Objectives Recent evidence has questioned modern psychiatric clinical practice, specifically the prescribing of “atypical” antipsychotics. Our Pan-European Research Group wished to ascertain clinical ...practice amongst European trainees, which treatments trainees would desire for themselves, and factors influencing this. Methods A semi-structured survey was constructed from prior literature, piloted, and a homogenous sample size of at least 50 was agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, with questions on preference of antipsychotic for patients in given scenarios, and factors influencing choice. Physicians were asked for their preference should they develop psychosis. Results i) Treatment choice of antipsychotic for patients 93% (n=600) of respondents chose to prescribe “atypical” antipsychotics (excluding Clozapine), 6% (n=42) choosing “typical” antipsychotics, 1% (n=6) choosing Clozapine as first-line therapy. ii) Treatment choice if trainees developed psychosis 89% (n=530) of responders chose to prescribe “atypical” antipsychotics (excluding Clozapine), 7% (n=40) choosing “typical” antipsychotics, 4% (n=23) choosing Clozapine as first-line therapy. iii) Factors influencing choice These mapped onto three domains: cost, efficacy and side-effect profile (less than 5% other reasons). 79% (n=458) of those who responded felt efficacy most important, 46% (n=270) felt side-effect profile most important and 3% (n=16) considered cost of paramount importance. 38% (n=272) of those who responded to the survey stated that the CATIE trial had influenced their decision-making. Conclusions Psychiatry trainees’ choice of antipsychotic medication for both patients and themselves is based on perceived benefits, as opposed to evidence base and recent literature.
Objectives Guidelines produced for management of Bipolar Disorder illustrate change in evidence-base for treatment of acute and maintenance phases of illness. Our Pan-European Research Group assessed ...clinical practice and desired treatments amongst amongst Psychiatry trainees. Methods A semi-structured survey was piloted, and homogenous sample size (at least 50) agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, questioning preference of mood stabiliser for patients, trainees themselves and factors influencing choice. Results Tables 1 summarise choices. Number (n) Percentage Drug(s) 263/224 40.8/34.8 Lithium 121/101 18.8/15.7 Semisodium Valproate 133/85 20.7/13.2 Sodium Valproate 21/50 3.3/7.8 Lamotrigine 27/18 4.2/2.8 Lithium and Sodium Valproate 10/15 1.6/2.3 Carbamezapine 24/12 3.7/1.9 2nd Generation Atypical antipsychotics 8/4 1.2/0.7 Various combinations 34/134 5.3/21 Left blank Choice of mood stabiliser for patient/themselves Factors influencing decision-making mapped onto cost, efficacy and side-effect profile (less than 4% other reasons). 66% (n=538) of respondents felt efficacy most important, 25% (n=202) felt side-effect profile most important and 3% (n=24) considered cost of most importance. Conclusions No clear difference exists in choice of mood stabiliser for European trainees and their patients, and decisions based on perceived efficacy are generally in keeping with established guidelines.
The objective of the present study was to assess differences in prevalence of the metabolic syndrome among depressed patients in regard to the duration of the illness (first episode versus recurrent ...episodes). A total of 190 patients suffering from major depressive disorder were included in the study, diagnosed according to International classification of disorders, 10th revision. The same criteria were used to divide participants into two groups: first episode major depressive disorder and major depressive disorder with recurrent episodes. The metabolic syndrome was defined according to the criteria of the American National Cholesterol Education Program-Treatment Panel III. Results showed that metabolic syndrome is significantly more prevalent in patients with recurrent major depressive disorder (45.2%) compared to patients with first episode of major depressive disorder (27.3%), mainly due to differences in plasma glucose, triglycerides and HDL-cholesterol levels. These findings indicate the importance of the duration of depression and the number of recurring episodes as factors involved in etiopathogenesis of the associated metabolic syndrome.
First descriptions of metabolic side-effects of antipsychotic drugs date back to the 1950s when these drugs were introduced. In the meantime, metabolic side-effects have been shown to occur not only ...during therapy including conventional antipsychotics like chlorpromazine. Presently, similar problems are encountered with application of the novel, so-called atypical antipsychotics. Introduction of atypical antipsychotics in therapy has substantially promoted the treatment of patients with schizophrenia and other psychotic disorders. Major advantage of these drugs in comparison to conventional antipsychotics is lower frequency of extrapyramidal side-effects and hyperprolactinemia, and generally better tolerance. Still, some atipical antipsychotics are associated to body weight gain, occurrence of diabetes, and elevated cholesterol and triglyceride concentrations. This review addresses differences in effect of certain atypical antipsychotics on glucose and insulin homeostasis and lipid metabolism, as well as the question of the rational method of applying antipsychotics that are accompanied by metabolic side-effects. For the first time in Croatia, this article provides recommendations for routine clinical practice, i.e. on the monitoring of metabolic status of patients treated by novel antipsychotics.
This paper focuses on how the chain of command is construed in Swedish municipal adult education. With a qualitative research approach and by drawing on the theoretical and methodological framework ...‘What’s the “problem” represented to be?’ (WPR) approach, the aim is directed at identifying, interrogating, and reconstructing problem representations. The empirical material consists of contemporary key adult education policy that focuses on the chain of command and was analyzed in NVivo. Ethical considerations as well as data credibility, validity and reliability reflections were made in the form of WPR-guided self-reflexivity. The results indicate that both heads of education and principals are held responsible for the ‘weaknesses’ of the chain of command. Different solutions are also construed to solve the ‘problem’ that calls for increased trust between the actors in the chain of command. However, this trust seems to be underpinned by a request for more follow-ups, rather than a trust in the principal’s pedagogical leadership. The way that these issues are construed as specific kinds of ‘problems’ and ‘solutions’ has effects on the individuals that are involved in adult education. Based on the analysis, the need for policymakers to work on understanding the unintentional consequences of policies is stressed.
In transnational policy, directives on how to improve "quality" through auditing flourish. However, more research is needed about how these quality audits affect school personnel in local contexts. ...This paper has scrutinised the discursive effects of how "quality" is construed in school personnel's comments during a quality audit conducted by the Swedish Schools Inspectorate. By drawing on Bacchi's (2009) WPR approach, such constructs were analysed and interrogated. The results indicate that "quality" is construed as an absence of "warning flags", and thus as compliance with standards. In effect, statements about quality seem to become problem-oriented. Moreover, "quality" is talked about as a responsibility, and in effect the concept becomes invisible. It is also suggested that "quality" is construed as something that both enables and obstructs different kinds of discussion and discernments. It silences what it is possible to say and calls into question the organisation of the adult education system.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Superintendent in Municipal adult edcuation - Between Politics and Principal in the Governance Chain. Swedish education policy often emphasises that the superintendent, in the form of the ...representative for the municipality authority, must take more responsibility for the quality of education. This also applies to municipal adult education (MAE), a form of schooling that differs from the rest of the school system regarding governance. However, there has been limited research conducted on it. Based on Bacchi’s (2009) WPR approach, this study scrutinises how governance is produced in superintendent’s talk about their relationship with the principal and politics. Delegated steering is supported by two different logics of responsibility and economics. The superintendent’s duties and responsibilities are often emphasised, and reference is made to the chain of command. Responsibility is partially shifted to the principal and/or politicians in certain municipalities. This affects the superintendent’ discretion and has both direct and indirect effects on the education offered by the municipality, ultimately impacting the students as well.
Distance education has received a lot of attention in contemporary policy as something that makes it possible for more students to participate, but also involves a certain set of challenges. When it ...comes to distance education, Swedish municipal adult education (MAE) stands out with its long history of flexible education, often provided on distance. Applying Bacchi’s poststructural WPR approach, the aim of this study was to scrutinise how distance education is construed, and the discursive effects of this, in comments by MAE school leaders and staff during a quality audit. The analysis shows that it becomes difficult to question or think differently about distance education within the flexibility discourse in adult education. Moreover, the blame for students’ lack of goal attainment and increased dropouts seems to be put on external providers, municipalities, and the students rather than on the way that the adult education system is organised or the demands around flexibility in adult education policy. What seems to be left out is a discussion about the pedagogical and didactical implications of distance education.
PDF
