The European Journal of Psychiatry

Common mental health disorders in children and adolescents in primary care: A survey of knowledge, skills and attitudes among general practitioners in a newly developed European country

Background and Objectives: General Practitioners (GPs) are generally the first point of contact for children and adolescents with mental health problems. This study investigates the confidence, beliefs, and knowledge of GPs regarding common mental health problems in youngsters. Methods: A self-designed questionnaire was distributed to nearly all registered GPs in a middle-income European country in order to address the aims of the study. Results: Response rate was 58%. Many GPs reported relatively low confidence on a number of issues, including diagnosis (70.0%), initiating management (86.6%), assessing the child-caregiver relationship (72.0%) and the ability to distinguish between normal and pathological behavioural problems (75.1%). However, GPs showed greater inclination to conduct follow-up care after assessment by specialist services (53.5%). Few GPs considered psychosocial interventions to play a role in the treatment of anxiety disorders (18.5%), hyperkinetic disorders (24.2%), depression (22.9%) and disruptive behaviour disorders (18.5%) and this largely came from younger GPs (p < 0.001). Conclusions: Confidence of GPs in the management of youngsters with mental health problems is generally low. They may require significant back-up from specialist services in the form of both training and clinical collaboration.

Screening for post-traumatic stress disorder (PTSD) in a psychiatric emergency setting

Background and Objectives: (i) to assess the prevalence of PTSD in a psychiatric emergency setting by means of a diagnostic instrument and to compare it with PTSD-prevalence of a clinically evaluated, historical sample; and (ii) to assess psychiatric residents´ perception of the systematic use of this diagnostic instrument. Methods: A consecutive sample of patients (N = 403) evaluated for a psychiatric emergency was assessed with the module J (PTSD) of the MINI, the historical sample (N = 350), assessed by chart review, consisted of consecutive patients of the same setting evaluated one year prior to the study period. Residents´ perceptions were assessed by means of a focus group. Results: While in only 0.57% of the historical sample (N = 350) a diagnosis of PTSD was recorded, 20.3% (N = 64) of the patients assessed with the diagnostic instrument (N = 316) qualified for a diagnosis of PTSD. Higher prevalence rates were observed in refugees and those without legal residency status (50%); patients from countries with a recent history of war (47.1%); those with four (44.4%) or three psychiatric co-morbidities (35.3%); migrants (29.8%) and patients without professional income (25%). Residents felt that the systematic use of the tool was not adequate in the psychiatric emergency setting for various reasons (e.g.: not suitable for a first or single consultation, negative impact on the clinical evaluation). Conclusions: The study confirms that PTSD is underdiagnosed in the psychiatric emergency setting. To improve the situation, targeted screening or educational and institutional strategies are needed.

Successful treatment of catatonic syndrome in bipolar I disorder adding aripiprazole to ECT: A case report

Background and Objectives: Catatonic syndrome is a condition presenting in multiple ways, sharing many of them with the neuroleptic malignant syndrome and other diseases. This diagnostic challenge is the main cause of keep treating catatonic syndromes without neuroleptics. Methods: Review of the literature and a case report. Results: We present the case of a 19 years old bipolar I patient with a severe catatonic syndrome, with a torpid clinical evolution, partial response to benzodiazepines and ECT, which successfully resolved with intramuscular aripiprazole. We found through a systematic review (PubMed 2005-2010) that there are few but significant case reports of catatonic syndromes treated with new second generation antipsychotics for different reasons with good outcomes as ours. The pharmacological profile of aripiprazole and the low incidence of NMS reported make it a suitable option in treating this syndrome. Conclusions: We think that this case report could contribute to add more evidence for aripiprazole to be considered a good third-line option in the treatment of catatonic syndrome. However, this would require randomized controlled trials to confirm its effectiveness and safety.

Cancer and common mental disorders in the community: Results of the Israel-World Mental Health Survey

Background and Objectives: To study common mental disorders (CMD) and other mental health-related variables among community residents with active cancer, cancer survivors and cancer-free respondents. Methods: Data were extracted from the Israeli component of the 28-country World Mental Health Survey. The sample included 165 respondents who reported ever having cancer and 2,282 cancer-free respondents, all aged 39 years and older. The WHO/Composite International Diagnostic Interview (CIDI) was used to determine the prevalence rate of CMD. Emotional distress (ED) was ascertained with the GHQ-12. Also, respondents were asked about sleep disturbances and mental health service utilization. Results: Respondents with active cancer were more likely to endorse CMD in the past year than cancer-free respondents, 22.1% SE = 6.1 and 7.2% SE = 2.5, respectively (adjusted odds ratio = 2.6, 95% CI 1.2-5.6); to have higher ED scores, M = 27.1 SE = 1.3 and M = 19.8 SE = 0.3, respectively (Wald F = 16.7, p < 0.001); and higher prevalence rates of sleep disturbances, 64.7% SE = 6.5% and 31.5% SE = 4.6%, respectively (adjusted odds ratio = 2.1, 95% CI 1.1-3.9). Cancer survivors did not significantly differ from cancer-free respondents on the study variables. Despite the emotional toll, there were no differences in mental health service utilization among the three cancer groups. Conclusions: Respondents with active cancer residing in the community show enhanced psychopathology. Study findings highlight a double need: to adequately assess mental health problems in persons with cancer and to bridge the treatment gap.

Attention in patients with chronic schizophrenia: Deficit in inhibitory control and positive symptoms

Background and Objectives: Attention is a central mechanism controlling information processing, activating and inhibiting processes, and forming a complex system including diferent networks in specific areas of the brain¹. To correctly assess the role of attention in schizophrenia it is necessary to discriminate its different attentional components, which may by selectively altered. Attention span, focused attention, selective attention, sustained attention and inhibitory response, were assessed in patients with chronic schizophrenia and healthy matched controls. Methods: The study included 32 patients diagnosed with chronic schizophrenia and 32 healthy subjects. The groups were matched in age, sex, and level of education. Symptom severity (positive symptoms, negative symptoms, and general psychopathology) was assessed with the Scale for the Assessment of Positive and Negative Symptoms (SAPS and SANS). Attentional components were measured by Forward Digit Span, Symbol Search, Digit Symbol Coding, Stroop Test and Picture Completion. Results: Schizophrenic patients exhibited lower attentional scores in all tests compared to the control group. Inhibitory control and sustained attention were the most affected traits in schizophrenic patients. An inverse correlation was observed between inhibitory control and delusions and disorganized thinking. No significant correlations were observed between negative symptoms and attentional performance. Conclusions: The pattern of results obtained in this paper evidences the role of an inhibitory control deficit in patients with chronic schizophrenia that could also be involved in other attentional and cognitive failures, and also be connected to positive symptoms.

Burnout, occupational stressors, and social support in psychiatric and medical trainees

Background and Objectives: Although previous research reports that psychiatrists experience greater work-related distress than other specialties, very little is known about how psychiatric trainees compare to their medical colleagues. The aim of this study was to compare psychiatric and general medical trainees in burnout, work stressors, and social support and investigate potential buffering effects of social support. Methods: This cross-sectional study included 112 psychiatric and 72 general medical trainees, based in the UK. Participants completed three questionnaires on-line: Maslach Burnout Inventory, Specialist Doctors´ Stress Inventory, and Social Support Scale. Results: According to the findings, psychiatric trainees reported less burnout, fewer time demands, more consultant and emotional support but less family support than general medical trainees. In addition, social support moderated the effects of specialty on burnout, as it substantially reduced depersonalisation in medical but not in psychiatric trainees. Conclusions: Findings may reflect recent changes in psychiatric training in the UK. Factors contributing specifically to medical trainees´ burnout and factors potentially preventing psychiatric trainees from utilising social support need to be explored in future research. The cross-sectional design and the low response rate were the main limitations of the study.

A brief motivational intervention based on positive experience and temporary smoking abstinence: Feasibility in a psychiatric hospital