are required, and there is room for pre-vocational training interventions.
DiscussionPsychosocial interventions are strong interventions. The strength of the evidence is varied. The use of psychosocial interventions rests on experience, evidence and ethics.
ConclusionsPsychosocial interventions are indispensable in building mental health care systems. Vocational interventions and residential services are mandatory. Peer involvement could help in moving mental health services forward.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
CS06
Quality assessment of mental health rehabilitation services
- H. Killaspy
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- 23 March 2020, p. S6
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Objectives
Providing good quality mental health care is vital to achieve better outcomes but service quality is a complex, multidimensional construct that extends beyond the delivery of specific evidence based treatments and interventions. This makes it difficult to operationalize and measure, particularly at the international level where different socioeconomic and political contexts impact. Mental health rehabilitation services focus on people with severe and complex psychosis. This group are one of the most socially excluded in society and are vulnerable to exploitation and abuse. They are also, be definition, difficult to treat and, historically, have often been institutionalised in hospital or community facilities.
AimsThis presentation will report on the development and application of an internationally validated quality assessment tool for longer term mental health care facilities, the Quality Indicator for Rehabilitative Care (QuIRC).
MethodsThe content of the QuIRC was derived from a systematic literature review, international Delphi exercise and review of care standards in ten European countries. Its psychometric properties were assessed in over 200 longer-term mental health facilities across Europe involving validation with over 1750 service users. It has subsequently been used in a national programme of research into inpatient mental health rehabilitation services in England which will also be briefly described.
ResultsThe QuIRC has excellent inter-rater reliability and validity. Specific aspects of care assessed by the QuIRC have been found to be associated with successful community discharge from inpatient mental health rehabilitation services.
ConclusionsThe QuIRC is a free to use, standardised and validated on-line international quality assessment benchmarking and research tool, available in ten European languages.
Disclosure of interestThe author has not supplied his declaration of competing interest.
CS07
Why mental health in young women is more at risk in the 21st century
- H. Herrman
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- Published online by Cambridge University Press:
- 23 March 2020, p. S7
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The mental health of women and girls is endangered when they experience violence and gender-based discrimination, including poor access to education and lack of autonomy in the family and broader community. The conditions of conflict and poverty that foster violence against women, including systematic sexual violence, are growing across some world regions including parts of Africa and Asia, even while women are becoming more empowered in others. The prevalence of abuse of women at home appears to be high across the regions, and the widespread nature of other forms of violence such as genital mutilation and trafficking is increasingly recognised.
The psychological consequences of violence increase the risk of mental illnesses such as depression and anxiety, including the risk of these conditions in the perinatal period. The services provided for women with mental ill health in primary health care, maternal and child health services, community mental health services or hospital settings do not in many places respond adequately to their needs. The inadequacies in response can reproduce or amplify the difficulties and injustices that women face in their lives, especially maltreatment as girls and intimate partner violence as adults.
The World Psychiatric Association aims to increase awareness of the need for improved mental health of women and girls worldwide, especially in settings of disadvantage, conflict and adversity. It is also aiming to work in partnership with other health and non-health organisations to develop a platform for action to respond to the need – for health promotion, risk reduction and access to prevention and treatment services.
Disclosure of interestThe author has not supplied his declaration of competing interest.
CS08
Early psychosis in young women
- A. Riecher-Rössler
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- Published online by Cambridge University Press:
- 23 March 2020, p. S7
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Introduction
It is well known that young women are at lower risk for schizophrenic psychoses than young men. However, little is known about the peculiarities of emerging psychosis in young women.
ObjectivesTo describe characteristics of emerging psychosis in women.
MethodsWithin the FePsy (Früherkennung von Psychosen = early detection of psychosis) study at the University of Basel Psychiatric Clinics we have examined consecutively all patients with a first episode of psychosis (FEP) or an at-risk mental state (ARMS) referred to us between 2000 and 2015.
ResultsWomen did not significantly differ from men regarding psychopathology, neither in the ARMS nor in the FEP group. This was true for positive as well as negative symptoms and basic symptoms. Interestingly, women had a higher correlation of self-rating with observer-rating regarding psychotic symptoms. Duration of untreated psychosis was significantly lower in women than in men. Women seek help more quickly than men and their first contact is more often their partner.
Regarding neurocognition women showed a slightly better performance in verbal tasks. They also had higher prolactin levels and larger pituitary volumes, even when drug-naive.
Transition to psychosis occurred as often and as quickly in women as in men.
ConclusionsThere are only few gender differences in patients with emerging psychosis, which resemble mainly those found in the general population, with women showing a better help-seeking behavior, being more partner-oriented, having a better verbal performance and potentially also a higher stress reactivity [1].
Disclosure of interestThe author has not supplied his declaration of competing interest.