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Ewelina Cichoń,1,2 Andrzej Kiejna,1,2 Tomasz M Gondek,3,4 Marcin Obrębski,5 Edyta Sutkowska,6 Cathy E Lloyd,7 Norman Sartorius,8 Andrzej Kokoszka5 1Department of Psychology, WSB University in Torun, Torun, Wroclaw, Poland; 2Department of Psychology, Faculty of Applied Studies, University of Lower Silesia, Wroclaw, Poland; 3Specialty Training Section, Polish Psychiatric Association, Wroclaw, Poland; 4Section on Education, World Psychiatric Association, Wroclaw, Poland; 5II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland; 6Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland; 7Faculty of Health and Social Care, The Open University, Milton Keynes, UK; 8Association for the Improvement of Mental Health Programmes (AIMH), Geneva, SwitzerlandCorrespondence: Andrzej KokoszkaII Department of Psychiatry, Medical University of Warsaw, 03-242 Kondratowicza 8 street, Warsaw, PolandTel/Fax +48 22 326 58 92Email andrzej.kokoszka@wum.edu.plPurpose: The aim of this study was to assess the structure and validate the Polish version of the Problem Areas in Diabetes (PAID) scale, as the current translations of the original English version significantly vary in their psychometric properties.Patients and Methods: Two hundred and sixteen consecutive Polish outpatients were invited to participate in this international cross-sectional study on depression in diabetes. The research was based on the demographic and clinical characteristics of the study population, including the level of glycated hemoglobin (HbA1c) and scores obtained in the Polish versions of the following questionnaires: PAID, World Health Organization-Five Well-Being Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9). The psychiatric diagnosis was conducted with the use of Mini-International Neuropsychiatric Interview (M.I.N.I.).Results: Exploratory factor analyses yielded a 1-factor structure that included all 20 items. The internal consistency of the Polish version of PAID was high (Cronbach α = 0.97). There were significant positive correlation between PAID and PHQ-9 and a negative correlation between PAID and WHO-5. We also observed a negative association between PAID scores and age and a positive correlation between PAID and HbA1c levels. Patients with depression reported significantly higher PAID scores as compared with those without depressive symptoms.Conclusion: The Polish version of PAID has a one-factor structure and is a reliable, valid outcome measure for Polish outpatients with type 2 diabetes and it may constitute a useful instrument for screening for psychologic issues in diabetic patients during their appointments at the diabetes clinic.Keywords: diabetes mellitus, type 2, emotional stress, depression, quality of life, problem areas in diabetes scale

Purpose of Review: People with mental disorders in Poland have increased standardized mortality ratios (SMRs). This is the first study to assess all-cause mortality in people with mental disorders in Poland during the COVID-19 pandemic., Recent Findings: A nationwide, register-based cohort study utilizing data from the registry of healthcare services (2011-2020) and the all-cause death registry (2021) in Poland was conducted. Individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (ICD-10) from 2011 to 2020 were identified. SMRs were compared between people with a history of mental disorder and the general population. SMRs for the pandemic period were also compared with prepandemic SMRs calculated for 2019.No significant differences in SMRs were observed overall between 2021 and 2019. A minor increase in SMR was observed in 2021 for people treated only in outpatient mental health clinics. In 2021, a significant decrease in SMRs was shown for individuals with diagnoses from groups F10-F19 and F20-F29, and a significant increase in SMRs was observed for those with diagnoses from group F40-F48., Summary: SMRs for people with any mental disorder in Poland in 2021 remained at comparable levels to those in 2019., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: This survey assessed psychiatry residents'/early-career psychiatrists' attitudes towards the utility of therapeutic drug monitoring (TDM) of antipsychotics., Methods: A previously developed questionnaire on attitudes on TDM utility during antipsychotic treatment was cross-sectionally disseminated by national coordinators between 01/01/2022-31/12/2023. The frequency of using TDM for antipsychotics other than clozapine was the main outcome in a linear regression analysis, including sex, clinical setting, caseload, and factors generated by an exploratory factor analysis. Comparisons between residents and early-career psychiatrists, respondents working in in- and outpatient settings, and low-/middle- and high-income countries were performed., Results: Altogether, 1,237 respondents completed the survey, with 37.9% having never used TDM for antipsychotics. Seven factors explained 41% of response variance; six of them were associated with frequency of TDM use ( p  < 0.05). Items with highest loadings for factors included clinical benefits of TDM (factors A and E: 0.7), negative expectations for beliefs of patients towards TDM (factor B: 0.6-0.7), weak TDM scientific evidence (factor C: 0.8), and TDM availability (factor D: -0.8). Respondents from low-/middle-income countries were less likely to frequently/almost always use TDM compared to high-income countries (9.4% vs. 21.5%, p  < 0.001)., Discussion: TDM use for antipsychotics was poor and associated with limited knowledge and insufficient availability.

Background: Climate change is one of the greatest threats to health that societies face and can adversely affect mental health. Given the current lack of a European consensus paper on the interplay between climate change and mental health, we signal a need for a pan-European position paper about this topic, written by stakeholders working in mental health care., Methods: On behalf of the European Psychiatric Association (EPA), we give recommendations to make mental health care, research, and education more sustainable based on a narrative review of the literature., Results: Examples of sustainable mental healthcare comprise preventive strategies, interdisciplinary collaborations, evidence-based patient care, addressing social determinants of mental health, maintaining health services during extreme weather events, optimising use of resources, and sustainable facility management. In mental health research, sustainable strategies include investigating the impact of climate change on mental health, promoting research on climate change interventions, strengthening the evidence base for mental health-care recommendations, evaluating the allocation of research funding, and establishing evidence-based definitions and clinical approaches for emerging issues such as 'eco-distress'. Regarding mental health education, planetary health, which refers to human health and how it is intertwined with ecosystems, may be integrated into educational courses., Conclusions: The EPA is committed to combat climate change as the latter poses a threat to the future of mental health care. The current EPA position paper on climate change and mental health may be of interest to a diverse readership of stakeholders, including clinicians, researchers, educators, patients, and policymakers.

Background: The COVID-19 pandemic has brought significant mental health challenges, particularly for vulnerable populations, including non-binary gender individuals. The COMET international study aimed to investigate specific risk factors for clinical depression or distress during the pandemic, also in these special populations., Methods: Chi-square tests were used for initial screening to select only those variables which would show an initial significance. Risk Ratios (RR) were calculated, and a Multiple Backward Stepwise Linear Regression Analysis (MBSLRA) was followed with those variables given significant results at screening and with the presence of distress or depression or the lack of both of them., Results: The most important risk factors for depression were female (RR = 1.59-5.49) and non-binary gender (RR = 1.56-7.41), unemployment (RR = 1.41-6.57), not working during lockdowns (RR = 1.43-5.79), bad general health (RR = 2.74-9.98), chronic somatic disorder (RR = 1.22-5.57), history of mental disorders (depression RR = 2.31-9.47; suicide attempt RR = 2.33-9.75; psychosis RR = 2.14-10.08; Bipolar disorder RR = 2.75-12.86), smoking status (RR = 1.15-5.31) and substance use (RR = 1.77-8.01). The risk factors for distress or depression that survived MBSLRA were younger age, being widowed, living alone, bad general health, being a carer, chronic somatic disorder, not working during lockdowns, being single, self-reported history of depression, bipolar disorder, self-harm, suicide attempts and of other mental disorders, smoking, alcohol, and substance use., Conclusions: Targeted preventive interventions are crucial to safeguard the mental health of vulnerable groups, emphasizing the importance of diverse samples in future research., Limitations: Online data collection may have resulted in the underrepresentation of certain population groups., Competing Interests: Declaration of competing interest None pertaining to the current paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders., Methods: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions., Results: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome., Conclusions: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Objectives: Anxiety disorders are significant predictors of suicidality and are proposed to be independent risk factors for suicide attempts. They are common in people with type 2 diabetes (T2DM) and are associated with longer duration of diabetes and poorer treatment outcomes. The aim was to examine associations between anxiety disorders and suicidal thoughts and behaviour in people with T2DM, to establish the prevalence of suicidality among people with T2DM in the selected European countries and to examine whether anxiety disorders were predictive of current outcomes of suicidality in this population using data from the International Prevalence and Treatment of Diabetes and Depression study., Methods: The study sample comprised 1063 adults with T2DM from 6 European countries. The presence of anxiety disorders and suicidality was assessed with the MINI International Neuropsychiatric Interview. The group of participants with current suicidal risk was compared with the group of participants with no suicidal risk., Results: The participants from Germany were more likely to report suicidality than those from other countries, whereas people from Serbia and Ukraine were less likely to report it. Depression and anxiety disorders significantly contributed to the increased presence of suicidality among people with T2DM. Agoraphobia was a significant predictor of suicidality when controlling for depression. The participants with T2DM and comorbid agoraphobia had 4.86 times higher odds to report suicidality than those without agoraphobia., Conclusions: Agoraphobia was a significant predictor of suicidality in people with T2DM.

Background: The COVID-19 pandemic placed great strain on healthcare professionals, leading to a substantial impact and a redistribution of the workforce. Despite the active involvement of the Eastern Mediterranean Region Office (EMRO) and the World Health Organization in managing mental health crises, there is a knowledge gap concerning the working conditions and training opportunities available for early career psychiatrists (ECPs) during the pandemic period., Objectives: This study aims to investigate the impact of the COVID-19 pandemic on ECPs and how it affected their well-being, employment, and educational opportunities., Methods: A mixed methods study has been conducted in Iran, Egypt, and Tunisia, three EMRO member countries. It includes a cross-sectional survey with self-reported questions, and a qualitative study with individual in-depth interviews., Discussion: The findings of this study will raise awareness to the working conditions of ECPs within the EMRO region and its member societies, both during the COVID-19 pandemic and beyond. The results will serve as a basis for encouraging supervisors and policymakers to mitigate the pandemic's impact on psychiatric training, strengthen healthcare systems' preparedness, and equip early career psychiatrists with the necessary skills to deal with the mental health consequences of the COVID-19 pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Hosseini, Hajebi, Shalbafan, Ghannadi, Larnaout, Nofal, Gondek and Pinto da Costa.)

Purpose of Review: The main purpose of the study was to assess university students' mental health and identify factors associated with the risk of suicidal thoughts, plans, and attempts during coronavirus disease 2019 (COVID-19) pandemic and distance learning., Recent Findings: The study was conducted in spring 2021 and comprised 10 760 Polish students. The survey employed modified versions of the C-SSRS, CIDI, WHO-5, GAD-7, the PTSD checklist for DSM-5 and CAGE-AID Questionnaire and included questions about panic attacks, COVID-19-related information and sociodemographic characteristics. The correlates of suicidality were examined using a series of logistic regression analyses. Almost 40% students experienced any suicidal thoughts and/or behaviours in the previous month: passive ideations only (15.8%), active ideations only (7.1%), plans without attempts (15%), and attempts (1.4%). Following variables were related to the increased risk for suicide attempts: severe anxiety [odds ratio (OR) = 11.39; 95% confidence interval (CI): 1.44-90.26], panic attacks (OR = 3.21; 95% CI: 1.75-5.91), and COVID-19 hospitalisation (OR = 11.04; 95% CI: 1.17-104.59). Major depression was associated with passive and active ideations, suicide plans, but not with attempts (OR = 1.37; 95% CI: 0.45-4.13)., Summary: University students present a high level of adverse mental health and increased risk of STBs during COVID-19 pandemic. A suicide prevention program tailored to this population is needed during and after the pandemic., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder and is associated with an increased risk of suicidal behavior, especially in females. The differences in the presentation of ADHD in females, factors contributing to suicidality and the effects of therapeutic interventions are presented in this review to highlight the relationship between ADHD and suicidality and self-harm behavior., Recent Findings: Impulsivity, an inherent symptom of ADHD, commonly acts as a risk factor of suicidality and is associated with both suicidal behavior and nonsuicidal self-injury. The combined subtype of ADHD, which typically is characterized by significant impulsivity, is linked with the highest vulnerability to suicide attempts. Female gender, lower educational attainment, comorbid substance abuse, a history of depression, and experience of childhood maltreatment were singled out as distinct factors that were independently linked to lifetime suicide attempts., Summary: The association of the ADHD and suicidality is gaining an increasing interest in recent years. Active suicide prevention is required in this population and it is crucial for clinicians and researchers to have access to the most current information in this field., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak., Materials and Methods: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively., Statistical Analysis: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables., Results: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23)., Conclusions: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Introduction: Attention-deficit/hyperactivity disorder (ADHD) was originally treated as a neurodevelopmental disorder that occurs mainly in children and tends to diminish or disappear with age, but we now know that symptoms persist into adulthood in over 50% of ADHD patients. Undiagnosed individuals often turn to psychoactive substance to minimize the negative aspects of functioning and improve quality of life., Methods: The study was conducted online using random sampling through a Facebook group administered by physicians and targeted to patients diagnosed with ADHD. The study was naturalistic and exploratory, therefore no hypothesis was made. 438 correctly completed questionnaires were received. Analysis of the results showed that people with ADHD turn to psychoactive substances relatively frequently., Results: The most commonly used stimulants include alcohol, marijuana, 3,4-methylenedioxymethamphetamine (MDMA), amphetamine/methamphetamine, and psilocybin. In the study population, methylphenidate is the most commonly used drug among patients. After treatment with psychostimulants, the majority of respondents note a decrease in symptoms of hyperactivity disorder, especially in male patients., Conclusion: It is necessary to perform proper diagnostics and actively look for ADHD symptoms in patients who tend to use psychoactive substances., Competing Interests: GW received honoraria for lectures from: Angelini Pharma Polska and support for attending meetings from: Angelini Pharma Polska, Apotex Poland/Aurovitas Pharma Polska, Lek-AM. IS received support for attending meetings from: Lek-AM. TG received honoraria for lectures from: Valeant Polska, Lundbeck Poland, Apotex Poland/Aurovitas Pharma Polska, Celon Pharma and support for attending meetings from: Lundbeck Poland, EGIS, GL Pharma. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Więckiewicz, Stokłosa, Stokłosa, Więckiewicz, Gorczyca and Gondek.)

Objectives: This study was conducted to investigate the impact of the COVID-19 pandemic on psychiatric trainees and early career psychiatrists in Iran., Methods: In this cross-sectional survey, the authors used a 24-item questionnaire inquiring about the sociodemographic characteristics of the participants, their views on the impact of the COVID-19 pandemic on their professional careers, methods of education, workplace environment, well-being and mental health, and the use of telepsychiatry in Iran., Results: A total of 159 responses were received. The majority (n=124, 78.0%) reported that "some but not all obligatory activities have been converted to online activities." Most of the participants (n=103, 64.8%) stated that the pandemic had not affected the duration of their training. Less than half (n=61, 38.4%) reported that their well-being had been affected rather negatively. Some (n=59, 37.1%) reported that their supervisors or coworkers had no significant impact on their well-being, whereas others (n=53, 33.3%) reported a rather positive impact. Almost half of the participants (n=78, 49.0%) did not have access to free psychological counseling. In addition, more than half (n=89, 56.0%) reported that there were no recommendations on how to proceed with telepsychiatry., Conclusions: This study calls for improvements in the education and well-being of psychiatric trainees and early career psychiatrists in Iran amid the COVID-19 pandemic. Additional research should be carried out to maximize learning, provide mental health care, and use telepsychiatry., (© 2022. The Author(s), under exclusive licence to American Association of Chairs of Departments of Psychiatry, American Association of Directors of Psychiatric Residency Training, Association for Academic Psychiatry and Association of Directors of Medical Student Education in Psychiatry.)

Background: Mortality among people with mental disorders is higher in comparison with the general population. There is a scarcity of studies on mortality in the abovementioned group of people in Central and Eastern European countries., Methods: The study aimed to assess all-cause mortality in people with mental disorders in Poland. We conducted a nationwide, register-based cohort study utilizing data from two nationwide registries in Poland: the registry of healthcare services reported to the National Health Fund (2009-2018) and the all-cause death registry from Statistics Poland (2019). We identified individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (International Statistical Classification of Diseases and Health Problems [ICD-10]) from 2009 to 2018. Standardized mortality ratios (SMRs) were compared between people with a history of mental disorder and the general population., Results: The study comprised 4,038,517 people. The SMR for individuals with any mental disorder compared with the general population was 1.54. SMRs varied across diagnostic groups, with the highest values for substance use disorders (3.04; 95% CI 3.00-3.09), schizophrenia, schizotypal and delusional disorders (2.12; 95% CI 2.06-2.18), and pervasive and specific developmental disorders (1.68; 95% CI 1.08-2.29). When only inpatients were considered, all-cause mortality risk was almost threefold higher than in the general population (SMR 2.90; 95% CI 2.86-2.94)., Conclusions: In Poland, mortality in people with mental disorders is significantly higher than in the general population. The results provide a reference point for future longitudinal studies on mortality in Poland.

Introduction: During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question., Material and Methods: During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively., Statistical Analysis: It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis RESULTS: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small., Conclusions: The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health. Our findings, support previous suggestions concerning the need for a proactive targeted intervention to protect mental health more specifically in vulnerable groups., (Copyright © 2022. Published by Elsevier B.V.)

Introduction: There are few published empirical data on the effects of COVID-19 on mental health, and until now, there is no large international study., Material and Methods: During the COVID-19 pandemic, an online questionnaire gathered data from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively., Statistical Analysis: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables., Results: Probable depression was detected in 17.80% and distress in 16.71%. A significant percentage reported a deterioration in mental state, family dynamics and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (31.82% vs. 13.07%). At least half of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop depression was associated with history of Bipolar disorder and self-harm/attempts (RR = 5.88). Suicidality was not increased in persons without a history of any mental disorder. Based on these results a model was developed., Conclusions: The final model revealed multiple vulnerabilities and an interplay leading from simple anxiety to probable depression and suicidality through distress. This could be of practical utility since many of these factors are modifiable. Future research and interventions should specifically focus on them., Competing Interests: Conflict of Interest None pertaining to the current paper., (Copyright © 2021 Elsevier B.V. and ECNP. All rights reserved.)

Background: Although psychoactive substance use disorders (PSUDs) are a domain of mental health, addiction psychiatry is only formally recognized as a subspecialty in a few European countries, and there is no standardized training curriculum. Methods: A 76-item questionnaire was developed and disseminated through an online anonymous data-collecting system and hand-to-hand amongst psychiatric trainees from the 47 European countries of the Council of Europe plus Israel and Belarus. Results: 1,049/1,118 psychiatric trainees from 30 European countries completed the questionnaire. Fifty-nine-point nine percent of trainees stated to have training in addictions. Amongst the trainees who described having training in addictions, 43% documented a not well-structured training and 37% an unsatisfactory training, mainly due to poor acquired knowledge. Overall, 97% of trainees stated that addiction represents a core curriculum for their training. Overall, general adult psychiatric trainees reported a better knowledge in addictions, compared to trainees in child and adolescent psychiatry. Conclusion: Despite a growing spread of PSUDs in European countries, addiction psychiatry is a relatively poorly trained field within psychiatry training programs. Further research should investigate reasons for poor training and timings of the educational activities to optimize experiential education training in addiction psychiatry., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Orsolini, Rojnić Palavra, Papanti, Potočan, Quattrone, Martens, Sklenářová, Levola, Grichy, Naughton, Grinevičiene, Kuiters, Gondek, Panfil, Borovcanin, San Roman Uria, Biskup, Sönmez Güngör, Casanova Dias, Tomori, Banjac, Marinova-Djambazova and Pinto da Costa.)

The European Psychiatric Association (EPA), the main association in the field of mental health in Europe, has long been supporting the development of early career psychiatrists. The EPA Early Career Psychiatrists Committee (ECPC) and its core task forces promote research activities among young psychiatrists, contribute to their professional development through organising courses and other educational events, prepare online educational materials and publications, and actively collaborate with other organisations. The EPA ECPC is always open to fostering cooperation on new professional, educational or research initiatives with early career psychiatrists from different countries., Competing Interests: T.M.G. received personal fees from VP Valeant Polska, Lundbeck Poland, Janssen-Cilag Polska, Apotex Poland (currently Aurovitas Pharma Polska), EGIS Polska, and GL Pharma outside the submitted work., (© The Authors 2020.)

Aims: This study evaluated the psychometric characteristics of the Polish version of the PHQ-9 in detecting major depression (MDD) and 'MDD and/or dysthymia' in people with and without type 2 diabetes., Methods: Participants were randomly selected from a diabetes outpatient facility (N = 216) and from among patients admitted to a medical center and psychiatric hospital (N = 99). The participants completed the PHQ-9. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to identify the presence of psychiatric symptoms. The optimal cut-offs for PHQ-9 in people with and without type 2 diabetes were investigated based on two methods: 1) Youden's index which identifies cut-off points useful in scientific research; 2) a second method of two-stage screening for depressive disorders to provide guidance for clinical practice., Results: The Polish version of the PHQ-9 is a reliable and valid screening tool for depression in people with and without type 2 diabetes. An optimal cut-off of ≥ 7 was indicated by Youden's index and ≥ 5 by the two-stage method for screening for MDD and 'MDD and/or dysthymia' in the group with type 2 diabetes. A cut-off of ≥ 11 was optimal for screening for both MDD and 'MDD and/or dysthymia' among people without diabetes (Youden's index). The two-stage approach suggested a ≥ 10 score for screening for MDD and ≥ 9 for screening for 'MDD and/or dysthymia' in people without diabetes., Conclusions: A lower cut-off score of the PHQ-9 is recommended for people with type 2 diabetes as compared to the general population., Competing Interests: The authors have declared that no competing interests exist.

Aims: To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries., Methods: People with type 2 diabetes treated in out-patient settings aged 18-65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of 'upset') between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables., Results: In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS., Conclusion: This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

Objectives: The aim of the study was to prepare the Polish adaptation of the SACS. The scale is a self-assessment tool designed to measure staff attitudes towards direct coercion of psychiatric wards patients., Methods: The sample consisted of 120 adults, staff from 7 psychiatric wards. The SACS is a tool created in Norway by Tonje Husum, comprising of 15 items describing psychiatric healthcare professionals attitudes towards direct coercion. The validation procedure incorporated three basic methods to be applied in the reliability analysis - the comparison of double tests with the same method, the analysis of statistical properties of test items as well as analysis of the relation of test items and subscales with the general test result., Results: After a "think aloud" type pilot study and a language validation, the internal consistency was assessed. The Cronbach's alpha ranged from 0.57 to 0.81 in the subscales, and it was 0.82 for the total score. The best solution obtained in exploratory factor analysis was a three-factor model, almost identical to the original one, confirming the division into three subscales: coercion as offending (critical attitude), as care and security (pragmatic attitude) and as treatment (positive attitude)., Conclusions: The psychometric characteristics of the Polish adaptation of the SACS are similar to those reported in the original version. The results allow to recommend the method for scientific research. However, further analyses are necessary to assess validity and discriminative power in larger settings.

In the past century, biological, psychological and social sciences have brought significant progresses to psychiatry, building it is a broad medical specialty, closely linked to somatic medicine, psychology and society. Many psychiatrists early in their career have understood that it is easier to face these challenges in a collaborative way, and therefore there has been in the last decades a growth of local and national associations of psychiatric trainees and early career psychiatrists across Europe. In 2007, the European Psychiatric Association (EPA) has integrated in its program the "Young Psychiatrists Committee", an informal network of young psychiatrists. This Committee since 2010 has been known as the Early Career Psychiatrists Committee (ECPC). EPA has been making remarkable efforts towards supporting early career psychiatrists' education and participation in scientific congresses, promoting their professional growth and integration into the international professional community. Likewise, early career psychiatrists contribute to EPA with their motivation, enthusiasm and creative ideas, proving this initiative as an effective win-win cooperation.

Aims: The objectives of the study were to assess the usefulness of measurements of apparent diffusion coefficient (ADC) in normal appearing white and grey matter (NAWM, NAGM) in differential diagnosis between patients with hyperintense demyelinating plaques in the course of multiple sclerosis (MS) and other conditions presenting white matter hyperintensities (WMHs), as well as to evaluate the relationship between clinical data and ADC values in MS patients., Material and Methods: The study comprised 66 patients with MS before treatment, 66 patients with WMHs and 64 control subjects (control group, CG), who underwent MRI (magnetic resonance imaging) examination including diffusion weighted imaging (DWI) with a 1.5 T MR unit. ADC measurements were obtained from NAWM of the cerebellum, pons as well as frontal, fronto-parietal and temporal regions bilaterally, and from NAGM of thalami and heads of caudate nuclei, using round region of interest (ROI) sized 200mm 2 ., Results: The mean ADC values in frontal, fronto-parietal and temporal NAWM were significantly higher in the MS group than in subjects with WMHs and CG (p < .001), whereas the mean ADC value in pons was higher in MS than in CG (p < .05). In the MS group we observed a positive correlation between the Expanded Disability Status Scale (EDSS) and lesion load, between duration of the disease and mean ADC values and between lesion load and mean ADC values., Conclusion: Our results suggest that ADC measurements may support the differential diagnosis between MS and other conditions associated with white matter hyperintensities. The most significant changes were observed in temporal white matter regions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aims: To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries., Methods: People with diabetes aged 18-65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale. Demographic and medical record data were collected., Results: A total of 2783 people with Type 2 diabetes (45.3% men, mean duration of diabetes 8.8 years) participated. Overall, 10.6% were diagnosed with current major depressive disorder and 17.0% reported moderate to severe levels of depressive symptomatology (Patient Health Questionnaire scores >9). Multivariable analyses showed that, after controlling for country, current major depressive disorder was significantly associated with gender (women) (P<0.0001), a lower level of education (P<0.05), doing less exercise (P<0.01), higher levels of diabetes distress (P<0.0001) and a previous diagnosis of major depressive disorder (P<0.0001). The proportion of those with either current major depressive disorder or moderate to severe levels of depressive symptomatology who had a diagnosis or any treatment for their depression recorded in their medical records was extremely low and non-existent in many countries (0-29.6%)., Conclusions: Our international study, the largest of this type ever undertaken, shows that people with diabetes frequently have depressive disorders and also significant levels of depressive symptoms. Our findings indicate that the identification and appropriate care for psychological and psychiatric problems is not the norm and suggest a lack of the comprehensive approach to diabetes management that is needed to improve clinical outcomes., (© 2018 Diabetes UK.)

Background: The excess mortality in schizophrenia is still a phenomenon insufficiently studied on the cross-national level. It is important to analyse current studies on morality in schizophrenia since significant changes have recently taken place in psychiatric health care systems and guidelines of pharmacological treatment have been developed in European countries., Subjects and Methods: This article reviews studies addressing mortality in schizophrenia in Europe that were published in English in the Pubmed database in 2009-2014. It aimed at determining countries where studies were conducted, methodologies and tools used, and current main mortality rates, as well as direction of causality in this group of patients., Results: The recently published studies were conducted only in few European countries. The majority of data was obtained from general medical records and death records. The studies indicate that schizophrenia patients are characterized by higher mortality rate than the general population, with natural causes (cardiovascular diseases and cancers) and suicides predominating. The increasing mortality gap with significantly shorter life expectancy of patients with schizophrenia in comparison with the general population is considerable., Conclusions: Death records are a crucial tool in studies on mortality in schizophrenia patients; however they are insufficiently employed. Recent European reports do not show positive tendencies, indicating that standardized mortality rates in schizophrenia remain on the same level or even increase, particularly for deaths resulting from natural causes. Due to various methodologies used in studies, their direct comparison is difficult. This limitation warrants further discussion on methods used in future studies on schizophrenia mortality in Europe.

Introduction: Schizophrenia is a chronic and one of the most severe mental disorders. From many years studies regarding mortality among people suffering from schizophrenia are being conducted as a way of controlling indirectly the effectiveness of medical care and therapy., Aim: The aim of this paper was to determine the course of studies of mortality in schizophrenia and to analyze possibilities of using this kind of studies to evaluate changes in mental care system in Poland., Material: This paper is a review of European literature concerning studies of mortality in schizophrenia. Most of the analyzed publications were created in Northern and Western Europe. There are no international publications originating from Southern and Eastern Europe. Directions of current studies include changes of causes of death in persons with a diagnosis of schizophrenia over years, coexistence of somatic diseases, medicine's impact on mortality in schizophrenia and worse access to medical care in comparison to mentally healthy people., Conclusions: Mortality in schizophrenia is a useful factor in clinical studies enabling evaluation health effects of changes in mental health care system, what allows creation of system based on scientific evidence.

Objective: The pathogenesis of idiopathic growth hormone deficiency (GHD) in children, including possible cerebral metabolic alterations, remains unclear. The aim of the study was to evaluate metabolic changes within the normal appearing brain in children with GHD using MR spectroscopy (MRS) and to correlate MRS measurements with hormonal concentrations and with pituitary gland size., Methods: Seventy children with GHD (mean age 7.8 yrs) and 11 healthy controls (mean age 8.4 yrs) were enrolled in the study. The MRS examinations were performed on a 1.5T scanner. Voxels were located in the posterior cingulate gyrus (PCG) and the left parietal white matter (PWM). The NAA/Cr, Cho/Cr and mI/Cr ratios were analyzed. The metabolite ratios, pituitary gland size and hormonal concentrations: growth hormone (GH) in two stimulation tests and GH during the night, as well as IGF-1 (insulin-like growth factor) and IGFBP3 (insulin-like growth factor-binding protein) levels were also correlated., Results: There was a significant (p < 0.05) decrease of the NAA/Cr ratios in PCG and PWM in children with GHD compared to the normal subjects. Other metabolite ratios showed no significant differences. We also found significant positive correlations between NAA/Cr ratio in PWM and IGFBP3 level, as well as with GH concentration in a stimulation test with glucagon., Conclusions: The reduction of NAA/Cr ratios may suggest loss of neuronal activity within normal appearing gray and white matters in children with GHD. MRS could be a sensitive marker of cerebral metabolic disturbances associated with GHD and maybe used as an additional indicator for therapy with recombinant GH., (Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)