DIABETIC KETOACIDOSIS ASSOCIATED WITH ANTIPSYCHOTIC DRUGS: CASE REPORTS AND A REVIEW OF LITERATURE

Background: Second generation antipsychotics (SGAs) are associated with metabolic disturbances. Diabetic ketoacidosis (DKA) is a rare, but potentially fatal sign of acute glucose metabolism dysregulation linked to the use of SGAs. The aims of this article are to present patients with a history of psychotic disorders and of severe metabolic diabetic ketoacidosis, possibly associated with the use of antipsychotics, and to review the current literature on the topic of antipsychotic-induced DKA. Method: PubMed/Medline and EBSCO databases were searched using the keywords: diabetic ketoacidosis, antipsychotics, atypical antipsychotics, second generation antipsychotics, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, paliperidone, amisulpride and haloperidol. Case reports, case series and reviews of case series were included in the review. Results: The majority of patients who developed DKA following treatment with antipsychotics were treated with olanzapine and clozapine in monotherapy or in combination with other antipsychotics. DKA mostly occurred in the first six months of antipsychotic treatment. Other risk factors included insulin resistance prior to antipsychotic treatment, male gender and middle age. Conclusion: Clinicians should consider the risk of DKA when starting treatment with SGAs. Preventive measures for patients with psychotic disorders using antipsychotics should include regular assessment of risk factors and screening for diabetes before and after administering antipsychotics, especially in the first months of treatment. Whenever possible, polypharmacy should be avoided

TRAINING IN SLEEP MEDICINE AMONG EUROPEAN EARLY CAREER PSYCHIATRISTS: A PROJECT FROM THE EUROPEAN PSYCHIATRIC ASSOCIATION – EARLY CAREER PSYCHIATRISTS COMMITTEE

Introduction: Sleep disorders have a proven association with psychiatric illness. Therefore, psychiatrists require appropriate training in diagnosing and treating sleep disorders. To date, there is no data available in Europe on training in sleep medicine for early career psychiatrists (ECP). Aims: To identify the availability of training in sleep medicine for psychiatric trainees across Europe and to establish how confident doctors feel in treating these conditions. Methods: European-wide survey carried out by the European Psychiatric Association (EPA)-Early Career Psychiatrists Committees. Representatives of ECPs from each participating European country filled in a questionnaire about availability of training in sleep medicine in their country. ECPs were also invited to fill out a questionnaire at the EPA congress in Nice in 2013. Results: 55 participants from 27 European countries responded. Only 24% had sleep medicine training mandatorily included in their national training curriculum. A majority (60%) felt that the quality of the training they received was either average or below average. 88% felt either very or fairly confident in treating insomnia. However, when asked to select the correct management options for insomnia from a provided list of six, only 19% and 33% of respondents chose the two correct options. Conclusions: There is a clear gap between the level of confidence and the clinical judgements being made to treat insomnia among European ECPs. There is a definite need to improve the availability and structure of sleep medicine training for psychiatric trainees in Europe

IMPACT OF STRESS RESPONSE IN DEVELOPMENT OF FIRST-EPISODE PSYCHOSIS IN SCHIZOPHRENIA: AN OVERVIEW OF SYSTEMATIC REVIEWS

Background: To summarize all available evidence from systematic reviews about the impact of stress response in development of first-episode psychosis (FEP) in schizophrenia. Methods: An overview of systematic reviews of any type of primary studies was performed. An electronic search of five databases was conducted in February 2017 (CDSR, DARE, Embase, MEDLINE and PsychINFO). Quality of included systematic reviews was assessed using the AMSTAR checklist. Results: Eight systematic reviews were included. The main findings of the included reviews point out a possible alteration of the stress response in a subgroup of persons with proneness to psychosis. However, the evidence is limited by the inadequate quality of studies, as well as lack of standardization of outcomes and assessment methods. Conclusions: Given the heterogeneity of current results, there is no solid evidence for uniform alterations of stress response found in persons with FEP in suggestive of schizophrenia that may serve as a marker of vulnerability to stress and possibly proneness to psychotic state in response to daily hassles

MEDICAL EDUCATION CHANGES STUDENTS\u27 ATTITUDES ON PSYCHIATRY: SURVEY AMONG MEDICAL STUDENTS IN CROATIA

In Croatia, psychiatric disorders are the leading group of disorders by days of hospitalization and they are in second place according to the number of hospitalizations in the period of working age. Nevertheless, psychiatry in Croatia, as well as in the world, is one of the least attractive specialties for medical students. In this paper we determined the impact of compulsory education in psychiatry on the attitudes of medical students of the fourth year of the Zagreb school of medicine and Osijek school of medicine. We tested attitudes toward psychiatry, psychiatric treatment and attitudes toward seeking professional psychological help using questionnaires that were filled out twice, at the beginning of psychiatry placement and at the end of psychiatry placement. Questionnaires were completed by 239 students from the Zagreb school of medicine and Faculty of medicine Osijek (response rate 78.4%). After the placement, students had significantly more positive attitudes about psychiatry and psychiatric treatment, as well as the attitudes toward seeking professional psychological help. Attitudes towards psychiatry, seeking psychological help and attitude towards psychiatric medication and psychotherapy correlated with the evaluation of the quality of psychiatric education. Additional forms of education in psychiatry should be offered, in order to maintain and increase the impact of education on students’ attitudes

NUMBERS OF EARLY CAREER PSYCHIATRISTS VARY MARKEDLY AMONG EUROPEAN COUNTRIES

In the field of psychiatry the decline of recruitment and brain-drain are currently one of the most discussed topics among stakeholders on national and European level. Even though comprehensive data on psychiatric training in Europe have been already reported, no data are available on even the approximate number of early career psychiatrists (ECPs). With this objective in mind, the Early Career Psychiatrists Committee of the European Psychiatric Association (EPAECPC) and the European Federation of Psychiatric Trainees (EFPT) have undertaken a survey. Based on the methodology used, the total number of ECPs in all European countries was 46 144 with the average number of ECPs being 5.5/100 000 country inhabitants. The actual numbers in this respect varied greatly among countries from 0.4 and 0.6 ECPs/100 000 in Azerbaijan resp. Russia; to 20.4 and 28.4 ECPs/100 000 in Norway resp. Switzerland. An obvious East-West gradient with increasing numbers of ECPs when moving from East to West, and from South to North were found, mirroring the economic strength of European countries. This is the first study to specifically explore the number of ECPs across Europe which might have key implications for planning and establishing recruitment activities and for developing strategies for prevention of brain-drain, such as improvement of educational system and enlargement of professional opportunities

EXPERIENCE OF PSYCHIATRY TEACHING AT MEDICAL SCHOOL INFLUENCES CROATIAN MEDICAL STUDENTS’ ATTITUDES TOWARDS CHOOSING PSYCHIATRY AS A CAREER

Background: Reports indicate that the number of students interested in choosing psychiatry as their future profession is constantly decreasing in the last decades. Our aim was to determine the proportion of medical students intending to pursue a career in psychiatry and to define undergraduate education-related factors influencing that choice. Subjects and methods: We report the preliminary findings of a cross sectional quantitative survey of final year Croatian medical students as part of the International Survey Of Student Career Choice In Psychiatry (ISOSCCIP). We surveyed medical students attending their final year at Zagreb School of Medicine in the academic year 2009/2010, using a structured questionnaire examining demographics, students\u27 preferences on future career choice and their evaluations of undergraduate psychiatry teaching. Results: The overall student evaluation of the compulsory psychiatry curriculum was “average”. Significantly higher ratings were reported by students who felt more involved in the teaching of the subject. The possibility of psychiatry as a career choice correlated significantly with better evaluation grades of psychiatry lectures. Furthermore, poor evaluation grades predicted a higher likelihood that medical students completely ruled out choosing a career in psychiatry. Conclusion: This is the first survey of this kind in Croatia. Student ratings of medical school psychiatric education and perceived involvement in teaching appears to influence the likelihood of a stated career in psychiatry. Addressing these issues may increase the number of students motivated to pursue psychiatry as their future career choice

THE PsyLOG MOBILE APPLICATION: DEVELOPMENT OF A TOOL FOR THE ASSESSMENT AND MONITORING OF SIDE EFFECTS OF PSYCHOTROPIC MEDICATION

Mobile health interventions are regarded as affordable and accessible tools that can enhance standard psychiatric care. As part of the mHealth Psycho-Educational Intervention Versus Antipsychotic-Induced Side Effects (mPIVAS) project (www.psylog.eu), we developed the mobile application "PsyLOG" based on mobile "smartphone" technology to monitor antipsychotic-induced side effects. The aim of this paper is to describe the rationale and development of the PsyLOG and its clinical use. The PsyLOG application runs on smartphones with Android operating system. The application is currently available in seven languages (Croatian, Czech, English, French, German, Japanese and Serbian). It consists of several categories: "My Drug Effects", "My Life Styles", "My Charts", "My Medication", "My Strategies", "My Supporters", "Settings" and "About". The main category "My Drug Effects" includes a list of 30 side effects with the possibility to add three additional side effects. Side effects are each accompanied by an appropriate description and the possibility to rate its severity on a visual analogue scale from 0-100%. The PsyLOG application is intended to enhance the link between patients and mental health professionals, serving as a tool that more objectively monitors side-effects over certain periods of time. To the best of our knowledge, no such applications have so far been developed for patients taking antipsychotic medication or for their therapists

SIGNIFICANTLY LOWER RIGHT MIDDLE CEREBRAL ARTERY BLOOD FLOW VELOCITY IN THE FIRST EPISODE OF PSYCHOSIS DURING NEUROCOGNITIVE TESTING

Background: Changes in cerebral hemodynamics have been reported in schizophrenia and proposed as underlying the cognitive deficits seen in patients. The objective of our study was to compare changes of the cerebral blood flow velocity (BFV) during neurocognitive tasks between the patients with the first episode of psychosis and healthy controls. Subjects and methods: We recruited 46 patients with the first episode of psychosis (FEP), admitted to the University Hospital Centre Zagreb during 2016-2017 and 41 control subjects. Transcranial Doppler ultrasonography monitoring of BFV in both middle cerebral arteries was recorded during 25-minute long neurocognitive assessment with Phonemic Verbal Fluency test, Trial Making Test B and Stroop test. Between every consecutive test resting periods were recorded. Results: After the adjustment for age, sex and education by quantile regression, patients with FEP had significantly lower BFV in middle cerebral arteries during the 3rd