European Psychiatrists Research Articles

Attitudes of European psychiatrists on psychedelics: a cross-sectional survey study

Research and public interest in psychedelic-assisted psychotherapy (PAP) are growing. This study investigated attitudes toward psychedelics among a diverse and multinational sample of psychiatrists currently working in Europe. We conducted an anonymous, web-based survey consisting of demographic information, a test of basic knowledge on psychedelics, and the previously validated 20-item Attitudes on Psychedelics Questionnaire (APQ), which was validated for the first time in English within this sample. We included N = 419 participants from 33 countries in the study. One-third of participants (34%) reported past use of psychedelics. The APQ sub-scale with the highest score was Openness to Psychedelics, while Risk Assessment of Psychedelics was rated lowest. Regression modelling, explaining 31.3% of variance in APQ scores, showed that younger male psychiatrists who identified as spiritual, were better at recognizing and classifying substances as psychedelics and had previously used psychedelics had more positive attitudes on psychedelics. No professional variables besides self-reported previous experience with PAP or psychedelic research predicted APQ scores. European psychiatrists, therefore, show a general openness to psychedelics and PAP, but are concerned by the potential risks associated with them. Our findings overall suggest that psychedelics are a subject where it is difficult to remain impartial. Protocol registration: The study was pre-registered at the Open Science Framework (available online at https://osf.io/upkv3).

Attitudes of European psychiatrists on psychedelics: a qualitative study

Introduction and aimIt is important to understand how mental health practitioners view recent findings on psychedelic-assisted psychotherapy (PAP) as there is potential this treatment may be incorporated into clinical practice. The aim of our study was to explore how psychiatrists who are not involved in psychedelic research and who are located in the European region perceive psychedelics and PAP.MethodsWe conducted online semi-structured interviews with 12 psychiatry specialists and psychiatry trainees from 8 European countries. Data were analyzed using a general inductive approach informed by codebook thematic analysis.ResultsBased on the interviews, we developed four main themes and 14 sub-themes, including (1) Psychedelics hold potential, (2) Psychedelics are dangerous, (3) Future of psychedelics is uncertain, and (4) Psychiatry is ambivalent toward psychedelics.DiscussionOur respondents-psychiatrists acknowledged the potential of PAP but remained cautious and did not yet perceive its evidence base as robust enough. Education on psychedelics is lacking in medical and psychiatric training and should be improved to facilitate the involvement of mental health experts in decision-making on PAP.

The current shapes of cyberviolence in digital relationships

AbstractSocial life has moved toward the digital world in many aspects. As the original inhabitants of virtual life, young people face several adversities while flirting and dating online. The anonymity of the online environment enables aggression without consequences. Cyberviolence has no boundaries as time or place. Thus it may cause psychological distress.Young people frequently use online dating and social networking sites, which makes them vulnerable to cyber dating violence, sextortion, and revenge porn. Cyberdating violence usually targets young women and girls. It is mainly related to stereotypical gender beliefs: presented as controlling behavior and psychological violence. Survivors of cyber dating violence tend to feel anger, hostility, and loneliness. Sextortion is image-based sexual abuse, which includes threats with intimate pictures or videos. Perpetrators of sextortion can be hackers, ex-partners, or admirers. Exposure to sextortion is related to shame, fear, and helplessness. Former partners may use revenge porn to control one’s behavior. It is another kind of image-based sexual abuse. Perpetrators may use nonconsensual pornography to punish or humiliate their ex-partners.Cyber victimization is as traumatic as real-life victimization. That results in depression, anxiety, and posttraumatic stress. Moreover, the absence of time and space restrictions can make cyberviolence even more debilitative. I aim to inform European psychiatrists about the current shapes of cyber psychological trauma in the context of online flirting and dating. So that psychiatrists can better understand its content and outcomes, especially while working with young people.Disclosure of InterestNone Declared

Editorial introductions.

Editorial introductions.

Improving Mental Health Care in Depression: A call for action.

Depressive disorders have one of the highest disability-adjusted life years (DALYs) of all medical conditions, which led the European Psychiatric Association to propose a policy paper, pinpointing their unmet health care and research needs. The first part focuses on what can be currently done to improve the care of patients with depression, and then discuss future trends for research and healthcare. Through the narration of clinical cases, the different points are illustrated. The necessary political framework is formulated, to implement such changes to fundamentally improve psychiatric care. The group of European Psychiatrist Association (EPA) experts insist on the need for (1) increased awareness of mental illness in primary care settings, (2) the development of novel (biological) markers, (3) the rapid implementation of machine learning (supporting diagnostics, prognostics, and therapeutics), (4) the generalized use of electronic devices and apps into everyday treatment, (5) the development of the new generation of treatment options, such as plasticity-promoting agents, and (6) the importance of comprehensive recovery approach. At a political level, the group also proposed four priorities, the need to (1) increase the use of open science, (2) implement reasonable data protection laws, (3) establish ethical electronic health records, and (4) enable better healthcare research and saving resources.

Effect of medical education on European psychiatrists’ knowledge in management of major depressive disorder and psychiatric emergencies

IntroductionThe challenge for psychiatrists is keeping up to date with the latest clinical trial data in managing major depressive disorder (MDD) and psychiatric emergencies.ObjectivesWe evaluated whether an online educational video lecture directed at psychiatrists, could improve knowledge and confidence regarding management of psychiatric emergencies associated with MDD.MethodsEducational effect was assessed using a 3-question repeated pairs, pre/post assessment survey. A paired-samples t-test was conducted to assess overall number correct and confidence change. A McNemar’s test was conducted to assess question-level significance. P values < 0.05 are statistically significant. Cohen’s d test was used to estimate the magnitude of effect of education. The activity launched on 8 April 2021, and preliminary data analysed as of 24 June 2021.Results 807 psychiatrists participated in the programme, of which 150 completed the pre- and post-assessment test. An average overall correct response rate of 44% pre- increased to 74% post- (67% relative increase, P<0.001; Cohen’s d = 0.91). Knowledge on the burden of suicide and MDD improved from 38% pre- to 85% post- (124% relative increase,P<0.001). Knowledge regarding clinical data for novel therapies for use in psychiatric emergencies improved from 47% pre- to 68% post- (45% relative increase, P<0.01). Knowledge regarding signs of suicidal intent in patients with MDD improved from 49% pre- to 71% (45% relative increase, P<0.001) following education.Conclusions This study demonstrates the positive effect of online medical education on psychiatrists’ knowledge in contemporary management of psychiatric emergencies associated with MDD in Europe.DisclosureThe results of this study were from an educational programme that was developed through independent educational funding from Janssen Neuroscience.

Early Career Psychiatrists in Europe During COVID-19 Outbreak: Results of The EPA ECPC-EFPT Cross-Sectional Survey

Abstract BodyThe COVID-19 pandemic has affected the lives and work of Early Career Psychiatrists (ECPs). Some had to revamp their professional life, start using telepsychiatry without prior training, change their workplace during the pandemic, or were quarantined. Others were not able to complete their training or take obligatory courses as planned. The aim of the study was to understand the impact of the pandemic on education and professional development, working conditions and wellbeing of ECPs, as well as their attitude to telepsychiatry. The anonymous, 24-question cross-sectional survey was conducted by the European Psychiatric Association Early Career Psychiatrists Committee (EPA ECPC) and the Task Force on Meetings and Associations with the collaboration and support of the European Federation of Psychiatric Trainees (EFPT). 517 participants from 39 different countries (member states of the Council of Europe) have been included in the analysis. Statistical analyses have been performed. Final results will be presented during the symposium. Identifying the impact of the COVID-19 pandemic on ECPs will help us better prepare for similar events in the future, equip them with the necessary skills and provide them with the right support.DisclosureNo significant relationships.

Treatment patterns and decision drivers to discharge patients with depression hospitalised for acute suicidal ideation in Europe

BackgroundThere is limited published information about the management of patients with major depressive disorder (MDD) hospitalised for acute suicidal ideation (SI). This study aimed to identify treatment patterns and unmet needs in the management of these patients and the decision drivers for hospital discharge. MethodsCross-sectional survey-based study enrolling hospital-based European psychiatrists. The study had a qualitative and a quantitative stage, including a conjoint exercise. ResultsEach respondent (N = 413) managed, on average, 62 MDD patients with acute SI per typical three-month period; 76% of these patients required hospitalisation. Severity of SI and severity of MDD were considered the most important factors for hospital admission and discharge. In the conjoint analysis, these attributes accounted for 54% of the discharge decision. Key treatment goals included improving depressive symptoms and achieving MDD remission. Antidepressants were a standard treatment for 98% of respondents but 63% defined rapid onset of action as a critical unmet need, followed by a good tolerability profile (34%). LimitationsThe study has a cross-sectional design representing respondents' behaviour and attitudes at a particular point in time. In the conjoint analysis, the results represent stated behaviour and not observed clinical behaviour. ConclusionsPhysicians' decisions to admit and discharge patients with MDD hospitalised for acute SI are mostly driven by the severity of SI and depression. Antidepressants with rapid onset of action, which can quickly improve depressive symptoms, represent a key unmet need for these patients and may contribute to a higher likelihood of early discharge.

Classification in Psychiatry

Classification in psychiatry has ancient roots but mainly took form in the 19th and 20th centuries. European and American psychiatrists brought to the fore careful observation and description of clinical course. Formal attempts to classify patients took root after World War II based on the exigencies of the time. The DSM-I was published in 1952 and summarized all the diagnoses in psychiatry. Diagnostic criteria were introduced in the DSM-III in 1980 to introduce reliability to the diagnostic process, and a multiaxial system was introduced to aid in the comprehensive assessment of patients, later dropped in the DSM-5. Dimensional measures were introduced to aid with patient assessment, although many categories were reformulated based on research findings. In the DSM-5, the diagnoses are listed in order of clinical importance. Residual categories exist for those who do not meet the criteria for a more specific disorder. Although the DSM-5 has been criticized, criteria-based diagnoses will persist until a system can be created based on etiology. This review contains 2 tables, and 23 references Keywords: classification in psychiatry, diagnostic criteria, DSM-5, Feighner criteria, International Classification of Diseases, Kraepelin

The sociodemographic and clinical profile of patients with major depressive disorder receiving SSRIs as first-line antidepressant treatment in European countries

IntroductionDue to favorable antidepressant (AD) efficacy and tolerability, selective-serotonin reuptake inhibitors (SSRIs) are consistently recommended as substances of first choice for the treatment of major depressive disorder (MDD) in international guidelines. However, little is known about the real-world clinical correlates of patients primarily prescribed SSRIs in contrast to those receiving alternative first-line ADs.MethodsThese secondary analyses are based on a naturalistic, multinational cross-sectional study conducted by the European Group for the Study of Resistant Depression at ten research sites. We compared the socio-demographic and clinical characteristics of 1410 patients with primary MDD, who were either prescribed SSRIs or alternative substances as first-line AD treatment, using chi-squared tests, analyses of covariance, and logistic regression analyses.ResultsSSRIs were prescribed in 52.1% of MDD patients who showed lower odds for unemployment, current severity of depressive symptoms, melancholic features, suicidality, as well as current inpatient treatment compared to patients receiving alternative first-line ADs. Furthermore, patients prescribed SSRIs less likely received add-on therapies including AD combination and augmentation with antipsychotics, and exhibited a trend towards higher response rates.ConclusionA more favorable socio-demographic and clinical profile associated with SSRIs in contrast to alternative first-line ADs may have guided European psychiatrists’ treatment choice for SSRIs, rather than any relevant pharmacological differences in mechanisms of action of the investigated ADs. Our results must be cautiously interpreted in light of predictable biases resulting from the open treatment selection, the possible allocation of less severely ill patients to SSRIs as well as the cross-sectional study design that does not allow to ascertain any causal conclusions.

Clinical decision-making style preferences of European psychiatrists: Results from the Ambassadors survey in 38 countries.

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. 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. 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. 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.

COVID-19 and cap: What changed in training and practice for early career child/adolescent psychiatrists?

The Covid-19 pandemic has transformed the world since the beginning of 2020 and many aspects of health care provision has changed dramatically. Despite not being regarded as a frontline field at first look, Child and Adolescent Psychiatry (CAP) has been highly impacted by the pandemic as a fundamentally biopsychosocial branch. CAP specialty training has also become a different experience due to the reprioritization of health care services along with the restricting rules of the ‘new normal’. In this symposium presentation, we will discuss the effects of the Covid-19 pandemic on the training and practice of CAP specialty trainees and early career specialists through the results of the ‘Early Career Psychiatrists in Europe during COVID-19 outbreak’ survey study, organized by the EPA and EFPT. The survey covers different areas including reorganization of training/practice during the pandemic, personal experiences with Covid-19 and adoption of Telepsychiatry practices. This pan-European study is expected to shed a light on the emerging issues for young doctors in CAP to plan necessary improvements on a European scale.DisclosureNo significant relationships.

Early career psychiatrists in europe during COVID-19 outbreak: Results of the EPA ECPC-EFPT cross-sectional survey

The COVID-19 outbreak has left its mark on the work of mental health care staff. Many professionals had to radically change their working conditions or were delegated to work in different facilities, in many cases taking on different responsibilities with little time for training. Many psychiatrists overnight had to partially or fully start working within telemedicine. Due to the lockdown, psychiatric trainees in many countries were not able to complete their training as planned. The measures taken by the governments to limit the impact of the pandemic also affected the capacity to conduct research studies and directions of new research initiatives. Dr. Gondek will present the results of the EPA ECPC-EFPT Cross-sectional survey on the effects of the outbreak on work and wellbeing of Early Career Psychiatrists in Europe.DisclosureNo significant relationships.

Early career psychiatrists in europe during the COVID-19 outbreak: Results of the EPA ECPC-EFPT cross-sectional survey

Abstract BodyThe COVID-19 outbreak has left its mark on the work of mental health care staff. Many professionals had to radically change their working conditions or were delegated to work in different facilities, in many cases taking on different responsibilities with little time for training. Many psychiatrists overnight had to partially or fully start working within telemedicine. Due to the lockdown, psychiatric trainees in many countries were not able to complete their training as planned. The measures taken by the governments to limit the impact of the pandemic also affected the capacity to conduct research studies and directions of new research initiatives. Dr. Gondek will present the results of the EPA ECPC-EFPT Cross-sectional survey on the effects of the outbreak on work and wellbeing of Early Career Psychiatrists in Europe.DisclosureNo significant relationships.

Identification and management of cardiometabolic risk in subjects with schizophrenia spectrum disorders: A Delphi expert consensus study.

Patients with schizophrenia spectrum disorders (SSD) have worse physical health and reduced life expectancy compared to the general population. In 2009, the European Psychiatric Association, the European Society of Cardiology and the European Association for the Study of Diabetes published a position paper aimed to improve cardiovascular and diabetes care in patients with severe mental illnesses. However, the initiative did not produce the expected results. Experts in SSD or in cardiovascular and metabolic diseases convened to identify main issues relevant to management of cardiometabolic risk factors in schizophrenia patients and to seek consensus through the Delphi method. The steering committee identified four topics: 1) cardiometabolic risk factors in schizophrenia patients; 2) cardiometabolic risk factors related to antipsychotic treatment; 3) differences in antipsychotic cardiometabolic profiles; 4) management of cardiometabolic risk. Twelve key statements were included in a Delphi questionnaire delivered to a panel of expert European psychiatrists. Consensus was reached for all statements with positive agreement higher than 85% in the first round. European psychiatrists agreed on: 1) high cardiometabolic risk in patients with SSD, 2) importance of correct risk management of cardiometabolic diseases, from lifestyle modification to treatment of risk factors, including the choice of antipsychotic drugs with a favourable cardiometabolic profile. The expert panel identified the psychiatrist as the central coordinating figure of management, possibly assisted by other specialists and general practitioners. This study demonstrates high level of agreement among European psychiatrists regarding the importance of cardiovascular risk assessment and management in subjects with SSD.

Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice.

The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations. The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the "EPA Ambassadors", on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19. While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations. Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers.

Editorial introductions.

Editorial introductions.

Psychedelic Birth: Bodies, Boundaries and the Perception of Pain in the 1970s

Psychedelic Birth: Bodies, Boundaries and the Perception of Pain in the 1970s

The Black Cat dir. by Edgar G. Ulmer, and: I Walked with a Zombie dir. by Jacques Tourneur, and: High and Low dir. by Akira Kurosawa, and: The Pumpkin Eater dir. by Jack Clayton, and: Gentlemen Prefer Blondes dir. by Howard Hawks, and: War and Peace dir. by Sergei Bondarchuk

Reviewed by: The Black Cat dir. by Edgar G. Ulmer, and: I Walked with a Zombie dir. by Jacques Tourneur, and: High and Low dir. by Akira Kurosawa, and: The Pumpkin Eater dir. by Jack Clayton, and: Gentlemen Prefer Blondes dir. by Howard Hawks, and: War and Peace dir. by Sergei Bondarchuk Jefferson Hunter (bio) Film Chronicle: The Black Cat, directed by Edgar G. Ulmer (Universal Vault Series, 2013; Amazon Prime streaming) I Walked with a Zombie, directed by Jacques Tourneur (Turner Home Entertainment, 2005; Amazon Prime and Criterion Channel streaming) High and Low, directed by Akira Kurosawa (Criterion Collection, 2011; Amazon Prime and Kanopy streaming) The Pumpkin Eater, directed by Jack Clayton (Powerhouse, 2017; Amazon Prime streaming) Gentlemen Prefer Blondes, directed by Howard Hawks (Twentieth-Century Fox, 2014; Amazon Prime streaming) War and Peace, directed by Sergei Bondarchuk (Criterion Collection, 2019; Criterion Channel streaming) Edgar G. Ulmer, one of the many Jewish filmmakers who fled Hitler's Germany for Hollywood, had designed sets for Max Reinhardt and collaborated with Billy Wilder and others on the innovative German documentary Menschen am Sonntag, and with those credentials he quickly found work in California. The second feature he made there, Universal's The Black Cat (1934), brought Boris Karloff and Béla Lugosi together onscreen for the first time and no doubt for that reason became a big hit. Viewed nowadays, it seems a rare old piece of hokum, entertaining, sometimes unintentionally funny, occasionally chilling. The screenplay is credited to Peter Ruric, a pseudonym for Paul Cain, one of the most lurid and violent of 1930s pulp writers. At the start his story could scarcely be more conventional. An innocent American couple on honeymoon in the Carpathians—ever since F. W. Murnau's Nosferatu, the location of choice for horror movies—encounters a suave and mysterious European psychiatrist (Lugosi). Then after a road accident they take shelter from the dark and the rain—the weather of choice for horror movies—in the fortress home of a suave and mysterious European architect (Karloff, here wearing heavy eyeliner and a bizarre widow's peak rather than monster make-up). The architect, it develops, is a Satanist. He stores the dead bodies of beautiful white-gowned women in glass cabinets and gloats over the collection while fondling his pet black cat. Furthermore, by magical powers he seems to make the American couple kiss (an action shown in an artful deep-focus shot contrived by Ulmer and his cinematographer, John J. Mescall), then plays Bach on the organ before presiding over a Black Mass with chanted Latin. By this point the film has grown creepy rather than conventional, and the creepiness, in spite of being countered every now and then by the downhome Americanness of the [End Page 281] young husband ("Sounds like a lot of supernatural baloney to me"), stays in effect all the way to the violent final confrontation between psychiatrist and architect, wherein a flaying alive takes place. You will be relieved to hear it is shown in shadow rather than directly photographed. Universal's poster for the film blazons the title as "Edgar Allan Poe's The Black Cat." Poe did indeed write a story called "The Black Cat," the condemned-cell narrative of a dipsomaniac who perversely kills his pet black cat and then his wife, immures her behind a brick wall, and is finally driven to confess by his hysterical guilt. Clearly, Ulmer's film uses almost nothing of this plot except the black cat, which (as in Poe) is at first caressed, then killed. That business of the cabinet-enclosed female corpses may distantly recall Poe's secret-burial theme, and the overwrought visuals of Ulmer's film look like a stylistic response to Poe's no less overwrought prose ("the image of a hideous—of a ghastly thing—of the Gallows!—oh, mournful and terrible engine of Horror and of Crime—of Agony and of Death!"), but in making The Black Cat Universal was obviously less interested in reworking the story than in borrowing Poe's sure-fire title and co-opting his cultural standing. Karloff, Lugosi, and Poe—What a trio!, the studio publicists must have exclaimed...

Editorial introductions

Editorial introductions