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Substantial barriers to prenatal mental health screening exist. The primary objective of this randomized controlled trial is to evaluate the acceptability of computer tablet-based prenatal screening compared to paper-based screening. Secondary objectives are to compare the two screening modes on: (1) detection of depression/anxiety symptoms; (2) disclosure of symptoms; (3) factors associated with acceptability, and disclosure; (4) psychometric properties of the e-version of the tools; and (5) cost-effectiveness. Pregnant women were recruited from maternity clinics in an urban Canadian city, and were eligible if they were: 1) able to speak/read English; 2) willing to have a diagnostic interview within 1 week. Allocation was by computer-generated randomization. Women in the intervention group completed screening on a computer tablet and those in the control group completed the same assessment in paper-based form. Intention-to-treat analyses compared groups on primary and secondary outcomes. Multivariable logistic regression will identify predictors of intervention acceptability and disclosure. Preliminary Results – Recruitment was completed on December 8, 2014 (n=587). Mean age of women was 28.7 years (SD 4.7) with 96% partnered and 77% completing at least some post-secondary education. One-third (32.3%) had been treated previously for a mental health problem. Over 90% of women in the intervention and control groups indicated they found/would find computer-based screening acceptable and could fully disclose their concerns. No significant differences in mean depression or anxiety scores were found between groups. Additional results to be generated for presentation Implications Clinical and cost data will inform approaches to routine prenatal mental health screening. [ABSTRACT FROM AUTHOR]

After several decades of Market Faith in Western societies and the most severe financial crash several generations has known, there has not really been a serious re-examination of the role of markets and money in our society. A market economy may be a valuable and effective tool for organizing productive activity. The problem is whether we have become a “market society”. That is, if the economic values have been transplanted to the whole of society – not only economic life – and we have become a monetized society: a society where just about everything is up for sale. That's to say, a way of life where market relations and market incentives and market values come to dominate all aspects of life. Paradoxically, it is possible that the economic crisis has only increased this trend. Administrations at different levels – European, States, Local… – have demanded tremendous sacrifices from the population intended to save the financial system, but on the way sacrificing a Welfare state that took decades to build. In this presentation, we will review the mental health consequences of the current economic crisis. Also it examines how the change in social values and sweeping assertion of economic values can affect the way we think about Mental Health and Psychiatric Care. [ABSTRACT FROM AUTHOR]

The presentation summarizes follow-up of EPA initiative on Guidance on Conflicts of Interests (CoI) results of which were presented at 19th and 20th European Psychiatric Congresses and published in extenso in European Psychiatry (HÖschl and Fialová, 2012). Guidance paper focuses on situations in which primary interest (well-being of patients, independence of medical education, and objectivity of medical research) might be influenced and compromised by secondary interests, such as financial profit, recognition and professional career advancement. CoI might arise in clinical practice, research, and education, and might include not only individuals but also institutions. The main purpose of EPA guidance paper on CoI is to contribute to CoI policy in psychiatry on the European level and therefore to the integrity of the psychiatric profession, to protection of the interests of our patients, and to public trust in our discipline. [ABSTRACT FROM AUTHOR]

Background. When facing a traumatic event, some people may experience positive changes, defined as posttraumatic growth (PTG). Methods. Understanding the possible positive consequences of the pandemic on the individual level is crucial for the development of supportive psychosocial interventions. The present paper aims to: 1) evaluate the levels of PTG in the general population; 2) to identify predictors of each dimension of post-traumatic growth. Results. The majority of the sample (67%, N = 13,889) did not report any significant improvement in any domain of PTG. Participants reported the highest levels of growth in the dimension of "appreciation of life" (2.3 ± 1.4), while the lowest level was found in the "spiritual change" (1.2 ± 1.2). Female participants reported a slightly higher level of PTG in areas of personal strength (p < .002) and appreciation for life (p < .007) compared to male participants, while no significant association was found with age. At the multivariate regression models, weighted for the propensity score, only the initial week of lockdown (between 9-15 April) had a negative impact on the dimension of "relating to others" (B =-.107, 95% CI =-.181 to-.032, p < .005), while over time no other effects were found. The duration of exposure to lockdown measures did not influence the other dimensions of PTG. Conclusions. The assessment of the levels of PTG is of great importance for the development of ad hoc supportive psychosocial interventions. From a public health perspective, the identification of protective factors is crucial for developing ad-hoc tailored interventions and for preventing the development of full-blown mental disorders in large scale. [ABSTRACT FROM AUTHOR]

wThe development of recovery-oriented practice inmental health has brought about a much greater prominence to the place of lived experience workers. Many aspects of indvidualised recovery-oriented care have been taken up in forensic mental health settings. However, the introduction of lived experience workers is arguably significantly more difficult when the dual vulnerabilities of forensic mental health services users are considered (Drennan&Alred, 2012). This paperwill describe a multi-layered approach to the introduction of lived experience roles in a forensic in-patient unit. Roles have developed from being solely ward-based, to service-wide roles that include participation in management and service development, the creation of a Recovery College Forensic Campus, and to co-production and co-delivery of the psychological therapies programme. In addition to 'mapping' these developments in co-production, this paper will also describe the development of the governance structures that have been necessary to support this infrastructure. Lived experience workers require recruitment, vetting, placement, and aftercare, when they engage in the activities available. On-going mental health and risk stability cannot be assumed, and so regular formal and informal psychosocial support is required to ensure that workload pressures do not negatively impact on other service users and staff. The paper will suggest that much more attention needs to be paid to the development of organisational infrastructure to sustain and manage the growth of lived experience roles in forensicmental health settings than is currently in place. [ABSTRACT FROM AUTHOR]

Introduction: Over the past ten years, a large number of New Psychoactive Substances (NPS) have entered the recreational drug scenario. NPS intake has been associated with health-related risks, and especially so for vulnerable populations such as the youngsters. Currently, most knowledge on the NPS health effects is learnt from both a range of users' reports, made available through the psychonauts' web fora, and fromthe few published, related toxicity, clinical observations. Objectives: This paper aims at providing an overview of NPS effects on youngsters'mental health, performing a systematic review of the current related knowledge. Methods: A systematic electronic search including original papers up to August 2019 was carried out by using the Pubmed/Medline database. Results: NPS consumption poses serious health risks, due to both a range of unpredictable clinical pharmacological properties and the typical concomitant use of other psychoactive molecules, which can lead to near misses and fatalities. In comparison with adults, the central nervous system of children/adolescents may be more vulnerable to the activity of these molecules, hence raising even further the levels of health-related concerns. Further research is needed, to provide evidence of both short- and long-term effects of NPS, related health risks, and their addiction potential. Conclusions: NPS constitute a challenging public health issue. Within the current drug scenario, where 'traditional' drugs of abuse are both controlled and easily identified, NPS may be seen as attractive, and especially so for young people. [ABSTRACT FROM AUTHOR]

The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare providers and policymakers to navigate this rapidly evolving field. We provide an overview of the current scientific and implementation status across two major domains of digitalisation: i) digital mental health interventions and ii) digital phenotyping, discuss the potential of each domain to improve the accessibility and outcomes of mental health services, and highlight current challenges faced by researchers, clinicians, and service users. Furthermore, we make several recommendations meant to foster the widespread adoption of evidence-based digital solutions for mental health care in themember states of the EPA. To realise the vision of a digitalised, patient-centred, and data-driven mental health ecosystem, a number of implementation challenges must be considered and addressed, spanning from human, technical, ethical-legal, and economic barriers. The list of priority areas and action points our expert panel has identified could serve as a playbook for this process. [ABSTRACT FROM AUTHOR]

Background. Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD). Methods. The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148). Results. About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines. Conclusions. Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Paranoia querulans is a type of persistent delusional disorder of the persecutory subtype, recognized under ICD-10 and DSM-IV. Being a classically described entity, evidence is lacking from its conceptualization as a nosological entity to diagnosis and treatment. Furthermore, controversy still exists regarding its interplay between the judicial and mental health systems. Objectives: To summarize current evidence and knowledge regarding Paranoia querulans on its conceptualization, ethiopathological explanations, therapeutical management and interface between psychiatry and the law. Methods: A systematic review was undertaken between June and October 2020 in the PubMed, Web of Science and Scopus databases according to PRISMA directive. Key-terms: ((querul* OR vexatious) AND (paranoia OR delusio* OR neuros* OR behavi* OR complai*) OR litig*) AND psychiatry. No language or time restrictions were established. Results: A total of 1648 studies were initially identified (PubMed: 679; WOS: 945; Scopus: 24; other: 0); after duplicates were removed, n=1381 studies remained. After screening title and abstract, 56 studies were included. Their main content was categorized into: 1. Conceptualization (n=26):Neurosis (n=5), psychosis (n=9), behavioral disorder (n=5); no psychiatric diagnosis (n=7). 2. Descriptive psychopathology (n=8) 3. Etiopathogenesis (n=9): Social or personality basis (n=3), culture (n=4), trauma (n=1), cognitive decline (n=1) 4. Management (n=1) 5. Psychiatry and Law: same object, different objectives (n=12) Conclusions: There is controversy regarding the nosological entity of querulousness, frompsychosis to neurosis or behavioral disorders. Someauthors consider this behavior to not be a psychiatric diagnosis. Furthermore, most papers dealtwith a social or nurture-based origin. There is a dearth of information regarding treatment. [ABSTRACT FROM AUTHOR]

Introduction: Family members are involved in the care of children with mental disorders (MD). While parental MD can negatively impact the child's development and mental health, MD in young people (YP) can also precipitate and exacerbateMDamong parents. Family interactions influence the journey of recovery, having the opportunity to both facilitate or impede it. Objectives: To present 2 clinical cases depicting the effect of family interactions on MD and recovery. To carry out a literature review on family focused practice (FFP) framework to determine its effectiveness, barriers and enablers. Methods: The clinical cases reveal delayed and hindered recovery as a result of negative family interactions which need to be addressed using a FFP framework (Figure 1 and 2). A literature search on FFP was carried out using Pubmed, Psychinfo and google scholars. Since the concept of FFP has been used interchangeably with other terms, its theoretical frameworks were used as part of the inclusion criteria when scoping the literature. PRISMA guidelines were followed to screen and identify eligible papers. Conclusions: Implementation of FFP framework has improved both the outcome of children with MD and the entire family. Barriers to this framework are present at an organizational, staff and family level, however implementation of training and policies on FFP can enhance its use to improve outcomes. Conclusions: Implementation of FFP framework has improved both the outcome of children with MD and the entire family. Barriers to this framework are present at an organizational, staff and family level, however implementation of training and policies on FFP can enhance its use to improve outcomes. [ABSTRACT FROM AUTHOR]

Introduction: There is a plenty of literature on providing psychological services for psychiatry inpatients and outpatients. Seeing a psychiatrist for the first time can be stressful. Objectives: This paper will identify challenges in setting up a clinical psychology service for consultees seen in Reception Department with consultative and primary specialized health care. 'Clinical psychology service' is a project in Moscow Research Institute of Psychiatry providing services within the Reception Department setting. A need to address mental ill health issues (getting a diagnosis and treatment plan) within the broader psychosocial needs of consultees has been identified. Methods: Clinical psychology established a brief intervention 'service' for consultees. Issues of establishing trust within this population suggested the need to provide a 'named' male or female psychologist. The psychologist accompanied psychiatric consultants' recommendations to familiarize a consultee of the availability of the service. Evaluation of the service, including uptake, client satisfaction, and outcome, is ongoing using quantitative and qualitative methods. Data is presented on key themes identified in providing psychological services to consultees. Results: Key themes identified included: 1. Service development: establishing trust, ensuring confidentiality, close between consultants working, flexibility, crisis management, safety, establish links with other agencies; 2. Complex psychological and social needs: mental health issues, trauma, substance misuse, domestic and sexual violence. Conclusions: Consultees present with a range of complex psychosocial needs. While this population may have reservations about accessing 'standard' mental health services, a flexible psychology service working in close liaison with psychiatric consultants may be effective in addressing these needs. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of mental health issues amongst domestic and foreign students in Slovakian medical schools and any differences between them is currently unknown. Objectives: The goals of this paper are to determine the prevalence and extent of mental health issues among medical students at Pavol Jozef Šafárik University (UPJŠ) in Kosice, Slovakia and to determine if there is a difference between domestic and foreign students' mental health at UPJŠ. Methods: A combined questionnaire utilizing well-known sources was distributed to UPJŠ medical students to self-assess their levels of anxiety, depression and hedonic capacity (Zung, 1965; Zung, 1971; Snaith et al., 1995). Two-tailed T-tests and regression statistical analyses were applied to determine the significance of the data and any differences. Results: 27% (n=319) and 25% (n=300) responses were collected from domestic and foreign UPJŠ medical students, respectively. 57% of domestic and 74% of foreign students screened positive for either anxiety, depression, or a combination. The 17% increased rate of anxiety and/or depression amongst foreign students when compared to domestic students was statistically significant (P<0.001). The differences between the two groups regarding hedonic tone were not statistically significant. Conclusions: The prevalence of mental health issues amongst domestic and foreign UPJŠ medical students is much higher than the worldwide average. The higher rate of anxiety and depression observed in foreign UPJŠ medical students when compared to domestic students may be due to a reduced social support system as well as studying in a foreign country. These data suggest special support may be necessary for medical students studying abroad. [ABSTRACT FROM AUTHOR]

Introduction: Eating disorders (ED) are characterized by perturbed eating habits or behaviors (APA, 2013). Even if treatments are available, they need to be more adapted to ED (Monthuy-Blanc, 2018). A complementary approach as yoga or mindfulness demonstrated positive effects with ED, such as an augmentation of mindfulness while eating (Rachel, Ivanka, Amanda, & Carlene, 2013), a better body satisfaction (Beccia, Dunlap, Hanes, Courneene, & Zwickey, 2018; Neumark-Sztainer, MacLehose, Watts, Pacanowski, & Eisenberg, 2018) and less preoccupation with food (Carei, Fyfe-Johnson, Breuner, & Brown, 2010). As the effects of yoga and mindfulness vary between the different ED and different uses, it is difficult to generalize the results obtained about the efficacy of yoga or mindfulness with ED. Objectives: A scoping review is actually done to map the evidence about the use (length, intensity, frequency) of yoga and mindfulness among ED and their effects. Methods: The realization of the scoping review is based on the Joanna Briggs Institute Methodological Framework(Peters, Godfrey, McInerney, Baldini Soares, Khalil, & Parker, 2017). Research will be done in the following databases: CINAHL, PsycInfo, PubMed/MEDLINE, Web of Science, EBM Reviews/Cochrane. Different types of papers are going to be included and a content analysis is going to be done among the extracted data. Results: Preliminary results of the scoping review are going to be presented. Conclusions: Among the different treatments used with ED, yoga and mindfulness have demonstrated positive effects. These approaches as part of integrative health are helpful to improve physical and mental health of individuals suffering from ED. [ABSTRACT FROM AUTHOR]

Introduction: The 2019 coronavirus disease (COVID-19) is a global health crisis that originated in China. As an adjacent city to the origin of COVID-19, Hong Kong has been facing different public health challenges raised by the epidemic. Objectives: This paper examined the prevalence of common physical symptoms, psychological symptoms, somatic symptoms, and health anxiety among the Hong Kong youth population. Methods: HKYES is an on-going territory-wide epidemiological study collecting youth mental health data with randomly stratified sampling. Participants aged 15-24 years were to complete a physical symptom checklist, Depression, Anxiety and Stress Scale (DASS-21), Insomnia Severity Index (ISI), Patient Health Questionnaire-15 (PHQ-15), and Short Health Anxiety Inventory (SHAI). Results: A total of 594 participants have completed the survey since April 2020. The three most common physical symptoms were headache (n=106, 17.8%), fever (n=94, 15.8%) and fatigue (n=78, 13.1%). The mean scores of DASS depression, anxiety and stress subscales were 7.98 (SD 8.14), 5.81 (SD 6.32), and 8.83 (SD 7.93) respectively. Among all, 135 (22.8%) participants reported moderate to severe levels of depressive symptoms, 133 (22.4%) reported moderate to severe levels of anxiety symptoms, and 71 (12%) reported moderate to severe levels of stress. There were 40 (6.7%) and 60 (10.1%) participants showing significant levels of insomnia and somatic symptoms, while around one-third of the participants reported a high level of health anxiety. Conclusions: Youth is at risk of severe psychological impact during the coronavirus. Monitoring the mental health trajectory for youth should become routine practice during times of crisis. [ABSTRACT FROM AUTHOR]

Introduction: This paper document mental health of employees working in the customer service, where advisors experimented several stressing conditions due to competitive objective requested by employers. Objectives: Document presence of neuropsychiatric diseases among customer service advisors Methods: Difference in neuropsychiatric diseases for male/female and part-time/full time workers were assessed with unpaired sample t-tests and linear regression Conclusions: The present study alerts on the potential effect of working full time in a call center as a risk factor for neuropsychiatric illnesses. Customer service employees are exposed to a continuous stimulation of their cognitive functions in addition to different stressors which can progressively and silently damage the nervous system. [ABSTRACT FROM AUTHOR]

Introduction: Offering a number of previously inaccessible opportunities to their users, smartphones have become an essential part of people's lives. People spend more and more time with their smartphones (Kola, 2019). Behavioral problems and mental disorders do not prevent use of digital technologies (Abu Rahal et al., 2019). Objectives: The study aims to assess new opportunities and aftereffects that use of modern smartphones bears to people's mental health. Methods: We analyzed the research papers presented on Pubmed database within the previous five years. Results: The positive side of using smartphones lies in high accessibility to the opportunities of e-mental health projects. They offer a wide variety of internet-based interventions - remote diagnosis, online counselling, psychotherapy, prevention programs for different psychological problems and mental disorders. Nevertheless, the issues of standardization and quality of the offered medical assistance, its legal status and technological support still need proper regulation. Besides, not all population groups are ready and able to use e-mental health services equally actively and effectively. The negative effects include the emergence of new psychological problems, such as hallucinatory phenomena (phantom vibration and ringing syndromes), nomophobia, smartphone addiction, Internet gaming addiction, social media addiction, online paraphilia, selfitis, hikikomori, cyberbullying etc. Most of them have relation to a higher level of perceived stress, anxiety and depression. Conclusions: Wide spread of smartphones not only offers their users new opportunities in maintaining their mental health but also bears new risks to them. E-mental health projects need standardization, while ways and duration of using smartphones by children and adolescents need regulation. [ABSTRACT FROM AUTHOR]

The bidirectional relationship between poverty and poor physical and mental health is well-known. All physicians should have sufficient knowledge on poverty as a social determinant and its impact on (mental) health. The knowledge of poverty in physicians is seldom investigated. An online and paper survey was circulated in March/April 2022 in Belgium, to assess physician’s opinions about and attitudes toward patients in poverty. Not only was interest in the subject rather low, but there were also substantial contradictions in the responses. The lack of knowledge about poverty among physicians leads to reduced quality of medical care for this target group. This is an individual medical–ethical and societal problem. We suggest 10 point-action plan for policymakers, educational institutions, and physicians.

The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value. [ABSTRACT FROM AUTHOR]

Introduction Daydreaming is a normal, very common experience in childhood and adulthood. However, a new phenomenon – termed ‘Maladaptive Daydreaming (MD)’ – which takes daydreaming to an extreme form, is currently being investigated. Maladaptive Daydreaming is not listed as an official disorder in the ICD-10 or DSM-5 presently. Objectives To review current literature on MD and explore whether MD could be acknowledged and classified as a real psychiatric disorder. Methods Data gathered via academic papers found through reliable sites, such as, Ovid, PubMed and Cochrane; through articles, videos and online forums to gather patients’ perspectives. Results There is enough information and literature available to create specific criteria to qualify a diagnosis of MD in patients. Possible aetiologies of Maladaptive Daydreaming have been identified. There has also been exploration into treatment options. Conclusions There is sufficient evidence for Maladaptive Daydreaming to be classified as an official disorder. Being included in the ICD-10 and DSM-5 would motivate research, expand identification of this disorder in patients, and advance access to help and support for patients. Disclosure No significant relationships.

Introduction Throughout this period we were confronted with news and information about the Corona virus and its consequences. Which led to the development of a huge sense of fear among people. Although fear has helped to maintain restrictions, it has also had a significant impact on mental health, especially among patients with a psychiatric history. Objectives In this paper I will highlight the consequences of the nocebo effect of the pandemic among people with a psychiatric history. Methods To complete this work I used medical articles, studies, and specialized information on the subject. Results The pandemic’s restrictions have made it difficult for psychiatric patients to be compliant treatment by avoiding regular psychiatric exams.Isolation and fear of infection has led to new decompensations in existing psychiatric pathologies. Conclusions The exacerbations of psychiatric pathology increased both in number and in their intensity, ultimately determined by the increase in the number of hospitalizations in psychiatric emergencies. Disclosure No significant relationships.

Background. While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. Methods. We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style – Staff questionnaire and a set of questions regarding clinicians’ expertise, training, and practice. Results. SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. Conclusions. The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe. [ABSTRACT FROM AUTHOR]

Background. Employment is intrinsic to recovery from mental health conditions, helping people live independently. Systematic reviews indicate supported employment (SE) focused on competitive employment, including individual placement and support (IPS), is effective in helping people with mental health conditions into work. Evidence is limited on cost-effectiveness. We comprehensively reviewed evidence on the economic case for SE/IPS programmes. Methods. We searched PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, IBSS, Business Source Complete, and EconLit for economic and return on investment analyses of SE/IPS programmes for mental health conditions. Traditional vocational rehabilitation, sheltered work, and return to work initiatives after sickness absence of less than 1 year were excluded. Studies were independently screened by two reviewers. We assessed quality using the Consolidate Health Economic Evaluation Reporting Standards checklist. The protocol was preregistered with PROSPERO-CRD42020184359. Results. From 40,015 references, 28 studies examined the economic case for IPS, four IPS augmented by another intervention, and 24 other forms of SE. Studies were very heterogenous, quality was variable. Of 41 studies with quality scores over 50%, 10 reported cost per quality-adjusted life year gained, (8 favourable to SE/IPS), 14 net monetary benefits (12 positive), 5 return on investment (4 positive), and 20 cost per employment outcome (14 favorable, 5 inconclusive, 1 negative). Totally, 24 of these 41 studies had monetary benefits that more than outweighed the additional costs of SE/IPS programmes. Conclusions. There is a strong economic case for the implementation of SE/IPS programmes. The economic case is conservative as evidence on long-term impacts of programmes is limited. [ABSTRACT FROM AUTHOR]

As COVID-19 becomes endemic, identifying vulnerable population groups for severe infection outcomes and defining rapid and effective preventive and therapeutic strategies remains a public health priority. We performed an umbrella review, including comprehensive studies (meta-analyses and systematic reviews) investigating COVID-19 risk for infection, hospitalization, intensive care unit (ICU) admission, and mortality in people with psychiatric disorders, and outlined evidence- and consensus-based recommendations for overcoming potential barriers that psychiatric patients may experience in preventing and managing COVID-19, and defining optimal therapeutic options and current research priorities in psychiatry. We searched Web of Science, PubMed, and Ovid/PsycINFO databases up to 17 January 2022 for the umbrella review. We synthesized evidence, extracting when available pooled odd ratio estimates for the categories “any mental disorder” and “severe mental disorders.” The quality of each study was assessed using the AMSTAR-2 approach and ranking evidence quality. We identified four systematic review/meta-analysis combinations, one meta-analysis, and three systematic reviews, each including up to 28 original studies. Although we rated the quality of studies from moderate to low and the evidence ranged from highly suggestive to non-significant, we found consistent evidence that people with mental illness are at increased risk of COVID-19 infection, hospitalization, and most importantly mortality, but not of ICU admission. The risk and the burden of COVID-19 in people with mental disorders, in particular those with severe mental illness, can no longer be ignored but demands urgent targeted and persistent action. Twenty-two recommendations are proposed to facilitate this process. [ABSTRACT FROM AUTHOR]

Abstract: Background: Subjects with psychoses have significantly increased rates of physical illnesses, but the nature of the relationship remains largely unknown. Material and methods: The present study is part of the European Prediction of Psychosis Study (EPOS). Data were collected from 245 help-seeking individuals from six European centers (age 16–35) who met criteria for ultra-high risk of psychosis criteria. This paper seeks to investigate self-reported physical ill health and its associations with psychiatric symptoms and disorders, risk factors, and onset of psychosis during 48 months of follow-up. Results: In multivariate analysis, lifetime panic disorder (OR=2.43, 95%CI: 1.03–5.73), known complications during pregnancy and delivery (OR=2.81, 95%CI: 1.10–7.15), female gender (OR=2.88, 95%CI: 1.16–7.17), family history of psychosis (OR=3.08, 95%CI: 1.18–8.07), and having a relationship (OR=3.44, 95%CI: 1.33–8.94) were significantly associated with self-reported physician-diagnosed illness. In the Cox proportional hazard model we found no significant differences between those who had undergone a transition to psychosis and those who had not. Conclusions: The physical health of patients defined to be at ultra-high risk of psychosis seems to be commonly impaired and associated with female gender, marital status, complications during pregnancy and birth, lifetime panic disorder, and genetic risk of psychosis. [Copyright &y& Elsevier]

Abstract: Health care and health care systems should be seen and understood in their socio-cultural context. Modern urbanized societies are likely to exhibit health care pluralism, and different therapeutic approaches are available side-by-side. The various models may take their origin in different cultural traditions, but in most societies one type of care is at a given time considered “above” the others. However health care activities in all societies show a degree of interrelation, reflecting societal changes in which normative practices, value systems and structures change over time. In the current Western health systems evidence-based biomedical care is the prevailing system taught to all professionals. The present paper outlines the prevailing health paradigms, and the advantages and shortcomings of the various approaches and their relation to modern care will be discussed. With increased multicultural backgrounds of patients there is a need for mental health professionals to recognize the existence of traditional approaches and be aware of the parallel systems of care. Competent treatment of such patients requires that mental health professionals are aware of this and exhibit a willingness and ability to bridge between the more traditional and the Western approaches to treatment. The delineations and various aspects of the concept cultural competence and its dimensions will be discussed from a clinical perspective. Comparative studies of the various Western and the traditional approaches respectively will be reviewed. [Copyright &y& Elsevier]

Abstract: Little information is available on the use of brief psychotherapy among subjects with generalised anxiety disorder (GAD) within community mental health services. This study compared results among subjects treated with brief Adlerian psychodynamic psychotherapy (B-APP), those treated with medication (MED), or those who experienced combined treatment (COM). Symptomatology and occupational functioning were assessed using the Hamilton Anxiety and Depression scales (HAM-A; HAM-D), Clinical Global Impression (CGI), and Social and Occupational Functioning Assessment Scale (SOFAS) at intake (T1) and at 3, 6, and 12months later (T3, T6, T12). The study sample included 87 patients with GAD (B-APP 34; MED 33; COM 20), and an ANOVA was applied for analysing repeated measures while controlling for personality disorder. After 6months, CGI, HAM-A, HAM-D, and SOFAS scores significantly improved independently from the type of treatment. Subjects with personality disorders treated with B-APP exhibited superior results to those treated using other methods only in SOFAS scores at T6. These results were generally maintained at T12. Remission rates among subjects (HAM-A scores <7) varied between 55% (MED) and 74% (B-APP) at T6 and between 63% (MED) and 78% (COM) at T12; no significant differences appeared between the three treatment groups. A logistic regression model predicted anxiety remission only by CGI at T1. This paper discusses these results in relation to the use of brief psychotherapy within community mental health services. [Copyright &y& Elsevier]

Introduction: The built environment influences physical and mental health, well-being and quality of life. For older adult living in institutional settings, the main mental health problems are: neurocognitive disorders, delirium, depression, anxiety and sleep disorders. Objectives: The present research aims to demonstrate the importance of the architecture of the nursing homes, reffering to both the principles of interior design and of the outdoor spaces, on the mental health of senior residents. Methods: The paper investigates interdisciplinarly from the point of view of two professionals, a physician, (geriatrics-gerontology and psychiatry) and an architect, three seniors centers: Ellesmere Nursing Home (2007, UK), Alcacer do Sal Nursing Home (2010, Portugal) and Dublin Respite Center (Ireland, 2007). Case studies are used. Results: The 3 seniors centers propose different architectures starting from the elderly user. Two of them have a height of GF+2 and one center only GF, all three using low rise. The functional scheme is clear in all 3 examples but the architectural instruments are used differently. Proper use of color for 2 examples are noted, while for one stands out negatively absence of color (white), giving the impression of hospital, although the center has certain architectural qualities. All the 3 centers have landscaped gardens, we notice the therapeutical features. Conclusions: The built environment can encompass healing capabilities and increase the therapeutic effect of medication and psychological intervention. A built environment based on age-friendly principles positively influences the mental health of seniors. [ABSTRACT FROM AUTHOR]

Abstract: Objective. – The review aims to identify the extent and nature of research on mental disorders and their care in immigrant populations in three major European countries with high levels of immigration, i.e. Germany, Italy, United Kingdom (UK). Method. – Peer-reviewed publications on the subject from the three countries between 1996 and 2004 were analyzed. The research questions addressed, the methods used, and the results obtained were assessed. Results. – Thirteen papers reporting empirical studies were found from Germany, four from Italy and 95 from the UK. Studies addressed a range of research questions and most frequently assessed rates of service utilization in different immigrant groups. The most consistent finding is a higher rate of hospital admissions for Afro-Caribbean patients in the UK. Many studies had serious methodological shortcomings with low sample sizes and unspecified inclusion criteria. Discussion. – Despite large scale immigration in each of the three studied countries, the numbers of relevant research publications vary greatly with a relatively high level of empirical research in the UK. Possible reasons for this are a generally stronger culture of mental health service research and a higher number of researchers who are themselves from immigrant backgrounds in the UK. Conclusion. – Overall the evidence base to guide the development of mental health services for immigrant populations appears limited. Future research requires appropriate funding, should be of sufficient methodological quality and may benefit from collaboration across Europe. [Copyright &y& Elsevier]

Abstract: Systematic reviews in mental health have become useful tools for health professionals in view of the massive amount and heterogeneous nature of biomedical information available today. In order to determine the risk of bias in the studies evaluated and to avoid bias in generalizing conclusions from the reviews it is therefore important to use a very strict methodology in systematic reviews. One bias which may affect the generalization of results is publication bias, which is determined by the nature and direction of the study results. To control or minimize this type of bias, the authors of systematic reviews undertake comprehensive searches of medical databases and expand on the findings, often undertaking searches of grey literature (material which is not formally published). This paper attempts to show the consequences (and risk) of generalizing the implications of grey literature in the control of publication bias, as was proposed in a recent systematic work. By repeating the analyses for the same outcome from three different systematic reviews that included both published and grey literature our results showed that confusion between grey literature and publication bias may affect the results of a concrete meta-analysis. [Copyright &y& Elsevier]

This paper presents data obtained in a one-day census investigation in five European countries (Austria, Hungary, Romania, Slovakia, Slovenia). The census forms were filled in for 4191 psychiatric inpatients. Concerning legal status, 11.2% were hospitalised against their will (committed) and 21.4% were treated in a ward with locked doors. There was only a small correlation between commitment and treatment in a locked ward. More frequent than treatment of committed patients in locked wards was treatment of committed patients in open wards (Austria, Hungary) and treatment of voluntary patients in closed wards (Slovakia, Slovenia). Concerning employment, 27.7% of patients aged 18–60 held a job before admission. The vast majority of patients (84.8%) had a length of stay of less than 3 months. A comparison of these data with the results of a study performed in 1996 and using the same method shows a decrease of rates of long-stay patients. In 1996 the rates of employment were significantly higher in Romania (39.3%) and Slovakia (42.5%) compared to Austria (30.7%). These differences disappeared in 1999 due to decreasing rates of employment in Romania and Slovakia. The numbers of mental health personnel varies between types of institution (university or non-university) and countries, being highest in Austria and lowest in Romania. A considerable increase in the numbers of staff was found in Slovakia. [Copyright &y& Elsevier]

Introduction The 2019 coronavirus disease (COVID-19) is a global health crisis that originated in China. As an adjacent city to the origin of COVID-19, Hong Kong has been facing different public health challenges raised by the epidemic. Objectives This paper examined the prevalence of common physical symptoms, psychological symptoms, somatic symptoms, and health anxiety among the Hong Kong youth population. Methods HKYES is an on-going territory-wide epidemiological study collecting youth mental health data with randomly stratified sampling. Participants aged 15-24 years were to complete a physical symptom checklist, Depression, Anxiety and Stress Scale (DASS-21), Insomnia Severity Index (ISI), Patient Health Questionnaire-15 (PHQ-15), and Short Health Anxiety Inventory (SHAI). Results A total of 594 participants have completed the survey since April 2020. The three most common physical symptoms were headache (n=106, 17.8%), fever (n=94, 15.8%) and fatigue (n=78, 13.1%). The mean scores of DASS depression, anxiety and stress subscales were 7.98 (SD 8.14), 5.81 (SD 6.32), and 8.83 (SD 7.93) respectively. Among all, 135 (22.8%) participants reported moderate to severe levels of depressive symptoms, 133 (22.4%) reported moderate to severe levels of anxiety symptoms, and 71 (12%) reported moderate to severe levels of stress. There were 40 (6.7%) and 60 (10.1%) participants showing significant levels of insomnia and somatic symptoms, while around one-third of the participants reported a high level of health anxiety. Conclusions Youth is at risk of severe psychological impact during the coronavirus. Monitoring the mental health trajectory for youth should become routine practice during times of crisis.

Introduction The prevalence of mental health issues amongst domestic and foreign students in Slovakian medical schools and any differences between them is currently unknown. Objectives The goals of this paper are to determine the prevalence and extent of mental health issues among medical students at Pavol Jozef Šafárik University (UPJŠ) in Kosice, Slovakia and to determine if there is a difference between domestic and foreign students’ mental health at UPJŠ. Methods A combined questionnaire utilizing well-known sources was distributed to UPJŠ medical students to self-assess their levels of anxiety, depression and hedonic capacity (Zung, 1965; Zung, 1971; Snaith et al., 1995). Two-tailed T-tests and regression statistical analyses were applied to determine the significance of the data and any differences. Results 27% (n=319) and 25% (n=300) responses were collected from domestic and foreign UPJŠ medical students, respectively. 57% of domestic and 74% of foreign students screened positive for either anxiety, depression, or a combination. The 17% increased rate of anxiety and/or depression amongst foreign students when compared to domestic students was statistically significant (P

Abstract Background When facing a traumatic event, some people may experience positive changes, defined as posttraumatic growth (PTG). Methods Understanding the possible positive consequences of the pandemic on the individual level is crucial for the development of supportive psychosocial interventions. The present paper aims to: 1) evaluate the levels of PTG in the general population; 2) to identify predictors of each dimension of post-traumatic growth. Results The majority of the sample (67%, N = 13,889) did not report any significant improvement in any domain of PTG. Participants reported the highest levels of growth in the dimension of “appreciation of life” (2.3 ± 1.4), while the lowest level was found in the “spiritual change” (1.2 ± 1.2). Female participants reported a slightly higher level of PTG in areas of personal strength (p

The concept of "race" and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be "the others," who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs aswell as freedoms. Thus, creation of "the other" on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of "race" is genetically incorrect. Therefore, the implicit racism that underlies many established "scientific" paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out. [ABSTRACT FROM AUTHOR]

Background. Paternal childcare is reported to benefit maternal mental health, but specific childcare behaviors have not been comprehensively determined. This study sought to identify paternal childcare behaviors associated with maternal mental health by adjusting for other covariates associated with maternal mental health and examining childcare behaviors. Methods. This study investigated whether seven types of paternal childcare behaviors at 6 months after delivery were associated with maternal psychological distress at 1 year after delivery, which was assessed using the Kessler Psychological Distress Scale (K6). After exclusions from a dataset of 103,062 pregnancies obtained in the Japan Environment and Children's Study, we evaluated data from 75,607 mothers. Results. More than 70% of fathers were always or sometimes involved in "playing at home," "playing outdoors," "changing diapers," and "bathing," 60%-70% in "helping with feeding" and "dressing," and 45.9% in "putting the child to bed." All paternal childcare behaviors showed some beneficial association with less maternal psychological distress, both moderate (K6 score 5-12) and severe (K6 score = 13) distress. Playing at home was the most beneficial association identified (adjusted odds ratio [aOR] 0.66, 95% confidence interval [CI] 0.56-0.76 for moderate psychological distress; aOR 0.36, 95% CI 0.28-0.48 for severe psychological distress). Conclusions. These seven types of paternal childcare behaviors may help lessen maternal psychological distress. Emphasis should be given to building education systems and working environments that promote paternal childcare. [ABSTRACT FROM AUTHOR]

Background. Public health measures to curb SARS-CoV-2 transmission rates may have negative psychosocial consequences in youth. Digital interventions may help to mitigate these effects. We investigated the associations between social isolation, COVID-19-related cognitive preoccupation, worries, and anxiety, objective social risk indicators, and psychological distress, as well as use of, and attitude toward, mobile health (mHealth) interventions in youth. Methods. Data were collected as part of the "Mental Health And Innovation During COVID-19 Survey"--a cross-sectional panel study including a representative sample of individuals aged 16-25 years (N = 666; Mage = 21.3; assessment period: May 5, 2020 to May 16, 2020). Results. Overall, 38% of youth met criteria for moderate or severe psychological distress. Social isolation worries and anxiety, and objective risk indicators were associated with psychological distress, with evidence of dose-response relationships for some of these associations. For instance, psychological distress was progressively more likely to occur as levels of social isolation increased (reporting "never" as reference group: "occasionally": adjusted odds ratio [aOR] 9.1, 95% confidence interval [CI] 4.3-19.1, p < 0.001; "often": aOR 22.2, CI 9.8-50.2, p < 0.001; "very often": aOR 42.3, CI 14.1-126.8, p < 0.001). There was evidence that psychological distress, worries, and anxiety were associated with a positive attitude toward using mHealth interventions, whereas psychological distress, worries, and anxiety were associated with actual use. Conclusions. Public healthmeasures during pandemicsmay be associated with poor mental health outcomes in youth. Evidence-based digital interventions may help mitigate the negative psychosocial impact without risk of viral infection given there is an objective need and subjective demand. [ABSTRACT FROM AUTHOR]

Background. The top biomedical research institutions have traditionally been assumed to provide better medical treatment for their patients. However, this may not necessarily be the case. Low-to-moderate negative associations between research activity and the quality-of-care provided by clinical departments have been described. We aimed to examine this relationship in the psychiatric units of the largest hospitals in Spain. Methods. Scientific publications for 50 hospitals were retrieved from the Web of Science (2006-2015), and quality of mental healthcare data were gathered from Spanish National Health System records (2008-2014). Spearman-rank correlation analyses (adjusting for number of beds and population) were used to examine the associations between research data and quality-ofcare outcomes in psychiatry. Stepwise regression models were built in order to determine the predictive value of research productivity for healthcare outcomes. Results. We found a positive association between research activity indicators (i.e., number of publications, number of citations, cumulative impact factor, and institutional H-index) and better quality-of-care outcomes in psychiatry (i.e., number of readmissions, transfers, and discharges from hospital). In particular, a higher research activity predicted a lower level of readmissions for individuals with psychoses (p = 0.025; R = 0.317), explaining 8.2% of the variance when other factors were accounted for. Conclusions. Higher research activity is associated with better quality of mental healthcare in psychiatry. Our results can inform decision-making in clinical and research management settings in order to determine the most appropriate quality measures of the impact of research on the prognosis of individuals with psychiatric conditions. [ABSTRACT FROM AUTHOR]

Introduction: Mental health stigma is a complex and universal phenomenon, influenced by both sociocultural and personal determinants. In recent years the interest in this field has increased and several studies suggest its importance in the evolution of patients suffering of psychiatric disorders. Objectives: The aim of this paper is to review the idea of stigma associated with mental illness. On this matter, we expose the main characteristics and results of two European Programmes created to fight against mental health discrimination. Methods: Literature review focused on the origins, characteristics, current manifestations, causes and consequences of stigma, as well as on main strategies accomplished for its reduction. Results: Stigma has an adverse impact in the access and adherence to mental health programmes. Likewise, several studies highlight the discrimination suffered by psychiatric patients in other areas (lower quality of medical care, legal injustices, limited access to quality jobs and decent housing...). Over the last decade, different anti-stigma projects have been articulated around three strategic approaches: protest, education and social contact. Conclusions: The fight against stigma must be based on a multidisciplinary approach, ensuring long-term interventions not only focused on the health services but also opened to all the community. Although research is limited and further studies are needed, several results do mention the utility of mental health anti-stigma programmes carried out so far. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences are still commonly found in a high number of children and adolescents. The risk for developing mental health disorders such as (complex) posttraumatic stress disorder (PTSD), depression or others is especially increased in survivors of interpersonal traumatic experiences. Recent years have seen an increased understanding of underlying neurobiologicalmechanisms, especially those involved in the central stress response, epigenetic changes as well as alterations in the immune response. Therefore, findings from mental and somatic health concerning and increased risk for the development of chronic disorders are being bridged through a joint understanding. There is a growing body of literature suggesting that the risk for several somatic disorders is increased in survivors of adverse childhood experiences. The presentation will focus on connections between adverse experiences, neurobiology, mental-, as well as somatic health. [ABSTRACT FROM AUTHOR]

Background. The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented traumatic event influencing the healthcare, economic, and social welfare systems worldwide. In order to slow the infection rates, lockdown has been implemented almost everywhere. Italy, one of the countries most severely affected, entered the "lockdown" on March 8, 2020. Methods. The COvid Mental hEalth Trial (COMET) network includes 10 Italian university sites and the National Institute of Health. The whole study has three different phases. The first phase includes an online survey conducted between March and May 2020 in the Italian population. Recruitment took place through email invitation letters, social media, mailing lists of universities, national medical associations, and associations of stakeholders (e.g., associations of users/carers). In order to evaluate the impact of lockdown on depressive, anxiety and stress symptoms, multivariate linear regression models were performed, weighted for the propensity score. Results. The final sample consisted of 20,720 participants. Among them, 12.4% of respondents (N= 2,555) reported severe or extremely severe levels of depressive symptoms, 17.6% (N= 3,627) of anxiety symptoms and 41.6% (N = 8,619) reported to feel at least moderately stressed by the situation at the DASS-21. According to the multivariate regression models, the depressive, anxiety and stress symptoms significantly worsened from the week April 9-15 to the week April 30 to May 4 (p < 0.0001). Moreover, female respondents and people with pre-existing mental health problems were at higher risk of developing severe depression and anxiety symptoms (p < 0.0001). Conclusions. Although physical isolation and lockdown represent essential public health measures for containing the spread of the COVID-19 pandemic, they are a serious threat for mental health and well-being of the general population. As an integral part of COVID-19 response, mental health needs should be addressed. [ABSTRACT FROM AUTHOR]

Background. The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services. Methods. We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases. Results. We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare. Conclusions. Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models. [ABSTRACT FROM AUTHOR]

Background. This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD). Methods. A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk. Results. TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38-2.95) together with high depressive symptom severity (OR: 1.29; CI95%: 1.01-1.65) were associated with TRD risk. Conclusions. Our findings align with neuroprogression models of depression, in which more severe patients, defined by greater verbal memory impairment and depressive symptoms, develop a more resistant profile as a result of increasingly detrimental neuronal changes. Moreover, our results support a more comprehensive approach in the evaluation and treatment of DTD in order to improve illness course. Longitudinal studies are warranted to confirm the predictive value of verbal memory and depression severity in the development of TRD. [ABSTRACT FROM AUTHOR]

Background. The aim of the present study was to estimate prevalence rates of psychiatric and substance use disorders in male and female prisoners on admission to prison in the north of France and compare the frequency of these disorders to the general population. Methods. This cross-sectional survey on Mental Health in the Prison Population (MHPP), conducted between March 2014 and April 2017, interviewed 653 randomly selected men and women who had recently been committed to the French general population prison system in the Nord and Pas-de-Calais departments. For each subject, the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric interview, was used to screen for psychiatric and substance use disorders. The prevalence rates were then compared with data from the Mental Health in the General Population (MHGP) survey, a general population survey that used the same assessment methodology as MHPP in the Nord and Pas-de-Calais departments. A control sample was taken from the MHGP survey with a ratio of one case (MHPP) to three controls (MHGP) matching on age and sex. Results. The sample was primarily composed of French men, most of them single with low educational levels at the time of imprisonment. The mean age was 31.7 (standard deviation = 9.9; min = 18; max = 67). Most of the subjects included were first-time prisoners. The prevalence of affective disorders among newly incarcerated individuals was 31.2% with higher rates for major depressive disorder (27.2%). The prevalence of anxiety disorders was 44.4% with higher rates for generalized anxiety disorder (25.2%). The prevalence of psychotic syndromes was 6.9%. The prevalence of substance use disorders was 53.5% and a suicide risk was identified in 31.4% of the prisoners interviewed. Higher prevalence rates were found in the MHPP when compared with the MHGP for all psychiatric and substance use disorders assessed except for dysthymia and current isolated psychotic syndrome. Conclusions. Our study shows very high levels of prevalence for psychiatric and substance use disorders in recently committed French prisoners. [ABSTRACT FROM AUTHOR]

Background. Schizophrenia is a leading cause of disability. People living with schizophrenia (PLWS) present unemployment, social isolation, excess mortality and morbidity, and poor quality of life. Early recognition and appropriate treatment reduce the risk of chronicity and comorbidity. Personalization and integration of pharmacological and psychosocial interventions, as well as accurate identification and management of psychiatric and somatic comorbidities, can significantly improve mental and physical health of PLWS, promoting recovery. Methods. A three-step Delphi approach was used to explore consensus on the essential components of early recognition and intervention, personalization, and integration of care to improve schizophrenia outcome, and on barriers and challenges to close treatment gaps. The consensus involved 8 Italian experts of schizophrenia, 100 psychiatrists from academic and nonacademic settings, including representatives of Italian Society of Psychiatry, and 65 trainees in psychiatry. Results. A strong consensus (from mostly agree to totally agree) emerged on the importance of early diagnosis (97%), standardized assessments (91%), correct management of somatic and psychiatric comorbidities (99%), and personalization and integration of care (94%). Lack of time, human resources, and training were identified as the main barriers and challenges to the translation of knowledge into clinical practice. Conclusions. The results of this Delphi study demonstrated a strong consensus on main components of schizophrenia care, as well as on unmet needs to promote best practice and gaps between knowledge and clinical practice. The involvement of a large group of professionals and trainees in this in-depth consensus process might contribute to raise awareness and stimulate innovative strategies to improve the outcome of PLWS. [ABSTRACT FROM AUTHOR]

The paper describes a conceptual model that illuminates why existential issues are an essential element of history taking and need to be addressed in clinical practice. There are four layers in the encounter with the patient: (1) the analysis of the clinical syndrome; (2) the investigation of the way the patient relates to her condition; (3) analysis of the way the psychiatric condition affects this latter relation (example: demoralization as depressive symptom affects the way the patient relates to her depression); and (4) investigation of the way the personality of the patient affects her relation to the clinical condition. Existential factors play a role in layer (4) and maybe crucial not only for understanding the patient but also for compliance and effectiveness of interventions. The paper will relate to other attempts to an integral view on patient care and will describe efforts to implement this view in clinical practice and residency training. [Copyright &y& Elsevier]

Objectives: We conducted a systematic review in order to identify the long term employment outcomes of people with Bipolar Disorder. Our aims were to identify the proportions working over time, the nature of employment status change over time and whether employment rates after a single episode are different to rates in recurrent Bipolar Disorder. Methods: We searched Medline, PsychInfo and Web of Science databases and used a predetermined decision tree to select papers for full text usage. Results: Out of 1410 abstracts retrieved, a total of 119 papers were selected for full text retrieval and 19 papers identified which met the full criteria for inclusion and data extraction. An assessment framework to assess the quality of papers was used to aid the analysis. There were few high quality studies. Most studies with samples of people with established Bipolar Disorder suggest that over a period of 5–15 years of follow-up, approximately 40–60% of people were in employment. However Bipolar Disorder appears to lead to underperformance whilst in employment and 40–50% of people may suffer a slide of their occupational status over time. Those with a first episode of Bipolar Disorder had a higher rate of employment than those with multiple episodes. Conclusions: Bipolar disorders damage employment prospects for sufferers in the short and longer term, but up to around 60% of people may be able to recover to the extent that they are in paid work. Maximal damage to employment functioning may occur in the early phases of Bipolar Disorder. [ABSTRACT FROM AUTHOR]

Introduction: Children and adolescents experience significant emotional disorders and the prevalence of these conditions is notable. In 1999, the U.S. Surgeon General''s report on children''s mental health listed the following prevalence data: Anxiety disorders 13.0%; Mood disorders 6.2%; Disruptive disorders 10.3%; Substance use disorders 2%; Any Disorder: 20.9%* (*Children age 9–17 with mental or addictive disorders, combined MECA sample, 6-month prevalence.) However, there is an acknowledged dearth of pediatric mental health care professionals in the U.S. and among those professionals available, geographic and reimbursement limitations restrict access to the care available for many children and adolescents. Objectives: Primary health care providers are being encouraged to provide some of the identification and care management to offset this access problem. Aims: Expand clinical skills of providers, develop tools for planning at state and local level, educate public about importance of early screening and diagnosis. Methods: In 2005, the American Academy of Pediatrics convened a Task Force of members and consultants to develop recommendations and paradigms for melding physical health care and mental/behavioral care in the primary practice medical home for children and adolescents. Results: This project concluded in 2010 with six published papers and appendices detailing increased identification of pediatric mental health conditions, methods for primary care providers working collaboratively with families and mental health specialists, algorithms for decisions and actions, and payment mechanisms supporting parity between mental and physical care in the US third party payer system. Conclusions: Paper presents the major recommendations and outcomes from this 5 year project. [Copyright &y& Elsevier]