Psychiatric reform in Russia

OBJECTIVE: To describe the mental health care system in Russia against the background of rapid social, economic and political change since the late 1980s. METHOD: Indicators of social stress and deteriorating population mental health and official data on service provision are presented. RESULTS: In the current system of psychiatric care dispensaries take a central position. Key issues of the discussion on mental health care include ways of coping with social stress disorders, strategies to redefine psychiatric rehabilitation in a changed social-economic context and steps towards strengthening social support networks for people with mental illness. Following political abuse of psychiatry, professionals have had to face justified and unjustified accusations, and been faced with a general challenge to their role. CONCLUSION: Tackling problems of social stress, the integration of mental health care in the general medical care system and the building-up of general hospital in-patient psychiatric units are of strategic importance.     

Suicide of Psychiatric Inpatients 1970–1993 in Baden-Württemberg (Germany)

The well-known fact of suicides of psychiatric inpatients duringpsychiatric hospital treatment is discussed according to national andinternational suicide data. In our Baden-Württemberg (Germany)Psychiatric Inpatient Suicide Study an increase in suicide and suicide ratesfrom 1970 to 1993 can be shown with an mostly impressive increase in the1970s and a plateau formation in the 1980s and constant figures in the1990s. The group of 585 suicides (59% men, 41%women) is composed of: 26% primarily depressives, 53%schizophrenics (ICD-9); where the following features were notablepresuicidal syndrome with depressive mood (68%), insight into illness(63%), feelings of suffering (64%), failure (57%),hopelessness (54%) and helplessness (54%).     

Psychiatric reform in the Veneto region of Italy: the state after five years

The state of the psychiatric reform in Italy since 1978 is now examined. The reform has faced many difficulties due to the economic crisis, political instability and inadequate implementation of regional facilities stipulated by law. However, it has had some positive effects and has awakened public opinion to the problem of the mentally ill. The study area chosen is the Veneto region of Italy. It is a widespread belief that with some modifications, particularly regarding the problem of long-term patients, the psychiatric reform can be carried out with success. The principles which have inspired it are worthy but its application is not easy as we are dealing more with a cultural reform than with a new organization of services; this will require more time.     

Psychiatric hospital reform in low- and middle-income countries: a systematic review of literature

Purpose

Psychiatric hospitals or mental asylums grew across the world in the colonial era. Despite concerns over quality of care and human rights violations, these hospitals continue to provide the majority of mental health care in most low- and middle-income countries (LMICs). We sought to review the evidence of reform of mental hospitals and associated patient outcomes.

Methods

We adopted an integrative review methodology by including experimental and non-experimental research. The review protocol was registered on PROSPERO (CRD42019130399). A range of databases and systematic hand searches were conducted by two independent reviewers. Research conducted between 1980 and May 2019, that focused on any aspect of reform in mental hospitals for adults (age 18 and upwards) with severe mental illness and published in English, were considered.

Results

16 studies were included in the review. 12 studies met inclusion criteria, and four additional reports emerged from the hand search. Studies covered—India, China, South Africa, Grenada, Georgia, Sri Lanka, Argentina and Brazil. Key findings emphasise the role of judicial intervention as a critical trigger of reform. Structural reform composed of optimisation of resources and renovations of colonial structures to cater to diverse patient needs. Process reforms include changes in medical management, admission processes and a move from closed to open wards. Staff engagement and capacity building have also been used as a modality of reform in mental hospital settings.

Conclusion

There is some documentation of reform in psychiatric hospitals. However, poor methodological quality and variation in approach and outcomes measured, make it challenging to extrapolate specific findings on process or outcomes of reform. Despite being integral service providers, psychiatric hospitals still do not adopt patient centric, recovery-oriented processes. Hence, there is an urgent need to generate robust evidence on psychiatric reform and its effect on patient outcomes.

     

Psychiatric, psychosomatic and medical psychological consultation and liaison activity in West Germany. Results of a survey

Results of the first survey of consultation/liaison psychiatry and psychosomatics in the Federal Republic of Germany are presented and discussed. All departments and units of psychiatry, psychosomatics and medical psychology were asked to fill in a questionnaire, characterizing the institution in question, the type and degree of cooperation with somatic units and the experiences made therewith, as well as special issues like the use of data bases and diagnosis, questions of organization, professional training and research in C/L work. The 177 institutions which replied (67% of the total of 263 institutions addressed) can be regarded as representative for those institutions which are involved in consultation/liaison work. As compared with psychiatry, psychosomatic (and medical psychology) departments are especially involved in C/L-work. Due to insufficient financing and relative neglect as concerns research and professional training and exchange, C/L-work in the Federal Republic of Germany at present is far from providing general hospital inpatients with the mental health care required, as indicated by prevalence estimates. Reasons for this are discussed and suggestions as to minimal standards of C/L-care are provided.     

Psychiatric morbidity and referral rates in general practices: Comparison of an industrial town and a rural area in West Germany

Summary Samples of the clientele of general practitioners in the industrial city of Mannheim and the county of Traunstein, a small-town-rural area in Upper Bavaria, were interviewed with the Clinical Psychiatric Interview (Goldberg et al. 1970). The prevalence and diagnostic distribution of psychiatric illness among 1.026 patients in Mannheim and 1.274 patients in Traunstein were established. In addition we examined the ability of general practitioners to detect mental disorders among the same patients. The relationship of this factor to the size of the practice and the duration of the doctor-patient relationship was tested. Controlling for sex, age and marital status yielded only minor differences in psychiatric prevalence rates and diagnostic distribution between the two areas. In Mannheim, however, more psychiatric cases identified by the interviewers were detected by the family physicians. In comparison with Traunstein the rate of psychiatric referrals was significantly higher in Mannheim.     

Psychiatric comorbidity in epilepsy

Many studies on psychiatric comorbidity in epilepsy have been performed using many different patient groups and diagnostic instruments. This methodological heterogeneity complicates comparison of the findings. In this article, psychiatric disorders in epilepsy are reviewed from the perspective of the DSM classification system. The empirical findings of axis I clinical disorders and axis II personality disorders are described separately. Furthermore, the existence and specificity of conditions such as interictal dysphoric disorder, interictal behavior syndrome, and psychosis of epilepsy are discussed. From the many studies that have been performed on this topic it can be learned that there is a need for well-controlled studies using representative patient groups and valid and standardized diagnostic instruments. So far, the majority of the studies have concerned axis I disorders; relatively little research has been performed on axis II personality disorders. More research on personality disorders, as well as on the relative contributions of the different (brain- and non-brain-related) factors to the relationship between epilepsy and psychiatric disorders, is recommended.     

Psychiatric issues in epilepsy

In recent years there has been considerable research interest at the interface between epilepsy and psychiatry. Topics of interest include the epidemiology of psychiatric co-morbidity in epilepsy; clinical syndromes at this interface and their classification; the relationship between cognitive dysfunction and psychiatric co-morbidity; biological mechanisms that mediate such co-morbidity, especially with developments in imaging and genetic research; the association between temporal lobe surgery, vagus nerve stimulation, and other non-pharmacological treatments, and the development of such co-morbidity; the contribution of anticonvulsant drugs towards the development of psychiatric co-morbidity; quality of life and other psychosocial issues; and non-epileptic attack disorder. In this review, papers on these psychiatric issues in epilepsy, with a focus on those published in the past year (October 1999 to October 2000) are critically evaluated, and some important current issues at this interface are considered in detail.