Child and adolescent psychiatric genetics

The current status of child and adolescent psychiatric genetics appears promising in light of the initiation of genome-wide association studies (GWAS) for diverse polygenic disorders and the molecular elucidation of monogenic Rett syndrome, for which recent functional studies provide hope for pharmacological treatment strategies. Within the last 50 years, tremendous progress has been made in linking genetic variation to behavioral phenotypes and psychiatric disorders. We summarize the major findings of the Human Genome Project and dwell on largely unsuccessful candidate gene and linkage studies. GWAS for the first time offer the possibility to detect single nucleotide polymorphisms and copy number variants without a priori hypotheses as to their molecular etiology. At the same time it is becoming increasingly clear that very large sample sizes are required in order to enable genome wide significant findings, thus necessitating further large-scaled ascertainment schemes for the successful elucidation of the molecular genetics of childhood and adolescent psychiatric disorders. We conclude by reflecting on different scenarios for future research into the molecular basis of early onset psychiatric disorders. This review represents the introductory article of this special issue of the European Child and Adolescent Psychiatry.

Attacks on German public figures, 1968-2004: warning behaviors, potentially lethal and non-lethal acts, psychiatric status, and motivations

Fourteen non-terrorist attackers of public figures in Germany between 1968 and 2004 were intensively studied, with a particular focus on warning behaviors, attack behaviors, and the relationship between psychiatric diagnosis, symptoms, and motivations for the assault. A large proportion of the attackers were severely mentally ill, and most likely to be in the potentially lethal rather than the non-lethal group. A new typology of seven warning behaviors was applied to the data, and all were present, most frequently fixation and pathway warning behavior, and least frequently a direct threat. Psychiatric diagnosis could be closely linked to motivation when analyzed at the level of symptom and content of thought, often delusional. Most of the attacks were directed at political figures, and the majority occurred after 1995.

Oncology nurses' perceptions about involving patients in the prevention of chemotherapy administration errors

To explore oncology nurses' perceptions and experiences with patient involvement in chemotherapy error prevention.

Chances and risks of publication of quality data - the perspectives of Swiss physicians and nurses

Background The release of quality data from acute care hospitals to the general public is based on the aim to inform the public, to provide transparency and to foster quality-based competition among providers. Due to the expected mechanisms of action and possibly the adverse consequences of public quality comparison, it is a controversial topic. The perspective of physicians and nurses is of particular importance in this context. They are mainly responsible for the collection of quality-control data, and are directly confronted with the results of public comparison. The research focus of this qualitative study was to discover what the views and opinions of the Swiss physicians and nurses were regarding these issues. It was investigated as to how the two professional groups appraised the opportunities as well as the risks of the release of quality data in Switzerland. Methods A qualitative approach was chosen to answer the research question. For data collection, four focus groups were conducted with physicians and nurses who were employed in Swiss acute care hospitals. Qualitative content analysis was applied to the data. Results The results revealed that both occupational groups had a very critical and negative attitude regarding the recent developments. The perceived risks were dominating their view. In summary, their main concerns were: the reduction of complexity, the one-sided focus on measurable quality variables, risk selection, the threat of data manipulation and the abuse of published information by the media. An additional concern was that the impression is given that the complex construct of quality can be reduced to a few key figures, and it that it is constructed from a false message which then influences society and politics. This critical attitude is associated with the different value system and the professional self-concept that both physicians and nurses have, in comparison to the underlying principles of a market-based economy and the economic orientation of health care business. Conclusions The critical and negative attitude of Swiss physicians and nurses must, under all conditions, be heeded to and investigated regarding its impact on work motivation and identification with the profession. At the same time, the two professional groups are obligated to reflect upon their critical attitude and take a proactive role in the development of appropriate quality indicators for the publication of quality data in Switzerland.

Threats to patient safety in the primary care office: concerns of physicians and nurses

Little is known about primary care professionals' concerns about risks to patient safety.

[Psychiatric assessment of alcoholic patients on a waiting list for liver transplantation : Which prognostic criteria are empirically proven?]

Liver disorders are the most frequent somatic complications of alcoholism. As 10‑20% of alcoholic patients will develop liver cirrhosis, this is the most frequent reason for premature death in alcoholic patients. Liver transplantation is now an accepted therapy for alcoholic liver cirrhosis but psychiatric assessment is usually required for patients entering a waiting list for transplantation. Prognostic criteria are controversially discussed, especially the so-called 6-month rule. Numerous studies and recent meta-analyses have indicated that duration of alcoholism, family history, age, sex, comorbid substance use and psychiatric disorders, noncompliance and social instability are outcome predictors. The 6-month criterion is not well proven but some studies are indicative. Possible therapeutic interventions for alcoholic patients on a waiting list are discussed.

Influence of single peer interventions on the recovery attitude of persons with a psychiatric disability

This study examined the influence of single peer to peer interventions on participants' recovery attitudes.

Who benefits from peer support in psychiatric institutions?

This study examines the influence of recovery-oriented peer events on participants' recovery attitudes and explores who benefits most from such events. Changes in participants' recovery attitudes were evaluated (pre, post, follow-up), and compared with changes of control groups. Distributions of recovery-related values in subgroups were analyzed descriptively. The results of non-parametric tests (Friedman) showed participants with significantly higher values in the dimension Recovery is possible directly after the interventions (P = 0.006), but not 6 months later, and not in comparison with members of control groups. On a descriptive level, women, participants with schizophrenia and with two or more episodes of the disorder showed higher recovery-related values compared to men, participants with an affective disorder and only one episode. Within their feedback, organizations and peers express a positive view of peer support, but evidence for a positive impact of the evaluated peer events on recovery attitude is limited.

In need of psychiatric help--leave a message after the beep

Every day, a substantial proportion of the general population experiences the distressing and frightening signs of an upcoming psychiatric illness. The consequences can be enormous because severe psychiatric disorders typically cause the loss of the ability to work and often mean a long-term burden for both the patients and their families. Even though most developed countries have an exceptionally high density of general practitioners and psychiatrists in private practice, getting a mental health appointment and seeing a doctor is often very difficult for patients with acute psychiatric symptoms. This study aimed at quantifying the time delay involved in seeking medical attendance when psychiatric disorders begin to develop.

[Heavy use of psychiatric hospitals and the use of outpatient services in Switzerland]

To identify user groups of inpatient psychiatry.