BACKGROUND: The increasing prevalence of mental health disorders among adolescents highlights the importance of early identification and intervention. Artemis-A is a web-based application of computerised adaptive testing (CAT), originally developed for secondary schools, to quickly and efficiently assess students' mental health. Due to its speed, reliability and accessibility, it may be a valuable tool for healthcare practitioners (HCPs) working with children and young people (CYP) in primary, community and potentially secondary care settings in the future. OBJECTIVE: To explore whether Artemis-A would be a useful, feasible and acceptable tool for HCPs working in primary and community care settings to identify CYP's mental health difficulties. METHODS: Semistructured interviews were conducted with 20 HCPs: 5 general practitioners, 5 Child and Adolescent Mental Health Services (CAMHS) staff, 5 school nurses and 5 community paediatricians. Data were analysed using the Framework approach. FINDINGS: HCPs reported that Artemis-A has the potential to enhance mental health assessment and aid overburdened services by providing a quick, patient-centred assessment and monitoring mechanism. Benefits of the app include facilitating earlier intervention and appropriate referrals. However, some concerns emerged about safety netting and the way Artemis-A presents its information. Responsibilities for ensuring care continuity also require careful clarification. CONCLUSIONS: With proper protocols and integration, Artemis-A could prove valuable in supporting HCPs to promptly detect mental health issues in CYP. Further research into optimal implementation is warranted. CLINICAL IMPLICATIONS: If paired with effective evidence-based interventions, the implementation of Artemis-A could help manage escalating demands in CAMHS.
- Klíčová slova
- Child & adolescent psychiatry,
- MeSH
- diagnóza počítačová MeSH
- dítě MeSH
- dospělí MeSH
- duševní poruchy diagnóza epidemiologie terapie MeSH
- duševní zdraví MeSH
- kvalitativní výzkum * MeSH
- lidé MeSH
- mladiství MeSH
- postoj zdravotnického personálu MeSH
- primární zdravotní péče * MeSH
- služby péče o duševní zdraví MeSH
- studie proveditelnosti * MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Spojené království epidemiologie MeSH
Progress in psychiatric treatment has led to important improvements in the quality of life of patients with severe mental illness (SMI). Nevertheless, the life expectancy of patients with SMI remains two decades shorter than that of the general population, and the most prevalent cause of death is cardiovascular disease. Given that the delivery of somatic care to a population of individuals with mental illness is specific, we developed a screening and intervention programme aimed at this vulnerable population. The "SOMA" programme is a complex somatic health intervention system consisting of screening and a set of interventions. Risk screening is evaluated automatically; the interventions include dietary intervention, healthy lifestyle education (HSE), physiotherapy, kinesiotherapy, and occupational therapy (KOP). The programme was introduced into the practice of the hospital, and its outcomes were monitored with a pilot population divided into 2 subprogrammes. CV risk factor prevalence study (n= 5481) as the most common CV risk factors identified hypertension (56.6 %) and smoking (55.7 %), high-risk patients proportion was 1364 (27 %). HSE (n=40) enrolled patients improved their body weight. KOP results show that patients with schizophrenia preferred physical activity less than others; 53 % of patients have no physical activity during hospitalization, and spontaneous physical activity depends on BMI in our sample. We observed improvement in cognitive functioning, perception of physical functions, or perceived limitations was comparable to the general population. Results show the usability of the program design; initial screening with two intervention branches can increase motivation for physical activity and adoption of health-promoting behaviors and support a recovery process in SMI patients. SOMA project is unique in the Czech environment, however, larger sample with longer observation period is needed.
- Klíčová slova
- Cardiovascular disease, Healthy lifestyle education, Nutritional care, Physiotherapy, Severe mental illness,
- MeSH
- dospělí MeSH
- duševní poruchy * terapie epidemiologie MeSH
- ergoterapie metody MeSH
- fyzioterapie (techniky) MeSH
- kardiovaskulární nemoci prevence a kontrola epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- plošný screening MeSH
- rizikové faktory MeSH
- schizofrenie terapie epidemiologie MeSH
- zdravý životní styl MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: Patients are the most common source of violence against EMS personnel. This study aims at elucidating specific clinical features in patients with mental alteration and aggressive behaviour increasing risk of violence. MATERIAL AND METHODS: This consecutive cross-sectional retrospective study analysed consecutive patients treated for prespecified list of primary diagnoses by one EMS provider in the Czech Republic between 1 January 2021 and 31 December 2023. The effect of individual features of medical history and present symptoms on the occurrence of violence, need for the Police assistance and use of restraints was evaluated, using linear regression model. RESULTS: 410 patients were evaluated. Verbal and brachial violence was present in 21.5 and 12.9 %, respectively. Police assistance was needed in 48.3 %, restraints were used in 4.6 %. The most significant predictor for violence, need for Police or restraints was agitation (OR 7.02, CI 4.14 - 11.90; OR 2.60, CI 1.60 - 4.24, OR 11.02, CI 3.49 - 34.80 respectively). Other predictors of violence included history of acute psychotic attacks and psychotic disorders, or outpatient psychiatry care. Among other predictors for Police assistance was presence of delusions, paranoia and history of outpatient psychiatry care. CONCLUSION: Prehospital care for patients with mental status alteration and aggressive behaviour is complex. Some clinical features seem to increase the risk of violence. Future research in the evaluation of agitated and violent patients is warranted to find strategies of risk mitigation for EMS personnel.
- MeSH
- agrese * psychologie MeSH
- dospělí MeSH
- duševní poruchy epidemiologie terapie MeSH
- fyzické omezení statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- násilí statistika a číselné údaje psychologie MeSH
- policie MeSH
- průřezové studie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- urgentní zdravotnické služby * statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
PURPOSE: To describe temporal trends in inpatient care use for adult mental disorders in Czechia from 1994 until 2015. METHODS: Data from the nationwide register of inpatient care use and yearly census data were used to calculate (a) yearly admissions rates, (b) median length of stay, and (c) standardized inpatient-years for adult mental disorders (ICD-10 codes F0-F6] or G30). Segmented regressions were used to analyze age- and sex-specific temporal trends. RESULTS: Admission rates were increasing in adults (average annual percent change = 0.51; 95% confidence interval = 0.16 to 0.86 for females and 1.01; 0.63 to 1.40 for males) and adolescents and emerging adults (3.27; 2.57 to 3.97 for females and 2.98; 2.08 to 3.88 for males), whereas in seniors, the trend was stable (1.22; -0.31 to 2.73 for females and 1.35; -0.30 to 2.98 for males). The median length of stay for studied mental disorders decreased across all age and sex strata except for a stable trend in male adolescents and emerging adults (-0.96; -2.02 to 0.10). Standardized inpatient-years were decreasing in adults of both sexes (-0.85; -1.42 to -0.28 for females and -0.87; -1.19 to -0.56 for males), increasing in female adolescents and emerging adults (0.95; 0.42 to 1.47), and stable in the remaining strata. CONCLUSION: Psychiatric hospital admissions were increasing or stable coupled with considerable reductions in median length of stay, suggesting that inpatient episodes for adult mental disorders have become more frequent and shorter over time. The overall psychiatric inpatient care use was decreasing or stable in adults and seniors, potentially implying a gradual shift away from hospital-based care.
- Klíčová slova
- Central and Eastern Europe, Common mental disorders, Healthcare services, Hospital-based care, National data, Psychiatric hospitalization, Schizophrenia, Substance use disorders, Temporal trends,
- MeSH
- délka pobytu * statistika a číselné údaje MeSH
- dospělí MeSH
- duševní poruchy * terapie epidemiologie MeSH
- hospitalizace * statistika a číselné údaje trendy MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- pacienti hospitalizovaní * statistika a číselné údaje MeSH
- příjem pacientů statistika a číselné údaje trendy MeSH
- registrace * MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness. AIMS: To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness. METHOD: Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders. RESULTS: People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors. CONCLUSIONS: A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.
- Klíčová slova
- Psychotic disorders/schizophrenia, bipolar type I or II disorders, comorbidity, depressive disorders, mortality and morbidity,
- MeSH
- dospělí MeSH
- duševní poruchy * epidemiologie MeSH
- kohortové studie MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- příčina smrti * MeSH
- registrace statistika a číselné údaje MeSH
- senioři MeSH
- zdravotní stav MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- MeSH
- demence * diagnóza epidemiologie MeSH
- duševní poruchy * diagnóza epidemiologie MeSH
- lidé MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- úvodníky MeSH
BACKGROUND: Evidence suggests reduced survival rates following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in people with preexisting mental disorders, especially psychotic disorders, before the broad introduction of vaccines. It remains unknown whether this elevated mortality risk persisted at later phases of the pandemic and when accounting for the confounding effect of vaccination uptake and clinically recorded physical comorbidities. METHODS AND FINDINGS: We used data from Czech national health registers to identify first-ever serologically confirmed SARS-CoV-2 infections in 5 epochs related to different phases of the pandemic: 1st March 2020 to 30th September 2020, 1st October 2020 to 26th December 2020, 27th December 2020 to 31st March 2021, 1st April 2021 to 31st October 2021, and 1st November 2021 to 29th February 2022. In these people, we ascertained cases of mental disorders using 2 approaches: (1) per the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes for substance use, psychotic, affective, and anxiety disorders; and (2) per ICD-10 diagnostic codes for the above mental disorders coupled with a prescription for anxiolytics/hypnotics/sedatives, antidepressants, antipsychotics, or stimulants per the Anatomical Therapeutic Chemical (ATC) classification codes. We matched individuals with preexisting mental disorders with counterparts who had no recorded mental disorders on age, sex, month and year of infection, vaccination status, and the Charlson Comorbidity Index (CCI). We assessed deaths with Coronavirus Disease 2019 (COVID-19) and from all-causes in the time period of 28 and 60 days following the infection using stratified Cox proportional hazards models, adjusting for matching variables and additional confounders. The number of individuals in matched-cohorts ranged from 1,328 in epoch 1 to 854,079 in epoch 5. The proportion of females ranged from 34.98% in people diagnosed with substance use disorders in epoch 3 to 71.16% in individuals diagnosed and treated with anxiety disorders in epoch 5. The mean age ranged from 40.97 years (standard deviation [SD] = 15.69 years) in individuals diagnosed with substance use disorders in epoch 5 to 56.04 years (SD = 18.37 years) in people diagnosed with psychotic disorders in epoch 2. People diagnosed with or diagnosed and treated for psychotic disorders had a consistently elevated risk of dying with COVID-19 in epochs 2, 3, 4, and 5, with adjusted hazard ratios (aHRs) ranging from 1.46 [95% confidence intervals (CIs), 1.18, 1.79] to 1.93 [95% CIs, 1.12, 3.32]. This patient group demonstrated also a consistently elevated risk of all-cause mortality in epochs 2, 3, 4, and 5 (aHR from 1.43 [95% CIs, 1.23, 1.66] to 1.99 [95% CIs, 1.25, 3.16]). The models could not be reliably fit for psychotic disorders in epoch 1. People diagnosed with substance use disorders had an increased risk of all-cause mortality 28 days postinfection in epoch 3, 4, and 5 (aHR from 1.30 [95% CIs, 1.14, 1.47] to 1.59 [95% CIs, 1.19, 2.12]) and 60 days postinfection in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.08, 1.38] to 1.52 [95% CIs, 1.16, 1.98]). Cases ascertained based on diagnosis of substance use disorders and treatment had increased risk of all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.03, 1.43] to 1.91 [95% CIs, 1.25, 2.91]). The models could not be reliably fit for substance use disorders in epoch 1. In contrast to these, people diagnosed with anxiety disorders had a decreased risk of death with COVID-19 in epoch 2, 3, and 5 (aHR from 0.78 [95% CIs, 0.69, 0.88] to 0.89 [95% CIs, 0.81, 0.98]) and all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 0.83 [95% CIs, 0.77, 0.90] to 0.88 [95% CIs, 0.83, 0.93]). People diagnosed and treated for affective disorders had a decreased risk of both death with COVID-19 and from all-causes in epoch 3 (aHR from 0.87 [95% CIs, 0.79, 0.96] to 0.90 [95% CIs, 0.83, 0.99]), but demonstrated broadly null effects in other epochs. Given the unavailability of data on a number of potentially influential confounders, particularly body mass index, tobacco smoking status, and socioeconomic status, part of the detected associations might be due to residual confounding. CONCLUSIONS: People with preexisting psychotic, and, less robustly, substance use disorders demonstrated a persistently elevated risk of death following SARS-CoV-2 infection throughout the pandemic. While it cannot be ruled out that part of the detected associations is due to residual confounding, this excess mortality cannot be fully explained by lower vaccination uptake and more clinically recorded physical comorbidities in these patient groups.
- MeSH
- Betacoronavirus MeSH
- COVID-19 * mortalita epidemiologie komplikace MeSH
- dospělí MeSH
- duševní poruchy * epidemiologie MeSH
- kohortové studie MeSH
- komorbidita MeSH
- koronavirové infekce mortalita epidemiologie komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- pandemie * MeSH
- příčina smrti MeSH
- registrace MeSH
- SARS-CoV-2 * MeSH
- senioři MeSH
- virová pneumonie mortalita epidemiologie komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: Knowledge of co-occurring mental disorders (termed 'dual diagnosis') among patients receiving opioid agonist treatment (OAT) is scarce. This study aimed (1) to estimate the prevalence and structure of dual diagnoses in two national cohorts of OAT patients and (2) to compare mental disorders between OAT patients and the general populations stratified on sex and standardized by age. METHODS: A registry-linkage study of OAT patients from Czechia (N = 4,280) and Norway (N = 11,389) during 2010-2019 was conducted. Data on mental disorders (F00-F99; ICD-10) recorded in nationwide health registers were linked to the individuals registered in OAT. Dual diagnoses were defined as any mental disorder excluding substance use disorders (SUDs, F10-F19; ICD-10). Sex-specific age-standardized morbidity ratios (SMR) were calculated for 2019 to compare OAT patients and the general populations. RESULTS: The prevalence of dual diagnosis was 57.3% for Czechia and 78.3% for Norway. In Czechia, anxiety (31.1%) and personality disorders (25.7%) were the most prevalent, whereas anxiety (33.8%) and depression (20.8%) were the most prevalent in Norway. Large country-specific variations were observed, e.g., in ADHD (0.5% in Czechia, 15.8% in Norway), implying differences in screening and diagnostic practices. The SMR estimates for any mental disorders were 3.1 (females) and 5.1 (males) in Czechia and 5.6 (females) and 8.2 (males) in Norway. OAT females had a significantly higher prevalence of co-occurring mental disorders, whereas SMRs were higher in OAT males. In addition to opioid use disorder (OUD), other substance use disorders (SUDs) were frequently recorded in both countries. CONCLUSIONS: Results indicate an excess of mental health problems in OAT patients compared to the general population of the same sex and age in both countries, requiring appropriate clinical attention. Country-specific differences may stem from variations in diagnostics and care, reporting to registers, OAT provision, or substance use patterns.
- Klíčová slova
- Dual diagnosis, Opioid agonist treatment, Opioid use disorder, Psychiatric comorbidity, Registry-based study,
- MeSH
- diagnóza dvojí (psychiatrie) MeSH
- dospělí MeSH
- duševní poruchy * epidemiologie farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- opiátová substituční terapie * statistika a číselné údaje MeSH
- opioidní analgetika terapeutické užití MeSH
- poruchy osobnosti epidemiologie MeSH
- poruchy spojené s užíváním opiátů * epidemiologie farmakoterapie MeSH
- prevalence MeSH
- registrace * MeSH
- senioři MeSH
- sexuální faktory MeSH
- úzkostné poruchy epidemiologie farmakoterapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Norsko epidemiologie MeSH
- Názvy látek
- opioidní analgetika MeSH
BACKGROUND: Improving Access to Psychological Therapies (IAPT) services address anxiety and depression in primary care, with psychotic disorders typically excluded. Our previous research found 1 in 4 patients report distressing psychotic experiences (PE) alongside common mental disorders, yet little is known about their clinical presentation and impact on recovery. METHODS: We used the Community Assessment of Psychic Experiences - Positive Scale (CAPE-P15) to assess the clinical presentation and symptomatic profile of PE within IAPT settings across three National Health Service (NHS) trusts, serving a diverse population in Southern England. We identified different classes based on the reported PE frequencies using latent class analysis. RESULTS: A total of 2042 IAPT patients completed the CAPE-P15. The mean age was 39.8 (±15.3) years. We identified five distinct classes of symptom profiles, findings that PE were common, especially self-referential and persecutory ideas. Prevalence and intensity increased across classes, extending to bizarre experiences and perceptual abnormalities in the fifth and least common class. Perceptual abnormalities were a strong indicator of symptom severity, with patients being the least likely to achieve recovery by the end of treatment. LIMITATIONS: Data were collected during a service evaluation. Replication of these findings across other IAPT services could prove beneficial. We did not collect information on negative PE. CONCLUSIONS: Patients seeking treatment for anxiety and depression in primary care commonly experience a wide range of positive PE. Self-referential and persecutory ideation were prevalent; perceptual abnormalities were infrequent. Providing information about prevalence and tailoring therapy may help reduce patient distress.
- Klíčová slova
- Anxiety, Common mental disorder, Depression, Improving access to psychological therapies, NHS talking therapies, Psychotic experiences,
- MeSH
- dospělí MeSH
- dostupnost zdravotnických služeb MeSH
- duševní poruchy * epidemiologie terapie MeSH
- kognitivně behaviorální terapie * MeSH
- lidé MeSH
- primární zdravotní péče MeSH
- psychotické poruchy * psychologie MeSH
- státní lékařství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Anglie MeSH
BACKGROUND: There has been a noticeable relative increase in psychiatric comorbidities among smokers as opposed to the general population. This is likely due to comparatively slower decrease in smoking prevalence among individuals with mental health conditions. This study aims to assess the prevalence trend of past or current mental health disorders in individuals seeking specialized smoking cessation assistance. METHODS: We conducted a retrospective single-centre observational study to assess the presence of mental disorders such as anxiety, depression, bipolar affective disorder, or schizophrenia in personal history of 6,546 smokers who sought treatment at the Centre for Treatment of Tobacco Dependence in Prague, Czech Republic between 2006 and 2019. The study examined the impact of gender, age, and the effect of successive years on the prevalence of the mental disorders using Poisson distribution regression. RESULTS: In the studied cohort, 1,743 patients (26.6%) reported having one or more mental disorders. Compared to patients without a psychiatric disorder, they exhibited similar levels of carbon monoxide in expired air (mean 17 ppm, SD 11 ppm) and scored one point higher on the Fagerström Test of Cigarette Dependence. Among smokers with a mental disorder, women were more prevalent (62%) than men (38%). The prevalence of mental disorders increased on average by 4% every year, rising from 23% in 2006 to 35% in 2019. CONCLUSIONS: Consistent with the observation that the prevalence of smoking among people with any mental disorder is higher and declining at a slower rate than in the general population, there is a steadily increasing percentage of these patients seeking specialized treatment over time. Professionals who offer tobacco dependence treatment should be aware of the upward trend in psychiatric disorders among smokers, as more intensive treatment may be needed. Similarly, psychiatric care should pay attention to smoking of their patients.
- Klíčová slova
- Comorbidity, Prevalence, Psychiatric disorders, Smoking cessation, Tobacco dependence, Treatment,
- MeSH
- duševní poruchy * epidemiologie MeSH
- kuřáci MeSH
- lidé MeSH
- poruchy vyvolané užíváním tabáku * epidemiologie terapie MeSH
- prevalence MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH