Perinatal psychiatry

Perinatal psychiatric disorders are common and can result in significant suffering for women and their families; indeed, suicide is a leading cause of maternal death. The most severe form of postpartum mood disorder – postpartum psychosis – follows approximately 1 in 1000 deliveries. Women with a history of bipolar disorder or who have suffered a previous severe postpartum episode are at a many hundred-fold increased risk, and their identification in the antenatal period is a key aspect of management. Decisions regarding the use of psychotropic medication in pregnancy must be made following a full risk–benefit analysis. Risks of taking many medications remain unknown but include teratogenic effects, withdrawal or toxic symptoms in the newborn and long-term developmental effects. However, these must be balanced against the risks of untreated mental illness and the risk of recurrence from stopping or switching well-established and efficacious medications. More data are clearly needed to inform the difficult choices regarding medication that women with severe mental illness are forced to make in regard to pregnancy

20 years on: The legacy of Daksha Emson for perinatal psychiatry

The tragedy of Daksha’s death illustrates both the importance of perinatal mental health and the stigma associated with doctors seeking help. With this letter, we express our hope that the lasting legacy of her and others’ tragic stories lies in the continuing improvement and worldwide expansion of perinatal psychiatric services and training so that those in greatest need receive the best care possible wherever — and whoever — they are

Are we training psychiatrists to develop skills in intellectual disability psychiatry? Current European context and future directions

The majority of people with intellectual disabilities (ID) and psychiatric disorders access mainstream mental health services across Europe. However, only 56% of countries provide postgraduate psychiatric training in ID according to a survey across 42 European countries. We explore the challenges of ID training and make recommendations for education and health policymakers. Keywords: Community Mental Health Teams; education and training; intellectual disability; learning disability; specialty trainin

Variations in patterns of involuntary hospitalisation and in legal frameworks: an international comparative study

Background Rising annual incidence of involuntary hospitalisation have been reported in England and some other higher-income countries, but the reasons for this increase are unclear. We aimed to describe the extent of variations in involuntary annual hospitalisation rates between countries, to compare trends over time, and to explore whether variations in legislation, demographics, economics, and health-care provision might be associated with variations in involuntary hospitalisation rates. Methods We compared annual incidence of involuntary hospitalisation between 2008 and 2017 (where available) for 22 countries across Europe, Australia, and New Zealand. We also obtained data on national legislation, demographic and economic factors (gross domestic product [GDP] per capita, prevalence of inequality and poverty, and the percentage of populations who are foreign born, members of ethnic minorities, or living in urban settings), and service characteristics (health-care spending and provision of psychiatric beds and mental health staff). Annual incidence data were obtained from government sources or published peer-reviewed literature. Findings The median rate of involuntary hospitalisation was 106·4 (IQR 58·5 to 150·9) per 100 000 people, with Austria having the highest (282 per 100 000 individuals) and Italy the lowest (14·5 per 100 000 individuals) most recently available rates. We observed no relationship between annual involuntary hospitalisation rates and any characteristics of the legal framework. Higher national rates of involuntary hospitalisation were associated with a larger number of beds (β coefficient 0·65, 95% CI 0·10 to 1·20, p=0·021), higher GDP per capita purchasing power parity (β coefficient 1·84, 0·30 to 3·38, p=0·019), health-care spending per capita (β coefficient 15·92, 3·34 to 28·49, p=0·013), the proportion of foreign-born individuals in the population (β coefficient 7·32, 0·44 to 14·19, p=0·037), and lower absolute poverty (β coefficient −11·5, −22·6 to −0·3, p=0·044). There was no evidence of an association between annual involuntary hospitalisation incidence and any other demographic, economic, or health-care indicator. Interpretation Variations between countries were large and for the most part unexplained. We found a higher annual incidence of involuntary hospitalisation to be associated with a lower rate of absolute poverty, with higher GDP and health-care spending per capita, a higher proportion of foreign-born individuals in a population, and larger numbers of inpatient beds, but limitations in ecological research must be noted, and the associations were weak. Other country-level demographic, economic, and health-care delivery indicators and characteristics of the legislative system appeared to be unrelated to annual involuntary hospitalisation rates. Understanding why involuntary hospitalisation rates vary so much could be advanced through a more fine-grained analysis of the relationships between involuntary hospitalisation and social context, clinical practice, and how legislation is implemented in practice

Symptom profile of postpartum and non-postpartum manic episodes in bipolar I disorder: a within-subjects study

The relationship of postpartum mania to episodes of mania occurring outside the perinatal period among women with bipolar disorder remains controversial. Previous studies have used between-subjects designs to compare the clinical presentations of these episodes meaning the differences, in part, may reflect between-group differences. To overcome this we have undertaken within-subject comparisons of the symptom profile of postpartum and non-postpartum manic episodes in 50 women with DSM-IV bipolar I disorder. For each woman detailed symptom information on a postpartum episode of mania and a comparison non-postpartum manic episode was collected. The occurrence of manic, psychotic and depressive symptoms in these episodes were compared. Postpartum manic episodes had a significantly higher incidence of perplexity and excessive self-reproach. Classic manic symptoms, specifically pressured speech and increased sociability, were significantly less frequent in postpartum manic episodes. Overall there were significantly fewer manic symptoms and significantly more depressive symptoms in the postpartum episodes than in the non-postpartum episodes. The mixed presentation of postpartum manic episodes suggests childbirth may act as a pathoplastic trigger in women with bipolar disorder. The differences in symptom profiles suggests further research is warranted into whether differences in treatment response exist among women experiencing postpartum and non-postpartum manic episodes

Joint European policy on the COVID-19 risks for people with mental disorders: An umbrella review and evidence- and consensus-based recommendations for mental and public health

As COVID-19 becomes endemic, identifying vulnerable population groups for severe infection outcomes and defining rapid and effective preventive and therapeutic strategies remains a public health priority. We performed an umbrella review, including comprehensive studies (meta-analyses and systematic reviews) investigating COVID-19 risk for infection, hospitalization, intensive care unit (ICU) admission, and mortality in people with psychiatric disorders, and outlined evidence- and consensus-based recommendations for overcoming potential barriers that psychiatric patients may experience in preventing and managing COVID-19, and defining optimal therapeutic options and current research priorities in psychiatry. We searched Web of Science, PubMed, and Ovid/PsycINFO databases up to 17 January 2022 for the umbrella review. We synthesized evidence, extracting when available pooled odd ratio estimates for the categories “any mental disorder” and “severe mental disorders.” The quality of each study was assessed using the AMSTAR-2 approach and ranking evidence quality. We identified four systematic review/meta-analysis combinations, one meta-analysis, and three systematic reviews, each including up to 28 original studies. Although we rated the quality of studies from moderate to low and the evidence ranged from highly suggestive to non-significant, we found consistent evidence that people with mental illness are at increased risk of COVID-19 infection, hospitalization, and most importantly mortality, but not of ICU admission. The risk and the burden of COVID-19 in people with mental disorders, in particular those with severe mental illness, can no longer be ignored but demands urgent targeted and persistent action. Twenty-two recommendations are proposed to facilitate this process

20 years on : the legacy of Daksha Emson for perinatal psychiatry

The tragedy of Daksha’s death illustrates both the importance of perinatal mental health and the stigma associated with doctors seeking help. With this letter, we express our hope that the lasting legacy of her and others’ tragic stories lies in the continuing improvement and worldwide expansion of perinatal psychiatric services and training so that those in greatest need receive the best care possible wherever — and whoever — they are

European Framework for Competencies in Psychiatry for Ensuring the Quality of Training for Psychiatrists and Care for People with Mental Health Disorders

Tema rada je prikaz kompetencija za zanimanje psihijatar prema Europskom okviru za kompetencije u psihijatriji (European Framework for Competences in Psychiatry, EFCP) Europske unije medicinskih specijalnosti (European Union of Medical Specialists, UEMS) - Odjela za psihijatriju. Rad opisuje sedam uloga liječnika-psihijatra s pridruženim kompetencijama, koje osiguravaju kvalitetu psihijatrijske skrbi, a mora ih steći svaki psihijatar da bi kvalitetno radio svoj posao: psihijatrijski stručnjak / klinički donositelj odluka, komunikator, suradnik, vođa, zagovornik zdravlja, učenik / znanstvenik i profesionalac. Svrha rada je povećati svijest o važnosti stjecanja specifičnih kompetencija za psihijatra, a osobito o potrebi procjene postignutih kompetencija u svim ulogama psihijatra, usporediti popis kompetencija u aktualnom programu specijalizacije iz psihijatrije u Hrvatskoj s EFCP popisom, te utvrditi postoji li potreba za revizijom hrvatskog programa specijalizacija iz psihijatrije. Metodologija: usporedba popisa kompetencija preporučenih u EFPC s popisom kompetencija iz hrvatskog programa specijalizacije iz psihijatrije. Glavni rezultati: usporedba EFPC-a s hrvatskim popisom kompetencija pokazuje razliku u pristupu klasifikaciji kompetencija: u EFPC-u se kompetencije opisuju u obliku sedam specifičnih uloga psihijatra, a u hrvatskom programu kompetencije su vezane za područja psihijatrije. Utvrđena je i razlika u metodama mjerenja, odnosno evaluacije o postignutim kompetencijama između hrvatskog i europskog programa evaluacije kompetencija za psihijatra. Zaključak: Usporedba EFCP-a s popisom kompetencija u hrvatskom programu specijalizacije iz psihijatrije upućuje na potrebu poboljšanja hrvatskog programa posebno u području procjene postignutih kompetencija za specijalista psihijatrije. Preporuke iz EFCP mogu biti korisne u analizi i reviziji svih europskih kurikuluma specijalizacije iz psihijatrije s ciljem harmonizacije izobrazbe za specijalista psihijatra u Europskoj uniji.The topic of this paper is a presentation of competencies for the profession of psychiatrist in the revised document of the European Framework for Competences in Psychiatry (EFCP) of the European Union of Medical Specialists (UEMS) - Section of Psychiatry. It describes the seven roles of physician-psychiatrist with the associated competencies that eachpsychiatrist needs to acquire to do his or her job according to high quality standards. It includes the following roles: a psychiatric expert/clinical decision maker, communicator, collaborator, team leader, scholar, advocate, and a professional. The purpose of this paper is to increase awareness of the importance of acquiring competencies, especially the need to assess the achieved competencies in all of the seven roles of psychiatrists, to compare the list of competencies in the current programme of specialization in psychiatry in Croatia with the EFCP list, and to determine whether there is a need to revise the Croatian programme of specialization in psychiatry. We have compared the list of competencies recommended in the EFPC with the list of competencies listed in the Croatian specialization programme in psychiatry. The main results established a difference in the approach to the classification of competencies. The EFPC describes the competencies using the model of seven roles of psychiatrists, whereas the Croatian list of competencies relates competencies to the fields of psychiatry. A difference from the recommended methods to measure the achievement of competencies has also been found. The comparison of the EFCP with the list of competencies in the Croatian specialization programme in psychiatry indicates the need to improve the Croatian programme, especially in terms of assessing the achieved competencies. One can use the EFCP in the analysis and audit of all EU specialization programmes in psychiatry, which can help in the harmonization of specialty training for psychiatrists at the EU level