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.
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.
Mental health systems in Eastern Europe started to develop separately in 1990.Inpatient care mainly concentrates in hospitals. There is still domination of separate psychiatric clinics. But patients with the neurotic spectrum disorders are admitted to the general hospitals, other patients receive inpatient care in psychiatric clinics. The main trend in inpatient care is deinstitutionalisation with decreasing number of beds and increasing number of daily stay facilities, rehabilitation centres, etc. Number of inpatient beds per 10 000 populations varies from 4,3 in Serbia to 12,9 in Latvia.Duration of hospitalisation in psychiatric departments has been reduced, but this sometimes leads to the vicious circle of multiple re-hospitalisations. Governmental residential facilities where disabled people may stay for longer periods are insufficient or lacking and if commercial ones exist in the country relatives of psychiatric patients very rarely can afford the expenses. One of the positive changes is the access to a much wider variety of medicines in psychiatric units. Sometimes in the hospital treatment with an expensive drug may be initialized, which may be unaffordable in outpatient care.The principle of multidisciplinary teamwork including involvement of a psychotherapist in the treatment process has been implemented in many hospitals. The main challenges for the inpatient care are: lack of financial resources, adaptation to the changing mental health system and brain drain.Reforming mental health in our countries we need to bear in mind that it should be effective to the patients and comfortable for the doctors to work in.
Purpose of the study- The clinical and neuropsychological estimation of vascular dementia.- Highlighting the clinical and neuropsychological and CT correlations depending on the degree of evolution in disease severity.- Assessing the possibility of establishing prior positive diagnosis, differential diagnosis, evolution and prognosis.Material and methods32 patients aged from 47 to 74 years (17 female and 15 males) diagnosed with vascular dementia were included. For diagnosis patients were examined clinically and neuropsychological, and CT.ResultsAccording Mini Mental Score: - 17 patients: 16–23 items- 11 patients: 6–15 items- 4 patients: <6 itemsIschemic Score Hachinsky:- 7 patients: <8 points- 15 patients: 8–11 points- 6 patients: 11–14 points- 4 patients: >18 pointsHamilton Depression Scale:- 11 patients: <7 points- 10 patients: 7–9 points- 8 patients: 10–12 points- 2 patients: >12 points.Evolutionary studies of vascular dementia were correlated with psychometric assessments and anatomical gap size revealed by brain CT.Differential diagnosis was made with Alzheimer's disease.Conclusions- In the onset and evolution of vascular dementia on the neurological examination predominant presence of signs of outbreak- Neuropsychological changes are manifested by cognitive symptoms- The direct link to increase the neuropsychological symptoms, depending on the severity of cerebral atrophy and volume of ischemic site on brain CT.- Clinical, neuropsychological tests and CT revealed that early positive diagnosis, differential diagnosis, progress and prognosis.
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