IntroductionPsychiatric training in the European Union is undergoing a process of harmonization of national curricula in order to establish a common postgraduate training framework. The Research Group of the European Federation of Psychiatric Trainees (EFPT) is conducting a multi-national study on psychiatry education of trainees among the European countries in regard to the Union Européenne Des Médecins Spécialistes (UEMS) 2009 competencies framework.ObjectivesThe aims are to raise awareness on these competencies, compile data on trainees‘ experience of their training and assessment methods, opinions on level of confidence, and on relevance of these competencies.MethodsThis study surveyed trainees from 15 EFPT countries using a questionnaire developed specifically for this research.ResultsPsychiatric training in Europe differs significantly regarding length, with a training duration ranging from 4 to 8 years. Only 26,7% of the trainees were well acquainted with the UEMS competencies and trainees from only 8 countries declared to have a competency based national training curriculum. These results reveal that trainees have different experiences and opinions on competencies and assessment methods depending on their country of residence.DiscussionsA limitation of the results may be that our respondents are the EFPT representatives’ and probably have better knowledge on the educational issues.ConclusionsThe combined quantitative and qualitative outlook on national training programmes from the trainees point of view enhances our understanding and perspective of the dynamic processes of psychiatric education in Europe. Data obtained from this research study contributes to the efforts to unify psychiatric training curricula.
Introduction:Studies show that children of oncologic patients resort more to psychiatric care and document the possibility that they face these episodes as traumatic events, easily developing PTSD if not properly signaled and followed.Objectives:The authors present the case of a boy who faced his father disease as a traumatic event, developing PTSD. They aim to describe the potential impact of parental oncologic diseases in children, as well as the benefits of acting preventively in those scenarios.Methods:Report of the clinical case of a 14 years old boy who was admitted as an outpatient at the Department of Child and Adolescent Psychiatry after being referred by his General Practitioner for having initiated behavioral disturbances in reaction to his father oncologic disease, which led to a radical surgery of the face and neck with significant physiognomic changes. He has been followed in consultation, medicated with Risperidone 0,5mg and submitted to psychotherapy.Results:During approximately three months of treatment there was a wide improvement of the clinical condition with better acceptance of his father oncologic disease and of the physiognomic changes caused by the treatment. It is also noticeable the fading of his indignation against the medical community caused by the aggressive nature of the surgery.Conclusions:This case shows a situation that would have benefited from a preventive intervention, because given the mutilating nature of the treatment, the adolescent should have been prepared to face his father's new appearance from a therapeutic perspective and not as a traumatic event.
Introduction:Bullying can occur in several circumstances but nowadays it is largely widespread in schools. Several studies reveal the amount of psychopathology and behavioral changes that it determines, with special focus on children that can suffer silently or react with somatic disorders.Objectives:The authors present a clinical case of a girl who was victim of bullying, with the aim to describe the potential impact of bullying, as well as its clinical and social implications.Methods:Report and analysis of the clinical case of a 13 years old girl who was admitted as an outpatient at the Department of Child and Adolescent Psychiatry after being referred by her General Practitioner for having become hoarse abruptly. She has been followed in consultation, medicated with antidepressants and submitted to psychotherapy. We also performed a medical screening, particularly the otorhinolaryngology specialty, which failed to detect alterations that could justify the aphonia.Results:During the clinical appointments we identified some bullying episodes at school, whose worsening temporally matched with the moment when she became hoarse. After six months of follow-up and intervention, there was an improvement of the mood state; however she only regained her voice after an apology from the bully.Conclusions:Although some would argue that bullying can teach life lessons and give strength, there is a consensus that it represents a way of abuse. We should pay particular attention in children, since as in this case, they often react with somatic symptoms that can delay and misled the diagnostic and intervention.
Introduction:Legal drugs are changing the standards of drug consumption. These substances, labelled ‘not for human consumption’ are sold as incense, bath salts or pills, tricking sanitary authorities and Food and Drug Administration. Despite the absence of clinical trials, they grant a feeling of safety by being freely sold over the internet and smart-shops, and by ending the fear of control, since medical analyzes do not detect them. This makes them appealing and their popularity is steadily growing.Objective:The authors aim to describe the results of analysis made to several legal drugs samples available online and its potential implications.Methods:Review of PubMed’ studies between 2010 e 2012, using as key-words: ‘legal drugs’ and ‘purchase online legal highs’.Results:Studies of substance labeling found a lack of information, since 81,9% of the analyzed products did not report side effects and 86,3% did not specify medical interactions. A study done six months after mephedrone's prohibition in the U.K., showed that 62,5% of products still presented this substance, as well as unlisted components. Three subsequent studies revealed that the majority of the drugs listed the active principle on the label, but a significant percentage also showed unlisted substances.Conclusions:In addition to the dangerous effects and interactions of the unlisted substances, consumers and sellers, misled by the nomenclature ‘legal’, may be committing an illegality when buying these drugs. Despite governmental efforts, the gap between the identification of a potentially harmful substance and its prohibition, makes difficult to prevent this potential flagellum.
IntroductionTelomeres are nucleoproteic structures arranged in a double helix, located at the end of chromosomes protecting them from deterioration. Each time a cell divides, the enzymatic machinery is unable to replicate integrity of telomeres and by this way, they became smaller, leading to cell aging and death. This shortening can be accelerated by inflammation, oxidative stress, radiation and toxins.Several studies have shown that the adverse early-life experiences may also contribute to premature aging of the telomeres.ObjectivesThis work aims to make a review of the literature published about the impact of adverse life experiences in the shortening of telomeres and premature aging.MethodsBibliographic review.ResultsSeveral studies show that early childhood abuse contribute to accelerated shortening of telomeres, some suggest that there is a direct relationship between the severity and duration of abuse and the degree of shortening. Some studies also show that exposure to trauma in adulthood contributes to the accelerated aging, particularly in individuals who develop PTSD.DiscussionThe interaction of the environment in the biology of the organism seems very deep and precocious. These findings will possible allow the reconstruction the of the biopsychosocial model, opening up new avenues for holistic understanding of the human being.
Introduction:Hyperkeratosis is characterized by abnormal palmoplantar skin thickening. These lesions can extend to other organs and be associated with a multiplicity of pathologies.Objectives:This paper aims to describe the features of psychosocial maladjustment in a patient firstly diagnosed as having hyperkeratosis of unknown etiology.Methods:We describe a 14-year-old boy admitted to our outpatient clinic after verbalizing suicidal thoughts to his endocrinologist.Results:His medical condition had been evolving since he was six, when his palms and specially soles became grossly thickened and painful and he would be found awake at night clawing at his severely scaly and itchy lesions. He was seen by geneticists, dermatologists and plastic surgeons. However, the thickened patches continued to progress over the years, with almost no response to treatment. He was unable to keep up with his friends walking and had to give up on sports. Due to medication he has a reduced stature and low puberty development. On his first appointment he was reported to be unable to manage routine affairs or handle money matters and his scholastic performance was poor. During mental state examination one could assess restricted interests, social and communication defficits, tantrums, self and hetero aggressions and IQ below normal, despite an extraordinary visuo-spatial memory and no suicidal intent. He was medicated with risperidone and structural family therapy was applied, with good response.Conclusions:Helping individuals and families dealing with behavioural problems improves family dynamics and quality of life even in the presence of such incapacitating diseases.
IntroductionRegular physical activity should be encouraged given its major role in health maintenance and disease prevention. However, in excess, exercise has the potential to cause physical and psychological harm and can become addictive. Excessive exercise can be described in an obsessive-compulsive dimension but it is included among the behavioural addictions since it presents some of its typical characteristics such as mood modification, tolerance, withdrawal symptoms and relapse after periods of abstinence or control.ObjectiveThe authors aim to describe the concept of Exercise Addiction and the current understanding of its symptoms, diagnosis criteria, epidemiology, etiology and mechanisms.MethodsExhaustive review of the literature on Exercise Addiction and its symptoms, diagnosis criteria, epidemiology, etiology and mechanisms, using PubMed.ResultsThe most addictive type of exercise varies with countries. Studies show that physical exercise activates de dopamine reward system contributing to stress reduction and there is evidence of the association between running, endorphins and cannabinoids – explaining the’runner's high’ that can cause addiction. Genetic studies reveal that the same genes control preference for drugs and for naturally rewarding behaviours. Psychological approaches focus on reward, habituation, social support, stress-relief, avoidance of withdrawal and anxiety reduction.ConclusionsExercising regularly has several positive effects on physical and mental health but in excess, may have serious physiological and psychological consequences. There are several hypotheses for the mechanisms of exercise addiction including reward, stress reduction, the euphoric effect, mood regulation and sympathetic arousal. More studies are needed to improve our understanding of this behavioural addiction.
Introduction:Since about 30% of children and adolescents attending primary care and pediatric outpatient departments have psychiatric disorders that cause significant distress and social impairment, the proper functioning of National Health System assumes a determinant role on promoting early detection and intervening in the prevention of mental illnesses which can almost only be done through an efficient matching between primary care and hospital care.Objectives:This paper aims to characterize the pediatric population hospitalized sent by their general practitioners to our outpatient clinic, on a level III Pediatric Hospital, evaluating the existence of psychopathology.Methods:Retrospective analyses of 309 cases, at their first appointment on our outpatient clinic from June 2002 to March 2013. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children and adolescents.Results:During 10 years, 185 male (45,95% 4–10 years; 54,05% 11–17 years) and 124 female (50,0% on each age group) were evaluated. Eighty-four percent of cases, scored for’any psychiatric disorder’. Correlation between parent-reported and self-reported data was found, slightly higher for male gender. Pronounced divergences were found regarding child and adolescents’ perception and their parents, concerning everyday life difficulties and hyperactivity scores, that is also valid for age group and gender. Total scores: emotional symptoms (51,8%), conduct problems (58,3%), hyperactivity score (59,2%).Conclusions:We observed a positive impact of primary care medicine on referral network since the majority of the evaluated children and adolescents had psychopathology.
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