V. Barbanti Silva

P02-224 What does it take to become a psychiatrist? Results from a survey on quality of training

As models of mental health care and the professional identity of psychiatry are dramatically changing throughout Europe, a constant redefinition of aims, procedures and standards of training in psychiatry is widely perceived as necessary. The aim of the present study was to assess, in a group of trainees in psychiatry and early career psychiatrists, facts and opinions about their own training. A 30-item ad hoc structured questionnaire, with both yes/no questions and rating scales, was administered to 92 Italian trainees in psychiatry and young psychiatrists, during a training event. The questionnaire focused on general work-related aspects (job satisfaction, self-confidence in different skills and therapeutic interventions) but also on more specific training-related aspects (supervision, training in psychotherapy, methods of evaluations, training in research). Mean (SD) age of respondents was 30 (3.51) years, with a M/F ratio of 0.31. Sixty-nine percent of respondents deemed themselves generally “satisfied” with their training, but when considering some specific areas of training, such as psychotherapy and forensic psychiatry, the satisfaction rates were sensibly lower (33 and 19% respectively). Lower levels of professional self-confidence were associated to forensic psychiatry, child and adolescent psychiatry, and emergency psychiatry. Respondents also reported problems in the definition and application of training instruments such as supervision and a training log-book. The definition and implementation of minimum educational international standards for training in psychiatry is still necessary. Thus, continuous research on definition of educational standards in psychiatry has to be promoted throughout Europe.

What Is the Biopsychosocial Role of Human Immunodeficiency Virus Positivity in Patients With End-Stage Liver Disease Who Undergo Orthotopic Liver Transplantation?

INTRODUCTION Since 2003 the National Research Program for Solid Organ Transplantation in patients with human immunodeficiency virus (HIV) is active at our liver transplantation center. Patients with HIV who enter this protocol are assessed by the Consultation Liaison Psychiatry Service. The aim of the present study was to evaluate their psychiatric comorbidity. METHODS An observational prospective study was conducted comparing end-stage liver disease (ESLD) patients with and without HIV. After the assessment, the psychiatrist compiled the Transplant Evaluation Rating Scale (TERS) and the Montgomery Asberg Depression Rating Scale (MADRS). Baseline evaluation was made before inclusion on the OLT waiting list and the follow-up evaluation was made 12 months later. RESULTS From January 2003 to December 2006 we assessed 553 patients: 39 (6%) with HIV and 361 (94%) without HIV. The 2 groups were homogeneous for gender (75% of male patients; P=not significant [NS]) but not for age (46+/-5 vs 56+/-9; P=NS). Psychiatric history was negative in 176 (49%) patients without HIV and in 6 (15%) patients with HIV (P< .001). At baseline psychiatric comorbidity was present in 33 HIV patients (85%) and in 148 non-HIV patients (41%; P< .001). At follow-up MADRS highlighted an improvement in all of the items for HIV patients. In the non-HIV group, the variation was as follows: baseline, 7.10; follow-up, 8.15. In the HIV group, the variation was as follows: baseline, 10.20; follow-up, 4.09 (P< .001). The average score at TERS was higher among patients with HIV (43+/-9 vs 35+/-9; P=NS). CONCLUSIONS At baseline HIV patients with ESLD showed a higher rate of psychopathology, but they improved at follow-up; the contrary happened in the non-HIV group.

YPSP01-16 - Teamwork in psychiatry

Objectives Teamwork in psychiatry is a very specific property of care organization, especially in the Italian tradition and daily practice. The purpose of the study was to define and describe the main variables that might influence and determine it. Methods A 15-item ad hoc questionnaire was specially designed and administered to health professionals of Modena Department of Mental Health. This questionnaire contained socio-demographic data (age, sex, longevity of service), professional characteristics, personal level of satisfaction and identification, and opinions on “ideality” and “reality” of teamwork. Statistical analysis was conducted to explore significant correlations. Results Satisfaction rate was 46.2%, identification rate 59.1%. Teamwork seems to function well as far as “information circulation” and “making practical decisions”, but lacks in “reciprocal understanding” and “reciprocal emotional support”. The level of correspondence between ideal and real teamwork is strongly correlated to satisfaction (p = 0), identification (p = 0), but not to age, sex or duration of service. The priority of teamwork was “discussion of clinical cases”. Conclusions This study attempts to suggest difficulties and limits of contemporary care organization in Italian psychiatry, but also offers several ideas for organizational, administrative, clinical, and human improvements. It represents a first step to analyze and identify the qualitative determinants of psychiatric teamwork.

YP10-03 Cross-cultural psychiatry, liaison psychiatry and other major challenges for modern psychiatrists

Beyond the awareness that psychiatry and contemporary medicine have undergone a dramatic change in recent years, walking the first steps as recently-qualified consultants in psychiatry is a major challenge. As a consequence of changes in society, technological progress and restricted funding availability, modern psychiatrists have to face problems that are new, and difficult to be faced, but also representing an opportunity to grow and contribute massively to medicine. This is particularly true in two specific fields, cross-cultural psychiatry and consultation-liaison psychiatry. The former is defined as psychiatry of disorders influenced by the cultural background; the latter is defined as the care of psychiatric disturbances in the medically ill. Though generic, these definitions highlight what is challenging in these branches of psychiatry: the disposition towards an inter-disciplinary approach to human illnesses. Both deepen their roots in the bio-psycho-social paradigm of George Engel and were in fact frequently mentioned in Engels writings as the future of psychiatry. Training and clinical experience in cross-cultural and consultation-liaison psychiatry are to be major components of the curriculum of psychiatric trainees. Therefore, the role of psychiatrists and psychiatrists-to-be in the contemporary scientific community and society must be a strong one: on the side of scientific knowledge, by marking the complex, systemic nature of physiopathology and therapy; on the side of epistemology, by marking the paradoxes of bio-medicine; on the side of organization of health care, by promoting the need for a person-oriented approach to illness; and finally on the side of culture, society and ethics.