Need For Psychiatric Treatment Research Articles

Social Determinants of Mental Health among Refugees in Germany - The Influence of Postmigratory Social Isolation and Resources on Psychopathology and Utilization Behavior

The mental health of refugees is influenced by a variety of pre-, peri- and postmigratory factors. It remains largely unclear how social determinants influence the utilization of psychiatric-psychotherapeutic treatment. We applied a questionnaire survey to 189 refugees from a clinical sample in a psychiatric hospital and from a control sample, which was not in treatment. The influence of social factors on psychopathology and utilization of care was analyzed by means of a CHAID algorithm. The total sample was highly stressed (54% PTSD and 41.4% depression symptoms). Patients were more severely affected in all psychometric scales as well as in traumatization and they were less able to draw on resources such as a social network or residence permit. The strongest predictor for psychotherapeutic-psychiatric treatment was social isolation in the living environment. For patients, the lack of a work permit was the strongest predictor of depression symptoms. The results point to the importance of postmigratory social determinants for the mental health of refugees. In particular, stable social relationships, together with formal factors such as work permit and residence title, should help to reduce mental distress and the need for psychiatric treatment.

Climate change, biodiversity loss and pollution: consequences for psychiatry

The climate crisis, loss of biodiversity and increasing global pollution are a threat to mental health. Comprehensive transformations are needed to overcome these crises, which will also affect the mental healthcare system. If done correctly these change processes can seize the chance to improve mental health while at the same time addressing the crises. This includes avoiding the need for psychiatric treatment by strengthening the focus on mental health promotion and prevention, and also considering environmental aspects when targetting therapy procedures. In addition, by focusing on nutrition, mobility and the effects of nature, patients can be empowered to increase their mental resilience whilst reducing the negative effects on the environment. At the same time, the mental healthcare system must adapt to changing environmental conditions: increasing heat waves make protective measures necessary, especially for people with mental illnesses and increasing extreme weather events can lead to shifts in the spectrum of illnesses. Appropriate funding mechanisms will have to be established to support mental healthcare throughout this transformation.

The Need for Psychiatric Treatment among Polish Users of Psychoactive Substances Is Increasing: This and Other Results from the Newest PolDrugs Survey.

Background and Objectives: PolDrugs is the largest Polish naturalistic nationwide survey to present basic demographic and epidemiological data that could potentially prevent harm from illicit substances intake in drugs users. The most recent results were presented in 2021. The goal of this year's edition was to re-present the above data and compare it to the previous edition's data to identify and describe the differences. Materials and Methods: The survey included original questions about basic demographics, substance use, and psychiatric treatment. The survey was administered via the Google Forms platform and promoted via social media. The data was collected from 1117 respondents. Results: People of all ages use a variety of psychoactive substances in many situations. The three most commonly used drugs are marijuana, 3,4-methylenedioxymethamphetamine, and hallucinogenic mushrooms. The most common reason for seeking professional medical help was amphetamine use. A total of 41.7 percent of respondents were receiving psychiatric treatment. The three most common psychiatric diagnoses among the respondents were depressive disorders, anxiety disorders, and ADHD. Conclusions: Key findings include increases in the use of psilocybin and DMT, increases in the use of heated tobacco products, and a near doubling in the percentage of individuals receiving psychiatric help in the past two years. These issues are discussed in the discussion section of this paper, which also addresses the limitations to the article.

Association between participation in the Northern Finland Birth Cohort 1966 study and use of psychiatric care services.

In most population-based epidemiological follow-up studies the aim is not to intervene in the life of the participants. Although the idea is not to intervene, being a member of the longitudinal follow-up study and studies conducted during follow-up may affect the target population. A population-based study including mental health enquiries might reduce the unmet need for psychiatric treatment by motivating people to seek treatment for their psychiatric ill-health. We examined the use of psychiatric care services in the population born in the year 1966 in Northern Finland, of whom 96.3% are participants in the prospective Northern Finland Birth Cohort 1966 (NFBC1966). As a study cohort we used people born in 1966 in Northern Finland (n = 11 447). The comparison cohort included all the people born in the years 1965 and 1967 in the same geographical area (n = 23 339). The follow-up period was from age 10 to 50 years. The outcome measure was the use of psychiatric care services, which was analysed using Cox Proportional Hazard regression and Zero-Truncated Negative Binomial Regression. People born in 1966 in Northern Finland did not differ from those born in 1965 and 1967 in terms of the outcome measure. We found no association between participation in an epidemiological follow-up study and the use of psychiatric care services. The NFBC1966 may be regarded as a representative at the population level in terms of psychiatric outcomes despite the personal follow-up of the birth cohort. The associations of participation in epidemiological follow-up studies have previously been under-examined, and the results need to be replicated.

Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study.

ObjectiveTo assess risk factors for anxiety and depression among pregnant women during the COVID‐19 pandemic using Mind‐COVID, a prospective cross‐sectional study that compares outcomes in middle‐income economies and high‐income economies.MethodsA total of 7102 pregnant women from 12 high‐income economies and nine middle‐income economies were included. The web‐based survey used two standardized instruments, General Anxiety Disorder‐7 (GAD‐7) and Patient Health Questionnaire–9 (PHQ‐9).ResultPregnant women in high‐income economies reported higher PHQ‐9 (0.18 standard deviation [SD], P < 0.001) and GAD‐7 (0.08 SD, P = 0.005) scores than those living in middle‐income economies. Multivariate regression analysis showed that increasing PHQ‐9 and GAD‐7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ‐9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD‐7 scores were associated with a pregnancy‐related complication, fear of adverse outcomes in children related to COVID‐19, and feeling of burden related to finances.ConclusionsAccording to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.

Nutritional Needs in Mental Healthcare: Study Protocol of a Prospective Analytic Observational Study Assessing Nutritional Status, Eating Behavior and Barriers to Healthy Eating in Psychiatric Inpatients and Outpatients Compared to Healthy Adults.

BackgroundMental disorders are often associated with unhealthy eating behaviors and metabolic comorbidities. This can result in reduced life expectancy and poorer quality of life in people with mental disorders. This study protocol describes an observational study that examines the nutritional status and eating behaviors of people with severe mental illness (SMI) and the need for psychiatric treatment who were between 18 and 65 years old. In addition, the study focuses on possible barriers for healthy eating that have not yet been examined in this population.MethodsA total of 192 study participants will be recruited: 64 inpatients and 64 outpatients from the Psychiatric Hospital of the University of Zurich with SMI as well as 64 healthy individuals from the general population as a control group. The participants will be interviewed regarding their nutritional status, eating behavior, nutrition knowledge, food and cooking skills, personality, attitudes and feelings toward nutrition. In addition, the severity of symptoms and several control variables (e.g., sociodemographic variables and physical activity) will be assessed. For the patient samples, data will comprise routine medical data, and, if available, routine laboratory data. Inpatients will be interviewed once at the beginning of their treatment. Outpatients will be interviewed at the beginning and after 3 months of treatment (same interview questions). Healthy adults of the control group will be interviewed once at any time during the recruitment period.DiscussionThe described study will identify nutritional needs and possible barriers to healthy eating in patients with mental disorders. The results will help to define recommendations for nutritional risk screening in psychiatric patients and for planning effective nutritional interventions.

Ekbom syndrome: a case report

IntroductionEkbom syndrome is a clinical term for delusional parasitosis, a condition characterized by the belief that one’s skin is infested by invisible parasites. Despite having no medical evidence, patients strive to prove their illness and interpret different sensations and symptoms as infestation with parasites.ObjectivesOur objective was to present a case report of a patient with Ekbom syndrome with detailed clinical information and treatment complications.MethodsWe included patient’s history, psychiatric evaluation, complete diagnostic work-up, therapy and follow-up.ResultsA 60-years old female patient was admitted to her first hospital treatment in our psychiatric clinic. Upon admittance, she was extremely tense, preoccupied with the idea that bed bugs have infested her body. She showed extensive medical documentation, including numerous dermatologic reports regarding her condition, interpreting them in accordance with her delusions. In attempt to help herself and “release” the bugs, she harmed herself causing multiple skin lesions across her body and face. The treatment was complicated with secondary skin infections, ulcers, cellulitis and oedemas. Initial treatment with olanzapine was switched to risperidone due to side-effects (sedation, increase of appetite, weight gain). Gradually, with pharmacological treatment, psychoeducation and support, remission was achieved, but poor insight to her previous condition and psychiatric symptoms remained.ConclusionsEkbom syndrome presents a serious disorder that can be complicated with secondary somatic complications, often requiring involvement of different medical specialists. Moreover, lack of insight into the need for psychiatric treatment can lead to therapy discontinuation and relapse of symptoms.DisclosureNo significant relationships.

Child and adolescent psychiatric and therapeutic treatment needs in care settings in the Lower Austrian industrial district. Asurvey of the demand situation

Ein steigender kinder- und jugendpsychiatrischer Versorgungsbedarf ist in den letzten Jahren deutlich zu beobachten. Die vorliegende Studie befasst sich mit 20 Kinder- und Jugendhilfeeinrichtungen im Industrieviertel (Niederösterreich) und dem kinder- und jugendpsychiatrischen Behandlungsbedarfs der 439 dort fremduntergebrachten Kinder und Jugendlichen. Es zeigen sich bei 270 (62 %) der Kinder und Jugendlichen psychiatrische Auffälligkeiten und bei 220 (50,1 %) ein oder mehrere psychiatrische Diagnosen. Davon sind 200 Kinder und Jugendlichen bereits in einer kinder- und jugendpsychiatrischen Behandlung. Bei elf Einrichtungen besteht ein Behandlungsbedarf von 80–100 % der fremduntergebrachten Kinder und Jugendlichen. Es ergibt sich daraus ein hochbelastetes Helfer:innensystem und eine große Versorgungsnotwendigkeit in den Einrichtungen. Eine intensivere Vernetzung und Zusammenarbeit der involvierten Institutionen bzw. Helfer:innensysteme und einer Weiterentwicklung des Kinder- und Jugendpsychiatrischen Angebots wäre wünschenswert, um den steigenden psychiatrischen Behandlungsbedarf bei Kindern und Jugendlichen adäquat begegnen zu können.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s40211-022-00419-y) enthalten.

The family-oriented open dialogue approach in the treatment of first-episode psychosis: Nineteen–year outcomes

Open Dialogue (OD) is a family-oriented early intervention approach which has demonstrated good outcomes in the treatment of first-episode psychosis (FEP). Nevertheless, more evidence is needed. In this register-based cohort study the long-term outcomes of OD were evaluated through a comparison with a control group over a period of approximately 19 years. We examined the mortality, the need for psychiatric treatment, and the granting of disability allowances. Data were obtained from Finnish national registers regarding all OD patients whose treatment for FEP commenced within the time of the original interventions (total N = 108). The control group consisted of all Finnish FEP patients who had a follow-up of 19–20 years and who were guided to other Finnish specialized mental healthcare facilities (N = 1763). No difference between the samples was found regarding the annual incidence of FEP, the diagnosis, and suicide rates. Over the entire follow-up, the figures for durations of hospital treatment, disability allowances, and the need for neuroleptics remained significantly lower with OD group. Findings indicated that many positive outcomes of OD are sustained over a long time period. Due to the observational nature of the study, randomized trials are still needed to provide more information on effectiveness of approach.

Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic.

An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns.

The effectiveness of three psychotherapies of different type and length in the treatment of patients suffering from anxiety disorder

IntroductionData on the comparative effect of short and long-term psychotherapy in anxiety disorder is scarce.AimTo compare the effectiveness of two short-term therapies and one long-term psychotherapy in the treatment of patients with anxiety disorder.MethodsAltogether 50 outpatients with anxiety disorder as the only axis I diagnosis, were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP), and solution-focused therapy (SFT) and were followed for 5 years. The outcome measures were psychiatric symptoms, working ability, need for psychiatric treatment, remission, and cost-effectiveness.ResultsDuring the first year of follow-up, no significant differences in the effectiveness between the therapies were noted. During the following 3 years, LPP and SFT more effectively reduced symptoms, improved work ability, and elevated the remission rate than SPP. No significant differences between LPP and SFT were seen. At the end of the follow-up, the use of auxiliary treatment was lowest in the SFT group whereas remission rates or changes in psychiatric symptom or work ability did not differ between the groups. The average total direct costs were about three times higher in the LPP group than in the short-term therapy groups.ConclusionsThe difference in effectiveness of LPP and SFT was negligible, whereas SPP appeared less effective. Thus, the resource-oriented SFT may be a cost-effective option in this selected patient group, while unconsidered allocation of patients to LPP does not appear to be cost-effective. Given the small number of patients, no firm conclusions should, however be drawn based on this study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A retrospective study of drug – drug interactions in patients treated with pharmacotherapy in the biggest Slovenian correctional facility

BackgroundDrug-drug interactions (DDIs) are known to lead to treatment failure.ObjectivesIn most European countries there are no data on DDIs in patients within correctional facilities.AimThe main aim of this paper is to present the most frequent DDIs in the biggest Slovenian male, Slovenian correctional facility Dob to avoid serious DDIs in future.MethodsA retrospective study was carried between September 2015 and June 2016 on 141 patients on substitution treatment (methadone, suboxone and buprenorphine) and 125 other prisoners with mental disorders in need for psychiatric treatment were included. All study data were extracted from the patients’ medical files of the psychiatric dispensary in the prison Dob. DDIs were determined by different interaction classes with Lexicomp Online™ 19.0 version and only X (major interactions and should be avoided) and D (minor interactions and avoid if it is possible) were included.ResultsTogether 220 patients were included. Number of patients with at least 1 interaction, were 139 (63.2%). Number of patients with at least 1 X interaction, were 59 (26.8%). Number of patients with more than one (1) X interactions was 15 (6.8%). More than half of the patients (56.4%) were treated by hypnotics and 38.4% with benzodiazepines. The most frequent X DDIs were: buprenorphine, methadone and sulpride with antipsychotics (clozapine and quetiapine) and antidepressants (e.g. escitalopram, fluoxetine).ConclusionsIn patients treated with methadone and buprenorphine there are frequent DDIs resulting in contraindications for prescribed combination of drugs. If an antidepressant is to be used in patients prescribed methadone and buprenorphine, sertraline is recommended.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neubrojivi počinitelji protupravnih djela u kaznenom pravu i sudskoj praksi Republike Hrvatske

This paper presents and analyses legal regulation of the position of mentally incapable perpetrators of unlawful acts from the perspective of criminal law and procedure and the provisions of the Law on Protection of Persons with Mental Disorders, as well as their application in case law, through analysis of 25 final verdicts against mentally incapable persons. The aim of the analysis is to detect good practice, but also questionable and unequal conducts of the courts, in order to improve quality of the decisions and the harmonization of case law. The analysis of the decision encompasses the use of legal terms, completeness of the verdicts, reasoning of the decisions to hold hearings in absence of the defendant, the form of the defendants’ statements, the decisions on costs of proceedings and particularly the quality of reasoning on the need of psychiatric treatment.

Silence of male child sexual abuse in India: Qualitative analysis of barriers for seeking psychiatric help in a multidisciplinary unit in a general hospital

Introduction:In 2007, Ministry of Women and Child Welfare, supported by United Nations Children's Fund, save the children and Prayas conducted a study to understand the magnitude of child abuse in India, they found that 53.22% children faced one or more forms of sexual abuse; among them, the number of boys abused was 52.94%.Aim:The aim of this study was to explore the barriers for seeking psychiatric help by qualitative analysis of stake holders of male victims of child abuse.Materials and Methods:All the statements made by the stakeholders regarding psychiatric assessment and treatment were recorded in each referral made to the psychiatrist. Semistructured interviews and in-depth interviews were conducted to explore the topic of understanding the need for psychiatric treatment to the victims.Results:Collaborative child response unit, a multidisciplinary team, to tackle child sexual abuse in a general hospital received three referrals of male child abuse among the 27 referrals in 20 months. The main theme of the barrier that was generated by interviewing the stakeholders of male child victims of abuse was the misconception of superiority of a male victim due to gender (patriarchy) an expectation that he will outgrow the experience. In-depth interviews of three cases of homosexual abuse explored the theme.Conclusion:Patriarchy is oppressing male children and acts as a barrier to seek psychiatric help in collaborative child response unit.

Challenging behaviour in school – special education teachers’ perceptions

This article explores the challenges that special education teachers encounter during their daily work in Finnish schools. The main focus is in those challenges which cause worry among teachers, especially aggressive behavior in class rooms and school area. This article scrutinizes the reasons and consequences of a problem from the perspective of special education teachers. The research shows, how problems are mainly caused by delays in assessments, treatments and rehabilitation for pupils with mental or behavioral disorders. The analysis shows how on teachers’ opinion, challenging situations, which induce great worry occur when pupil has a need for psychiatric treatment but had not received it in time. In these kind of situations teachers feel frustrated and partly helpless as their professional skills and knowledge is not enough to provide the support pupil needs. When the neediest pupils do not receive support and treatment in time, it leads to situation where special education teachers have to provide support and face pupils’ challenging behavior even if they may not have measures for it.

A guide to treating military personnel in a civilian mental health facility.

As the number of troops returning home from the Middle East continues to rise, so does the need for psychiatric treatment. More and more often, civilian mental health facilities will be faced with treating active duty service members. Because the patients are active duty status, civilian providers need to become familiar with the unique intricacies and challenges of interacting with military command and mental health clinics. Concepts such as confidentiality and consent have a slightly different meaning in the military that affects care in the civilian realm. Diagnoses, medication choices, and treatment planning can also have an impact on a service member's career in the military that civilian providers may not recognize. This guide serves as a "beginner's" manual for working with active duty service members.

Unusual trichobezoar of the stomach and the intestine: a case report.

IntroductionTrichobezoars are an infrequent form of bezoar found in the stomach or intestine, created from ingested hair. This condition has been well described in the surgical literature, but less reported in psychiatry.Case presentationWe describe the case of an 18-year-old Middle Eastern Caucasian woman with trichotillomania who presented to our emergency department with a history of central abdominal pain associated with vomiting and constipation for five days. An examination showed a trichobezoar requiring emergent surgical intervention, and indicating the need for psychiatric treatment. The trichobezoar was treated successfully by laparotomy.ConclusionThe medical and psychiatric sequelae of trichotillomania should not be underestimated, and early diagnosis and treatment is of utmost importance to save the patient’s life and prevent recurrence. Although laparotomy is still considered an excellent option, pharmacotherapy and behavioral assessment play a useful role in patient management. Our case highlights the fundamental concept of a holistic approach rather than only treating the symptoms, by considering factors such as genetic influences to understand the disease.

Health-related and legal interventions: A comparison of allegedly delinquent and convicted opioid addicts in Austria

In Austria, judges can offer quasi-compulsory treatment options (in- and outpatient settings) as an alternative to imprisonment for drug-related delinquencies. A standard assessment of medical, psychological and legal data on the implementation of health-related and legal interventions in Austria was applied in 96 opioid-dependent individuals (10.4% female) undergoing quasi-compulsory treatment, receiving health-related measures. Additional data from the official prison registry were collected (data of 228 imprisoned individuals sentenced for drug-related crimes; 14.5% female) to gain comparable information to in- and outpatient health-related measure groups. Health-related measures were offered significantly more often to individuals charged with solely narcotics possession and/or trade, whereas imprisonment was filed significantly more often when concomitant property or violent crimes were committed in addition to drug possession/dealing (p &lt; 0.001). Both cohorts had high prevalences of previous convictions (health-related measure 84.4%, prison 93.9%). The majority of patients in health-related measures suffered at the time of investigation from severe depression (62.5%), anxiety disorders (58.3%) and had a high loading of suicidal ideation (45.8%). Women showed a higher prevalence of affective disorders (p = 0.042), with higher administration rates of psychopharmacological medication (p = 0.045), whereas male offenders scored significantly higher in violent behaviour (p = 0.004). Inpatients showed a significantly higher burden of comorbid disorders compared to outpatients and reported a higher need for psychiatric treatment and legal counselling (all p &lt; 0.001). The inpatient sample had a longer duration of opioid use (p = 0.024), a higher lifetime prevalence of intravenous drug use (p &lt; 0.001) and a higher rate of hepatitis C infections (p = 0.012). Results confirm that imprisonment is sentenced to a vast extent for severe crimes, and health-related measure is well accepted among judges. However, based on patients’ high loading of previous convictions and alarmingly high burden of comorbidities, quality improvement and assurance in health-related measure are required when patients have their first contact with the criminal justice system. Continuous focus on applying diversion procedures is also required to reduce societal costs.

US regional differences in death rates from depression

Studies in a few countries (including the US) have reported that mortality rates in the population from psychiatric disorders are much higher when they are based on all causes of death ("multiple causes" or "mentions") coded on death certificates versus only the underlying cause. Studies appear to be lacking on geographic variation within the US in mortality rates from psychiatric disorders based on multiple causes of death. The present study examined the US age-standardized rate (ASR) for death with depression using multiple causes versus underlying cause alone in each of the Census Bureau's four regions and nine divisions. ASRs for schizophrenia were also examined for comparison. For the entire US, the ratio of the ASR based on multiple causes to the ASR based on underlying cause was 20.9 for depression and 9.2 for schizophrenia; in analyses by region and division, these ratios showed limited variation. The most consistent finding for both depression and schizophrenia was that ASRs, whether based on multiple causes or only on underlying cause, were highest in the Midwest region (especially the East North Central division) and lowest in the South (and in each of its three divisions). For ASRs (using multiple causes of death) from depression, these regional differences were evident within each of several levels of urbanization. For deaths with depression coded as other than the underlying cause, ASRs for each of the three most common underlying causes (cardiovascular diseases, intentional injuries, and neoplasms) were highest in the Midwest and lowest in the South. Studies are needed to determine if these regional differences in mortality from depression are due to regional differences in: certifier practices (i.e., in assigning causes of death among persons with psychiatric conditions); the prevalence (among persons with psychiatric disorders) of lifestyle-related factors (e.g., tobacco use and obesity) that mediate mortality risks; and/or in unmet need for psychiatric treatment and medical care for other chronic diseases in persons with psychiatric conditions. Similar studies are needed of regional variation within other countries.

Recognition of psychopathology with religious content by clergy members: a case vignette study

Clergy members (CMs) frequently offer support and counselling for people with mental health problems. The current study aims to obtain insight into the ability among CMs to recognise psychopathology and need for psychiatric treatment. A random sample of CMs (N = 143) and a control sample of mental health professionals (MHPs, N = 73), were compared as to their evaluations of four vignettes. CMs considered the psychiatric states to be related to religious or spiritual problems to a similar degree as they did for the non-psychiatric states. Sensitivity of CMs with regard to the need of psychiatric care for the psychiatric states was modest (66%) and differed significantly from MHPs (96%). Specificity of the CMs was 89%, which was significantly lower than the MHPs (97%). The CMs did recognise psychopathology with religious content but clearly to a lower extent than MHPs. Requests by CMs for education about recognising psychopathology may be considered as justified.