[Crisis intervention for serious mental disorders. The example of the First Department of Psychiatry of Athens University].

We describe the crisis management and resolution service for serious mental disorders established by the First Department of Psychiatry of the National and Kapodistrian University of Athens. The service is intended to meet patients' needs for adequate management of acute mental crisis without hospitalization, while implementing modern standards in mental care and considering existing restrictions in mental health resources and public expenditure. Last decade we witness an increase in demand for psychiatric beds in Psychiatric clinics of General Hospitals resulting in a drastic increase of auxiliary beds that becomes a serious problem in mental health provision. The shutdown of big psychiatric hospitals in the process of psychiatric reform, accompanied by a delay in the establishment of all the anticipated beds in general hospitals together with overloaded and insufficient network of mental health services in the community are the major determinants. Additionally, fiscal economic crisis of the last decade intensified even more the problem by diminishing funding for the recruitment of new personnel and drastically reducing allocated funding for new and old services. In 2016 we set up a crisis intervention service for serious mental disorders within the operational framework of the emergency psychiatric services of the Department of Psychiatry in Eginition Hospital in Athens. The crisis resolution team is composed by two psychiatrists, a psychiatric nurse, social workers, a psychologist, mental health volunteers, and mental health trainees/students. The patient enters the service through the emergency service when an indication for hospitalization is given by the emergency psychiatrist, followed by the clinical estimation of a member of our team. The therapeutic team convenes twice a week for the new entrants and for follow-up sessions with the participation of the patient and the family members whenever feasible. The rest of the therapeutic interventions take place during the week. The work 'with' the person and not 'to' the person encapsulates the philosophy of the service, which is characterized by a holistic treatment approach aiming to empower the individual strengths and sense of control of the patient for crisis resolution on the basis of a safe therapeutic milieu. Therapeutic interventions include family and supportive members, as well as community interventions. In summation, interventions consist of a) comprehensive evaluation (psychiatric/ physical) and therapeutic plan, b) psychopharmacological treatment, c) psychotherapeutic support for the patient and the family for management of the crisis, d) training for the management of future crises and e) referral to appropriate community services for follow up management and treatment. Treatment lasts approximately 6-8 weeks. Initial data of the evaluation study indicate clinical effectiveness and high levels of satisfaction for patients and family. Conclusively, crisis management and resolution services are feasible even in a time of heavy restrictions in recourses, and anticipated benefits are multiple for the economy, mental health provision, the public health system, patients and relatives alike.

[New patients' access to psychiatric treatment services: Improving the quality indicators of mental health services].

Accessibility of patients to the health system as well as the system's rapid and effective response to patients' needs constitute basic quality indices of health services. Major parameter of accessibility is the required waiting time for a new patient to enter the health system. We present the results of the use of an organized system for the management of new requests for psychiatric treatment, which is based on the triage and evaluation of priorities. While taking into consideration the administrative distribution of the health services, our system intervenes in the waiting time by evaluating the requests in terms of medical and moral criteria, via gradual prioritization. Principal aim is waiting time reduction as well as the optimal response of our service to the needs of our patients. This perspective study was based on the new requests. The 1839 (100%) requests for first psychiatric evaluation at the outpatient clinic of Eginition University Hospital in 2019 were studied in relation to different parameters, as well as the efficacy of the system in terms of waiting-time management. Mean age of the petitioners was 45.8 (± 16.8), with statistically significant rate of women over men (N=1062, 59.1%, p˂0.05). The initial communication with the petitioners and the evaluation of the requests rendered the correct management feasible via immediate referrals to special psychiatric services depending on the nature of the cases, as well as redirection to their local psychiatric services for 1057 (57,5%) of the requests, where needed. The remaining 595 (33,4%) requests, after their assortment into three categories of graded prioritization, were placed in outpatient psychiatric clinics after waiting time of 25 days, 50 days and 76 days, respectively. In conclusion, the results of the study show that the systematic management of psychiatric treatment requests, when scientifically and ethically substantiated, may provide mental health services with manifold benefits.Accessibility of patients to the health system as well as the system's rapid and effective response to patients' needs constitute basic quality indices of health services. Major parameter of accessibility is the required waiting time for a new patient to enter the health system. We present the results of the use of an organized system for the management of new requests for psychiatric treatment, which is based on the triage and evaluation of priorities. While taking into consideration the administrative distribution of the health services, our system intervenes in the waiting time by evaluating the requests in terms of medical and moral criteria, via gradual prioritization. Principal aim is waiting time reduction as well as the optimal response of our service to the needs of our patients. This perspective study was based on the new requests. The 1839 (100%) requests for first psychiatric evaluation at the outpatient clinic of Eginition University Hospital in 2019 were studied in relation to different parameters, as well as the efficacy of the system in terms of waiting-time management. Mean age of the petitioners was 45.8 (± 16.8), with statistically significant rate of women over men (N=1062, 59.1%, p<0.05). The initial communication with the petitioners and the evaluation of the requests rendered the correct management feasible via immediate referrals to special psychiatric services depending on the nature of the cases, as well as redirection to their local psychiatric services for 1057 (57,5%) of the requests, where needed. The remaining 595 (33,4%) requests, after their assortment into three categories of graded prioritization, were placed in outpatient psychiatric clinics after waiting time of 25 days, 50 days and 76 days, respectively. In conclusion, the results of the study show that the systematic management of psychiatric treatment requests, when scientifically and ethically substantiated, may provide mental health services with manifold benefits.

EEG-based investigation of brain connectivity changes in psychotic patients undergoing the primitive expression form of dance therapy: a methodological pilot study.

Primitive expression (PE) is a form of dance therapy (DT) that involves an interaction of ethologically and socially based forms which are supplied for re-enactment. There exist very few studies of DT applications including in their protocol the measurement of neurophysiological parameters. The present pilot study investigates the use of the correlation coefficient (ρ) and mutual information (MI), and of novel measures extracted from ρ and MI, on electroencephalographic (EEG) data recorded in patients with schizophrenia while they undergo PE DT, in order to expand the set of neurophysiology-based approaches for quantifying possible DT effects, using parameters that might provide insights about any potential brain connectivity changes in these patients during the PE DT process. Indication is provided for an acute potentiation effect, apparent at late-stage PE DT, on the inter-hemispheric connectivity in frontal areas, as well as for attenuation of the inter-hemispheric connectivity of left frontal and right central areas and for potentiation of the intra-hemispheric connectivity of frontal and central areas, bilaterally, in the transition from early to late-stage PE DT. This pilot study indicates that by using EEG connectivity measures based on ρ and MI, the set of useful neurophysiology-based approaches for quantifying possible DT effects is expanded. In the framework of the present study, the causes of the observed connectivity changes cannot be attributed with certainty to PE DT, but indications are provided that these measures may contribute to a detailed assessment of neurophysiological mechanisms possibly being affected by this therapeutic process.

Homeless mentally ill in Athens area: a cross-sectional study on unmet needs and help-seeking.

BACKGROUND: Homelessness, a worldwide psychosocial phenomenon, is now also prevalent in Greece, mainly in Athens area. METHODS: The possible psychiatric morbidity related to help-seeking and the underlying factors were explored in a sample of 254 homeless people from Greater Athens area, using the Mini International Neuropsychiatric Interview (M.I.N.I.). RESULTS: The sample was predominantly male (74%) with mean age of 51 years, being in their majority homeless for over 25 months, 34.3% of them living in rough sleeping places. Overall, 56.7% of the sample met the criteria for a current Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) psychiatric disorder with 20.8% comorbidity. Only 36.2% of the identified psychiatric cases had any recent psychiatric care, while 44.4% were taking non-prescribed medication and 20.2% have been hospitalized in the last year. On the contrary, 70% of alcohol- and drug-dependent persons have been treated in a psychiatric agency, while 60.0% of them participated in rehabilitation program the last year. Logistic regression analysis revealed that being older, more educated with longer duration of homelessness, recognizing the suffering from a psychiatric problem as well as being diagnosed as 'psychotic' increased the likelihood to seek help. CONCLUSIONS: The vast majority of the homeless mentally ill persons were lacking any current psychiatric care. The planning of a mental health-care delivery parallel to the existing social welfare system is needed to serve the unmet mental health needs of this population.

Prevalence of psychiatric disorders among homeless people in Athens area: a cross-sectional study.

PURPOSE: Homelessness is a chronic social phenomenon in European and other Western cities. In the recent years, the number of homeless people in Greece, mainly in Athens, is also increasing. METHOD: The aim of this study was to explore the prevalence of psychiatric disorders among a sample of 254 homeless people, using the Mini International Neuropsychiatric Interview (M.I.N.I.). The sample was drawn from the existing shelters, soup kitchens, and the streets. RESULTS: The sample was predominantly male (74 %) with mean age 51 years, being in their majority homeless for over 25 months, 27 % of them living in the streets. The vast majority of the sample was single or separated with an education level <12 years. Current prevalence of psychiatric disorders was 56.7 % with 20.8 % comorbidity. For psychotic and mood disorders, current prevalence rates were 13 and 16 %, respectively. One year prevalence of alcohol and drug dependence was found to be low. Logistic regression analysis revealed that being older with higher number of months living in the streets and exposed to high frequency of adverse social events, increase the likelihood to become a psychiatric case. Finally, the vast majority of the identified psychiatric cases were lacking any current psychiatric care. CONCLUSIONS: The magnitude of the prevalence of psychiatric morbidity was more than three times higher than that of the general population in Athens. Implications for psychosocial care and the organization of a support network for the homeless people are discussed.