Case Report : Severe Side Effects Following Treatment With First Generation Antipsychotics While Cariprazine Leads to Full Recovery

Schizophrenia is a psychiatric disorder characterized by positive, negative, cognitive and affective symptoms. Patient cooperation with health care professionals, compliance with the treatment regime, and regular use of medications are some of the preconditions that need to be met for a favorable disease course. A negative experience following the use of a first-generation antipsychotic to treat first-episode psychosis can negatively affect a patient's motivation for further medication use. In the clinical case reported here, cariprazine was able to restore one such patient's confidence in therapy and facilitated their cooperation with the physician, thereby ensuring effective control of negative and positive symptoms and good functioning for a period of 1 year. Cariprazine may be a good option for maintenance therapy following first-episode psychosis, especially in situations in which a patient has had a negative first experience associated with antipsychotic medication use.publishersversionPeer reviewe

Evaluation of the Patients’ Satisfaction with Psychiatric Health Care Services with an Adapted PIPEQ-OS Tool

Until now, the assessment of health care services provided by psychiatric institutions in Latvia has not been carried out and questionnaires to provide assessment from the patient's perspective have not been adapted. For this study, a questionnaire that has been validated and successfully employed for several years in Norway was chosen to assess patients' experience and in a psychiatric inpatient setting. The aim of the study was to determine patients' satisfaction with the quality of mental health care services in Latvia in the subacute inpatient psychiatric ward in Riga, adapting during this process the PIPEQ-OS (Psychiatric Inpatient Patient Experience Questionnaire) tool in Latvia. The pilot quantitative study was conducted from June 2016 till February 2017. In the study, an anonymous patient self-assessment questionnaire PIPEQ-OS containing 21 questions was used. During the adaptation process, the questionnaire was translated from English into Latvian and Russian and backwards. The quality and compliance of the translation was subsequently tested in cognitive interviews. During the study, 297 patients were discharged from the unit, and 231 of them completed the questionnaire. 12% of the completed questionnaires were not included in data processing due to being incorrectly filled in. Cognitive interviews with 20 patients were carried out; the average length of an interview was 15 minutes. Overall, the translation of the questionnaire proved to be relevant to the research theme. The subsequent factor analysis revealed three significant factors that reached the Cronbach's alpha index of 0.7. Further studies using socio-demographic data and based on various inpatient units as well as the comparison of satisfaction indicators across different diagnostic groups are needed.publishersversionPeer reviewe

EMOTION REGULATION DIFFICULTIES IN DEPRESSION

Patients diagnosed with depression often experience difficulty in regulating their emotions due to non-adaptive regulatory strategies (e.g., avoidance, suppression, rumination). Adaptive emotion regulation skills (e.g., awareness, acceptance, self-support) can be trained and improved through psychological treatment. The objective of this study was to identify differences in emotion regulation skills between a clinical group of patients with depression (n=56) and a non-clinical group (n=56), adults without symptoms of depression. Methods. The study was based on socio-demographic survey and three self-report questionnaires adapted for use in Latvia: Difficulties in Emotion Regulation Scale (DERS; Gratz Roemer, 2004), Emotion Regulation Skills Questionnaire (ERSQ; Berking Znoj, 2008) and Emotion Regulation Questionnaire (ERQ; Gross John, 2003). Results. Compared to the non-clinical group, the clinical group presented significantly decreased scores in several scales of ERSQ: Understanding, Self-support, Tolerance, Acceptance, Modification (p.001) and increased scores in four scales of DERS: Lack of emotional clarity, Difficulty engaging in goal-directed behaviour, Non-acceptance of emotional responses and Limited access to effective emotion regulation strategies (p.001). Conclusions. This study helps to identify the main emotion regulation difficulties for depression patients in Latvia – the ability to understand, accept, tolerate and modify emotions. 

Exploring the Mediating Role of Parental Anxiety in the Link between Children’s Mental Health and Glycemic Control in Type 1 Diabetes

Funding Information: This research was funded by a Doctoral Study Grant of Riga Stradins University (Protocol No. 2-S-1/7/2022). Publisher Copyright: © 2023 by the authors.Pediatric diabetes type 1 diabetes mellitus (T1D), as a chronic, incurable disease, is associated with psychoemotional and socioeconomic burden for the whole family. Disease outcomes are determined by the metabolic compensation of diabetes, characterized by the level of glycated hemoglobin (HbA1c). The caregivers play a critical role in the metabolic control of children with T1D. The aim of this study was to investigate which environmental factors may explain the relationship between diabetes compensation and anxiety and depression of a child. The cross-sectional interdisciplinary study recruited dyads from adolescents and their parents (N = 251). Adolescent and parent groups were screened for anxiety and depression. General linear model (GLM) mediation analysis was performed to determine the potential mediating effect of surrounding factors on the relationship between dependent variables (glycated hemoglobin) and independent variables (the child’s anxiety and depression symptoms). The study revealed that the relationship between HbA1c and the child’s anxiety and depression is fully mediated (B = 0.366, z = 4.31, p < 0.001) by parental anxiety. Diabetes metabolic control in adolescents with T1D is related to adolescents’ mental health via parents’ anxiety. This means that parents’ anxiety plays a more significant role in the level of HbA1c than the anxiety and depression of the adolescent.Peer reviewe

ADAPTING OPEN DIALOGUE FOR EARLY-ONSET PSYCHOSIS IN LATVIA : BARRIERS AND FACILITATORS

Open Dialogue (OD) is the Finnish crisis intervention approach based on an open dialogue involving various professionals and a trusted person of the patient. This publication has demonstrated both clinical and economic benefits from the implementation of the principles of OD. The implementation of this approach was started in Latvia in cooperation with Dr. D. Ziedonis from the Department of Psychiatry, University of Massachusetts Medical School (today working at University of California San Diego), by translating into Latvian “The Key Elements of Dialogic Practice in Open Dialogue” and carrying out expert consensus panel discussions on the barriers and facilitators of the approach. The obstacles are linked with the lack of education in family therapy, lack of resources, possible problems of cooperation among professionals, and the existing standard practice where there are no active home visits in crisis situations. At the same time, positive elements that are close to Latvian psychiatry can be observed in the OD approach, for instance, the importance of a clinical conversation and listening to the points of views of family members encourage psychiatrists in Latvia to use this approach. The setting of OD could be communitybased mental health centres as well as inpatient psychiatric departments dealing with acutely psychotic patients. OD can be a valuable addition and alternative in the case of new psychotic patients when treatment with medications is not efficient, and the patient is not favourably disposed to the use of medications, but nevertheless is seeking helppublishersversionPeer reviewe

Transition to hospital process orientation : The case of regional hospitals in Latvia

Management of processes instead of functions has growing importance into the health care. Transition to hospital process orientation (HPO) changes the way physicians and other health professionals have used to practice before. Study was performed to explore factors affecting introduction of HPO in Latvian hospitals responding to significant external pressures during the years of economic crisis to detect the best practices used for process management implementation in clinical setting. To reach the research goal dissimilarities between current performance and management of hospitals were explored. As changes in hospital reimbursement system demand improved efficiency, hospital’s performance was measured by decrease in avoidable hospitalisations, and increase in usage of more cost effective alternatives to a full hospitalisation. A regression analysis was performed to evaluate correlations of hospitalisation rates in Latvian hospitals to various outpatient health services utilisation indicators. This was done to exclude influence of external factors on hospital performance and to prove the positive impact of HPO initiatives on hospitalisation rate. Afterward the performance of all regional hospitals was compared and the two most distinct hospitals were selected for further in depth analysis. Operational data of the selected hospitals and a set of structured interviews outlined the differences between both hospital’s managerial practices and factors affecting the introduction of process oriented initiatives. The theoretical research together with comparative analysis of approaches used in both hospitals served as a basis for elaboration of recommendations towards development of HPO and facilitation of the development of self-management competence of health professionalspublishersversionPeer reviewe

Challenges facing mental health systems arising from the COVID-19 pandemic: Evidence from 14 European and North American countries

We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All countries in our sample implemented new policies or initiatives to strengthen mental health service delivery - with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regulations and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America

Changes in the Provision of Institutionalized Mental Health Care in Post-Communist Countries

PMCID: PMC3371010This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Evaluation of the Patients’ Satisfaction with Psychiatric Health Care Services with an Adapted PIPEQ-OS Tool

Until now, the assessment of health care services provided by psychiatric institutions in Latvia has not been carried out and questionnaires to provide assessment from the patient’s perspective have not been adapted. For this study, a questionnaire that has been validated and successfully employed for several years in Norway was chosen to assess patients’ experience and in a psychiatric inpatient setting. The aim of the study was to determine patients’ satisfaction with the quality of mental health care services in Latvia in the subacute inpatient psychiatric ward in Rīga, adapting during this process the PIPEQ-OS (Psychiatric Inpatient Patient Experience Questionnaire) tool in Latvia. The pilot quantitative study was conducted from June 2016 till February 2017. In the study, an anonymous patient self-assessment questionnaire PIPEQ-OS containing 21 questions was used. During the adaptation process, the questionnaire was translated from English into Latvian and Russian and backwards. The quality and compliance of the translation was subsequently tested in cognitive interviews. During the study, 297 patients were discharged from the unit, and 231 of them completed the questionnaire. 12% of the completed questionnaires were not included in data processing due to being incorrectly filled in. Cognitive interviews with 20 patients were carried out; the average length of an interview was 15 minutes. Overall, the translation of the questionnaire proved to be relevant to the research theme. The subsequent factor analysis revealed three significant factors that reached the Cronbach’s alpha index of 0.7. Further studies using socio-demographic data and based on various inpatient units as well as the comparison of satisfaction indicators across different diagnostic groups are needed