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Background: Polypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient's priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults.Methods: We designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months.Discussion: Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient's goals and priorities for treatment.Trial Registration: Clinical Trials.gov NCT02942927. First registered on October 24, 2016. [ABSTRACT FROM AUTHOR]

Previous accounts of psychiatry within Communist Europe have emphasized the dominance of biological approaches to mental health treatment. Psychotherapy was thus framed as a taboo or marginal component of East European psychiatric care. In more recent years, this interpretation has been re-examined as historians are beginning to delve deeper into the diversity of mental healthcare within the Communist world, noting many instances in which psychotherapeutic techniques and theory entered into clinical practice. Despite their excellent work uncovering these hitherto neglected histories, however, historians of the psy-disciplines in Eastern Europe (and indeed other parts of the world) have neglected to fully consider the ways that post-World War II psychotherapeutic developments were not simply continuations of pre-war psychoanalytic traditions, but rather products of emerging transnational networks and knowledge exchanges in the post-war period. This article highlights how psychotherapy became a leading form of treatment within Communist Yugoslavia. Inspired by theorists in France and the United Kingdom, among other places, Yugoslav practitioners became well versed in a number of psychotherapeutic techniques, especially 'brief psychotherapy' and group-based treatment. These developments were not accidents of ideology, whereby group psychotherapy might be accepted by authorities as a nod to some idea of 'the collective', but were rather products of economic limitations and strong links with international networks of practitioners, especially in the domains of social psychiatry and group analysis. The Yugoslav example underscores the need for more historical attention to transnational connections among psychotherapists and within the psy-disciplines more broadly. [ABSTRACT FROM AUTHOR]

This article traces the history of psychoanalytically-oriented mental health care in the Socialist Federal Republic of Yugoslavia. Like many other places in Central and Eastern Europe, psychoanalysis in post-war Yugoslavia faced a host of barriers to its long term survival. Rather than retreating or dying out, psychoanalytic ideas came to greatly influence Yugoslav psychiatry, both by informing treatment modalities and by providing a theoretical framework for understanding mental illness. The article outlines exactly how this transformation came to pass by documenting the threats posed to psychoanalysis and then analysing how these challenges were overcome. [ABSTRACT FROM AUTHOR]

In the era of Communist rule in Yugoslavia (1945–91), few problems attracted as much psychiatric attention as alcoholism. Conducting widespread epidemiological research, practitioners discovered an alarming trend as rates of the disease were seemingly rising in every territory and segment of the population. Such an upswing of problem drinking seemed to threaten the ideological, economical, and social well-being of the state and its citizens. This widespread panic spurred psychiatric investigations into the aetiology of alcoholism. Much of this work focused on the role of the family, the workplace, class and societal changes as the genesis of problem drinking. Ultimately, these researchers concluded that alcoholism was not merely an affliction of the individual but rather a social disease with cause and consequence extending far beyond the problem drinker. [ABSTRACT FROM PUBLISHER]