Time is the enemy: Negative symptoms are related to even slight differences in the duration of untreated psychosis.

BACKGROUND: Negative symptoms (NS) represent a detrimental symptomatic domain in schizophrenia affecting social and occupational outcomes. AIMS: We aimed to identify factors from the baseline visit (V1) - with a mean illness duration of 0.47 years (SD = 0.45) - that predict the magnitude of NS at the follow-up visit (V3), occurring 4.4 years later (mean +/- 0.45). METHOD: Using longitudinal data from 77 first-episode schizophrenia spectrum patients, we analysed eight predictors of NS severity at V3: (1) the age at disease onset, (2) age at V1, (3) sex, (4) diagnosis, (5) NS severity at V1, (6) the dose of antipsychotic medication at V3, (7) hospitalisation days before V1 and; (8) the duration of untreated psychosis /DUP/). Secondly, using a multiple linear regression model, we studied the longitudinal relationship between such identified predictors and NS severity at V3 using a multiple linear regression model. RESULTS: DUP (Pearson's r = 0.37, p = 0.001) and NS severity at V1 (Pearson's r = 0.49, p < 0.001) survived correction for multiple comparisons. The logarithmic-like relationship between DUP and NS was responsible for the initial stunning incremental contribution of DUP to the severity of NS. For DUP < 6 months, with the sharpest DUP/NS correlation, prolonging DUP by five days resulted in a measurable one-point increase in the 6-item negative symptoms PANSS domain assessed 4.9 (+/- 0.6) years after the illness onset. Prolongation of DUP to 14.7 days doubled this NS gain, whereas 39 days longer DUP tripled NS increase. CONCLUSION: The results suggest the petrification of NS during the early stages of the schizophrenia spectrum and a crucial dependence of this symptom domain on DUP. These findings are clinically significant and highlight the need for primary preventive actions.

Attitudes of psychiatrists towards people with mental illness: a cross-sectional, multicentre study of stigma in 32 European countries.

Background: Mental health-related stigma occurs among the public and professionals alike. The lived experience of mental illness has been linked to less stigmatising attitudes. However, data on psychiatrists and the relationship between stigmatising attitudes and psychotherapeutic activity or case discussion groups remains scarce. Methods: A cross-sectional multicentre study was performed in 32 European countries to investigate the lived experiences and attitudes of psychiatrists toward patients with mental illness as well as the relationship between stigma, psychosocial and professional factors. The self-reported, anonymous, internet-based Opening Minds Stigma Scale for Health Care Providers was used to measure the stigmatising attitudes. The survey was translated into the local language of each participating country. All participants were practising specialists and trainees in general adult or child and adolescent psychiatry. The study took place between 2nd October, 2019 and 9th July, 2021 and was preregistered at ClinicalTrial.gov (NCT04644978). Findings: A total of 4245 psychiatrists completed the survey. The majority, 2797 (66%), had completed training in psychiatry, and 3320 (78%) worked in adult psychiatry. The final regression model showed that across European countries more favourable attitudes toward people with mental illness were statistically significantly associated with the lived experience of participants (including seeking help for their own mental health conditions (d = -0.92, 95% confidence interval (CI) = -1.68 to -0.15, p = 0.019), receiving medical treatment for a mental illness (d = -0.88, 95% CI = -1.71 to -0.04, p = 0.040), as well as having a friend or a family member similarly affected (d = -0.68, 95% CI = -1.14 to -0.22, p = 0.004)), being surrounded by colleagues who are less stigmatising (d = -0.98, 95% CI = -1.26 to -0.70, p < 0.001), providing psychotherapy to patients (d = -1.14, 95% CI = -1.63 to -0.65 p < 0.001), and being open to (d = -1.69, 95% CI = -2.53 to -0.85, p < 0.001) and actively participating in (d = -0.94, 95% CI = -1.45 to -0.42, p < 0.001) case discussion, supervision, or Balint groups. Interpretation: Our study highlights the importance of psychotherapy training, supervision, case discussions and Balint groups in reducing the stigmatising attitudes of psychiatrists toward patients. As the findings represent cross-national predictors, Europe-wide policy interventions, national psychiatric education systems and the management of psychiatric institutions should take these findings into consideration. Funding: National Youth Talent Award (Ministry of Human Resources, Hungary, (NTP-NFTÖ-20-B-0134). All authors received no funding for their contribution.

"I Didn't Expect to Be So Caught Up in It": a Qualitative Study of Experiences of Medical Students' Volunteering for Ukrainian Refugees.

OBJECTIVE: Russia's invasion of Ukraine in February 2022 triggered a huge wave of migration, with thousands of refugees arriving at Prague's Central Station. With no medical service available, medical students started to volunteer and were running an infirmary available around the clock. The research aimed to explore medical students' professional experiences, emotionally challenging situations, and coping strategies in this demanding setting. METHODS: The authors used a qualitative analysis of semi-structured in-depth interviews with 19 participants recruited through purposive sampling. Interviews took place between April and May 2022. Data were recorded, transcribed, and processed by using thematic qualitative analysis. RESULTS: The research identified five emotionally challenging situations: caring for traumatized refugees, refusal of treatment, disruption of everyday life, independent decision-making, and complexity of voluntary work. Students adopted both adaptive and maladaptive coping strategies for dealing with stress and trauma. Almost half the students reported signs of secondary traumatization and moral distress; however, no one asked for psychological help. CONCLUSIONS: Medical school curricula should cover trauma-informed approaches, healthy coping strategies, and destigmatization of psychological problems.

Psychometric properties of the Opening Minds Stigma Scale for Health Care Providers in 32 European countries - A bifactor ESEM representation.

Aims: To measure the stigma of healthcare providers toward people suffering from mental illness, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a commonly applied instrument. However, this scale has not been thoroughly validated in many European countries, its psychometric properties are still unknown and data on practicing psychiatrists is lacking. Therefore, this multicenter study aimed to assess the psychometric characteristics of the 15-item OMS-HC in trainees and specialists in adult and child psychiatry in 32 countries across Europe. Materials and methods: The OMS-HC was conducted as an anonymous online survey and sent via Email to European adult and child psychiatrists. Parallel analysis was used to estimate the number of OMS-HC dimensions. Separate for each country, the bifactor ESEM, a bifactor exploratory structural equation modeling approach, was applied to investigate the factor structure of the scale. Cross-cultural validation was done based on multigroup confirmatory factor analyses and reliability measures. Results: A total of 4,245 practitioners were included, 2,826 (67%) female, 1,389 (33%) male. The majority (66%) of participants were specialists, with 78% working in adult psychiatry. When country data were analyzed separately, the bifactor model (higher-order factor solution with a general factor and three specific factors) showed the best model fit (for the total sample χ2/df = 9.760, RMSEA = 0.045 (0.042-0.049), CFI = 0.981; TLI = 0.960, WRMR = 1.200). The average proportion of variance explained by the general factor was high (ECV = 0.682). This suggests that the aspects of 'attitude,' 'disclosure and help-seeking,' and 'social distance' could be treated as a single dimension of stigma. Among the specific factors, the 'disclosure and help-seeking' factor explained a considerable unique proportion of variance in the observed scores. Conclusion: This international study has led to cross-cultural analysis of the OMS-HC on a large sample of practicing psychiatrists. The bifactor structure displayed the best overall model fit in each country. Rather than using the subscales, we recommend the total score to quantify the overall stigmatizing attitudes. Further studies are required to strengthen our findings in countries where the proposed model was found to be weak.

The Challenges of Inter-role Conflicts for Peer Support Workers.

The definitions of the roles of peer support workers (PSWs) are unclear, creating one of the main challenges to PSWs' successful involvement in mental health care. In this empirical qualitative study conducted in the Czech Republic, four common roles of PSWs (N=15) were identified: friend, professional, staff member, and expert-by-experience. Conflicts were observed between the roles of friend and professional and between staff member and expert-by-experience. These conflicts may have a detrimental effect on the PSWs' well-being. The authors therefore call on organizations to prioritize regular supervision, team education, clear definition of the PSW position within an organization, and the destigmatization of people with mental illness in mental health services.

Stress management techniques for healthcare workers as an important professional tool to fight (not only) COVID-19 pandemics.

COVID-19 pandemics places extreme demands on healthcare workers. Mental health support is supposed to be an indispensable part of complex care for workers for the sake of their adequate professional performance and prevention of psychological disturbances and psychiatric disorders. The most common problems connected with hard work conditions are reviewed and specific techniques to deal with acute stress are presented.

Attitudes towards People with Mental Illness and Low Interest in Psychiatry among Medical Students in Central and Eastern Europe.

This study aimed to examine attitudes towards people with mental illness and psychiatry and interest in career choice in psychiatry among medical students from three medical schools in Czechia and Slovakia. A total of 495 medical students participated in a cross-sectional study. Participants completed (1) the Medical students' version of mental illness: clinicians' attitudes (MICA-2) scale, (2) the Reported and intended behaviour scale (RIBS), (3) the Attractiveness of working on a psychiatry-related position scale (P-ATTRACT), and (4) the Status of psychiatry scale (P-STATUS). Descriptive statistics, group comparisons and regression models were calculated. From 23 to 30% of students considered a specialization in psychiatry. However, only about 1% of them had a strong interest in psychiatry as a future career, moreover, students of higher years of study found psychiatry less attractive compared to those who are in the beginning of the study. The consideration of specialization in psychiatry was found to be statistically significantly associated with less stigmatizing attitudes and lower social distance towards people with mental illness. There were statistically significant differences in stigmatizing attitudes among medical schools, with a medical school emphasizing the education in psychiatry the most showing more positive attitudes. It is necessary to increase the interest in psychiatry and minimize stigma among medical students. Psychiatry curriculum in Central and Eastern European region should include more psychiatry-related courses, training in community and out-patient facilities, peer-lectors, and offer counselling after exposure to emotionally challenging clinical situations.

Impact of palliative care consult service in inpatient hospital setting: a systematic literature review.

OBJECTIVES: Despite a number of studies on effectiveness of palliative care, there is a lack of complex updated review of the impact of in-hospital palliative care consult service. The objective is to update information on the impact of palliative care consult service in inpatient hospital setting. METHODS: This study was a systematic literature review, following the standard protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Joanna Briggs Institute tools) to ensure the transparent and robust review procedure. The effect of palliative care consult service was classified as being associated with improvement, no difference, deterioration or mixed results in specific outcomes. PubMed, Scopus, Academic Search Ultimate and SocINDEX were systematically searched up to February 2020. Studies were included if they focused on the impact of palliative care consult service caring for adult palliative care patients and their families in inpatient hospital setting. RESULTS: After removing duplicates, 959 citations were screened of which 49 full-text articles were retained. A total of 28 different outcome variables were extracted. 18 of them showed positive effects within patient, family, staff and healthcare system domains. No difference was observed in patient survival and depression. Inconclusive results represented patient social support and staff satisfaction with care. CONCLUSIONS: Palliative care consult service has a number of positive effects for patients, families, staff and healthcare system. More research is needed on factors such as patient spiritual well-being, social support, performance, family understanding of patient diagnosis or staff stress.

Medical Students' Career Choice and Attitudes Toward Psychiatry: Case of the Czech Republic.

OBJECTIVE: A survey among medical students of all medical schools in the Czech Republic was conducted to investigate attitudes and views of psychiatry and career choice of psychiatry. METHODS: A Czech version of the Attitudes to Psychiatry Scale (APS) and a questionnaire surveying demographic characteristics and choices of future specialty were distributed to all medical students of eight medical schools in the Czech Republic via the schools' internal communication systems in the form of an anonymous online questionnaire. RESULTS: Out of a total of 10,147 medical students in the Czech Republic (academic year 2019/2020), 2418 students participated in the survey (response rate 23.8%). Psychiatry as a non-exclusive career choice was considered by 31.3% respondents; child and adolescent psychiatry was considered by 15.4% respondents. Psychiatry as the only choice was considered by 1.6%, and child and adolescent psychiatry was not considered at all. The interest in both specialties was declining since the first year of study. The status of psychiatry among other medical specialties was perceived as low; students were rather discouraged from entering psychiatry by their families. They did not feel encouraged by their teachers to pursue career in psychiatry despite the fact that they were interested in psychiatry. They also felt uncomfortable with patients with mental illness. CONCLUSIONS: Despite high enthusiasm for psychiatry in the first year of medical school, only a small proportion of medical students consider to choose psychiatry, and especially child and adolescent psychiatry, as a career at the end of medical school.

How to reduce stigmatization of people with mental illness in medical education: READ intervention.

Stigmatization of people with mental illness in health care is a serious problem contributing to poor provision of health care and preventive medicine, it decreases their willingness to seek help and reduces quality of their life and life expectancy. The aim of this study is to evaluate the impact of the anti-stigma training READ on medical students during their psychiatric module. The training was held by a psychiatrist and a peer lecturer. This study is a part of the international project INDIGO. A total of 53 medical students participated in this study (32 in intervention group, 21 in control group). Participants completed questionnaire at baseline and at immediate follow-up. It contained scales measuring attitudes, knowledge, empathy and intergroup anxiety. The intervention group demonstrated reductions in stigma-related attitudes, improvements in mental illness knowledge and reductions in intergroup anxiety. At immediate follow-up the control group demonstrated improvements in mental illness knowledge and reductions in intergroup anxiety. Based on the results of this study common psychiatric module at the medical school (including theoretical and practical education) does not contribute to the sufficient reduction of stigma. The training READ with an involvement of peer lecturers appears to be a convenient instrument how to reduce stigmatization of people with mental illness at medical schools. The contact with people who are not in the acute state of the illness is crucial for destigmatization.

Prevalence of late-life depression and gap in mental health service use across European regions.

Background We aimed to determine the prevalence and gap in use of mental health services for late-life depression in four European regions (Western Europe, Scandinavia, Southern Europe and Central and Eastern Europe) and explore socio-demographic, social and health-related factors associated with it. Methods We conducted a cross-sectional study based on data from the Survey on Health, Ageing and Retirement in Europe. Participants were a population-based sample of 28 796 persons (53% women, mean age 74 years old) residing in Europe. Mental health service use was estimated using information about the diagnosis or treatment for depression. Results The prevalence of late-life depression was 29% in the whole sample and was highest in Southern Europe (35%), followed by Central and Eastern Europe (32%), Western Europe (26%) and lowest in Scandinavia (17%). Factors that had the strongest association with depression were total number of chronic diseases, pain, limitations in instrumental activities of daily living, grip strength and cognitive impairment. The gap in mental health service use was 79%. Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization.

Mental illness stigma among medical students and teachers.

BACKGROUND: Medical school curriculum contributes to future doctors' attitude formation towards people with mental illness. AIM: The purpose of this study was to compare stigmatizing attitudes between medical students and faculty, analyse stigmatizing attitudes among students from different years of study and identify factors predicting stigma. METHODS: A cross-sectional study with the use of scales measuring attitudes and social distance was designed. Online questionnaires were distributed to all students and teachers at a medical faculty in the Czech Republic. RESULTS: The response rate was 32.1% ( n = 308) among students and 26.7% ( n = 149) among teachers. Teachers had a greater prevalence of stigmatizing attitudes than students. Increased tolerant attitudes in students were detected after the fourth year, that is, following introduction to psychiatry. Preferred specialization in psychiatry and attending two psychiatry courses predicted more tolerant attitudes. Among both students and teachers, men possessed more stigmatizing attitudes towards people with mental illness. Age was an important predictor of stigmatizing attitudes among teachers. CONCLUSION: Educators should pay closer attention to the role of medical psychology and communication training implementation, which may be beneficial to improving skills and increasing medical students' self-esteem and feeling of competence throughout their psychiatry rotation.

Psychoeducation for schizophrenia in the Czech Republic: curriculum modification based on opinions of service users and providers.

OBJECTIVE: The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic. METHODS: The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews. RESULTS: Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation. CONCLUSION: The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives' frustrations.

Effectiveness of the information technology-aided program of relapse prevention in schizophrenia (ITAREPS): a randomized, controlled, double-blind study.

PURPOSE: To evaluate the effectiveness of the Information Technology-Aided Program of Re lapse Prevention in Schizophrenia (ITAREPS). METHODS: Relapse-prone outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n=75) or control group (n=71). In the active arm, according to the protocol, investigators were prompted to increase the antipsychotic dose upon occurrence of a pharmacological inter vention requiring event (PIRE) detected by ITAREPS. RESULTS: Intention-to-treat (ITT) analysis found no between-group difference in the hospitalization-free survival rate at 12 months. However, the trial suffered from high non-adherence of investigators in the active group, with no antipsychotic dose increase in 61% of PIREs. Furthermore, Cox regression analysis showed a 11-fold increased risk of hospitalization in the absence of pharmacological intervention following a PIRE (hazard ratio [HR]=10.8; 95% confidence interval [CI] 1.4-80.0; p=0.002). Therefore, a post-hoc as-treated analysis was performed, which demonstrated a nine-fold reduction in the risk of hospitalization in ITAREPS Algorithm-Adherers (IAAs, n=25) compared with the ITAREPS Non-interventional group (INIs, n=70; Kaplan-Meier survival analysis, HR=0.11, 95% CI 0.05-0.28, p=0.009; number needed to treat [NNT]=4, 95% CI 3-10). A significant difference in favor of the IAA group was seen in the number of inpatient days (p<0.05) and costs (p<0.05). CONCLUSION: Future ITAREPS trials should target the underlying mechanisms that cause low investigator adherence to the program. TRIAL REGISTRATION: Clinical Trials NCT00712660.

[Education in schizophrenia: how patients and their relatives assess the relapse prevention programme PREDUKA]. / Edukace u schizofrenie: Jak pacienti a príbuzní hodnotí program prevence relapsu PREDUKA.

Antipsychotic medication and early relapse warning signs detection are the cornerstone of relapse prevention in schizophrenia spectrum disorders. Many patients do not use antipsychotic medication because of lack of information about its preventive effects and the risk of relapse. We introduce PREDUKA--PREventive EDUcational programme for relapse prevention. The goal of the programme is to deliver the information about schizophrenia to patients and their relatives. 178 patients and 252 relatives (118 mothers and 51 fathers) took part in 25 one-day psychoeducational programmes in 6 centres in the Czech Republic between January 2008 and June 2009 and anonymously fulfilled a short questionnaire. Patients and relatives assessed the programme with an average mark 1.4 (1 best, 5 worst). 49.4% patients and 49.0% relatives had received enough information about psychotic disorders during their hospitalization. Moreover 94.1% patients and 95.7% relatives confirmed acquiring new information on how to live with psychosis as a result of PREDUKA programme. 59.6% patients and 73.8% relatives were interested in ITAREPS - Information Technology Aided Relapse Prevention Programme. Mothers were significantly more interested (82.2%) than fathers (62.2%) (p = 0.031). Expressed high interest of patients and their relatives in both programmes indicates their readiness to become active and competent partners in the long-term treatment of schizophrenia spectrum disorders.

Subjective quality of life in psychiatric patients: diagnosis and illness-specific profiles.

OBJECTIVE: In accordance with the definition of health by the World Health Organization, outcome measures beyond mere syndromic recovery, such as quality of life ratings, would aid psychiatric practice and research. This is the first study of psychiatric diagnosis and illness stage specific profiles of subjective quality of life (SQOL) impairment. METHOD: Patients (n = 150) hospitalized at the Prague Psychiatric Center rated their SQOL using the Schwartz Outcome Scale at admission and discharge. Severity of illness and clinical improvement were measured by the Clinical Global Impression Scale. RESULTS: The highest and lowest SQOL at admission were reported by patients with psychosis and mood disorders respectively (F = 7.3, df = 2,147, P < 0.001). SQOL improved significantly during hospitalization in all diagnostic categories (F = 90.0, df = 1,147, P < 0.001), with the smallest and largest improvement in patients with psychosis and mood disorders, respectively (F = 5.6, df = 2,147, P = 0.005). There was a trend for differences in ratings of clinical improvement by patients, compared with psychiatrists, across diagnostic categories (F = 2.9, df = 2,147, P = 0.06), with significant differences only in patients with anxiety disorders. These patients also reported the lowest SQOL at discharge (F = 3.0, df = 2,147, P = 0.05). Global improvement correlated with improvement in SQOL only in patients with mood disorders (r = -0.4, P = 0.005). CONCLUSIONS: Main psychiatric diagnostic categories differ in SQOL and in association between SQOL and treatment. These differences may reflect illness-specific mechanisms, such as depressive symptoms in mood disorders, low insight in psychotic patients, aggravation of anxiety before discharge in patients with anxiety disorders, and may aid in planning of specific treatment interventions.

ITAREPS: information technology aided relapse prevention programme in schizophrenia.

ITAREPS presents a mobile phone-based telemedicine solution for weekly remote patient monitoring and disease management in schizophrenia and psychotic disorders in general. The programme provides health professionals with home telemonitoring via a PC-to-phone SMS platform that identifies prodromal symptoms of relapse, to enable early intervention and prevent unnecessary hospitalizations. Its web-based interface offers the authorized physician a longitudinal analysis of the dynamics and development of possible prodromes. This work presents preliminary findings from a one-year mirror-design follow-up evaluation of the programme's clinical effectiveness in 45 patients with psychotic illness. There was a statistically significant 60% decrease in the number of hospitalizations during the mean 283.3+/-111.9 days of participation in the ITAREPS, compared to the same time period before the ITAREPS entry (sign test, p<0.004). Variables significantly influencing the number of hospitalizations after the ITAREPS entry (medication compliance along with factors intrinsic to the ITAREPS, i.e. adherence to the programme and involvement of a family member) suggest a critical role of the programme in controlling the number of relapses and subsequent hospitalizations in psychosis.

Analysis of parasuicide, psychiatric care and completed suicides, implications for intervention strategy (Czech Republic, 1996-2000).

BACKGROUND: This retrospective study analyses the differences between suicide with and without previous parasuicide. The Czech Republic was one of the countries with the traditionally highest level of suicide mortality. During collapse of the communist regime and deep societal changes in the Czech Republic after the year 1989 the escalation of suicides was expected. Mortality from suicides decreased, however the gender and age differences increased. METHODS: A total of 2,711 suicides in the Czech Republic (1996-2000) were studied. Effects of socioeconomic characteristics, psychiatric diagnosis and care, and lifetime history of parasuicide on the risk of death from suicide were estimated using logistic regression. RESULTS: Twenty-three percent of persons who committed suicide had a prior history of parasuicide and almost twenty percent of them received no psychiatric care after the attempt. Young males with basic education, economically active and diagnosed with substance abuse related disorders and the elderly were least likely to receive psychiatric care before their suicide death. CONCLUSIONS: Implications for age specific primary and secondary prevention are discussed.