Použití omezovacích opatření v psychiatrii

Psychiatrie má jedinečné postavení mezi ostatními lékařskými disciplínami vzhledem k tomu, že omezení autonomie pacientů používá v jejich nejlepším zájmu jak k jejich léčbě tak k jejich kontrole. Omezovací opatření, jako jsou umístění pacienta do izolace, omezení pacienta v pohybu, nebo užití neklidové medikace jsou široce užívané v klinické praxi jako metody zvládání akutních psychiatrických stavů či neklidných pacientů. Tato dizertační práce byla provedena v rámci mezinárodního projektu EUNOMIA (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice), který probíhal ve dvanácti Evropských státech. Byly stanoveny tyto výzkumné otázky: jaké jsou sociodemografické a klinické charakteristiky nedobrovolně hospitalizovaných pacientů u kterých jsou použita omezovací opatření; jaké typy omezovacích opatření jsou užívaná nejčastěji; jaké jsou interní a externí rizikové faktory související s jejích užitím; a konečně jaké jsou genderové rozdíly u pacientů se schizofrenií, u kterých bylo užito omezovacích opatření. Do studie bylo zařazeno 2,030 nedobrovolně hospitalizovaných pacientů, z nichž celkem u 770 (38%) bylo použito 1,462 omezovacích opatření. Procento pacientů, u kterých bylo použito omezovacích opatření, se ve sledovaných zemích nachází v rozmezí 21% až 59%, a do...Psychiatry has unique status among other medical disciplines where patients` autonomy might be restricted in the best interest of the patient in order to both cure and control the patient. Coercive measures such as seclusion, physical restraint or forced medication are widely used in clinical practice as methods for managing acute, disturbed or violent psychiatric patients. This thesis was carried out as a part of the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) in which centers from twelve European countries recruited involuntary admitted patients. The research questions of this thesis were the following: what are the socio-demographic and clinical characteristics of the patients who receive coercive measures; what types of coercive measures are used with involuntarily treated patients; what are the internal and external risk factors for their use; and finally what are the gender differences among involuntary admitted coerced patients with schizophrenia. All together we evaluated a group of 2,030 involuntarily admitted patients, in which 1,462 coercive measures were used with 770 patients (38%). The percentage of patients receiving coercive measures in each country varied between 21% and 59%. These twelve countries varied greatly in...Department of Psychiatry First Faculty of Medicine and General University Hospital in PraguePsychiatrická klinika 1. LF a VFN v PrazeFirst Faculty of Medicine1. lékařská fakult

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

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

Gender differences in coerced patients with schizophrenia

European Commission (Quality of life and Management of Living Resources Programme, contract number QLG4-CT- 2002-01036), Czech Ministry of Education research grant MSM002160849, and research grants PRVOUK–P26/LF1/4 and PRVOUK–P03/LF1/

Depression and suicidality among psychiatric residents - results from a multi-country study

Background Previous studies have highlighted risks for depression and suicide in medical cohorts, but evidence regarding psychiatric residents is missing. This study aimed to determine rates of depression, suicide ideation and suicide attempt among psychiatric residents and to identify associated individual, educational and work-related risk factors. Methods A total of 1980 residents from 22 countries completed the online survey which collected data on depression (PHQ-9), suicidality (SIBQ), socio-demographic profiles, training, and education. Generalized linear modeling and logistic regression analysis were used to predict depression and suicide ideation, respectively. Results The vast majority of residents did not report depression, suicide ideation or attempting suicide during psychiatric training. Approximately 15% (n=280) of residents met criteria for depression, 12.3% (n=225) reported active suicide ideation, and 0.7% (n=12) attempted suicide during the training. Long working hours and no clinical supervision were associated with depression, while more completed years of training and lack of other postgraduate education (e.g. PhD or psychotherapy training) were associated with increased risk for suicide ideation during psychiatric training. Being single and female was associated with worse mental health during training. Limitations Due to the cross-sectional nature of the study, results should be confirmed by longitudinal studies. Response rate was variable but the outcome variables did not statistically significantly differ between countries with response rates of more or less than 50%. Conclusion Depression rates among psychiatric residents in this study were lower than previously reported data, while suicide ideation rates were similar to previous reports. Poor working and training conditions were associated with worse outcomes. Training programmes should include effective help for residents experiencing mental health problems so that they could progress through their career to the benefit of their patients and wider society

In-Game-Advertising : Implementierung und konzeptionelle Umsetzung von In-Game-Werbung

Die Bachelorarbeit beschäftigt sich mit der Integration von Werbung in Computer- und Videospielen. Am Beispiel von der Modefirma Ben Sherman wird die Vielfältigkeit und die Komplexität von Spiele-Werbung näher erläutert. Ziel der Arbeit ist es die unterschiedlichen Formen von In-Game Werbung darzustellen und anhand von Beispielen die Möglichkeiten dieses noch jungen Massenmediums aufzuzeigen. Der klassische Begriff der Werbung in Rundfunk und in Tele- und Mediendiensten, gezielt und bewusst zu beeinflussen und Bedürfnisse durch emotionale und informierende Werbebotschaften zum Zweck der Handlungsmotivation zu wecken, wird im Gegensatz dazu im In-Game Advertising durch eine starke emotionale Bindung zur Werbung erzeugt. Die In-Game Werbung soll für den Spieler nicht als solche wahrnehmbar sein, sondern sich homogen in die Spielwelt integrieren. Im Laufe der Arbeit wird beschrieben wie es Spielwerbung schafft, den Spieler nicht vom eigentlichen Spielszenario abzulenken, sondern als ein Teil der Spielwelt zu sehen. Neben der Analyse der einzelnen Formen werden außerdem die Umsetzung und die zukünftige Entwicklung dieses sich forcierenden Marktes, Thema dieser Arbeit sein. Dahinter steht die Frage, wie eine Werbung einer Marke im Spiel erfolgreich umgesetzt wird. Am Ende der Arbeit wird die Zukunft des In-Game Advertising anhand von aktuellen Entwicklungen dargestellt

The use of coercive measures in psychiatry

Psychiatry has unique status among other medical disciplines where patients` autonomy might be restricted in the best interest of the patient in order to both cure and control the patient. Coercive measures such as seclusion, physical restraint or forced medication are widely used in clinical practice as methods for managing acute, disturbed or violent psychiatric patients. This thesis was carried out as a part of the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) in which centers from twelve European countries recruited involuntary admitted patients. The research questions of this thesis were the following: what are the socio-demographic and clinical characteristics of the patients who receive coercive measures; what types of coercive measures are used with involuntarily treated patients; what are the internal and external risk factors for their use; and finally what are the gender differences among involuntary admitted coerced patients with schizophrenia. All together we evaluated a group of 2,030 involuntarily admitted patients, in which 1,462 coercive measures were used with 770 patients (38%). The percentage of patients receiving coercive measures in each country varied between 21% and 59%. These twelve countries varied greatly in..