Promoting mental health in the healthcare sector in Romania

Adela‑Magdalena Ciobanu1,2, Floris Iliuţă1,2, Carmen‑Petrina Niculae1,2, Larisa‑Maria Geafer1,2

1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania

The healthcare sector is one of the most vulnerable groups in terms of mental health. In Romania, due to the huge lack of medical personnel, there is a marked overload on the people who work in the medical system, putting their mental health at risk. Chronic fatigue syndrome, exacerbation of preexisting pathologies or the onset of mental illnesses occur especially in those who perform a large number of night shifts and who face sleep deprivation, increased stress level, low autonomy, busy schedule, in addition to which the complex pathology of the patients is added. Also, the risk of malpractice and patients’ easy access to legislation and information have further increased the pressure on them. The existence of a well-trained and motivated medical staff is an essential condition for ensuring quality services. These workplace stressors negatively affect the mental health of medical staff, increasing the likelihood of medical errors or decreased performance, which can affect the health of patients.

Healthcare professionals faced difficult circumstances as a result of the recent COVID-19 pandemic. Along with the increased risk of infection and worries about spreading the virus to their loved ones, they also had to deal with emotional distress, sleep issues, isolation, lack of contact with their families, extended shifts and physical exhaustion, which led to an increased level of burnout, depression and suicide.

In the healthcare sector in Romania, it is necessary to develop a multi-level and multi-sector approach with the following key elements: early identification and detection of mental disorders, public education, awareness raising and anti-stigma programs in healthcare sector and through the media; development of self-help programs; training programs and continuing professional development for a range of workers in health and related services.

Keywords: mental health, health sector, mental disorders, public education


Therapeutic challenges in psychiatric patients at risk
of intraocular pressure and glaucoma

Adela‑Magdalena Ciobanu1,2, Cristina Anghele2, Vlad Dionisie1,2, Alexandra Mihăilescu2,3

1. Discipline of Psychiatry, Department of Neurosciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania
3. Discipline of Medical Psychology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Over time, the number of accessible pharmacological therapies has grown, but with the rise of side effects. In addition to weight gain, gastrointestinal difficulties or parkinsonism, unpleasant ocular consequences have been recorded. These side effects are uncommon, but they can be hazardous to the patient.

The aim of this paper is to review current knowledge on the risk of increased intraocular pressure and glaucoma caused by pharmacological treatment, updating clinicians involved in the treatment of patients with glaucoma or with risk factors for glaucoma.

Selective serotonin and noradrenaline reuptake inhibitors have the most studies reporting safety in administrating to glaucoma patients. Antipsychotics, especially first-generation drugs, appear to have no correlation with increased intraocular pressure. However, special care should be taken when using ziprasidone. Tricyclic antidepressants, benzodiazepines and topiramate should be avoided in patients predisposed to or diagnosed with glaucoma.

Patients receiving psychotropic medication should be closely monitored to prevent this condition. Regardless of the pharmacological regimen considered, the patient with glaucoma must be under the strict supervision of the ophthalmologist.

Keywords: SNRI, SSRI, tricyclic antidepressants, antipsychotics, benzodiazepines, topiramate, glaucoma, intraocular pressure


Challenges of informal caregivers during the COVID-19 pandemic

Ana-Claudia Damian1,2, Cristina Anghele2, Constantin‑Alexandru Ciobanu3, Floris Iliuţă1,2, Adela‑Magdalena Ciobanu1,2

1. Discipline of Psychiatry, Department of Neurosciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania
3. Faculty of Medicine, “Titu Maiorescu” University of Medicine and Pharmacy, Bucharest, Romania

The coronavirus pandemic had a global impact on mental and physical health. The duties of informal caregivers multiplied during this period due to the increased rate of infectivity, fear of the unknown, overcrowded hospitals and multiple restrictions. We aimed to describe the impact of this pandemic on informal caregivers.

The most frequent challenges were: difficulty in accessing medical services, worsening neurocognitive symptoms, coronavirus infection (either for the patient or the caregiver), maintaining the socio-professional status, social isolation, difficulties accessing telemedicine, lack of support, emotional disturbances in caregivers, financial difficulties and physical exhaustion.

Physical and mental health were negatively influenced by the fear of SARS-CoV-2 which led to emotional disturbances.

This pandemic has highlighted the importance of social interaction and the possibilities for improving health services through telemedicine. Caregivers can benefit from socialization and support programs, as well as early detection of affective disorders.

Keywords: COVID-19 pandemic, caregivers, life quality


Immunological and endocrine changes in burnout

Ana-Claudia Damian1,2, Cristina Anghele2, Adela‑Magdalena Ciobanu1,2, Constantin‑Alexandru Ciobanu3

1. Discipline of Psychiatry, Department of Neurosciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. Department of Psychiatry, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania
3. Faculty of Medicine, “Titu Maiorescu” University of Medicine and Pharmacy, Bucharest, Romania

Numerous studies have been focused on the biological link between stress, burnout and biomarkers, therefore the aim of this presentation is to describe the immunological and endocrine changes in patients with burnout, but also to provide clinicians with updated data on the subject.

The focus is on the hypothalamic-pituitary-adrenal (HPA) axis, which can be affected by chronic stress and can be investigated by measuring the hormonal response – corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol, prolactin, and thyroid hormones. An important challenge faced by this field is the pulsatile and diurnal fluctuation of these hormones, which cannot always be taken into account, thus the disparities in the literature.

Many studies have explored the pathways linking the immune system and chronic stress, but only a few have specifically assessed this process for future diagnostic or prognostic biomarkers.

In conclusion, burnout has cumulative effects on our body, and stress does not affect us in a singular direction; on the contrary, there are significant clinical implications, not just microscopic, but affective symptoms that lead to anxiety and depression.

Keywords: burnout, stress, immunology, endocrinology, depression, anxiety

Update in schizophrenia

Michael Davidson

Head of the Department of Psychiatry at the Sheba Medical Center;  Professor of Psychiatry at the Sackler School of Medicine

Schizophrenia is characterized by psychosis, negative symptoms and cognitive impairment. Whether schizophrenia as defined in DSM-5 is a definite phenomenological entity or a continuum overlapping with other mental illnesses or with normality is still a matter of debate. Imaging, neuropathologic and neurotransmitters studies revealed group differences between patients and controls, but the differences were not sufficient to generate sensitive and specific biologic markers.

A familial/genetic component is undeniable; however, it appears that many diverse mutations may produce similar clinical pictures which are modulated by environmental factors. 

Current available drugs which interfere with the dopamine and serotonin neurotransmission ameliorate agitation and psychosis, but not the negative symptoms or the cognitive impairment.

Over the last decade, a number of non-dopamine related drugs with better tolerability profiles and, hopefully, with better and broader efficacy have entered clinical trials, which will be discussed in the presentation. 

Keywords: schizophrenia, genetic component, environmental factors, non-dopamine related drugs

Organic versus psychosocial factors in psychiatric pathogenesis

Liana Dehelean

“Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania

In the absence of identified biological diagnostic markers, the main classification systems describe mental disorders exclusively from the perspective of symptoms. Biochemistry and functional cerebral neuroimaging studies, despite limitations, have drawn attention to the importance of the neurotransmitters’ circuits and the connections that are established between brain structures. Thus, interesting working hypotheses had been proposed regarding the pathogenesis of mental disorders, starting from the identification of circuits involved in affective, cognitive and motivational processing involving the individual himself or in relation to other people. This paper aims to analyze the interactions between the psychological and biological factors that contribute to the onset and evolution of mental disorders from the perspective of the neural circuits or networks that connect the brain structures to each other.

Keywords: mental disorders, neurotransmitters’ circuits, psychological factors, biological factors


Leptin – a potential therapeutic target in major depressive disorder

Larisa‑Maria Geafer1,2, Constantin‑Alexandru Ciobanu3, Adela‑Magdalena Ciobanu1,2

1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania
3. “Titu Maiorescu” University of Medicine and Pharmacy, Bucharest, Romania

Depression is an important psychopathological category and it can affect 20% of the global population during their lifetime. Traditional theories regarding the pathological mechanisms of depression involve dysregulation of neurotrophic factors, monoaminergic neurotransmission, and hippocampal neurogenesis. Antidepressants, which manifest their therapeutic benefits by enhancing monoaminergic neurotransmission, are the backbone of current treatments for depression. However, antidepressants do not always meet expectations in terms of efficacy, onset of action and tolerability. Therefore, because of the slow onset of therapeutic action and side effects, there is a need for new antidepressants with novel mechanisms of action. Leptin, produced and secreted by white adipose tissue, plays an essential role in the regulation of body weight, food intake and energy metabolism. Recent research has revealed that leptin plays a crucial role in the enhancement of mood and cognition by controlling synaptic alterations in the brain, which are associated with antidepressant-like effects. It has been postulated that low leptin levels may be the cause of the behavioral abnormalities associated with depression, based on the discovery of low circulating leptin levels in animal model studies of the depression. Acute administration of leptin has been reported in the literature to have antidepressant and anxiolytic effects in mice. Furthermore, clinical research has indicated that leptin mRNA and protein expression are positively linked with the severity of depression. New information on the underlying brain plasticity processes in depression is now available thanks to recent discoveries. Leptin could have an impact on these pathways, making it a potential target for novel therapeutic strategies for the treatment of depression.

Keywords: leptin, depression, antidepressants, psychotropic treatment


Recent advances in the treatment of depression

Siegfried Kasper

Professor and Emeritus Chair, Medical University of Vienna, Austria

Despite the available therapies for treatment-resistant depression (TRD), there are a limited number that are evidence-based and effective in this hard-to-treat population. The European Group for the Study of Resistant Depression (GSRD) investigated in the last two decades the illness characteristics, genetic underpinnings, as well as psychopharmacotherapy of TRD. The GSRD staging model characterizing response, nonresponse and resistance to antidepressant (AD) treatment was applied to 2762 patients in eight European countries. The retrospective and prospective studies of the GSRD reporting that switching antidepressants according to different classes was not associated with better response or remission rates influenced the European Medicines Agency (EMA) that subsequently revised its definition for TRD. Accordingly, the EMA defines TRD as non-response to at least two courses of antidepressants of the same or a different substance class administered in adequate doses and duration in adherent patients (EMA, 2013). A prediction model reaching accuracy of above 0.7 highlighted symptom severity, suicidality, comorbid anxiety and lifetime MDEs as the most informative predictors for TRD. Novel associations of single nucleoid polymorphisms (SNPs) within the PPP3CC, ST8SIA2, CHL1, GAP43 and ITGB3 genes and gene pathways associated with neuroplasticity, intracellular signaling and chromatin silencing have also been found to be associated with TRD. Applying machine learning algorithms, a signature of three SNPs of the BDNF, PPP3CC and HTR2A genes and lacking melancholia predicted treatment response. Taken together, the plethora of findings substantiated by the GSRD over two decades of research offers a unique and balanced perspective on TRD. On this foundation, further research will elaborate on specific clinical and genetic hypotheses, as well as treatment strategies within appropriate study-designs, especially interaction-based models for studying treatment outcome predictors and RCTs for investigating efficacy of particular psychopharmacotherapeutic strategies and prediction models.

Keywords: treatment-resistant depression, predictors for TRD, single nucleoid polymorphisms, chromatin silencing, machine learning algorithms


Electroconvulsive therapy and its effect on neurotransmitters

Luana Ionescu1, Larisa‑Maria Geafer1,2, Carmen‑Petrina Niculae1, Constantin‑Alexandru Ciobanu3, Octavian Baiu­1,
Adela‑Magdalena Ciobanu1,2

1. Neuroscience Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. Clinical Department, “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry
Titu Maiorescu” University, Bucharest, Romania

Introduction. Electroconvulsive therapy (ECT) represents a viable alternative for many psychiatric patients who respond inadequately to treatment. While the therapeutic effects of ECT on treatment resistant depression, treatment resistant schizophrenia and even on non-psychiatric diseases, such as Parkinson’s disease, is well documented, there is still a lack of consensus on the neurophysiological mechanism by which this treatment method works.

Objectives. Our aim is to review the current literature regarding the effects that ECT has on neurotransmitters.

Methodology. A review of the specialized literature was conducted, using the most relevant papers. The PubMed database was used.

Results. Electroconvulsive therapy has marked effects on the dopaminergic system, on the serotoninergic and on GABA systems, while also influencing the noradrenergic pathways. ECT alters several serotonin receptor subtypes in the brain, increasing their sensitivity to 5-hydroxytryptamine (5-HT). Free circulating GABA was reduced in patients in the first hour following ECT. Electroconvulsive therapy was found to modulate dopamine receptors and increase dopamine release.

Conclusions. Electroconvulsive therapy influences several neurotransmitter pathways in the central nervous system, providing therapeutic benefits to many treatment-resistant psychiatric patients.

Keywords: dopamine, ECT, psychosis, serotonin, GABA, depression, electroconvulsive therapy


Tradition and innovation in Cluj psychiatry

Ioana Micluţia

“Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Psychiatry and the Cluj School of Psychiatry can only be understood in the national and international context. While isolated initiatives dedicated to medical education in Cluj can be identified as early as the 18th century, the Faculty of Medicine was established by imperial decree in 1776. Patients were hospitalized in a “maniconiu” (large hospital for entire county), either in peripheral or in more central areas of Cluj. However, a distinct education system can be discussed only after 1903, within the framework of the Francis Joseph University and the first professor, Karoly Lechner, who initiated the construction of the neurology-psychiatry pavilion complex, with the contribution of the architect of the Hungarian Parliament. The complex was integrated into a park with occupational therapy facilities and connected to other clinical and preclinical specialties. The transition to Romanian medical education was done smoothly, with the University of Upper Dacia taking over the Cluj education. We can mention professors Constantin Urechia, Mihail Kernbach, Salvator Cupcea and Maximilian Müller, who intertwined psychiatry with forensic medicine and hygiene, or Arthur Dan, a promoter of German school psychopathology, or professor Eduard Pamfil, with a French background and an openness to philosophy, cybernetics and anthropology. However, more daring initiatives were notable in the 1980s, with a focus on biological psychiatry, medical psychology, sexology, and integration into the global psychiatry field through international participation and publications. In recent decades, the foundations have been laid for approaches based on biological grounds (genetics, immunology, imaging), psychopathology (cognitive), social aspects (de-stigmatization), psychotherapy and multidisciplinary fields (psychosomatics, sexology). These approaches are part of both national and international specializations, with extensive collaborations in teaching, clinical practice and research.

Keywords: Cluj School of Psychiatry , Karoly Lechner, Constantin Urechia, Mihail Kernbach, Salvator Cupcea, Maximilian Müller, Arthur Dan, Eduard Pamfil, integration into global psychiatry


Placing under interdiction, judicial counseling and special guardianship.
Controversies of the past, present and future, according to a forensic doctor

Bogdan Mălinescu

Primary Medical Examiner, Chief of Ilfov Forensic Medical Service, Romania

Decision no. 601/2020 regarding the exception of unconstitutionality of the provisions of Article 164 paragraph (1) of Law no. 287/2009 of the Civil Code, pronounced on 16 July 2020, published in the Official Gazette of Romania (Monitorul Oficial al României) on 27 January 2021, was followed by a period of legislative void through the suspension of the declared unconstitutional article until the appearance of Law no. 140/17 May 2022, on certain protective measures for persons with intellectual and psychosocial disabilities and the amendment and completion of certain normative acts, published in the Official Gazette of Romania on 20 May 2022, and which entered into force 90 days after publication (i.e., on 17 August 2022). Thus, for almost one year and seven months, the activities of the prosecutor’s offices and courts, but also of psychiatric forensic expertise in cases of persons under interdiction were conducted inconsistently, inconsistently and randomly, with various practices being applied by the courts, prosecutor’s offices, and forensic institutions in Romania.

Finally, after this long period of waiting, the Romanian Parliament, considering its obligation to reconcile the provisions found unconstitutional with Constitutional Court Decision no. 601/2020 and the provisions of the Romanian Constitution, made a comprehensive legislative intervention in the field of civil protective measures that can benefit individuals with intellectual and psychosocial disabilities, with significant changes in both general legislation and special legislation, creating new legal instruments in the field, followed by the establishment of a new methodology for examining individuals with intellectual and psychosocial disabilities, in which forensic institutions are no longer included.

A paradigm shift has occurred in the field, targeting the fight against social exclusion and discrimination and encouraging the active participation of these categories of individuals in civil and socioeconomic life, which is beneficial, but also a fundamental change in the provision of medical evidence, essential for courts in establishing a certain protective measure for a specific individual with intellectual or psychosocial disabilities, which entails pros and cons discussions.

This presentation aims to review the issues raised in the analysis of cases where the application of protective measures for individuals with intellectual and psychosocial disabilities is requested, starting from the old legal regulation of “interdiction”, continuing with the current regulation regarding the establishment of “judicial counseling” and “special guardianship”, and attempting to outline possible future developments in the field of medical evaluation activities in this domain.

A comparison is made between the old reports of psychiatric forensic expertise and the current reports of medical and psychological evaluation of individuals with intellectual and psychosocial disabilities.

We present a study conducted at the Ilfov Forensic Medicine Service for the year 2000, regarding interdiction expertise, which provides an overall picture of the cases where protective measures were requested (analysis by gender, age, types of pathologies, persons requesting such measures, types of conclusions of psychiatric forensic expertise, encountered difficulties etc.).

The advantages and disadvantages of the new legislation in the field are analyzed, as well as the difficulties or obstacles that may arise in current practice in the preparation of medical and psychological reports requested by law, from the perspective of the experience of the forensic medicine network that has conducted these expertises so far.

Keywords: Law no. 140, placing under interdiction, intellectual and psychosocial disabilities, examination methodology, judicial counseling, special guardianship

The quest for neurodegenerative disease treatment –
focusing on Alzheimer’s disease personalized diets

Matei Palimariciuc, Bogdan Gireadă, Roxana Chiriţă, Mihai Apostu, Vasile Chiriţă, Romeo Petru Dobrin

“Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

The most common cause of dementia is represented by Alzheimer’s disease (AD), which accounts for up to 80% of all dementia cases. Despite the extensive studies regarding the etiology and risk factors that have been performed in recent decades, and that the current knowledge about AD pathophysiology significantly improved with the recent advances in science and technology, little is still known about its treatment options. In this controverted context, a nutritional approach could be a promising way to formulate improved AD management strategies and to further analyze possible treatment strategy options based on personalized diets, and nutritional psychiatry is currently gaining relevance in neuropsychiatric disease treatment. Based on the current knowledge of AD pathophysiology, as well as based on the repeatedly documented anti-inflammatory and antioxidant potential of different functional foods, we aimed to find, describe and correlate several dietary compounds that could be useful in formulating a nutritional approach in AD management. We performed a screening for relevant studies on the main scientific databases using keywords such as “Alzheimer’s disease”, “dementia”, “treatment”, “medication”, “treatment alternatives”, “vitamin E”, “nutrition”, “selenium”, “Ginkgo biloba”, “antioxidants”, “medicinal plants” and “traditional medicine” in combinations.

Results. Nutrients could be a key component in the physiologic and anatomic development of the brain. Several nutrients have been studied in the pursuit of the mechanism triggered by the pathology of AD: vitamin D, fatty acids, selenium, as well as neuroprotective plant extracts (i.e., Ginkgo biloba, Panax ginseng, Curcuma longa), suggesting that the nutritional patterns could modulate the cognitive status and provide neuroprotection. The multifactorial origin of AD development and progression could suggest that nutrition could greatly contribute to the complex pathological picture. The identification of adequate nutritional interventions and the not yet fully understood nutrient activity in Alzheimer’s disease could be the next steps in finding several innovative treatment options for neurodegenerative disorders.

Keywords: Alzheimer disease, dementia, nutritional psychiatry, nutrients, plant extracts


Minor neurological signs in patients with schizophrenia

Cristian Petrescu1,2,3, Diana M. Petrescu1,2, Gabriela Marian2, Brînduşa E. Focşeneanu2,3,
Adela‑Magdalena Ciobanu1,3

1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2. Faculty of Medicine, “Titu Maiorescu” University, Bucharest, Romania
3. “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania

Introduction and objective. Minor neurological signs (MNS) are subtle neurological abnormalities that can be more frequently observed in patients with schizophrenia than in healthy individuals. Research on MNS has advanced in recent years. However, questions remain regarding their origin and their correlation with schizophrenia symptoms. Thus, this study aims at highlighting the importance of obtaining new information in the hope of future research that will help provide individualized treatment for these patients. For this paper, we conducted a research on the most recent articles published (2013-2023) in ScienceDirect and PubMed, which evaluated the impact of minor neurological signs in correlation with symptomatology, neuroleptic treatment and structural brain changes in patients with schizophrenia. Relevant articles on the topic, including both longitudinal and cross-sectional studies, were included.

Conclusions. The majority of research has shown that patients with schizophrenia had higher scores on neurological scales than healthy participants, but similar to those of first-degree relatives, thus supporting a genetic perspective. The greatest improvement in scores was observed in patients who had a remissive course of the disease, as demonstrated by decreases in neurological assessment scores, along with scores assessing psychotic symptomatology, suggesting a close correlation between MNS and the developmental stage of schizophrenia.

Keywords: minor neurological signs, schizophrenia, neurologic scales, genetics, evolutive stage

The outcome of total knee arthroplasty for patients with psychiatric disorders:
a single-center retrospective study

Cristian‑Ioan Stoica1,2, Georgiana Nedelea1, Dragoş C. Cotor1, Mihai Gherghe1, Dragoş‑Eugen Georgescu2,3,
Christiana Dragosloveanu2, Şerban Dragosloveanu1,2

1. Department of Orthopedics, “Foişor” Orthopedics Hospital, Bucharest, Romania
2. Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3. Department of General Surgery, “Dr. Ion Cantacuzino” Clinical Hospital, Bucharest, Romania

Background and objectives. In recent years, there has been an increasing amount of concern about the effect of psychiatric disorders on the outcomes of patients who have undergone total knee arthroplasties (TKA), therefore psychiatric pathologies have become a major factor in evaluating the results of total knee arthroplasty. As with other patient-related items, patients who are diagnosed with psychiatric illnesses encounter higher costs of medical treatment, longer recovery after surgery and longer hospital stays. The main purpose of this paper is to assess and determine the impact of mental diseases on the surgical outcome of the patient compared with patients with no history of psychiatric disorders.

Materials and method. We undertook a single-center retrospective study at our hospital, between June 2020 and January 2022. The experimental group consisted of patients with history of mental disorders, such as schizophrenia, bipolar disease, depression, substance abuse or other disorders from the psychiatric specialty. The control group was composed of patients who had undergone total knee arthroplasties with no sign, symptom or record of any mental disorder. In our study, there have also been other parameters recorded, such as length of hospital stay and postoperative complications. We used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS) as outcome measures.

Results. The study was conducted between June 2020 and January 2022. A total of 634 patients underwent total knee arthroplasty in our clinic, of which 239 had prior or concurrently psychiatric disorders. The majority of patients were females (61%) and the average hospital stay was significantly longer for patients with mental illness (6.8 days versus 2.8 days). Preoperative WOMAC and KS function scores demonstrated statistically significant differences between groups (67.83±17.8 versus 62.75±15.7, and 29.31±19.8 versus 34.98±21.3). Knee Society Score did not indicate significant differences preoperatively. All postoperative functional scores showed significantly better results for the control group compared to the mental illness group.

Conclusions. We have shown that patients with mental illnesses have longer hospital stays, increased complications, and more frequent readmissions, compared to the control group. A careful assessment of mental status during the initial consultation is recommended to discover those patients who have a reduced mental state. We would recommend that patients with documented psychiatric illnesses who are undergoing total knee arthroplasty be referred to a psychiatrist first for relief of symptoms. These patients have an increased risk of being discharged much later than normal. In conclusion, mental illness appears to be linked with lower TKA scores before and after the surgical procedure.

Keywords: total knee arthroplasties, TKA, osteoarthritis, mental illness, surgical outcome