Is There a Relationship between Objectively Measured Cognitive Changes in Cancer Patients Undergoing Chemotherapy Treatment and Their Health-related Quality of Life? A Systematic Review

Background/purpose: Many people living with cancer experience depression. Research suggests that the therapeutic effect of exercise on depression is similar to pharmacotherapy or psychological intervention, yet cancer survivors are under-exercising compared to recommended doses. Self-efficacy may be a factor to explain exercise engagement. This cross-sectional study investigated whether exercise task self-efficacy (ETSE) was associated with exercise engagement, further examining differences between cancer survivors with and without elevated depressive symptoms. \ud \ud Methods: Ninety-seven cancer survivors (60.8 ±9.9 years) were mailed self-report questionnaires on ETSE, exercise engagement, and depressive symptoms. A Hospital Anxiety and Depression Scale D cutoff score (≥8) was used to assign participants to a symptomatic (n = 34) or non-symptomatic group (n = 63). An independent t-test was used to examine differences in ETSE between groups. Correlational analyses were used to examine relationships between exercise task self-efficacy and exercise engagement. \ud \ud Results: There was a significant difference in the degree of exercise task self-efficacy between cancer survivors with (M=35.74, SD= 31.47) and without (M=57.30, SD= 26.71) depressive symptoms, t(95) =_3.56, p<0.01, with a large effect size (d =0.74). A positive association was found between ETSE and exercise engagement, r(95)= 0.49, p<0.01, which was similar for both groups. \ud \ud Conclusions: Exercise task self-efficacy appears to influence exercise engagement independently of mood status, but people with higher levels of depression symptoms tend to have lower self-efficacy. Therefore, future research should examine interventions to enhance exercise task self-efficacy, thereby potentially increasing exercise engagement in cancer survivors. Research Implications: These findings demonstrated that cancer survivors with depressive symptoms have low ETSE and that ETSE can predict exercise engagement. This suggests a role for enhancing ETSE to influence exercise engagement in cancer survivors. Future research could investigate causality between ETSE and exercise engagement and interventions to enhance ETSE. The findings of the present study could assist with more definitive research which could aid clinicians interested in behavioral change with regard to exercise engagement and improvement of depressive symptomatology in cancer survivors. Practice Implications: The findings illustrate that exercise self-efficacy predicts exercise engagement, independently of mood. Therefore, clinicians working with depressed or non-depressed cancer survivors should initially target increasing exercise self-efficacy as opposed to reinforcing the positive health benefits of increased physical activity

Compulsory admissions of patients with mental disorders : State of the art on ethical and legislative aspects in 40 European countries

Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of MedicineBACKGROUND.: Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. METHODS.: The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. RESULTS.: We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. CONCLUSIONS.: We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.Peer reviewe

Compulsory admissions of patients with mental disorders : State of the art on ethical and legislative aspects in 40 European countries

Background. Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. Methods. The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. Results. We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. Conclusions. We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.Peer reviewe

A cross-sectional study of service user needs in the Republic of Moldova first step of implementation of mental health reform

The Republic of Moldova has been undergoing a comprehensive national reform of its mental health system since 2014 in an effort to deinstitutionalize mental health care. The central aim was to implement a continuum of mental health care provided through family doctors, community mental health care teams and mental health care specialists in acute psychiatric wards and general regional hospitals. The current research was conducted in the context of an ongoing reform of mental health services in the Republic of Moldova since 2014, where efforts have been devoted to creating community-based mental health services. This paper presents a snapshot of the needs of mental health service users in the Republic of Moldova and helps to understand how and with which services their needs can be addressed in line with the triage and care pathway modifications made as part of the ongoing reform of the mental health services in the country. This cross-sectional study compared the levels of needs, quality of life, mental health status and functioning among mental health service users consecutively admitted to the psychiatric hospital in Chisinau, Moldova. All service users resided in one of the project’s pilot districts where community mental health services were being developed. Conclusions – There was a high number of unmet needs among this inpatient population, particularly social needs and service-related needs, which helps to guide future service delivery reform efforts in Moldova. A continuum of inpatient and outpatient care, and individual treatment plans can help address the different needs of different patients. Individual treatment plans for patients, and the choice of the appropriate treatment for patients could be guided successfully by an assessment of service users’ (unmet) needs of care and level of functioning

Comprehensive medical and functional assessment of patients with severe mental illnesses receiving care in period of reforming mental health system 2017-2020 in Republic of Moldova

Introduction: Prior to initiation of the mental health reform in August 2014, people with mental health problems were provided the bulk of their care in psychiatric hospitals or residential institutions. While care in institutions was central, a number of people with mental health problems quality for care in community-based settings, either in: a) primary care services led by family doctors and nurses; b) community mental health centers staffed by a multidisciplinary community mental health team, or c) short-term inpatient admission to an acute inpatient ward in a regional general hospital. To understand how many and which patients qualify for shifting to services in community settings, this study aims to carry out a psychological and functional assessment of patients that are residents of the MENSANA project’s 4 pilot rayons (Orhei, Soroca, Cahul and Cimislia), and after the assessment, applying a referral/indication algorithm for the more appropriate mental health services that fits their needs. This study carries potential benefits for people with mental health problems, as they can be re-directed, if necessary, to care that may be a better fit for their needs and enable them to lead a more fulfilling life in their communities. Depending on the outcome of the individual assessment, some patients may stay in the service in which they already receive care (i.e. a psychiatric hospital). This study will have an impact on the patient flow in the mental health care system in Moldova, particularly for mental health services in the 4 pilot rayons. Objective: To conduct a comprehensive diagnostic and functional (psychological and social) assessment of the patients receiving mental health care that reside in the districts of Orhei, Soroca, Cimislia or Cahul, in order to determine their further needs for mental health services. A number of countries have documented the shift in care from psychiatric hospital care to community-based settings (e.g. England, Canada, Australia). Within these processes, the most frequently assessed outcomes are social functioning, psychiatric symptoms, and quality of life. Materials and methods: In order to have a comprehensive assessment to build a patient profile, the survey developed is a comprehensive assessment consisting of several validated tools and outcome measures that assess the following dimensions: • Diagnostic assessment (medical psychiatric assessment); • Psychological assessment (symptoms and functioning); • Functional assessment (social functioning, daily life functioning, quality of life). The first part of the assessment obtains patient-level information which can either be completed by a ward staff member or CMHC employee and corroborated by the patient. Demographic and socioeconomic data such as (1) gender, (2) age, (3) partner status, (4) presence or absence of children under age 18, (5) housing status: independent living (yes/no), (6) occupational status (paid job yes/no; if yes, how many hours per week). In addition, we like to have some clinical information: (1) ICD-10 diagnosis, (2) psychiatric and somatic comorbidities, (3) WHO DAS 2 disability level, (5) EQ-5D quality of life. Conclusions: Often during the course of a mental health problem in Moldova, patients will rotate in and out of different kinds of services (e.g., hospital-based or community-based) and receive different kinds of health care interventions (e.g., pharmacological). Given these changes in service utilization patterns, it is important to capture the types of treatments and services received by patients to be able to compute the economic costs of offering these treatments and services

Taking steps towards deinstitutionalizing mental health care within a low and middle-income country:A cross-sectional study of service user needs in the Republic of Moldova

Aim: The current research was conducted in the context of an ongoing reform of mental health services in the Republic of Moldova since 2014, where efforts have been devoted to creating community-based mental health services. This article presents a snapshot of the needs of mental health service users in the Republic of Moldova and helps to understand how and with which services their needs can be addressed. Methods: This cross-sectional study compared the levels of needs (CANSAS scale), quality of life (EQ-5D 3L), mental health status (MINI for psychotic disorders) and functioning (WHO-DAS) among mental health service users in the psychiatric hospital in Chisinau, Moldova. All service users resided in districts where community mental health services were being developed. Correlations between quality of life, functioning and unmet need were explored. Results: Of 83 participants, one third had a psychotic or a mood disorder. On average, participants reported needs in 9.41 domains (SD = 4.41), of which 4.29 were unmet (SD = 3.63). Most unmet needs related to intimacy and relation to others. The level of functioning and quality of life were reported. We found strong, negative associations between the number of unmet needs and level of functioning, as well as the quality of life. We also found that higher functioning levels were positively associated with higher quality of life. Conclusion: There were a high number of unmet needs among this inpatient population, particularly social needs and service-related needs. A continuum of inpatient and outpatient care and individual treatment plans can help address the different needs of different patients. Individual treatment plans for patients and the choice of the appropriate treatment for patients could be guided by an assessment of service users’ (unmet) needs of care and level of functioning

EPA-1268 - Mental health disorders in emergency departments of general hospital in east european countries

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Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries

BACKGROUND: Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. METHODS: The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. RESULTS: We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. CONCLUSIONS: We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions