Impact on psychiatric interns of watching live electroconvulsive treatment.

OBJECTIVE: Watching a live electroconvulsive treatment (ECT) has both positive and negative effects on spectators. The authors aim to survey the attitude change towards ECT in interns after watching a live ECT session. METHODS: A 23-item questionnaire was administered to 66 interns before and after watching ECT. RESULTS: In five statements, the number of answers indicating negative attitudes decreased significantly after viewing ECT. A general change in attitude towards ECT depended on the interns' knowledge about the treatment. In the group of interns claiming minimal knowledge about ECT, a positive attitude change toward ECT and an increase in the acceptance of ECT were found, while in the group with moderate self-rated knowledge no significant attitude change, but a decrease in acceptance, were detected. CONCLUSION: The visual information on ECT reduced the interns' negative attitudes, in general; however, acceptance of the treatment decreased in a subgroup of interns.

Survey of referrals to electroconvulsive therapy in Hungary.

BACKGROUND: The diagnostic distribution of patients treated with electroconvulsive therapy (ECT) in Hungary is significantly different from that in Western Europe or the USA. In Hungary most of the treated patients are diagnosed with schizophrenia. AIM: To analyze the practice of referring patients for ECT in Hungary. METHODS: Questionnaires containing socio-demographic data were mailed to all Hungarian psychiatric units where ECT was used (n=34), and all of the psychiatrists working there were invited to participate. Respondents were asked to rate how often they considered ECT for various symptoms/syndromes on a five-point Likert Scale. RESULTS: A total of 78 questionnaires were returned. Altogether, 89% of the respondents have referred patients to ECT, and 54.8% had done so in the last year. The respondents had most frequently recommended ECT for antipsychotic and antidepressant-resistant patients, catatonic symptoms, or patients with previous good treatment response to ECT. CONCLUSION: Considering the very high Hungarian suicide rate, the low referral rate in cases of severe suicidal intent and threat is surprising. The respondents also rarely considered ECT for NMS or severe depression. The discrepancy between current referral practices and standard recommendations could be decreased with more ECT training courses.

[Psychiatric disorders leading to noncompliance in a consultative psychiatric practice]. / Noncompliance-hez vezeto pszichiátriai zavarok a konzultációs pszichiátriai gyakorlatban.

INTRODUCTION: Noncompliance is a complex problem which can appear in each phase of the medical treatment. Lack of cooperation can cause difficulties in the examinations, during the invasive interventions following the diagnostic process, and also in the pharmacological treatment. Among the reasons leading to noncompliance, psychiatric disorders concomitant with somatic disturbances play a major role. AIM: To study the most common psychiatric disorders leading to noncooperative behavior through the examination of those cases, in which the reason of the psychiatric consultation was noncompliance. METHOD: The documentation of a five years period's consultations was retrospectively studied in the Consultation-Liaison Psychiatric Service of Szt. László Hospital. In this publication we discuss those consultations which were requested because of noncompliance. RESULTS: Dementia (27.3%) and affective disorders (40.9%) were most commonly diagnosed in noncompliance patients. Diabetes, pulmonary and renal failures were more frequent in noncompliance patients than in the whole consulted patient group. CONCLUSIONS: As comorbid depression is appearing more frequently in chronically ill patients, and because noncompliance is more frequent in depressed individuals, screening of depression in patients with diabetes, pulmonary and renal failure is a good chance in the prevention of noncompliance.

[Impact of comorbid psychiatric disorders on the length of stay and the cost of medical treatment among geriatric patients treated on internal medicine wards]. / Idos, belgyógyászati fekvobetegek komorbid pszichiátriai állapotainak hatása a kórházi kezelés idotartamára és a kezeléssel kapcsolatos költségekre.

INTRODUCTION: Coexistence of psychiatric comorbidity is very common in patients hospitalized with somatic problems. Several studies have shown that comorbid dementia increases the length of stay (LOS) in hospitals. The literature is more contradictory in the case of anxiety disorders, substance-related disorders, mood disorders and delirium. AIMS: Our aim was to explore the influence of psychiatric comorbidity on the average length of hospital stay and the related costs among geriatric patients treated in internal wards. METHODS: The examination was conducted on two departments of internal medicine for 3 months on all admitted patients above 65 years. Four psychometric tests were carried out in the first three days after hospitalization as a screen for psychiatric comorbidity. RESULTS: In the whole study group the incidence of a depression syndrome of various severity reached 56%. We have not identified any difference in LOS when the depressive and non-depressive groups were compared. 59% of the patients showed some degree of cognitive impairment. Mean LOS was 7.4 days longer among patient suffering in severe dementia than in the group showing no cognitive deficit. CONCLUSION: Our results have demonstrated that of the investigated psychiatric comorbid conditions, an increased LOS is connected only with dementia. The degree of the cognitive impairment shows a positive correlation with the length of stay and the cost of medical treatment. Given the high incidence rate of affective syndromes, it can be assumed that comorbid depression increases the chance of admission to an internal medicine ward with some somatic complaints. This can be attributed to a larval stage of depression manifesting as somatic symptoms.

[Gerontopsychiatric problems in a consultation-liaison practice]. / Gerontopszichiatriai problémák megjelenése a konzultációs pszichiátriai gyakorlatban.

UNLABELLED: The most effective way for the diagnosing and the treatment of psychopathological symptoms appearing in non-psychiatric hospitalized patients is the utilization of consultation-liaison psychiatry. With the increasing number of the elderly patients, number of appearing gerontopsychiatric problems in consultation work is also growing. AIM: We have studied among the patients of a consultation-liaison service the problems which led to the psychiatric consultations, the diagnoses which were set up, the concomitant somatic disorders and the treatment recommendations. METHOD: We have retrospectively studied the data of the patients in the consultation-liaison service of St. László Hospital. RESULTS: 77% of the consultations were asked from internal medicine. Most frequent reason of the requests were the presence of any psychiatric symptom, but unexplained somatic complains were also common. Gerontopsychiatric problems were most frequently associated to cardiovascular disorders. Demencia and delirium were the most frequent diagnoses. The rate of affective disorders was higher than reported in the literature. CONCLUSIONS: Consultations were most frequently asked for non-compliance in patients with demencia, and for unexplained somatic complain in affective disorders. Most frequent reason of psychiatric referrals was symptoms of delirium. Authors try to explain these results in accordance with the literature.