Non-pharmacological interventions for schizophrenia—analysis of treatment guidelines and implementation in 12 Southeast European countries

This study aimed to analyze treatment guidelines of 12 SEE countries to identify non-pharmacological interventions recommended for schizophrenia, explore the evidence base supporting recommendations, and assess the implementation of recommended interventions. Desk and content analysis were employed to analyze the guidelines. Experts were surveyed across the 12 countries to assess availability of non-pharmacological treatments in leading mental health institutions, staff training, and inclusion in the official service price list. Most SEE countries have published treatment guidelines for schizophrenia focused on pharmacotherapy. Nine countries—Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Moldova, Montenegro, North Macedonia, and Serbia—included non-pharmacological interventions. The remaining three countries—Kosovo (UN Resolution), Romania, and Slovenia—have not published such treatment guidelines, however they are on offer in leading institutions. The median number of recommended interventions was seven (range 5–11). Family therapy and psychoeducation were recommended in most treatment guidelines. The majority of recommended interventions have a negative or mixed randomized controlled trial evidence base. A small proportion of leading mental health institutions includes these interventions in their official service price list. The interventions recommended in the treatment guidelines seem to be rarely implemented within mental health services in the SEE countries.

Non-pharmacological treatments for schizophrenia in Southeast Europe: An expert survey

BACKGROUND

Non-pharmacological treatment for schizophrenia includes educational, psychotherapeutic, social, and physical interventions. Despite growing importance of these interventions in the holistic treatment of individuals with schizophrenia, very little is known about their availability in South-East European countries (SEE).

OBJECTIVE

To explore mental health care experts' opinions of the availability of non-pharmacological treatment for people with schizophrenia in SEE.

METHODS

An online survey containing 11 questions was completed by one mental health expert from each of the following SEE countries: Albania, Bosnia and Herzegovina (B&H), Bulgaria, Croatia, Greece, Kosovo^†, Montenegro, Moldova, North Macedonia, Romania, Serbia, and Slovenia. Data were collected on estimated rates of received non-pharmacological interventions, type of services delivering these interventions, and expert views of availability barriers.

RESULTS

In eight countries, the estimated percentage of people with schizophrenia who receive non-pharmacological treatments was below 35%. The primary explanations for the low availability of non-pharmacological treatments were: lack of human and financial resources, lack of training for clinicians, and pharmacotherapy dominance in the treatment for schizophrenia.

CONCLUSION

Lack of personal and institutional resources and state support were identified as primary obstacles to staff training and delivering non-pharmacological treatments to people with schizophrenia on individual and systemic levels, respectively. This evidence can be used to improve holistic, evidence-based treatment for schizophrenia in the SEE countries.

Association of the Five-Factor Model personality traits and opioid addiction treatment outcome

Many patients with opioid addiction continue to use opioids during and after treatment, and their career of drug taking is usually punctuated by repeated treatment admissions and relapses. Personality traits are considered risk factors for drug use, and, in turn, the psychoactive substances impact individuals' traits. The most widely used system of traits is called the Five-Factor Model (FFM). Studies have shown that persons who use heroin are consistently depicted as high on Neuroticism and higher Extroversion, also they are described as more impulsive and less sociable. Those who maintain abstinence are characterized by a higher Agreeableness and Conscientiousness. Treatment programs for opioid addiction vary substantially in treatment processes, and an early identification of patients traits that address their strengths and weaknesses within specific treatment settings could be useful in decreasing the possibility of relapse.

Delirium during i. v. citalopram treatment: a case report

This paper reports the case of a 65-year-old depressed man without somatic illnesses in whom monotherapy with i. v. citalopram induced delirium. He was admitted to a closed geriatric ward as a psychotically depressed patient with somatic and depressive delusions, and suicidal thoughts. Because he rejected all oral medications, monotherapy was initiated with 20 mg of i. v. citalopram per day. After 3 days, he became delirious and physically aggressive. This description of acute hyperkinetic delirium associated with i. v. citalopram therapy is the first one of this kind addressing side effects of i. v. citalopram.

Patients with anxiety disorders, stress related disorders and somatoform disorders in the Psychiatric Emergency Out-patient Clinic

OBJECTIVES

To establish possible differences in gender, age and urgency between patients with anxiety disorders, stress related disorders and somatoform disorders and patients with other psychiatric diagnoses.

SUBJECTS AND METHODS

2760 consecutive admissions in the Psychiatric Emergency Out-patient Clinic (PEOC) over the period 2004-2005 were included. Data about diagnosis (ICD-10), gender, age and urgency were gathered from medical documentation. Data were compared between two groups of patients according to diagnosis; the first group encompassed anxiety disorders, stress related disorders and somatoform disorders (F 40-F 48) and the second group gathered all other psychiatric diagnoses (others).

RESULTS

One third (36%) of patients examined in PEOC suffered for anxiety disorders, stress related disorders and somatoform disorders. The most common diagnoses within this group were stress related disorders (F 43: 41.7%). Gender ratio was in favour of women in both groups. Significantly more women suffered for anxiety, stress-related and somatoform disorders (63.4% vs. 56.9%, p<0.005). Patients with anxiety, stress-related and somatoform disorders were significantly younger compared with others (40.4 years vs. 45.2 years, p<0.001), and they were significantly less urgent cases compared with others (46.7% vs. 65.3.3%, p<0.001).

CONCLUSION

Anxiety disorders, stress related disorders and somatoform disorders are common in PEOC. The higher percentage of women among these patients is in accordance with data from the literature; lower age might be a consequence of earlier onset of the above mentioned disorders.