Clinical decision-making style preferences of European psychiatrists : Results from the Ambassadors survey in 38 countries

Background While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. Methods We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style - Staff questionnaire and a set of questions regarding clinicians' expertise, training, and practice. Results SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. Conclusions The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.Peer reviewe

Transformation of personality features and coping strategies depending on the duration of recurrent depressive disorder

Background. The high prevalence of recurrent depressive disorders and the severity of the medical and social consequences of the depression in the form of chronization, relapse, resistance, disorders of social functioning, quality of life and suicidal behavior place the problem in the rank of the most urgent, requiring study in terms of early diagnosis and assessment of the condition, depending on the duration of the disease. Methods. An integrated approach was used including clinical-psychopathological, psychodiagnostic and statistical methods. 40 patients with recurrent depressive disorders were examined, 35 people without mental disorders were included in the comparison group. Results. The structure of clinical-psychopathological manifestations of the depressive spectrum in patients with the recurrent depressive disorder was characterized by the presence of affective, motivational-will, cognitive, psychomotor and somatic disorders. Among the personality features, patients differed in a more actualization of the non-adaptive copy-strategy and low self-actualization. Conclusion. Data which we received should be considered when conducting diagnostic and psychotherapeutic interventions for patients with the recurrent depressive disorder

CLINICAL-PSYCHOPATHOLOGICAL ANALYSIS OF THE STRUCTURE AND EXPRESSION OF NEGATIVE AND POSITIVE SYMPTOMS IN PATIENTS WITH SCHIZOPHRENIA

The aim: to determine the features of the clinical-psychopathological structure and severity of negative and positive symptoms in patients with schizophrenia to improve diagnosis and treatment of schizophrenia. Materials and methods. 252 patients with negative symptoms (NS) in schizophrenia and 79 patients with positive symptoms (PS) in schizophrenia were examined. The research used a comprehensive approach, which consisted in the use of clinical-psychopathological, psychometric (PANSS scale) and statistical research methods. Results. Manifestations of positive symptoms in patients with NS in schizophrenia were mainly delineated by delusions of a minimal and weak level; minimal manifestations of delirium, unusual behavior and thought disorders; the predominance of patients with no disorders, minimal disorders and a weak level of disorders of hallucinatory behavior, excitement, ideas of grandeur, suspiciousness, and hostility. Manifestations of negative symptoms in patients with NS in schizophrenia were characterized by a predominance of medium and severe levels of blunted affect; moderate and average levels of emotional alienation; violation of abstract thinking of a weak and moderate level; average level of impaired fluency and spontaneity of speech; moderate communication impairment; passive-apathetic social detachment of the average level. Among patients with PS in schizophrenia, the manifestations of positive symptoms were mainly delineated by delusions of medium and strong levels of severity; moderate and pronounced manifestations of delirium; a moderate level of severity of thinking disorders and unusual behavior; predominance of moderate, medium and strong levels of expression of hallucinatory behavior, excitement, ideas of grandeur, suspicion and hostility. Manifestations of negative symptoms in patients with PS in schizophrenia were characterized by a predominance of a minimal level of expression of dulled affect, social exclusion and impaired fluency and spontaneity of speech; minimal and weak levels of emotional alienation; average level of communication disorders and abstract thinking. Conclusions. Features of the clinical-psychopathological structure and severity of negative and positive symptoms in patients with schizophrenia were established. The obtained data can serve as diagnostic criteria for conducting differential diagnosis and choosing treatment strategies for patients with schizophrenia

Clinical decision-making style preferences of European psychiatrists: Results from the Ambassadors survey in 38 countries

Background While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. Methods We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style - Staff questionnaire and a set of questions regarding clinicians' expertise, training, and practice. Results SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. Conclusions The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe