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Introduction: Given the increasing global burden of mental illness, the existing shortage of psychiatrists internationally is a concerning development with a deteriorating trajectory. In 2016, only 5% of US medical students considered a career in psychiatry, and the situation is similar in other areas (e.g., European countries). Attracting medical students to the field of psychiatry is evidently necessary. This paper investigates European medical students’ attitudes towards psychiatry, their intentions to pursue psychiatry as a career, and the role of different factors such as personal experience and education on their interest in psychiatry. Methods: A cross-sectional survey was analyzed from 799 medical students in two European countries. Data was collected in 2016. Participants completed a survey on their attitudes towards psychiatry, their medical education regarding psychiatry, and personal experiences. Cross tabulations with chi-square tests were performed for inferential analyses using a significance level of 0.05. Results: The number of years spent in medical school, the students’ personal experiences, and the perceived quality of education was significantly associated with specialty choice and ranking of psychiatry relative to other specialties. Students’ exposure to internships, psychiatric placements, and their view on psychiatric instructors also played a significant role in choosing psychiatry as a profession. Conclusions: The systematic evaluation of students’ attitudes towards psychiatry and motivational factors for pursuing psychiatry as a specialty, such as psychiatric education in medical school and personal experience, can inform necessary changes in the recruitment of students to the field. Efforts must address the worldwide shortage of psychiatrists to effectively reduce the burden of disease associated with mental health and substance use.

Aim First use of opioids often happens in adolescence and an increasing number of opioid overdoses are being reported among youth. The purpose of this narrative review was to present the treatment approaches for youth with high-risk opioid use, determine whether the literature supports the use of opioid agonist treatment among youth and identify evidence for better treatment outcomes in the younger population. Methods A search of the literature on PubMed using MeSH terms specific to youth, opioid use and treatment approaches generated 1436 references. Following a screening process, 137 papers were found to be relevant to the treatment of high-risk opioid use among youth. After full-text review, 19 eligible studies were included: four randomized controlled trials, nine observational studies and six reviews. Results Research for the different treatment options among youth is limited. The available evidence shows better outcomes in terms of retention in care and cost-effectiveness for opioid agonist treatment than abstinence-based comparisons. Integrating psychosocial interventions into the continuum of care for youth can be an effective way of addressing comorbid psychiatric conditions and emotional drivers of substance use, leading to improved treatment trajectories. Conclusions From the limited findings, there is no evidence to deny youth with high-risk opioid use the same treatment options available to adults. A combination of pharmacological and youth-specific psychosocial interventions is required to maximize retention and survival. There is an urgent need for more research to inform clinical strategies toward appropriate treatment goals for such vulnerable individuals.

Adverse Childhood Experiences (ACE) are a well-known risk-factor for depression. Additionally, (high-sensitive) C-reactive Protein (hsCRP) is elevated in subgroups of depressed patients and high following ACE. In this context the literature considers hsCRP and ACE to be associated with treatment resistant depression. With the data being heterogenous, this study aimed to explore the associations of ACE, hsCRP levels and response to antidepressant treatment in uni- and bipolar depression. N = 76 patients diagnosed with uni- or bipolar depression and N = 53 healthy controls were included. Treatment was over 6 weeks in an inpatient psychiatric setting within an observatory study design. Depressive symptoms were assessed by the Montgomery-Asberg Depression Rating Scale (MADRS), ACE were assessed by the Childhood Trauma Questionnaire (CTQ); the body-mass-index (BMI) and hsCRP were measured. HsCRP levels did not differ between the study population and the healthy controls. While the depressive symptoms decreased, the hsCRP levels increased. Sexual abuse was associated with significant higher and emotional abuse with lower levels of hsCRP after 6 weeks. The baseline hsCRP levels and the ACE subgroups did not show significant associations with the treatment response in unipolar depressed patients. The long-lasting effects of specific forms of ACE may have relevant impact on inflammation, supporting hsCRP to be a suitable biomarker. With ACE and hsCRP not showing any significant associations with treatment response in the unipolar depressed subgroup, a more differentiate research concerning biomarkers and treatment regimens is needed when talking about treatment response.