SOCIAL PHOBIA: EPIDEMIOLOGY AND HEALTH CARE EPIDEMIOLOGIE UND VERSORGUNG DER SOZIALPHOBIE

This paper gives an overview on the epidemiology of social phobia. About 4.5% of the adult general populations suffer from social phobia, i.e. it is the most frequent of all anxiety disorders. Social phobia is clearly more frequent among women than among men. About the half of all individuals with social phobia suffer from any comorbid mental disorders. Reviews show a large variability between single studies, probably due to methodological differences. Several population surveys indicate that a marked proportion of those with social phobia do not receive adequate treatment

Prevalence of Mental Diseases in Austria. Systematic Review of the Published Evidence

Background: Addressing the growing burden of mental diseases is a public health priority. Nevertheless, many countries lack reliable estimates of the proportion of the population affected, which are crucial for health and social policy planning. This study aimed to collect existing evidence on the prevalence of mental diseases in Austria. Methods: A systematic review was conducted using MeSH, EMTREE and free-text terms in seven bibliographic databases. In addition, the references of included papers and relevant Austria-specific websites were searched. Articles published after 1996 pertaining to the Austrian adult population and presenting prevalence data for mental diseases were included in the analysis. Results: A total of 2612 records were identified in the database search, 19 of which were included in the analysis, 13 were community-based studies and 6 examined institutionalized populations. Sample sizes ranged from 200 to 15,474. The evidence was centered around depression (n= 6, 32%), eating disorders (n= 4, 21%) and alcohol dependence (n= 3, 16%). While most studies (n= 10, 53%) used questionnaires and scales to identify mental diseases, seven studies used structured clinical interviews, and two studies examined use of psychotropic drugs. Due to the diversity of methodologies, no statistical pooling of prevalence estimates was possible. Conclusion: Information on the prevalence of mental diseases in Austria is limited and comparability between studies is restricted. A variety of diagnostic instruments, targeted populations and investigated diseases contribute to discrepancies in the prevalence rates. A systematic, large-scale study on the prevalence of mental diseases in Austria is needed for comprehensive and robust epidemiological evidence

DEPRESSION: WIRD DIE DIAGNOSE RICHTIG VERWENDET?

Depression is a very common mental disorder which often results in relevant negative consequences ranging from impaired quality of life to an increased suicide rate. Unfortunately, non-psychiatric physicians frequently underdiagnose and under-treat depression. Nevertheless, sometime the diagnosis “depression” is used for mentally well and other mental disorders (i.e. sometimes depression is overdiagnosed). Screening tools were suggested to improve the recognition of mental disorders in everyday clinical work. Studies have shown that the criterion validity of usual screening questionnaires such as the Geriatric Depression Scale (GDS) is sufficient, while very short questionnaires consisting of one or two questions must not be used because of high misclassification rates. A meta-analysis of randomized trials of screening for depression indicate that screening for depression is probably effective when it is coupled with additional activities such as educational programs for primary care physicians.Depression ist eine häufige psychische Erkrankung. Untern den zahlreichen negativen Folgen für die Betroffenen sind unter anderem Beeinträchtigungen der Lebensqualität und ein erhöhtes Suizidrisiko zu finden. Nicht-psychiatrische Ärzte übersehen im klinischen Alltag immer wieder Depressionen, was zur Folge hat, dass sie oft zu selten behandelt werden. Es gibt aber auch Fälle, in denen psychisch Gesund irrtümlich als depressiv diagnostiziert werden oder der Begriff „Depression“ fälschlich für andere psychische Erkrankungen verwendet werden. Somit gibt es sowohl ein Unter- als auch ein Überdiagnostizieren. Um solche Fehler zu vermeiden, wurde immer wieder vorgeschlagen, im klinischen Alltag Screening-Instrumente zu verwenden. Zahlreiche Studien haben gezeigt, dass übliche Screening-Instrumente wie zum Beispiel die Geriatric Depression Scale (GDS) zufriedenstellende Kennwerte der Kriteriumsvalidität aufweisen. Extrem kurze Fragebögen, bestehend aus einer oder zwei Fragen, haben aber sehr hohe Fehlerquoten und sollten daher nicht verwendet werden. Eine Metaanalyse von randomisierten kontrollierten Studien über Screening bei Depressionen weist darauf hin, dass Screening dann wirksam sein dürfte, wenn es mit anderen unterstützenden Interventionen wie Schulungsangeboten für Allgemeinmediziner kombiniert wird

Decision-making and risk-taking in forensic and non-forensic patients with schizophrenia spectrum disorders: A multicenter European study

Studies of patients with schizophrenia and offenders with severe mental disorders decision-making performance have produced mixed findings. In addition, most earlier studies have assessed decision-making skills in offenders or people with mental disorders, separately, thus neglecting the possible additional contribution of a mental disorder on choice patterns in people who offend. This study aimed to fill this gap by comparing risk-taking in patients with schizophrenia spectrum disorders (SSD), with and without a history of serious violent offending assessing whether, and to what extent, risk-taking represents a significant predictor of group membership, controlling for their executive skills, as well as for sociodemographic and clinical characteristics. Overall, 115 patients with a primary diagnosis of SSD were recruited: 74 were forensic patients with a lifetime history of severe interpersonal violence and 41 were patients with SSD without such a history. No significant group differences were observed on psychopathological symptoms severity. Forensic generally displayed lower scores than non-forensic patients in all cognitive subtests of the Brief Assessment of Cognition in Schizophrenia (except for the "token motor" and the "digit sequencing" tasks) and on all the six dimensions of the Cambridge Gambling Task, except for "Deliberation time", in which forensic scored higher than non-forensic patients. "Deliberation time" was also positively, although weakly correlated with "poor impulse control". Identifying those facets of impaired decision-making mostly predicting offenders' behaviour among individuals with mental disorder might inform risk assessment and be targeted in treatment and rehabilitation protocols

Pharmacological interventions to reduce violence in patients with schizophrenia in forensic psychiatry.

Abstract Background The purpose was to systematically investigate which pharmacological strategies are effective to reduce the risk of violence among patients with Schizophrenia Spectrum Disorders (SSD) in forensic settings. Methods For this systematic review six electronic data bases were searched. Two researchers independently screened the 6,003 abstracts resulting in 143 potential papers. These were then analyzed in detail by two independent researchers. Of these, 133 were excluded for various reasons leaving 10 articles in the present review. Results Of the 10 articles included, five were merely observational, and three were pre-post studies without controls. One study applied a matched case-control design and one was a non-randomized controlled trial. Clozapine was investigated most frequently, followed by olanzapine and risperidone. Often, outcome measures were specific to the study and sample sizes were small. Frequently, relevant methodological information was missing. Due to heterogeneous study designs and outcomes meta-analytic methods could not be applied. Conclusion Due to substantial methodological limitations it is difficult to draw any firm conclusions about the most effective pharmacological strategies to reduce the risk of violence in patents with SSD in forensic psychiatry settings. Studies applying more rigorous methods regarding case-definition, outcome measures, sample sizes, and study designs are urgently needed

Neurocognition and social cognition in patients with schizophrenia spectrum disorders with and without a history of violence: results of a multinational European study

Objective: Neurocognitive impairment has been extensively studied in people with schizophrenia spectrum disorders and seems to be one of the major determinants of functional outcome in this clinical population. Data exploring the link between neuropsychological deficits and the risk of violence in schizophrenia has been more inconsistent. In this study, we analyse the differential predictive potential of neurocognition and social cognition to discriminate patients with schizophrenia spectrum disorders with and without a history of severe violence. Methods: Overall, 398 (221 cases and 177 controls) patients were recruited in forensic and general psychiatric settings across five European countries and assessed using a standardized battery. Results: Education and processing speed were the strongest discriminators between forensic and non-forensic patients, followed by emotion recognition. In particular, increased accuracy for anger recognition was the most distinctive feature of the forensic group. Conclusions: These results may have important clinical implications, suggesting potential enhancements of the assessment and treatment of patients with schizophrenia spectrum disorders with a history of violence, who may benefit from consideration of socio-cognitive skills commonly neglected in ordinary clinical practice

Preventing the mental health consequences of war in refugee populations

The refugee experience is associated with several potentially traumatic events that increase the risk of developing mental health consequences, including worsening of subjective wellbeing and quality of life, and risk of developing mental disorders. Here we present actions that countries hosting forcibly displaced refugees may implement to decrease exposure to potentially traumatic stressors, enhance subjective wellbeing and prevent the onset of mental disorders. A first set of actions refers to the development of reception conditions aiming to decrease exposure to post-migration stressors, and a second set of actions refers to the implementation of evidence-based psychological interventions aimed at reducing stress, preventing the development of mental disorders and enhancing subjective wellbeing

Impairments in psychological functioning in refugees and asylum seekers

© 2024 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version’s total and six subdomains’ scores (‘mobility’, ‘life activities’, ‘cognition’, ‘participation’, ‘self-care’, ‘getting along’) as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in ‘mobility’ and ‘participation’, followed by ‘life activities’ and ‘cognition’. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in ‘participation’, while past events of being close to death were associated with fewer issues with ‘self-care’. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.Peer reviewe

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