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Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self- reported problems and 18.6% were rated to be 'markedly ill', 'severely ill' or 'among the most extremely ill' by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared.

Background Profound clinical, conceptual and ideological differences between child and adult mental health service models contribute to transition-related discontinuity of care. Many of these may be related to psychiatry training. Methods A systematic review on General Adult Psychiatry (GAP) and Child and Adult Psychiatry (CAP) training in Europe, with a particular focus on transition as a theme in GAP and CAP training. Results Thirty-four full-papers, six abstracts and seven additional full text documents were identified. Important variations between countries were found across several domains including assessment of trainees, clinical and educational supervision, psychotherapy training and continuing medical education. Three models of training were identified: i) a generalist common training programme; ii) totally separate training programmes; iii) mixed types. Only two national training programs (UK and Ireland) were identified to have addressed transition as a topic, both involving CAP exclusively. Conclusion Three models of training in GAP and CAP across Europe are identified, suggesting that the harmonization is not yet realised and a possible barrier to improving transitional care. Training in transition has only recently been considered. It is timely, topical and important to develop evidence-based training approaches on transitional care across Europe into both CAP and GAP training. Electronic supplementary material The online version of this article (10.1186/s12909-019-1576-0) contains supplementary material, which is available to authorized users.

Introduction and Aims: Cognitive impairment is common among maintenance hemodialysis (HD) patients. Anemia has been identified as a risk factor for cognitive impairment in HD patients, but little is known about influence of erythropoietin on cognitive functions before and after HD session. In this study, Symbol Digit Modalities Test (SDMT), Trail Making Test, form A (TMT A) and Complex Reactiometer Drenovac (CRD series), a battery of computer generated psychological tests were used to assess possible relationship between erythropoietin treatment and cognitive function in maintenance HD patients. Methods: A selected population of 50 (aged 61.40±10.84 years) adult patient on maintenance HD (3.80±2.82 years) were investigated. Data of EPO administration usage per week (EPO_week IU/week) and EPO administration usage per week per kg of body weight (EPO_week_kg) were assessed from patient’s records 3 weeks retrospectively before cognitive testing. Assessment of cognitive functions was performed one hour before HD and one hour after HD treatment by CRD series tests to measure simple visual discrimination of signal location, short-term memory, simple convergent visual orientation and convergent thinking test. Results of CRD-series tests were given as total time of test solving (TT) and minimum time of test item solving (MT). Higher CRD-series tests scores (TT and MT measured in seconds) indicate poorer cognitive performance. Also, SDMT was used to measure oculomotor abilities and hand- eye coordination. Higher SDMT score indicated better cognitive performance. Furthermore, TMT A measure attention, visual scanning, motor speed and planning ability. Lower scores indicating better cognitive function. Results: In this group of HD patients we found statistically significant negative correlations between total EPO_weekly dose and cognitive test scores. Also, statistically significant negative correlations between EPO_weekly_/kg dose and cognitive test scores were found as presented in Table 1. Those HD patients with higher EPO_weekly and EPO_weekly_kg dose performed better on cognitive testing (needed less time to perform CRD series tests and TMT test and reached higher test score on SDMT). In order to test possible independent influence of total EPO_weekly and EPO_weekly_kg dose on cognitive performance, a partial correlation with hemoglobin as control variable was done. The results showed a statistically significant positive correlation between total EPO_weekly dose and SDMT score before HD (r=0.284, p=0.044). Conclusions: These results demonstrated that higher EPO dose is correlated with better cognitive performance and also showed possible independent effect of supplementation with EPO on cognitive functions. It still remains unknown whether this is solely due to an improvement in the blood count or an independent effect of supplementation with EPO. Future research, with larger number of participants in a prospective research model, should continue to examine which cognitive domains are particularly related to EPO treatment in HD patients.

Background: Prevalence of prescribing psychotropic medications, particularly inappropriate prescription, is widespread in older adults, both in nursing home residents as well as community-dwelling older adults. This review describes prevalence and prevention of inappropriate prescribing and risk factors associated with psychotropic medications. Methods: MEDLINE and GOOGLE SCHOLAR data base were searched for the key words “older adults”, “psychotropic drugs”, ”inappropriate prescribing”, “nursing home residents”, community-dwelling older adults”. The study was limited to the articles published in English in the period from 2007 to 2014. The list of references includes additional articles that were searched manually. Results: The utilization of different psychotropic medications is prevalent among older adults worldwide, regardless of whether they live in nursing homes or in the community. Among older adults, nursing home residents are the most vulnerable individuals for potentially inappropriate drug prescription. The most common potentially inappropriate prescribed medications in the elderly are benzodiazepines, particularly long-acting, antipsychotics and antidepressants, particularly SSRIs. All classes of listed medications have been associated with different adverse events, particularly falls and falls-related fractures and increased risk for mortality. Many different pharmacological and non-pharmacological interventions, such as monitoring polypharmacy, reviewing medications, spending more time in the institution by a physician, reducing the number of prescribers in the institution as well as greater involvement of geriatricians, general practitioners and pharmacists should be implemented to reduce this health issue. Conclusion: The prevalence of prescribing psychotropic medications to older adults is high. Inappropriate prescribing of psychotropic drugs and polypharmacy are present in institutionalized and non-institutionalized older adults and can cause adverse health events, and can significantly reduce the quality of life of these vulnerable groups. Multidisciplinary approach is needed in addressing widespread problem of prevalence of psychotropic medications in older adults.

Introduction: The contemporary data show how adherence of patients with mental illness is still inadequate. In time period of one year, about three-quarters of patients prescribed psychotropic medication will discontinue making this decision themselves without consulting their health professional. Nonadherence to antipsychotic medication regimens represents an important issue which leads to increased treatment costs and serious concequences. As many as 60% of patients with schizophrenia do not take their medications as prescribed. This can derail the process of recovery, lead to successive hospitalization and diminish the posibility of functional rehabilitation in order to participate adequatley in one' s social environment [1]. Therefore, for optimal treatment of patients therapeutic drug monitoring (TDM) is useful for drugs such as: antipsychotic, antidepressants and benzodiazepines. This helps to reduce non- compliance, adverse effects, non-response or “resistance” and intoxications. Relatively low cost and available method is high performance liquid chromatography (HPLC) in combination with liquid chromatography-mass spectrometry (LC-MS). The LC-MS is also an analytical chemistry tehnique that combines the physical separation capabilities of liquid chromatography (HPLC) with mass analysis capabilities of mass spectrometry (MS) [2, 3]. Aim of the study: To objectively determine the therapeutic adherence with therapeutic drug monitoring (TDM) of patients with psychotic disorders in two different population: adolescents and adults and one's who were frequently hospitalized due relapses/possible nonadherence despite taking peroral antipsychotic medication. Methods: The study was conducted on Psychiatric Clinic in Clinical Hospital Centre Osijek (Croatia) and in two different departments: Child and Adolescent Psychiatry Department and on Department of Biological psychiatry with intensive care and in co-operation with our specialized Molecular Laboratory. All patients had a diagnosis of psychotic disorder accoridng to ICD-X (F20.x ; F23.x ; F28, F29). Adolescent group was consisted of ages 15–18 years old (equally males and females) and adult group had a span of 18–35 year old of equally distributed both sexes. Each group (divided by sex) consisted of 30 patients. All patients have signed the informed consent. We have observed concentrations of these antipsychotics int he blood: risperidone, olanzapine, quetiapine. The blood sample was taken only upon addmitance of a patient to the specific psychiatric department and was processed in the laboratory with two consecutive methods: high performance liquid chromatography and liquid chromatography-mass spectrometry. Summary and Conclusion: Our study showed somewhat dissapointing results. In the group of adults, almost one-half of adult male patients had inadequate concentrations of antipsychotics in their blood sample, especially quetiapine and olanzapine. One-third in the group of adult female patients showed low concetrations of olanzapine and one-fourth reduced concetrations of risperidone. In the group of adolescents only one-fourth had borderline low antipsychotic concentrations. We believe these differences between adults and adolescents were due to inadequate lifestyles in the group of adults and parental care in adolescent group. No matter results, we find these methods valuable for our clinical practice due to objective validation of treatment and are planning to expand this study and also implement these methods in everyday practice among high-risk for nonadherence patients.

Significant correlation was noted between body mass index, serum creatinine, total cholesterol and albumin level with cognitive–psychomotor performance. Hemodialysis patients with a poorer nutritional status performed worse on cognitive and psychomotor tests. Further research is needed to assess the effects of treating malnutrition on cognitive–psychomotor performance in these patients.