Barriers to treatment of infectious and other somatic comorbidity in drug users.

BACKGROUND: Intensive use of illicit drugs in general and drug injecting in particular are associated with higher somatic co-morbidity, especially of infectious aetiology. The treatment participation of drug users is complicated by a number of barriers. MATERIAL AND METHODS: At the end of 2013, a cross-sectional questionnaire study was conducted on a non-random sample of 240 drug users (188 men and 52 women) recruited in low-threshold drug services in Prague based on their willingness to participate in the study. Drug injecting sometimes in their lifetime was reported by 237 respondents (98.8%), injecting drug use in the last 12 months by 232 (96.7%), and injecting drug use in the last 30 days by 228 (95.0%). The questionnaire included 38 of the 59 original items from the Barriers to Treatment Inventory (BTI). Factor analysis of these items was performed. In addition to the questionnaire survey, two focus groups with a total of 14 clients were carried out. RESULTS: The factor analysis resulted in a 5-factor model that was fed with 23 BTI items. The factors identified can be interpreted as: (1) difficulty entering treatment due to additional responsibilities (e.g. children, family, work, etc.), (2) previous poor treatment experience, fear and concerns about the treatment or negative attitudes of staff, (3) financial difficulties and formal barriers (health insurance debts, problems with the law, etc.), (4) concerns that entering treatment will be too complicated and difficult, (5) distrust of the treatment's ability to improve the client's life situation. The results of the focus groups have shown that drug users face stigmatization and discrimination in healthcare facilities. CONCLUSION: The access to treatment of infectious and other somatic co-morbidity in drug users is complicated by a number of barriers, which largely arise from the lifestyle and socio-economic situation associated with drug use and from negative experiences with the attitude of medical staff. Healthcare professionals should actively identify and respond to barriers to care among drug users by taking appropriate measures in the context of a multidisciplinary approach and cooperation.

The early improvement of depressive symptoms as a potential predictor of response to antidepressants in depressive patients who failed to respond to previous antidepressant treatments. Analysis of naturalistic data.

INTRODUCTION: Current studies suggest that improvement of depressive symptoms after 2 weeks of treatment could predict the subsequent response. The aim of our study was to compare the predictive effect of early improvement (EI) after 1 and 2 weeks of treatment in patients who had failed to respond to previous antidepressant treatments (≥1 unsuccessful antidepressant trial). METHOD: Seventy-one subjects were treated (≥4 weeks) with various antidepressants chosen according to the judgment of attending psychiatrists. We used three definitions of EI (MADRS reduction ≥20, 25, 30%) at both time points. Areas under curve (AUC) were calculated to compare predictive effect of EI. RESULTS: We found lower MADRS scores in weeks 1 and 2 in responders (≥50% reduction of MADRS, n=35) compared to nonresponders. AUCs of MADRS reduction for response prediction at week 1 and 2 were not significantly different (0.73 vs 0.8; p=0.24). CONCLUSION: The results indicate that improvement of depressive symptoms in the treatment of resistant patients may occur after the first week of treatment. The predictive potential might be comparable to that found after the second week of antidepressant intervention and be clinically meaningful.

The Information Technology Aided Relapse Prevention Programme in Schizophrenia: an extension of a mirror-design follow-up.

AIMS: Decreasing a number of hospital admissions is important for improving outcomes for people with schizophrenia. The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) programme enables early pharmacological intervention in psychosis by identification of prodromal symptoms of relapse using home telemonitoring via a phone-to-PC SMS platform. METHODS: This study was a 1-year extension of a previously published mirror-design follow-up evaluation of programme clinical effectiveness. In total, 73 patients with psychotic illness (45 patients from original sample and 28 newly added subjects) collaborating with 56 family members participated in the clinical evaluation. RESULTS: There was a statistically significant 77% decrease in the number of hospitalisations during the mean 396.8 +/- 249.4 days of participation in ITAREPS, compared with the same time period before participation in ITAREPS (Wilcoxon-signed ranks test, p < 0.00001), as well as significantly reduced number of hospitalisation days when in the ITAREPS (2365 hospitalisation days before and 991 days after ITAREPS enrolment respectively, Wilcoxon-signed ranks test, p < 0.003). CONCLUSION: The ITAREPS programme represents an effective tool in the long-term treatment of patients with psychotic disorders.

Czech men's drinking in changing political climates 1983-93: a three-wave longitudinal study.

AIMS: To analyse the relationships between political developments in the Czech Republic and the drinking behaviour of Czech men. DESIGN: A longitudinal (panel) design provided data collected on a cohort of 586 Czech men in three different political climates in 1983, 1988 and 1993. SETTING: In 1986-88 the ruling Communist party tried to reduce alcohol consumption in the country by a Gorbachev-inspired anti-alcohol campaign; after 1989 the re-establishment of democracy and a market economy abolished all political control over drinking and deregulated prices of beverage alcohol. PARTICIPANTS: A representative cohort of Prague men born 1950-61. MEASUREMENTS: Beverage-specific interview reports on drinking behaviour and questionnaire data on attitudes to drinking. FINDINGS: In those followed-up, mean alcohol consumption decreased between 1983 and 1988 by 26% and increased again by 16% between 1988 and 1993, mirroring per capita consumption in the Czech Republic. The same time trend was observed across all educational levels and also among men who were registered for alcohol abuse. Attitudes of the men to drinking changed minimally over the 10 years of follow-up. Individual attitudes to drinking interacted with the period effects: men with strong positive attitudes to drinking decreased their consumption less than others during the anti-alcohol campaign and such men increased their consumption more than the average during the liberalisation period. CONCLUSIONS: The downward and then upward in average alcohol consumption of the men during the 10 years of follow-up can be interpreted as affected partly by price changes and partly by changes in political control over drinking.

Predicting academic performance of medical students: the first three years.

OBJECTIVE: The purpose of this exploratory study was to identify a cluster of variables that would most economically explain variations in the grade point averages of medical students during the first 3 years of study. METHOD: Data were derived from a study of 92 students admitted to the 3rd Faculty of Medicine in 1992-1993 academic year and who were still in the medical school at the end of the sixth semester (third year). Stepwise regression analysis was used to build models for predicting log-transformed changes in grade point average after six semesters of study-at the end of the first, second, and third years. Predictor variables were chosen from four domains: 1) high school grade point averages in physics, mathematics, and the Czech language over 4 years of study, 2) results of admission tests in biology, chemistry, and physics, 3) admission committee's assessment of the applicant's ability to reproduce a text, motivation to study medicine, and social maturity, and 4) scores on the sentimentality and attachment scales of the Tridimensional Personality Questionnaire. RESULTS: The regression model, which included performance in high school physics, results of the admission test in physics, assessment of the applicant's motivation to study medicine, and attachment scale score, accounted for 32% of the change in grade point average over six semesters of study. The regression models using the first-, second-, and third-year grade point averages as the dependent variables showed slightly decreasing amounts of explained variance toward the end of the third year of study and within domains, changing the structure of predictor variables. CONCLUSIONS: The results suggest that variables chosen from the assessment domains of high school performance, written entrance examination, admission interview, and personality traits may be significant predictors of academic success during the first 3 years of medical study.

Prague women's drinking before and after the 'velvet revolution' of 1989: a longitudinal study.

Results are presented of a follow-up study in which a representative sample of 608 Prague women aged 20-49 years in 1987 at first interview was re-interviewed in 1992 3 years after the resolution that ended the 41 years of the Communist era in Czechoslovakia. The average yearly consumption of alcohol in the followed-up female sample increased between 1987-92 from a reported 3.6 litres to 4.8 litres. The percentage of heavier drinkers (with average daily consumption of over 20 g alcohol) increased from 7.2% to 14.0%. The women expressed increased tolerance of drunkenness in their attitudes to drinking. The consumption increase was mainly due to increased drinking frequency of spirits and to increased quantity of beer consumed per occasion. The consumption increase was largest in women working as free-lance and the newly emerging self-employed women; economically inactive women did not increase their consumption. Women who reported a positive impact of the socio-political changes on their personal lives and an expansion of social contacts also reported larger than average consumption increases. A coincidence of stressful, possibly self-inflicted, life events and increased alcohol use was observed and interpreted as probably a two-way influence.

[Validity of the Brief Psychiatric Rating Scale]. / Validita "Krátké psychiatrické posuzovací stupnice"--BPRS.

The internal structure and validity of terms used in the Brief Psychiatric Rating Scale (Overall and Gorham, 1962) was analyzed. The data which had been gained at the entrance examination of 1557 inpatients with the diagnosis according to ICD-9 (schizophrenia simplex, schizophrenia paranoids, schizoaffective disease depressive type, schizoaffective disease manic type, manic-depressive disease manic phase, manic-depressive disease depressive phase) were processed using stepwise discriminant analysis (SDA). Three-dimensional space defined by SDA provided a sufficient frame of relations for the majority of diagnostic groups. Incomplete component analysis justified the assumption of a relatively stabile internal structure of the method. The findings allow to recommend the Czech version of the scale for the purpose of description of psychic impairments in psychiatry.

The substance specificity of psychosocial correlates of alcohol, tobacco, coffee and drug use by Czech women.

The paper reports results of an analysis based on face-to-face interviews with two samples of Prague women aged 20-49: (1) a probabilistic sample (n = 718) of the Prague female population; and (2) a sample of 152 inpatients treated for substance dependence/abuse. Of the inpatients, 79% were diagnosed as alcohol dependent only, 15% as both alcohol dependent and drug dependent/abusers, 6% as drug dependent only. With very few exceptions, those with drug problems among the inpatients abused analgesics, hypnotics, or anxiolytics. With data obtained from the general population sample, two-stage hierarchical logistic regression was run with each of the eleven differently defined substance uses as dependent variables. Four demographic variables were entered as predictors into the regression equations in the first stage. From the seven potential risk factors of substance use statistically significant predictors were entered stepwise in stage two. The major result of the study is the specificity of the pattern of predictors related to each of the eleven considered substance uses. It is also found that in the general population the use of a particular substance is generally uncorrelated with the use of other substances. Alcohol use (even heavy alcohol use) has no relation to smoking, to the use of analgesics, hypnotics, anxiolytics--and is connected with a specific pattern of predictors.

A case-control study of risk factors of alcohol misuse in Czech women: are there four types of female alcoholism?

Three samples of Prague women aged 20-49 were interviewed with regard to hypothetical risk factors of alcoholism: 139 inpatients diagnosed as alcohol dependent, 39 inebriated females admitted for 1-day detoxification, and 718 randomly selected women (the controls). Irrespective of case definition, father's alcoholism, incomplete family of origin, conduct disorders in childhood and adolescence, and social surroundings marked by heavy drinking were supported as risk factors of alcoholism. A factor analysis of alcohol-related problems led to two dimensions (dependence, disruptiveness) and consequently to four types of female alcoholism with different patterns of risk factors.

[Reliability of the psychiatric section in the 10th revision of the International Classification of Diseases]. / Reliabilita psychiatrické cásti 10. revize Mezinárodní klasifikace nemocí.

In collaboration with WHO the authors participated in sessions on the reliability of the Vth chapter of mental disease of the 10th revision of the International Classification of Diseases. The object was to evaluate the comprehensibility and utility of the diagnosis of mental disorders, evaluate to what extent the new classification describes adequately disorders of different types of psychiatric patients and to provide information on the extent and type of diagnostic agreement and disagreement. The evaluation was done by four psychiatrists; a total of 38 written case-histories were evaluated (30 patients of the Psychiatric Research Institute and 8 case-histories from other centres). Diagnostic agreement according to Kappa was very good, best in organic mental disorders and schizophrenic disorders, approximately equal in affective and neurotic disorders. It was lowest in personality disorders. The investigation indicates diagnostic agreement practically equal to that in ICD-9. More reliable data will be obtained after summarization of the entire WHO investigation which was implemented in various departments in the world.

Heart rate response as indicator of mental strain: interaction of personality and situational factors.

Relation between mental strain defined as heart rate deviation score from person's baseline and persistence-excitation concept based on the Eysenck personality theory under various density information flow was investigated. Two groups the HPE(high EPQ-N and low EPQ-E score) and the LPE(low EPQ-N and high EPQ-E score) of a nuclear power plant operators were investigated under a monotonous condition (HPE: 15 Ss; LPE:12 Ss) and under a high density information flow condition (HPE: 17Ss, LPE: 15 Ss). The data support the view that the high persistence-low inhibition individual will be more mentally strained under high density information flow and that the level of strain will decelerate more slowly in comparison to persons with low persistence-high inhibition EPQ characteristics. The low persistence-high inhibition individuals will experience higher mental strain under monotonous situations. The findings suggest that the average EPQ-E and EPQ-N score might be useful criterion for selecting persons for tasks with alternatively monotonous and cognitively demanding situations.

Alcohol abuse and its psychosocial correlates in sons of alcoholics as young men and in the general population of young men in Prague.

A sample of 107 sons of alcoholics aged 22-33 is compared to a representative sample of 1,274 Prague men of the same age range with respect to alcohol abuse and its psychosocial antecedents and correlates. Data sources were cumulative records of alcohol abuse in health care files and interviews. The estimated relative risk of alcohol abuse for sons of alcoholics versus other men is about 3.5 with both registration and self-report criteria if a broad definition of abuse is adopted. If, however, serious registered abuse and/or medical treatment of alcoholism at or before age 22 is the criterion of abuse, the estimated relative risk is about 10. In both compared samples, father's low education, discontinued family socialization and undisciplined behavior in childhood were antecedents of abuse registered at or before age 22. Self-reported abuse in the 6 months before interview had similar psychosocial correlates in both samples (heavily drinking friends, a positive attitude to heavy drinking, etc.). In both samples about 40% began to drink regularly at 17 or earlier. However, early start of drinking led very frequently to early registered abuse in sons of alcoholics whereas no such contingency was observed in the general male population.

Verapamil in affective disorders: a controlled, double-blind study.

Eighty-six depressed inpatients were divided into four groups: patients in each of three groups were treated, respectively, with identical capsules of verapamil, amitriptyline, or placebo, whereas the fourth group was treated eclectically by the ward physician with so-called state-adjusted treatment (SAT). Each treatment period lasted 5 weeks. Psychopathology was assessed with the Hamilton Rating Scale for Depression, by the Zung self-rating scale, by the 100-mm analog scale, and by general clinical impression. Results indicated that amitriptyline and SAT were superior to verapamil or placebo. There was no significant difference between verapamil and placebo or between SAT and amitriptyline. This finding was more definitive in the homogeneous subgroup of 55 women with DSM-III diagnosis of Major depression. In addition, 12 manic inpatients (DSM-III) were treated orally with verapamil, 24 with neuroleptics, and 11 with both neuroleptics and lithium carbonate. The decline of their psychopathology, assessed by the Brief Psychiatric Rating Scale (BPRS) and general impression, was fully comparable. Using Analysis of Variance (ANOVA), the statistical difference among courses of psychopathology expressed as total BPRS scores reaches borderline significance in favor of verapamil. In contrast to neuroleptics, verapamil did not induce any sedative, hypnotic, or cataleptic effects, and was well tolerated.

Psychometric properties of the Zung Self-Rating Depression Scale.

Some psychometric parameters of the instrument were estimated using a sample of depressed patients and a sample of normal subjects from the Czech population. The findings considerably support the hypothesis that the SDS items belong to the same psychometric family. Most items and the scale as a whole show a remarkable ability to discriminate between normal subjects and those suffering from depressive disorder. The result also rather convincingly indicate the SDS capacity to monitor changes of depressive disorder symptoms during treatment to be rather independent of relatively stable personality traits as measured by the EPQ. It might be concluded that the SDS psychometric parameters qualify the instrument for measurement of milder forms of depressive disorder in the Czech population.