The Usefulness of Telemedicine in Perinatal Mental Health Services During and after COVID-19 Pandemic. Detailed Experience of the Team of „Together” Baby-Mother-Father Unit in Budapest

Due to the nature of the perinatal period, it affects generations who are more at home in the electronic space, hence some form of telemedicine can be used in a number of areas. The “Together” Baby-Mother-Father Integrated Program has been running since 2004. Both the condition of those affected and the current epidemic makes it difficult for patients and their families to access adequate perinatal specialist care. At the beginning of the epidemic, the switch to telemedicinal psychiatric care has been rapid and focused mainly on the use of Phone, Skype, Viber and Email. To our findings the advantages include, easier access to care, and more frequent contacts. The home environment is accessible and the families are more involved. Also, care does not compete with the scarce resources of time and space. Some of the possible disadvantages are, that more work on intimacy is needed, and the treatability of certain diseases is questionable (e.g., psychoses). Care is less documentable with the current regulations, and funding has not yet been adapted to the changes. The telemedicinal care and support network in Hungary - among many - contains an online medical system (EESZT) including e-prescription. Online- psychotherapy, consultation, peer-group platforms. There is a non-stop hotline for patients, etc. In 2021 the total number of our cases increased by 34%, but realistically the visit number was also higher, due to the amount of shorter telephone and e-mail interactions. Depression and bipolar disorder were among the highest proportion by the patients present.

Disclosure

No significant relationships.

The Effects of the COVID-19 Pandemic on Mother-Infant Mental Health Relationship

Maternal health cannot be separated from infant, child and adolescent health, which includes mental health as well. Expecting mothers go through a number of changes during their pregnancy. Due to the specific alterations of their physique and immune system, pregnant mothers are more vulnerable to the Covid-19 infection. This highlights the importance of the vaccinations in their cases. During the pandemic, mental health problems such as anxiety, depression and stress aroused in greater numbers. This affected mothers, and younger children as well. Expecting mothers, without pre-existing mental disorder (>50%) reported a weightier level of anxiety in their first trimester. Also, infants can suffer developmental disadvantages, as their infected mothers are separated from them. Even though evidence is not yet clear in this topic, vertical transmission seems to be fairly uncommon. Treatment guidelines, that could help Covid-19 infected mothers to handle their infants, are scarce. Hence the importance of telehealth has started to be outlined. Separation from the children might be necessary, while the mental health of mother and infant is continuously screened, since the long-term consequences of the symptoms are still unknown. Hence, prevention is imperative to avoid any negative effects. Even still, WHO advises mothers to breastfeed safely, with good respiratory hygiene, emphasizing the importance of skin-to-skin contact of newborns and sharing the room with them. On policy level: investment into pre-, peri-, post-natal care, family supporting national programs, inter-sectoral collaborations, monitoring and research are important elements of prevention and treatment efforts during the Epidemic and the post-Covid-19 era.

Disclosure

No significant relationships.

What should General Adult Psychiatrists know about Reproductive Counselling of Women with Severe Mental Illness?

A notable part of psychiatry is prevention. Our job, as psychiatrists, is not only to treat mental disorders, but also to prevent them. Treating mothers in postnatal period reducing the negative consequence of depression for child development, for example. General adult psychiatrists face the challenge of having patients, who receive psychiatric health care, while also planning to have a child. Many professionals may find themselves in a situation, when they feel clueless on what to advise regarding pharmacotherapy and realistic expectations on having a child. The presentation will focus on some crucial topics. What should counselling include when planning pregnancy, highlighting differences among first and second or further children. Potentials risks and harms on the fetus / new-born baby will be introduced with emphasis on pharmacological/chemical agents, infectious effects and social, relational and family stressors. What the guidelines are for Covid-19 vaccination and pregnancy. Relative and absolute contraindications of planned pregnancy will be discussed. The crucial question of artificial/therapeutic abortion; are there any psychiatric conditions, when a psychiatrist can/should suggest it? The advantage and knowledge of perinatal mental health guideline papers, bio-ethical aspects will be discussed, along with the consequences of untreated mental illness. Advantage of breastfeeding and an up-to-date view on what should be psychiatrists’ aim will be introduced. Why is it inevitable to cooperate with GPs, obstetric- and gynecology colleagues and further medical professionals? The essential aspect and advantages of involving fathers and extended family members in this approach also will be explained.

Quality indicators for mental healthcare in the Danube region: results from a pilot feasibility study

Quality indicators are vital for monitoring the transformation of institution-based mental health services towards the provision of person-centered mental healthcare. While several mental healthcare quality indicators have been identified as relevant and valid, their actual usability and utility for routine monitoring healthcare quality over time is significantly determined by the availability and trustworthiness of the underlying data. In this feasibility study, quality indicators that have been systematically identified for use in the Danube region countries of Bulgaria, the Czech Republic, Hungary, and Serbia were measured on the basis of existing mental healthcare data in the four countries. Data were collected retrospectively by means of the best available, most standardized, trustworthy, and up-to-date data in each country. Out of 21 proposed quality indicators, 18 could be measured in Hungary, 17 could be measured in Bulgaria and in the Czech Republic, and 8 could be measured in Serbia. The results demonstrate that a majority of quality indicators can be measured in most of the countries by means of already existing data, thereby demonstrating the feasibility of quality measurement and regular quality monitoring. However, data availability and usability are scattered across countries and care sectors, which leads to variations in the quality of the quality indicators themselves. Making the planning and outputs of national mental healthcare reforms more transparent and evidence-based requires (trans-)national standardization of healthcare quality data, their routine availability and standardized assessment, and the regular reporting of quality indicators.

The role of perinatalcare in early life trauma prevention

Abstract Body

Mental health support for parents, infants and children as an interdisciplinary, cross-sectoral task has existed for decades in many European countries. A highlighted goal of integrated services (medical, social and educational) is to support competent parenting and the positive parent-child relationship, for the optimal development including mental health of infants and children. In clinical practice, the role of psychiatrists is often linked to healing and rehabilitation, even though we also have an important role in prevention. The mental support, treatment and prevention of psychiatric disorders during the pre-, peri- and postnatal period are often not considered being preventive measures. The perinatal period is the most sensitive and at the same time one of the most important stages of our lives. The traumas suffered during this period affect both the mother and the newborn, in fact it affects the family as a whole. Models for the prevention of early trauma appear at the level of social community and, inter alia, health and social care. Traumas are closely linked to social determinants of health. Gene environment interactions also allow for the transgenerational transmission of trauma. The presentation introduces individual and family levels of interdisciplinary care, good practices and programs the knowledge of which may be important to psychiatrists. How the practicing psychiatrist can contribute to trauma prevention and how to understand the development of resilience. The presenter will detail good practices, and highlight the possibilities for all clinicians on ways to work in their respective field with a trauma preventive approach.

Disclosure

No significant relationships.

Family healing: Contextual interventions in perinatal clinical practice

Abstract Body

In perinatal clinical practice (PCP), the focus of care has shifted from the mother and then the baby-mother dyad to the emphasis on the role of fathers. Individual and therapeutic interventions are multimodal, and in almost all cases interdisciplinary cooperation is assumed. The preferred therapeutic methods for perinatal mental disorders are psychological and psychotherapeutic interventions. Through the life-course model, the central, therapeutic-conceptual role of the family can be understood, which - in clinical practice - reflects the need for “think-family” in psychiatric care. Hence there is a growing need for evidence-based family-interventions. Parental mental health disorders may have an impact on family functioning and partner relationship, as well as parent-child interactions, the quality of attachment and relationship with the child. Even though we have an increasing number of evidence regarding the aims and effectiveness of family interventions, additional evidence is needed to determine what interventions and modalities are effective in the perinatal period. And we also need information when these interventions are contraindicated and regarding their risk. It is conceivable that there is not much difference between the efficacy of family intervention methods used in other indications and the perinatal application of the same methods. We have gathered evidence primarily on perinatal depression, which opens the path of family interventions in other disorders. When thinking in the family as a general framework, it should be filled with evidence-based quantitative and qualitative anchors. The conceptual framework can be based on systems- and network theory. The presentation is illustrated with clinical vignettes.

Disclosure

No significant relationships.

Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries

Background.

Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.

Methods.

The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.

Results.

We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.

Conclusions.

We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe

PURPOSE

Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.

METHODS

We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.

RESULTS

We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.

DISCUSSION

The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.

CONCLUSION

Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.

EPA guidance on how to improve the image of psychiatry and of the psychiatrist

Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.