Igor Filipčić

Fighting stigma of mental illness in midsize European countries.

PurposeStigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published.MethodsThe review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible.ResultsThe anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country.ConclusionsAlthough much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

Perception of Stigmatization in Forensic Patients With Schizophrenia

Background: The literature about perceived stigmatization of forensic patients with schizophrenia is sparse. Aims: To examine relations between the perceived stigmatization of forensic patients with schizophrenia and the intensity of the symptoms, age, regular home visiting, kind of offence, perceived family support and duration of hospitalization. Method: Sixty-two male forensic patients with schizophrenia were included. Perceived stigmatization was measured by the modified questions from the World Health Organization Disability Assessment Schedule II. Symptomatology was assessed with the Positive and Negative Syndrome Scale. Perception of family support was assessed with a visual-analogue scale. Due to different characteristics of offences and possibilities for home visiting, patients were divided into groups of those who had committed violent and non-violent offences, and those with and without the possibility of regular home visiting. Results: Symptoms have an impact on the perception of stigma. The kind of offence committed does not have a significant role in the perception of discrimination. Age was negatively correlated with the perception of stigma. Conclusion: Results might have significance for a better understanding of social relations between forensic patients and their environment and provide us with information about institutionalized forms of stigma. Results might have implications for the treatment and the quality of life of these patients.

Cost-Utility Analysis of Depot Atypical Antipsychotics for Chronic Schizophrenia in Croatia

OBJECTIVES As a nation with a developing economy, Croatia is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. We conducted a pharmacoeconomic analysis to determine the cost-effectiveness of atypical depots in Croatia. METHODS A 1-year decision-analytic framework modeled drug use. We determined the average direct cost to the Croatian Institute for Health Insurance of using depot formulations of paliperidone palmitate long-acting injectable (PP-LAI), risperidone LAI (RIS-LAI), or olanzapine LAI (OLZ-LAI). An expert panel plus literature-derived clinical rates populated the core model, along with costs adjusted to 2012 by using the Croatian consumer price index. Clinical outcomes included quality-adjusted life-years, hospitalization rates, emergency room treatment rates, and relapse days. Robustness of results was examined with one-way sensitivity analyses on important inputs; overall, all inputs were varied over 10,000 simulations in a Monte Carlo analysis. RESULTS Costs (quality-adjusted life-years) per patient were €5061 (0.817) for PP-LAI, €5168 (0.807) for RIS-LAI, and €6410 (0.812) for OLZ-LAI. PP-LAI had the fewest relapse days, emergency room visits, and hospitalizations. Results were sensitive against RIS-LAI with respect to drug costs and adherence rates, but were generally robust overall, dominating OLZ-LAI in 77.3% and RIS-LAI in 56.8% of the simulations. CONCLUSIONS PP-LAI dominated the other drugs because it had the lowest cost and best clinical outcomes. Compared with depots of olanzapine and risperidone and oral olanzapine, PP-LAI was the cost-effective atypical LAI for treating chronic schizophrenia in Croatia. Using depot paliperidone in place of either olanzapine or risperidone would reduce the overall costs of caring for these patients.

EFFICACY AND SAFETY OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION USING AN H1-COIL OR FIGURE-8-COIL IN THE TREATMENT OF UNIPOLAR MAJOR DEPRESSIVE DISORDER: A STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique with few side effects that has been reported to be effective in the treatment of major depressive disorder (MDD). At present, no randomized controlled trials (RCT) have compared the efficacy and safety of rTMS delivered by the figure-8-coil and the H1-coil. We describe an industry-independent, randomized, controlled, single-blinded, single-center study protocol assessing the differences in efficacy and safety of rTMS for patients diagnosed with MDD with the H1-coil and figure-8-coil as an add-on to stable pharmacotherapy or pharmacotherapy alone. Stimulation protocols follow those that led to the FDA clearance of these treatments for MDD. The sample of 76 patents in each of the three groups will be enrolled and assessed with clinical and neuropsychological tests. The primary outcome is remission rate defined as Hamilton depression rating scale (HAM-D17) score ≤7 at the end of week-4. This clinical trial will address the efficacy and safety of rTMS modalities for MDD. The evaluation of biological markers will also help to elucidate the pathophysiology of MDD and the mechanisms of action of rTMS.

Stigma in Midsize European Countries

This chapter presents reports from ten mid-size European countries. Authors from Austria, Croatia, Norway, Poland, Portugal, Romania, Sweden, Slovakia, Slovenia and Turkey report about the situation in their countries. In all countries, various activities have been performed in order to fight against stigma. These included national and local campaigns, as well focussed programmes for pupils, students and other groups of the population. The content of the campaigns showed a broad range. While some included all types of mental disorders, other focussed on selected psychiatric disorders. Despite a lot of efforts, stigmatization and discrimination of people with mental disorders is a major problem in all countries. Studies about the effectiveness of anti-stigma activities show contrasting results, some of them indicate that activities were not successful. Research on anti-stigma interventions is essential to understand what might help to reduce stigma and discrimination.

F96. AGE AND GENDER DETERMINED DIFFERENCES IN THE ONSET OF CHRONIC PHYSICAL MULTIMORBIDITIES AMONG PATIENTS WITH SCHIZOPHRENIA OR DEPRESSION AND THE GENERAL POPULATION

Abstract Background The links between schizophrenia (SCH) or major depressive disorder (MDD) and chronic physical multimorbidities (CPM) are well established. Patients diagnosed with these disorders have a higher prevalence of CPM than the general population (GEP). However, our knowledge of age and gender determined differences in the development of CPM between SCH, MDD, and GEP remains fragmented and inconsistent. This exploratory study intended to compare the onset of CPM in female and male SCH and MDD patients, and the general population (GEP). Methods This nested, single-centered, cross-sectional study was performed during 2016 at Psychiatric hospital Sveti Ivan, Zagreb-Croatia. Data were collected for a consecutive sample of 136 patients diagnosed with SCH, 290 diagnosed with MDD, and 861 participants from the general population of the city of Zagreb and Zagreb County. The primary outcome was the prevalence of CPM. The secondary outcome was the prevalence of CPM in the youngest age group ≤35 years. Results After adjustment for gender and education, the prevalence of CPM was significantly different between patients with SCH or MDD and GEP (p<0.001). In the oldest age group (≥65 years) the difference was not significant anymore. In the youngest age group, the prevalence was highest in SCH patients (33%) followed by MDD (26%) and GEP (15%) indicating the early onset of CPM in severe mental illness. In the male participants <35 years old, there were no significant differences in the prevalence of CPM between SCH (25%), MDD (23%) and GEP (15%) (p=0.411). However, in the female participants <35 years old the difference was significant and clinically relevant (p=0.006). Prevalence of CPM in female participants was 50% in SCH, 33% in MDD and 14% in GEP. Discussion This study finding indicated the earlier onset of CPM in SCH and MDD patients than in GEP. This difference is primarily caused by the high prevalence of CPM in young female patients diagnosed with SCH. More prevalent physical morbidity points to a substantial disadvantage of female SCH patients early in the course of the illness. Understanding the nature and biological basis regarding the risk and outcome of CPM might help to identify new therapeutic targets, allow more individualized treatment, and facilitate better risk prediction and application of healthcare resources.

F97. CHRONIC PHYSICAL MULTIMORBIDITIES, GENDER DISPARITIES AND TREATMENT OUTCOME IN SCHIZOPHRENIA

Abstract Background Increased physical morbidity in patients with schizophrenia (SCH) is well established. However, our knowledge on the role of gender in chronic physical multimorbidities (CPM) remains limited, and the evidence about the effect of CPM on SCH treatment outcome is sparse. The present study explored the gender-dependent differences in the prevalence, and age of onset of CPM between SCH and the general population (GEP), as well as the effect of CPM on hospital readmission in patients with SCH. Methods This cross-sectional study was nested within the larger frame of a prospective cohort study conducted at Psychiatric Hospital ‘‘Sveti Ivan’’, Croatia. Data were collected for a consecutive sample of 136 (49 female and 87 male) patients diagnosed with SCH (ICD-10) and 861 (467 female and 394 male) participants from the general population. The primary outcome was the prevalence of CPM. A secondary outcome was the number of psychiatric readmissions since diagnosis. Results In the total sample we observed the significant difference in CPM prevalence between SCH and GEP in the youngest age group, <35 years old (p=0.006). Among the male participants <35 years old, there were no significant differences in the prevalence of CPM between SCH (25%) and GEP (15%) (p=0.216). However, among the female participants <35 years old, the difference was significant and clinically relevant (p=0.002). Prevalence of CPM was 50% in SCH patients, and 14% in GEP. After the adjustment for age, sex, a number of psychiatric comorbidities and duration of SCH, the number of physical illness comorbidities was significantly associated with the number of previous psychiatric hospital readmission. (multivariate, robust regression; B=0.98; β=0.24; p=0.022). Approximately, the number of rehospitalizations increases for one with each chronic physical illness. Discussion This study identified gender differences in the prevalence of CPM in SCH patients, and the significant association of CPM with psychiatric hospital readmission. Higher physical morbidity points to a substantial disadvantage of female patients early in the course of illness. Understanding the nature and biological basis of gender-determined differences in risk and outcome of CPM might help to identify new therapeutic targets, allow more individualized treatment, and facilitate better risk prediction and application of healthcare resources.

PREVALENCE OF PATHOLOGICAL GAMBLING AMONG ALCOHOL ADDICTS IN OUTPATIENT TREATMENT IN THE CITY OF ZAGREB: A CROSS-SECTIONAL STUDY

BACKGROUND Various types of addictions often co-occur, particularly substance and behavioral ones, which affects the clinical course of mental health disorders as well as the efficacy of therapy and rehabilitation efforts. The present study aims to explore gambling activities and possible gambling addiction among alcoholics in an outpatient treatment in the city of Zagreb. SUBJECTS AND METHODS Gambling activities were assessed in 140 members of alcohol addiction clubs in the City of Zagreb (Croatia). Participants were undergoing treatment after being diagnosed by their psychiatrist with alcohol dependence syndrome based on ICD-10 criteria. Intensity of gambling-related problems was measured using the South Oaks Gambling Screen (SOGS), while intensity of alcohol addiction was assessed using DSM-5 diagnostic criteria for alcohol use disorder. All instruments were self-report forms and were completed using pen and paper in a group context during outpatient treatment. RESULTS Pathological gambling was more prevalent in this clinical subsample than in general populations analysed in other studies. Alcohol addicts showing problematic or pathological gambling behaviors tended to play more highly addictive games (sports betting, slot machines, roulette). However, intensity of gambling-related problems did not correlate significantly with the intensity of alcohol addiction. CONCLUSION These results confirm studies from other countries showing higher prevalence of problematic and pathological gambling among alcohol addicts than in the general population. Gambling behavior in our sample more often involved games with greater addictive potential. These findings suggest that alcohol addicts should be systematically screened for problematic and pathological gambling, which may improve therapeutic efficacy and rehabilitation, as well as reduce relapse in addictive behavior in general.