Psychiatry training in 42 European countries: A comparative analysis.

Psychiatry qualifications are automatically recognized among European Union (EU) countries despite differences in national training programs. A widening gap between the number of psychiatrists, their competencies and the growing burden of mental illnesses in Europe has renewed calls for international standardization of training. Comprehensive information about training programs is missing, which limits thorough comparisons and undermines development of an actionable strategy to improve and harmonize psychiatry training. This study describes and compares the existing postgraduate psychiatry programs in 42 countries in the European region. Representatives of national psychiatry associations completed a semi-structured, 58-item questionnaire. Training structure and working conditions of each country were compared with population needs calculated by the World Health Organization to determine the European mean and contrasted among pre-2004 and post-2004 EU members and countries with unrecognized qualifications. Differences were tested with nonparametric (Wilcoxon) and parametric (Anova) tests. Median training duration was 60 months, significantly shorter in countries with unrecognized qualifications (48 months, χ²16.5, p < 0.001). In 80% of the countries, placement in a non-psychiatric specialty such as neurology or internal medicine was mandatory. Only 17 countries (40%) stipulated a one-month rotation in substance abuse and 11 (26%) in old-age psychiatry. The overall deficit of training versus population need was 22% for substance abuse and 15% for old-age psychiatry. Salaries were significantly higher in pre-2004 EU members (χ²22.9, p < 0.001) with the highest in Switzerland (€5,000). Significant variations in curricula, training structure and salaries exist in Europe. Harmonization of training standards could offer significant benefits for improving mental healthcare.

[Disruptive Mood Dysregulation Disorder: a controversial new diagnostic entity in the DSM-5]. / Disruptive Affektregulations- störung: eine umstrittene neue Diagnose im DSM-5.

The Disruptive Mood Dysregulation Disorder (DMDD) was included for the first time in the 5th Revision of the DSM. A transatlantic controversy surrounding the clinical picture and prevalence of early-onset bipolar disorder gave the occasion to develop a new diagnostic category in the chapter "Depressive Disorders" capturing a behavioral phenotype of non-episodic, chronic irritability and frequent temper tantrums. The present paper reviews the first available studies applying the new criteria. While DMDD can be clearly distinguished from bipolar disorder, preliminary evidence suggests a strong overlap with oppositional-defiant disorders (ODD). For the upcoming revision of the ICD it should be discussed to introduce a specifier indicating whether or not the presentation of ODD includes chronic irritability and anger, rather than establishing a new diagnosis. Regardless of the nosological categorization of the described behavioral phenotype main challenges represent a better understanding with regard to its etiology, developmental psychopathology and prognosis and the development of beneficial treatment options.

Sustained reduction of seizures in patients with intractable epilepsy after self-regulation training of slow cortical potentials - 10 years after.

The aim of this study was to determine whether the reduction of seizures in patients with intractable epilepsy after self-regulation of slow cortical potentials (SCPs) was maintained almost 10 years after the end of treatment. Originally, 41 patients received training with SCP-neurofeedback. A control group of 12 patients received respiratory feedback while another group of 11 patients had their anticonvulsant medications reviewed. Nineteen patients in the experimental group participated at least in parts of the long-term follow-up, but only two patients from each control group agreed to do so. The follow-up participants completed the same seizure diaries as in the original study. Patients of the experimental group also took part in three SCP-training sessions at the follow-up evaluation. Due to the small sample size, the results of participants in the control groups were not considered in the analysis. A significant decrease in seizure frequency was found about 10 years after the end of SCP treatment. The clinical significance of this result is considered medium to high. All patients were still able to self-regulate their SCPs during the feedback condition. This success was achieved without booster sessions. This is the longest follow-up evaluation of the outcome of a psychophysiological treatment in patients with epilepsy ever reported. Reduced seizure frequency may be the result of patients continued ability to self-regulate their SCPs. Given such a long follow-up period, the possible impact of confounding variables should be taken into account. The small number of patients participating in this follow-up evaluation diminishes the ability to make causal inferences. However, the consistency and duration of improvement for patients who received SCP-feedback training suggests that such treatment may be considered as a treatment for patients with intractable epilepsy and as an adjunct to conventional therapies.

[Bipolar depression in childhood and adolescence]. / Bipolare Depression im Kindes- und Jugendalter.

Depressive episodes in the course of bipolar disorders present various challenges for diagnosis and treatment. This review gives an overview of the epidemiology, etiology, diagnosis, course and the treatment of bipolar depression in children and adolescents as well as existing problems for clinical practice. Usually it takes a longer period until affected patients with bipolar disorder receive correct diagnosis and treatment. In many cases, unipolar and bipolar depressive episodes may only be distinguished in the long-term course. Manic episodes in children and adolescents often show atypical features, and hypomanic episodes are often not perceived as impairing. Comorbidities are common and complicate the diagnostic process. Up to now, there is no German child and adolescent psychiatric instrument to support diagnosis. Cogitive behavioural therapy, Interpersonal Therapy and Family-focussed Therapy for adolescents seem promising. Regarding psychopharmacotherapy there is only limited evidence to guide clinical decisions for youth. A better understanding of the prodromal phase appears to be important. Delay of treatment initiation could be minimized by a closer collaboration between the various treatment systems, e. g. using centers for early recognition.