Daria Smirnova

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

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse 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 not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries

PurposeThere is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes.MethodsThis is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of ‘low satisfaction’ were examined by comparisons of binary and multivariate associations in multilevel regression models.ResultsA final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38–48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio.ConclusionFurther studies on patients’ satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients’ disempowerment, and power imbalance.

Second language as a compensatory resource for maintaining verbal fluency in bilingual immigrants with schizophrenia

BACKGROUND AND OBJECTIVES Due to the large migrations over the past three decades, large numbers of individuals with schizophrenia are learning a second language and being seen in clinics in that second language. We conducted within-subject comparisons to clarify the contribution of clinical, linguistic and bilingual features in the first and second languages of bilinguals with schizophrenia. METHODS Ten bilingual Russian(L1) and Hebrew(L2) proficient patients, who developed clinical schizophrenia after achieving proficiency in both languages, were selected from 60 candidates referred for the study; they were resident in Israel 7-32 years with 3-10 years from immigration to diagnosis. Clinical, linguistic and fluency markers were coded in transcripts of clinical interviews. RESULTS There was a trend toward more verbal productivity in the first language (L1) than the second language (L2). Clinical speech markers associated with thought disorder and cognitive impairment (blocking and topic shift) were similar in both languages. Among linguistic markers of schizophrenia, Incomplete syntax and Speech role reference were significantly more frequent in L2 than L1; Lexical repetition and Unclear reference demonstrated a trend in the same direction. For fluency phenomena, Discourse markers were more prevalent in L1 than L2, and Codeswitching was similar across languages, showing that the patients were attuned to the socio-pragmatics of language use. CONCLUSIONS More frequent linguistic markers of schizophrenia in L2 show more impairment in the syntactic/semantic components of language, reflecting greater thought and cognitive dysfunction. Patients are well able to acquire a second language. Nevertheless, schizophrenia finds expression in that language. Finally, more frequent fluency markers in L1 suggests motivation to maintain fluency, evidenced in particular by codeswitched L2 lexical items, a compensatory resource.

Asian federation of early career psychiatrists: building bridges and expanding horizons.

Suman Kumar Sinha , Nikita Bezborodovs , Dmitry Krupchanka , Olga Paravaya , Marie Bendix , Daria Smirnova f a Department of Psychiatry and De-addiction, Lady Hardinge Medical College, New Delhi 110049, India b Riga Stradins University, Riga Centre of Psychiatry and Addiction Disorders, Latvia c Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus d Republican Research and Practice Centre of Mental Health, Minsk, Belarus e Psychiatric Clinic, Karolinska University Hospital Huddinge, Stockholm, Sweden f Psychiatry, Narcology, Psychotherapy and Clinical Psychology Department, Samara State Medical University, Samara, Russia

Family and family therapy in Russia

Abstract This article represents the information about family and family therapy in the context of culture, traditions and contemporary changes of social situations in Russia. The legislation of family rights are mentioned within items about marriage and family in the Constitution, Civil Code and Family Code of the Russian Federation which has changed during recent years. The definition of family and description of family structure are given through the prism of the current demographic situation, dynamics of statistics of marriage and divorce rates, mental disorders, disabilities and such phenomena as social abandonment. The actual curriculum, teaching of family therapy and its disadvantages, system of continuous education, supervision and initiatives of the Institute of Integrative Family Therapy in improvement of preparing of specialists who can provide qualified psychosocial assistance for the family according to the actual needs of society are noted. The directions of state and private practice of family counselling and therapy both for psychiatric patients and medical patients, for adults and children in a family systemic approach are highlighted with an indication of the spectrum of techniques and methods used by Russian professionals. The main obstacles and perspectives of development of family therapy in Russia are summarized.

Early career psychiatrists corner: Third young psychiatrists’ network meeting: Stigma in YPs’ perspective

The movement of the young psychiatrists’ (YPs) network (YPN) was born in 2009 and has developed substantially since then. The idea of network collaboration was suggested by the Swedish Eastern Europe Committee (Assoc. Professor Jerker Hanson) and found approval of YPs from Lithuania, Sweden, Belarus, and Russia in Kaliningrad in May 2009. Next 2 meetings took place in Vilnius, Lithuania in 2010 devoted to neuropsychiatry and diagnostic scales and Riga, Latvia in 2011 with the main topics of personality disorders and coercive care. The number of countries-delegates has increased from 4 in 2009 to 18 (90 YPs) in 2011. YPN is open to all interested YPs all over the world and supports any activity of participants in the field of professional development. YPN preferentially focuses on international exchange of recent evidence-based knowledge about mental health and treatment focusing on patient’s rights, national diversities and cultural traditions and working toward destigmatizing psychiatrists and mental disorders in society using the creative ideas of young minds and innovative technologies. The interaction between in YPN is based on mutual respect, openness and already friendship. The activity of organization includes both on-line collaboration and annual conferences with publishing of abstract booklets of young researchers. Programmes of YPN Meetings include not only lectures by prominent professors but maintain workshops and social program as a way to increase activity and involvement of young participants. After each conference all YPs are welcomed to take part in organizing committee of the future meeting. The forthcoming Meeting is supported by European Federation of Psychiatric Trainees and will take place in Minsk, Belarus, 27–29th September 2012. The project is oriented on the development of new perspectives in understanding of phenomenon of stigma of mental disorders in patients, professionals and society, as it seems to be a real substantial obstacle in contemporary psychiatry. The program of the conference is accessible at www.ypsnet. org and includes lectures by Professors N. Sartorius (Switzerland), Sir D. Goldberg (UK), W. Gaebel (Germany), W. Rutz (Sweden), R. D’Souza, A. Janca (Australia), E. Mohandas, Anu Kant Mital (India), R. Evsegneev, O. Skugarevsky, S. Igumnov (Belarus). Members of early career psychiatrists’ organizations such as EFPT, WPA ECPC, AFECP, Russian ECPC and others will discuss their collaboration during the meeting of YPN without involvement or creation of any new organization. YPN is just the unity of early career psychiatrists from all countries of Europe and Russia. YPN is not an organization of any hierarchy but collaboration of enthusiastic YPs from Europe and Russia who encourage each other in an open dialogue and a brainstorming fostering atmosphere. The importance of meeting is emphasized by first participation of young colleagues from AFECP and their involvement in activities of organizing committees of future annual Meetings. It is an important step for AFECP to promote itself on the international level among ECPs organizations, demonstrate the opinion, share experience and make a contribution into networking on behalf of Asia. Members of AFECP are welcomed to provide the ideas of networking worldwide through the countries of Asia and strengthen collaboration between European and Asian YPs for further assistance in solving current professional problems and mutual benefits of early career psychiatrists in their own countries. YPN is sincerely grateful to Elsevier who kindly supported the process of developing and publishing of promoting materials about the Meeting.

The second training and educational fellowship program of AFECP

The 2nd fellowship program of Asian Federation of Early Career Psychiatrists (AFECP) took place under the guidance of Prof. Russell D’Souza, due to support of distinguished faculty and as a precongress activity of Indian Global Psychiatric Initiative (IGPI) on the 15th–16th of January 2012 in Kochi, Kerala, India. Eighteen participants from Asian countries including Russia, Egypt, Indonesia, Malaysia, China, Bangladesh, Iraq, Singapore, Australia and 18 from India took part in the training. The theme was ‘‘Image of modern psychiatrist: professionalism, humanism and leadership’’; faculty from Australia, USA, Malaysia, France and UK participated in interactive training and team building tasks among ECPs during 2 days. A visit to Amrita Institute of Medical Sciences, Hospital Complex and Psychiatry and Behavior Medicine Department was an interesting event for non-indian colleagues and stimulated discussion about Mental Health Care systems functioning in transition. The topics of development of professional competence within studying and teaching with diagnostic and communication skills, biological approach in psychiatry on the model of psychotic disorders, clinical trials management and publishing of scientific papers, vivid discussions about existential concept of mental disorders, well-being theories and creativity in idea management and inspiration in everyday work emphasized the unity and equal importance of noticed directions for the professional growth of contemporary specialists. The executive committee of AFECP finalized the Statutes of AFECP, plans on web-page modification and updates of research projects. The number of members of organization has increased from 48 since inception to nearly 290 with affiliations of societies from Malaysia, Egypt, Russia, Kazakhstan and others as member-societies of AFECP besides individual members from 23 countries. ECPs evinced an interest in additional education and international collaboration. The interaction among ECPs and senior advisors augurs promising developments in psychiatry across Asia. Members of AFECP will attend the conference ‘‘Stigma in YPs perspective: hopes and challenges’’ in Minsk, Belarus on 27th–29th September 2012. The next AFECP training is scheduled for IGPI in Bangalore, India in 2013.

Language Patterns Discriminate Mild Depression From Normal Sadness and Euthymic State

Objectives Deviations from typical word use have been previously reported in clinical depression, but language patterns of mild depression (MD), as distinct from normal sadness (NS) and euthymic state, are unknown. In this study, we aimed to apply the linguistic approach as an additional diagnostic key for understanding clinical variability along the continuum of affective states. Methods We studied 402 written reports from 124 Russian-speaking patients and 77 healthy controls (HC), including 35 cases of NS, using hand-coding procedures. The focus of our psycholinguistic methods was on lexico-semantic [e.g., rhetorical figures (metaphors, similes)], syntactic [e.g., predominant sentence type (single-clause and multi-clause)], and lexico-grammatical [e.g., pronouns (indefinite, personal)] variables. Statistical evaluations included Cohen’s kappa for inter-rater reliability measures, a non-parametric approach (Mann–Whitney U-test and Pearson chi-square test), one-way ANOVA for between-group differences, Spearman’s and point-biserial correlations to analyze relationships between linguistic and gender variables, discriminant analysis (Wilks’ λ) of linguistic variables in relation to the affective diagnostic types, all using SPSS-22 (significant, p < 0.05). Results In MD, as compared with healthy individuals, written responses were longer, demonstrated descriptive rather than analytic style, showed signs of spoken and figurative language, single-clause sentences domination over multi-clause, atypical word order, increased use of personal and indefinite pronouns, and verb use in continuous/imperfective and past tenses. In NS, as compared with HC, we found greater use of lexical repetitions, omission of words, and verbs in continuous and present tenses. MD was significantly differentiated from NS and euthymic state by linguistic variables [98.6%; Wilks’ λ(40) = 0.009; p < 0.001; r = 0.992]. The highest predictors in discrimination between MD, NS, and euthymic state groups were the variables of word order (typical/atypical) (r = −0.405), ellipses (omission of words) (r = 0.583), colloquialisms (informal words/phrases) (r = 0.534), verb tense (past/present/future) (r = −0.460), verbs form (continuous/perfect) (r = 0.345), amount of reflexive (e.g., myself)/personal (r = 0.344), and negative (e.g., nobody)/indefinite (r = 0.451) pronouns. The most significant between-group differences were observed in MD as compared with both NS and euthymic state. Conclusion MD is characterized by patterns of atypical language use distinguishing depression from NS and euthymic state, which points to a potential role of linguistic indicators in diagnosing affective states.

Schizophrenia in Bilingual Immigrants: is Verbal Fluency Preserved in Second Language Acquisition?

Objectives Language disturbances are the core symptoms of schizophrenia [Crow,2000]. Considering the influence of migration on the symptoms of schizophrenia [Bhugra, Gupta,2011] and few studies on the interaction of schizophrenia and bilingualism [Bersudsky, et al.,2005], we hope to clarify the linguistic profile of disorder and emphasize the role of language in schizophrenia research. Aim To examine the linguistic features of schizophrenia in the first (L1) and the second (L2) languages, particularly in fluency as the ability to cope with native and nonnative pragmatics. Methods Among sixty Russian immigrants to Israel diagnosed with schizophrenia, ten Russian-Hebrew fluent bilinguals met criteria for inclusion in the study (age: M=33.8,s.d.=11.0; length of residence: M=14.6,s.d.=6.8; time of immigration to diagnosis:M=5.3,s.d=3.9; PANSS Total score: M = 94.9,s.d = 9.8). Interviews were analyzed using clinical, linguistic and fluency speech markers. Statistical evaluation included t-test for dependent samples, two-way ANOVA(Fisher LSD post-hoc test). Results The mean length of language samples demonstrated more productivity in L1 (Table1). Clinical speech markers associated with thought disorders were similarly represented in both languages. Linguistic markers of schizophrenia occurred more often in L2. Discourse markers, as bilingual phenomenona, reflected more dysfluency in L1. Download : Download full-size image Conclusions 1) The higher frequency of linguistic schizophrenia markers in L2 shows more impairments in the syntax/semantic components of language, where different neural representations may underlay the two languages in a bilingual brain damaged by schizophrenia. 2) The higher frequency of fluency markers in L1 reflects attempts to maintain verbal fluency, evidenced by the use of L2 lexical items, which afford a compensatory resource for communicative discourse in schizophrenia.

1499 – Neurodynamic patterns of sleep disturbances related to posttraumatic stress disorder in war veterans

Sleep disturbances are important features of posttraumatic stress disorder (PTSD), however, data characterizing PTSD sleep phenomena are limited. Detailed clinical description of sleep function and its study with the use of modern instrumental methods is important for timely and differential diagnosis of mental disorders in PTSD patients. 21 war veterans fighting in “hot spots were observed during treatment in the specialized department of psychological rehabilitation, Samara Regional Clinical Hospital for War Veterans. After clinical interview the overnight polysomnography “Sagura-2000” (PSG) was performed. Sleep disorders in PTSD patients are characterized by the complex of subjective, clinical and neurophysiological symptoms: 1. Superficial sleep (restless, lack of deep sleep); 2. Increased motor activity during sleep (number of activations of the paradoxical phase of sleep to those of deep sleep); 3. Nightmares; 4. Specific (defensive) movements during sleep; 5. Frequent nocturnal awakening (increased number and duration of awakenings); 6. The excess of REM sleep. PSG identified the most frequently related nightmares neurodynamic phenomena: 1. Deficiency of the deep sleep (stages 3 and 4 NREM); 2. Up to 70% of the time NREM takes stage 2 sleep; 3. The increase in motor and EEG activations; 4. The number of activations of the REM than those of NREM; 5. The increase in total REM sleep time; 6. Increasing episodes of REM sleep. Further studies are required to clarify polysomnographic sleep changes, in particular, role of REM sleep dysregulation and treatment of sleep disorders in PTSD. Study was supported by Russian Humanitarian Scientific Foundation (???? 12-36-01155)