Rationale, component description and pilot evaluation of a physical health promotion measure for people with mental disorders across Europe

Introduction: The HELPS project aimed at developing a toolkit for the promotion of physical health in people with mental disorders to reduce the substantial excess morbidity and mortality in the target group. Methods: The HELPS toolkit was developed by means of national and international literature reviews, Delphi rounds with mental health experts and focus groups with mental health experts and patients/ residents in 14 European countries. The toolkit was translated into the languages of all participating countries, and usability of toolkit modules was tested. Results: The toolkit consists of several modules addressing diverse somatic health problems, lifestyle, environment issues, patient goals and motivation for health-promotion measures. It aims at empowering people with mental illness and staff to identify physical health risks in their specific contexts and to select the most appropriate modules from a range of health promotion tools. Discussion: The HELPS project used an integrative approach to the development of simple tools for the target population and is available online in 14 European languages. Preliminary evidence suggests that the toolkit can be used in routine care settings and should be put to test in controlled trials to reveal its potential impact

Anti-neuroinflammatory microRNA-146a-5p as a potential biomarker for neuronavigation-guided rTMS therapy success in medication resistant depression disorder

Treatment-resistant depression (TRD) is a challenging issue to address. Repetitive transcranial magnetic stimulation (rTMS) is commonly used but shows varying efficacy, necessitating a deeper understanding of depression physiology and rTMS mechanisms. Notably, an increasing amount of recent data has displayed the connection of TRD and its clinical outcome with chronic inflammatory processes. The current study included 19 TRD patients undergoing rTMS and 11 depressed patients responding to medication as a comparison group. We assessed therapeutic efficacy using MADRS, HAM-D-17, GAD-7, and PHQ-9 tests. Inflammatory markers, neurotrophins, and associated miRNAs were measured in patients blood serum before and during treatment. A control group of 18 healthy individuals provided baseline data. The results of our study showed significantly higher levels of pro-inflammatory interleukins-6 and − 8 in TRD patients compared to drug-responders, which also related to more severe symptoms before treatment. In addition, TRD patients, both before and during treatment, exhibited higher average blood serum concentrations of pro-inflammatory interleukin-18 and lower levels of anti-neuroinflammatory miR-146a-5p compared to healthy controls. We also observed that the expression of miR-16-5p, miR-93-5p, and especially miR-146a-5p correlated with clinical changes following rTMS. Our study confirmed that TRD patients possess a higher inflammatory status, while the anti-neuroinflammatory miR-146a-5p was demonstrated to have a considerable potential for predicting their rTMS treatment success

WPA expert committee on the Ukrainian mental health crisis: June 2020

A major policy shift and the onset of the COVID-19 pandemic at the beginning of April 2020 have propelled mental health provision in the Ukraine into a humanitarian crisis. The reduction of funds for in-patient treatment before completing the preparation of community-based mental health care services ensuring the shift of staff to such services resulted in dismissal of personnel and premature discharges of patients putting their life in danger. On top of this came the problems of coping with mental health care in the face of the COIVD pandemic which hit Ukraine at almost the same time. Patients and their families are in despair, the first fatalities after discharge were reported within six weeks of the start of the crisis. The policy planning for communitybased mental health services was on a good trajectory, however not in harmony with the allocation of resources, resulting in the discharges and lay-offs. A draft National Action Plan on Mental Health exists, developed by a working group of the Ministry of Health, however its details have yet to be fully disclosed and vetting by national psychiatrists has yet to be undertaken. The WPA Expert Committee examined an early version of the document. It wishes to support the idea of reform of institutional-based mental health care and a well-planned transition to a new system of care. It recommends that the latest version of this document be used as a basis for discussions between the Ministry and the psychiatric profession, as well as other stakeholders, retaining elements that have been well developedVilniaus universitetasVytauto Didžiojo universiteta

Ukrainian mental health services and World Psychiatric Association Expert Committee recommendations

Vilniaus universitetasVytauto Didžiojo universiteta

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

Background: People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design: HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion: A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities