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Background: Schizophrenia is a severe psychiatric disorder with periods of remission and relapse. As discontinuation of antipsychotic medication is the most important reason for relapse, long-term maintenance treatment is key. Whether intramuscular long-acting (depot) antipsychotics are more efficacious than oral medication in preventing medication discontinuation is still unresolved. We aimed to compare time to all-cause discontinuation in patients randomly allocated to long-acting injectable (LAI) versus oral medication., Methods: EULAST was a pragmatic, randomised, open-label trial conducted at 50 general hospitals and psychiatric specialty clinics in 15 European countries and Israel. Patients aged 18 years and older, with DSM-IV schizophrenia (as confirmed by the Mini International Neuropsychiatric Interview 5 plus) and having experienced their first psychotic episode from 6 months to 7 years before screening, were randomly allocated (1:1:1:1) using block randomisation to LAI paliperidone, LAI aripiprazole, or the respective oral formulations of these antipsychotics. Randomisation was stratified by country and duration of illness (6 months up to 3 years vs 4 to 7 years). Patients were followed up for up to 19 months. The primary endpoint was discontinuation, regardless of the reason, during 19 months of treatment. We used survival analysis to assess the time until all-cause discontinuation in the intention-to-treat (ITT) group, and per protocol analyses were also done. This trial is registered with ClinicalTrials.gov, NCT02146547, and is complete., Findings: Between Feb 24, 2015, and Dec 15, 2018, 533 individuals were recruited and assessed for eligibility. The ITT population included 511 participants, with 171 (33%) women and 340 (67%) men, and a mean age of 30·5 (SD 9·6) years. 410 (80%) of 511 participants were White, 35 (7%) were Black, 20 (4%) were Asian, and 46 (9%) were other ethnicity. In the combined oral antipsychotics treatment group of 247 patients, 72 (29%) patients completed the study and 175 (71%) met all-cause discontinuation criteria. In the combined LAI treatment arm of 264 patients, 95 (36%) completed the study and 169 (64%) met the all-cause discontinuation criteria. Cox regression analyses showed that treatment discontinuation for any cause did not differ between the two combined treatment groups (hazard ration [HR] 1·16, 95% CI 0·94-1·43, p=0·18). No significant difference was found in the time to all-cause discontinuation between the combined oral and combined LAI treatment groups (log rank test χ 2 =1·87 [df 1]; p=0·17). During the study, 121 psychiatric hospitalisations occurred in 103 patients, and one patient from each of the LAI groups died; the death of the patient assigned to paliperidone was assessed to be unrelated to the medication, but the cause of other patient's death was not shared with the study team. 86 (25%) of 350 participants with available data met akathisia criteria and 70 (20%) met parkinsonism criteria at some point during the study., Interpretation: We found no substantial advantage for LAI antipsychotic treatment over oral treatment regarding time to discontinuation in patients with early-phase schizophrenia, indicating that there is no reason to prescribe LAIs instead of oral antipsychotics if the goal is to prevent discontinuation of antipsychotic medication in daily clinical practice., Funding: Lundbeck and Otsuka., Competing Interests: Declaration of interests SG reports consulting fees from Angelini, Janssen Pharmaceuticals, Gedeon-Richter, Recordati, and Innova Pharma; and honoraria and expenses from Angelini, Gedeon-Richter, Recordati, Janssen Pharmaceuticals, Janssen-Cilag, Lundbeck, Lundbeck Italia, and Sunovion. SL reports payments to the institution from European Group for Research In Schizophrenia for the conduct of the trial; consulting fees from Alkermes, Angelini, Lundbeck, Lundbeck Foundation, Otsuka, Recordati, Rovi, and Teva; and honoraria for lectures from Angelini, Eisai, Gedeon, Lundbeck, Medichem, Merck, Mitsubishi, Otsuka, Recordati, and Sanofi-Aventis. IB reports grants from the EU to the Semmelweise University; royalties from Oxford University for a published book (editor); consulting fees from Gedeon Richter, Janssen, Janssen Cilag; speaker fees from Hikma Janssen, Janssen Cilag, Gedeon Richter, Medichem Pharmaceuticals by Unilab, and Mitsubishi Tanabe Pharma Signapure; and leadership or fiduciary roles with European College of Neuropsychopharmacology, the European Psychiatry Association, and Clincal Pharmacological Ethics Committee and Medical Research Council (Hungary). BG has been the leader of a Lundbeck Foundation Centre of Excellence for Clinical Intervention and Neuropsychiatric Schizophrenia Research (January, 2009–December, 2021), which was partially financed by an independent grant from the Lundbeck Foundation based on international review and partially financed by the Mental Health Services in the Capital Region of Denmark, the University of Copenhagen, and other foundations; all grants are the property of the Mental Health Services in the Capital Region of Denmark and administrated by them. AH reports speaker fees from Lundbeck, Otsuka, Janssen, Recordati, and Rovi; was member of advisory boards for Lundbeck, Otsuka, Janssen, Recordati, and Rovi; and is an Editor of the German Association of Scientific Medical Societies in Germany and World Federation of Societies of Biological Psychiatry schizophrenia guidelines. GP reports honoraria from Lundbeck, Janssen, Schwabe Austria; support for attending meetings from Schwabe Austria; being president at the Austrian Society for Social Psychiatry and Gerontopsychiatry; and stock with Janssen. PR reports an advisory board role for Angelini. NS reports honoraria for lectures from Recordati Hellas, BGP Pharmaceuticals, Lundbeck Hellas, and Vianex. MD is an employee of Minerva Neurosciences with stock options. RSK reports consulting fees from Alkermes, Sunovion, Gedeon-Richter, and Otsuka. WWF reports consultant fees from Angelini, Richter, Recordati, Lundbeck, Otsuka, Teva, Boehringer-Ingelheim, Pierre Fabre, Janssen, Sunovion, Dainippon-Sumitomo, Takeda, and Pfizer; speaker fees from Janssen, Lundbeck, Otsuka, Richter, and Recordati; and grants from Janssen, Lundbeck, and Otsuka. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally., Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation., Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well., Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue., Funding: None., Competing Interests: JP is funded by a National Health and Medical Research Council Investigator Grant (GNT1173126). DG receives funding support from the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust. He is an unpaid member of the UK Government's Department of Health and Social Care National Suicide Prevention Strategy Advisory Group, England and the COVID-19 response sub-group, an unpaid member of the Samaritan's Policy, Partnerships and Research Committee, and an unpaid member of the Movember Global Advisory Committee. LA has a research grant to Manchester University from Health Quality Improvement Partnership, on behalf of NHS England and devolved UK governments. He is also Chair, National Suicide Prevention Strategy Advisory Group, Department of Health and Social Care. SF was Special Advisor to a Coroner for a specific investigation and is Chairperson, New Zealand Mortality Review Committee. AB is supported by the EU Erasmus+ Strategic Partnership Programme (2019-1-SE01-KA203-060571). LFC is Primary Investigator for pesticide suicide research in Malaysia funded by the Centre of Pesticide Suicide Prevention Malaysia, University of Edinburgh (Oct 2020-31 March 2022). NK is Member, National Suicide Prevention Strategy Advisory Group (England) and Topic Advisor for NICE self-harm guidelines. NK also declares research grants paid to his institution by NIHR, HQIP and DHSC for work related to the treatment and prevention of suicidal behaviour (but not directly related to the current work). OJK is supported by a Senior Postdoctoral Fellowship from Research Foundation Flanders (FWO 1257821N); payment made to institution (KU Leuven). OJK reports grants from UCB Community Health Fund, outside the submitted work. The UCB Community Health funds in this case are managed and disbursed by the King Baudouin Foundation (Belgium). Selection is by an independent jury and UCB is not involved. Payment is to the institution (KU Leuven). OJK received a waived registration fee for the 2021 International Academy of Suicide Research (IASR) Summit in Barcelona (held online), as an invited speaker (unrelated to the current work). No payment was received directly. Fee was automatically waived at registration. OJK is a member of the Samaritans Research Ethics Board (SREB); this is an unpaid role. OJK is co-chair of the Early Career Group of the International Association for Suicide Prevention (IASP). This role is unpaid, but yearly IASP membership fee is covered in return for this service role. No funds are exchanged, but membership fee is covered directly by IASP. DK reports that the Wellcome Trust has supported the Elizabeth Blackwell Institute with a ISSF grant. DK also declares a grant from the Centre for Pesticide Suicide Prevention to conduct COVID-19 related work on self-harm in Sri Lanka, and panel fees from the Department of Health and Social Care for assessing grants. She also declares a leadership or fiduciary role with Migration Health and Development Research Initiative; no fees received. SL declares a $75,000 grant from Queensland Health; payment will be made to institution when payment occurs. SL also declares project funding from the Queensland Government for the Queensland Suicide Register; made to his institution. SL is also on the Technical Advisory Group (unfunded role), NSW Suicide Monitoring System. HO declares registration for the online congress DGPPN (2020 and 2021) and for the DGPPN congress (2019). He also declares registration for the congress OGPP (2019). SP declares a personal consultancy for support and advice to the National Office for Suicide Prevention (Health Service Executive, Dublin, Ireland) and a personal consultancy for support and advice to the National Suicide Prevention Leadership Group and the Scottish Government. SP also declares support from the World Health Organization for attending a workshop on National Suicide Prevention Implementation and Evaluation, Geneva, November 2019. SP also holds unpaid roles as adviser and committee chairmanships with the International Association for Suicide Prevention. GP is supported by the Flemish Government – Department of Health, Wellbeing and Family. AR and CR-L declare support by the Federal Health Ministry of Germany (BMG), grant number ZMVI1-2517FSB136. CR-L also declares payment or honoraria and participation on a Data Safety Monitoring Board or Advisory Board with Janssen and LivaNova. NR-V declares she is the designated representative of the Puerto Rico Department of Health in the Puerto Rico Administration of Mental Health and Anti-Addiction Services’ Mental Health and Addiction Council. It is not a paid position; she attends meetings as part of her responsibilities at the Puerto Rico Department of Health and is the Coordinator of the Public Policy Committee within this advisory council. The aforementioned council is a requisite with which the Puerto Rico Administration of Mental Health and Anti-Addiction Services must comply with because this Administration receives federal funding from the Substance Abuse and Mental Health Services Administration of the United States of America., (© 2022 The Authors.)

Assisted suicide is currently still prohibited in Austria. However, following a finding of the Austrian Constitutional Court it would be completely legal from 2022. A statutory regulation defining the limits between legal ways of assistance and the conditions therefor on the one hand and, on the other hand, assistive actions that shall remain prohibited is currently not in sight. However, a suicidal action performed upon the request of the person willing to die solely by someone else will remain illegal; this also applies if the person willing to commit suicide is physically unable to participate in her or his killing. In several European countries euthanasia and/or assisted suicide has already been legalized and in some countries, Switzerland for example, assisted suicide is a legal option even for patients without suffering from a life-limiting disease, unbearable suffering and insufficient treatment options are the only criteria. In this case report the clinical case of an Austrian patient will be presented, suffering from a personality disorder, who planed an assisted suicide in Switzerland. Ethic and legal backgrounds are discussed.The possibility of assisted suicide bears the danger that people suffering from psychiatric disorders, especially current major depressive episode, could refuse treatment options and choose suicide trough a commercial provider of assisted suicide.In particular it must be considered that currently severely depressed people usually suffer from limited insight and judgement as well as from limited freedom of choice., (© 2021. The Author(s).)

Background: The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world., Methods: We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries' ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms "suicide" and "cause of death", before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis)., Findings: We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72-0·91]); Alberta, Canada (0·80 [0·68-0·93]); British Columbia, Canada (0·76 [0·66-0·87]); Chile (0·85 [0·78-0·94]); Leipzig, Germany (0·49 [0·32-0·74]); Japan (0·94 [0·91-0·96]); New Zealand (0·79 [0·68-0·91]); South Korea (0·94 [0·92-0·97]); California, USA (0·90 [0·85-0·95]); Illinois (Cook County), USA (0·79 [0·67-0·93]); Texas (four counties), USA (0·82 [0·68-0·98]); and Ecuador (0·74 [0·67-0·82])., Interpretation: This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This paper is general statement about the psychosocial care of refugees, developed by the of the Austrian Society for Psychiatry, Psychotherapy and Psychosomatics as well as by the Austrian Society for Social Psychiatry. Reasons of recent wave of refugees and the usual mental disorders among refugees are described. The increasing number of refugees, asylum seekers and irregular migrants poses a challenge for mental health services in Europe. As a consequence, several expert recommendations were given. As a first step, basic needs of refugees such as regular housing facilities, sufficient nutrition and safety in everyday life should be met. Fast decisions about the applications for asylum and support of social integration through education and employment are essential for mental health. Provision of mental health care should be needs based as described by the intervention pyramid for mental health and psychosocial support as given by the Inter-Agency Standing Committee of the World Health Organization. In addition, culture-specific aspects must be considered in everyday clinical work and the training of health professionals.

Tardive dyskinesia (TD) remains a relevant clinical problem despite the increasing use of new-generation antipsychotics. Antipsychotic-induced tardive syndromes are difficult to treat and have a low tendency of remission. Therefore, prophylaxis is of utmost importance, with the responsible use of antipsychotics as a prime desideratum. With respect to managing tardive dyskinesia, discontinuing the antipsychotic, if possible, albeit not backed up by unequivocal evidence, is still the main recommendation. If this is not possible, the switch to an antipsychotic with a lower TD risk is the next-preferred option. Other symptomatic treatments have been explored, but clinical trials have provided inhomogeneous results and only very few compounds are approved for the treatment of tardive dyskinesia. This manuscript summarizes the current evidence with respect to the phenomenology, course, prevention and treatment of tardive syndromes.

The future of a dementia-appropriate care rests on early diagnosis and treatment (also in terms of a timely information, counselling and assistance), developing mobile medical healthcare, integrating and coordinating all dementia care partners and stakeholders, appropriate assessments of the stages of care allowance, providing new forms of housing, addressing the migration issue, and reducing unnecessary administrative bureaucracy - as well as, last but not least, the fight against prejudice. People affected by dementia suffer not only from symptoms of their illness but also from society's reaction towards this illness. Stigmatisation of dementia prevents an early diagnosis and treatment which could improve the course of the illness and create a "better everyday life", a more of inclusion for the affected people and their environment. But Albert Einstein already knew: "It's harder to crack prejudice than an atom." Nevertheless, it is paramount to work towards it - for dementia can affect each and every one of us. Dementia matters, for all of us.

Background: During the last 20 years Austrian psychiatric services underwent fundamental changes, as a focus was set on downsizing psychiatric hospitals. Little is known about how restructuring of mental health services affected patients with major depression and suicide rates., Methods: Monthly hospital discharges from all hospitals in Austria with the diagnosis of unipolar major depression as primary reason for inpatient treatment were obtained for the time period between 1989 and 2008. These data were correlated with relevant parameters from the general health system, such as number of hospital beds, suicide rate, density of psychotherapists and sales of antidepressants., Results: While the number of psychiatric beds was reduced by almost 30%, the total annual numbers of inpatient treatment episodes for depression increased by 360%. This increase was stronger for men than for women. Further on this development was accompanied by a decrease in the suicide rate and an improvement in the availability of professional outpatient mental health service providers., Limitations: Only aggregated patient data and no single case histories were available for this study. The validity of the correct diagnosis of unipolar major depression must be doubted, as most likely not all patients were seen by a clinical expert., Conclusions: Our data show that although inpatient treatment for unipolar major depression dramatically increased, reduction of psychiatric beds did not lead to an increase of suicide rates., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.

Background Dementia is considered widely under-detected in primary care, and general practitioners (GPs) frequently ask for easy to use tools to assist in its early detection.Aim To determine the degree of correlation between the Mini-Cog Assessment (Mini-Cog) as performed by GPs and the Mini-Mental State Examination (MMSE).Design of study This was a prospective study (2005, 2006) comparing two cognitive screening instruments.Setting Ten general practices in Austria, with patients with a hitherto undiagnosed suspicion of dementia seen consecutively.Method Sensitivity, specificity and positive and negative predictive values (PPVs and NPVs) of the Mini-Cog (applying both a colour-coded and the original rating method) were assessed for degree of correlation with the MMSE. In phase one GPs examined patients suspected of having dementia using the Mini-Cog; in phase two a neurologist retested them applying the MMSE, a clock-drawing test (CDT) and a routine clinical examination. A questionnaire on the practicability of the Mini-Cog was answered by GPs.Results Of the 107 patients who participated 86 completed the whole study protocol. The Mini-Cog, as performed by the ten GPs, displayed a sensitivity of 0.85 (95% CI: 0.71, 0.98), a specificity of 0.58 (95% CI: 0.46, 0.71), a PPV of 0.47 (95% CI: 0.33, 0.61) and an NPV of 0.90 (95% CI: 0.80, 0.99) as against the MMSE carried out by neurologists. The GPs judged the Mini-Cog useful and time saving.Conclusion The Mini-Cog has a high sensitivity and acceptable specificity in the general practice setting and has proved to be a practicable tool for the diagnosis of dementia in primary care.