Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation

Füredi, János; Mohr, Pavel; Swingler, Dave; Bitter, István; Gheorghe, M.D.; Hotujac, Ljubomir; Jarema, Marek; Kocmur, Marga; Koychev, G. I.; Sn, Mosolov; Pecenak, Jan; Rybakowski, J.K.; Švestka, Jaromír; Sartorius, Norman

doi:10.1111/j.1600-0447.2006.00804.x

Cited by 27 publications

(22 citation statements)

References 15 publications

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“…This finding is consistent with use of long-term institutionalization as an acceptable local practice in psychiatric treatment and management in this region [16][17][18][19][20].…”

Section: Discussionsupporting

confidence: 76%

Regional disease characteristics and comorbidities of patients with schizophrenia in the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC): Findings from an international large simple trial

Kane¹,

Fleischhacker²,

Kolitsopoulos³

et al. 2012

OJPsych

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Background: Using baseline data from the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC), we assessed disease characteristics and prevalence of select comorbidities among subjects with schizophrenia in different clinical settings across 18 countries. ZODIAC was a randomized, open-label, one-year, large simple trial (LST) that enrolled 18,239 individuals with schizophrenia. Methods: Subjects were randomized to open-label treatment with ziprasidone (n = 9120) or olanzapine (n = 9119) in naturalistic (usual care) settings and followed for one year. Study sites (n = 749) applied minimal selection criteria in an attempt to make the study population as representative as possible of those receiving treatment in "real world" circumstances across the countries. Results: Mean patient age was 41 years, 55% were male, 34% were markedly ill or presented with more severe disease, and 66% of subjects had one or more select comorbid conditions [i.e. heart attack, stroke, hypertension, CAD/angina, high cholesterol/triglycerides, diabetes, or overweight (BMI ≥ 25)] at baseline. History of suicide attempt was greatest in the US (38%), compared with Sweden (34%), Brazil/South America (26%), Asia (23%), and Eastern Europe (20%). Overweight or obesity was the most prevalent comorbid risk factor, representing 60% of enrolled subjects, 70% of US subjects compared with 30% in Asia and 52% -64% in the other regions studied. High cholesterol/triglycerides levels were found in 23% of US subjects compared with a relatively low prevalence in other countries (3% -11%). History of cardiovascular or diabetes-related comorbidities was found in 31% of subjects. Current smoking (46.5%) and past smoking (11.8%) were common with men dominating the proportion of current smokers: US (61%); Asia (60%); Sweden (50%); Eastern Europe (49%); and Latin America (44%). Conclusions: Our findings indicate substantial baseline variations across countries in demographics, comorbid conditions, and psychiatric disease history. These data provide an international epidemiologic picture of schizophrenia and may help guide future research and treatment initiatives.

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“…This finding is consistent with use of long-term institutionalization as an acceptable local practice in psychiatric treatment and management in this region [16][17][18][19][20].…”

Section: Discussionsupporting

confidence: 76%

Regional disease characteristics and comorbidities of patients with schizophrenia in the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC): Findings from an international large simple trial

Kane¹,

Fleischhacker²,

Kolitsopoulos³

et al. 2012

OJPsych

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“…The burden of mental and substance use disorders in CEE has been identified as one of the greatest in the world 13 , the prevalence of PTSD and other mental health problems seems to be considerably elevated in countries that have experienced recent conflict 14 , suicide rates are medium to high, 15 and the level of alcohol consumption is excessive. 16 Despite some success in deinstitutionalization and changes in legislation, 17 there is evidence of excessively long or unacceptably short hospitalizations 18 and otherwise inadequate services, 19 as well as reports of the abuse of psychiatry 20 and human rights violations in some countries 19,[21][22][23] . The allocation of financial resources for mental health care is reported to be far below the EU average of European Union (EU) 24 and the vast majority of resources are still spent on outdated institutional systems 25 .…”

mentioning

confidence: 99%

A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe

Winkler

Krupchanka

Roberts

et al. 2017

The Lancet Psychiatry

122

145

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Twenty-five years have passed since the major socio-political changes in Central and Eastern Europe and our aim was to map and analyze the development of mental health care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is non-transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be high compared to other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which occurred due to grassroots initiatives supported by international organizations, rather than due to systematic implementation of government policies.(150 words, unstructured)Funding: This study had no specific funding.

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“…For example in Poland, mental health service provision developed more similarly to worldwide trends: between 1970 and 1990, before the political change, psychiatric bed numbers were reduced by about 20% [28]. After the political change of 1989, all CEEC underwent important reforms of mental health care provision including the reduction of psychiatric hospital beds, reforms of mental health legislation and transformation of the reimbursement systems [29].…”

Section: Introductionmentioning

confidence: 99%

Changes in the Provision of Institutionalized Mental Health Care in Post-Communist Countries

et al. 2012

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BackgroundGeneral psychiatric and forensic psychiatric beds, supported housing and the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to increasing prison populations. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context.Methodology/Principal FindingsGeneral psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population rates were collected in Azerbaijan, Belarus, Croatia, Czech Republic, East Germany, Hungary, Kazakhstan, Latvia, Poland, Romania, Russia and Slovenia. Percentage change of indicators over the decades 1989–1999, 1999–2009 and the whole period of 1989–2009 and correlations between changes of different indicators were calculated. Between 1989 and 2009, the number of general psychiatric beds was reduced in all countries. The decrease ranged from −11% in Croatia to −51% in East Germany. In 2009, the bed numbers per 100,000 population ranged from 44.7 in Azerbaijan to 134.4 in Latvia. Forensic psychiatric bed numbers and supported housing capacities increased in most countries. From 1989–2009, trends in the prison population ranged from a decrease of −58% in East Germany to an increase of 43% in Belarus and Poland. Trends in different indicators of institutionalised care did not show statistically significant associations.Conclusions/SignificanceAfter the political changes in 1989, post-communist countries experienced a substantial reduction in general psychiatric hospital beds, which in some countries may have partly been compensated by an increase in supported housing capacities and more forensic psychiatric beds. Changes in the prison population are inconsistent. The findings do not support the Penrose hypothesis in that historical context as a general rule for most of the countries.

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Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation

Abstract: The major changes in the period of transition documented in the review pose new challenges for psychiatry.

Cited by 27 publications

References 15 publications

Regional disease characteristics and comorbidities of patients with schizophrenia in the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC): Findings from an international large simple trial

Regional disease characteristics and comorbidities of patients with schizophrenia in the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC): Findings from an international large simple trial

A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe

Changes in the Provision of Institutionalized Mental Health Care in Post-Communist Countries

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