Th e role of „Al. Obregia” Hospital in the promotion of child and adolescent neuropsychiatry in Romania
SUMMARY
The contribution of “Prof. Alexandru Obregia Hospital” to the development of the child and adolescent neuropsychiatry in Romania is presented, emphasizing the role of the national methodological centre of the clinic and the special role of Acad. Prof. Vasile Predescu and of the teaching staff of the clinic. Key words: child and adolescent neuropsychiatry, origins, scientifi c research, Alexandru Obregia
Child and Adolescent Neuropsychiatry was officially recognized in our country in 1948. It was not an acquisition due to the Soviet influence, as one might believe, because, in Russia, paediatric neurology and psychiatry had already been separated. The Western European model was preferred rather from the desire to simplify the effort needed to set up two medical specialties. This term has remained the same for 48 years. At the same time, the Faculty of Paediatrics was established, a fact that is particularly important given the importance of providing child and adolescent care in our country and of training specialists in the field.
The assistance of the child and adolescent with neurological and psychological disorders followed a very tedious process of development, marked by compromises and theoretical and practical errors as well as by a great gap from the level of development in the field that existed in Western European countries. While in the West, the medical-psychosocial concept was promoted, the negative role of institutionalization, the destigmatization of mental suffering, as well as the role as co-therapist of the community and family were admitted and there was a concern for the patients’ quality of life. Besides, in 1937, the “First International Congress of Infantile Psychiatry” took place in Paris. For a long time, progress had been marked by the direct role of adult professionals and their theoretical and practical accumulations. Here I would mention the special role of Professor Vasile Predescu, who had notable contributions in the field not only locally but also nationally.
In 1923, in Bucharest, the psychiatric hospital was established which, in 1998, was to be given the name of the one who formed the basis of its construction, namely, Prof. Dr. Alexandru Obregia. After 27 years, (in 1950), the Department of Infantile Neuropsychiatry (INP) was inaugurated, headed by Eugenia Negulici, an adult psychiatrist, between 1950 and 1957. She was followed, between 1957 and1973, by Dr. Iancu Isidor and then, for 32 years, by Dr. Ştefan Milea. In the beginning, the team consisted of Dr. Iancu Isidor and Dr. Costiner Elmano, a psychologist, a social worker, nurses and a
nurse for occupational therapy. Dr. Berbescu Costin joined this team, too, in 1965.
It is the merit of Prof. Dr. Vasile Predescu to have coordinated developments at several levels. Thus:
– He established the paediatric psychiatry discipline at “Carol Davila” University of Medicine and Pharmacy and transformed the department into a university clinic with internship for the students at the paediatrics faculty. This discipline had a distinct syllabus, one-semester courses of two hours per week, a practical 3-hour traineeship a week (which, unfortunately, is non-existent nowadays), and a team of teachers represented initially by Dr. Costiner Elmano and Dr. Stefan Margareta.
– He trained a complex team of specialised academic staff made up of Dr. Costiner Elmano (1962, assistant), Dr. Stefan Margareta (1962, assistant), Dr. Milea Ştefan (1965, assistant), Dr. Măgureanu Sanda (1967, assistant), Dr. Oancea Constantin (1967 tutor), Dr. Dobrescu Iuliana (1984 tutor), psychologists: Al Sen, D. Ivana, Răşcanu Ruxandra and Serbănescu Maria, and Dr. Roman Ignat expert electroencephalografist, Dr. E. Paraschivescu neuro-radiologist, a geneticist neurologist, Prof. Dr. Voiculescu Vlad, psychiatrists for adults, Dr. Ciurea Vlad, neurosurgeon and Dr. C Tăutu, anatomopathologist.
This team was to cover all stages of the distinctive curriculum required by the infantile neuropsychiatry specialty and ensure the conditions necessary for the autonomy of university education in the specialty of child and adolescent psychiatry.
– In 1963, by moving the national university and postgraduate training centre to Bucharest, he awarded it the role of a national postgraduate vocational training centre. Thus, annually, there are series of specialists, graduates of paediatric psychiatry, adult psychiatry, paediatric neurology, adult neurology, psychology and neurosurgery. The course lasting one year ends with a written, oral and laboratory exam followed by two years of practical training.
– Annually, in the methodological centre of Bucharest based in “Alexandru Obregia” Hospital thematic training courses are held with a duration of 1-3 months.
– In 1972 he established the Institute of Neurology and Psychiatry with an INP department and staff (Dr. Şerban Ionescu, Dr. Loreta Cantili, Dr. Helene Nedelcu and Associate Professor Dr. Margareta Ştefan.
– He has developed three national programs to promote and protect mental health with distinct chapters dedicated to INP. During the period 1961-1973, Associate Professor Dr Predescu delivered paediatric psychiatry courses of one semester and practical internships in the INP clinic, after which the didactic activity was fully transferred to the profile teaching staff. Taking advantage of the status of university clinic and the National Methodological Centre, the Department of Infantile Neuropsychiatry has annually trained paediatric graduates, INP specialists and organised training courses and exams for awarding professional degrees.
SCIENTIFIC RESEARCH
The clinic also constituted a basis for scientific research, being doubled by the three INP specialists of the research department of the Institute of Neurology and Psychiatry, with its headquarters situated in the hospital, too. To these, one should mention the research quota for the teaching staff. Several accomplishments need to be pointed out; students’ diploma theses, more than 30 doctoral theses, articles published in the 4 annual issues of the Romanian Journal of Child and Adolescent Neurology and Psychiatry (RJCANP) and communications at over 40 national conferences of RSCANP as well as participation in international scientific events. Of all these, the CENTAUR study on the epidemiology of neuropsychiatric disorders in children aged 0-16 years should be mentioned, which was coordinated by Dr. D. Cristodorescu Dan.
It was a very ample study whose results were kept secret, this is the reason why the data were published only in 2003 (see Grigoroiu-Şerbănescu). Studies have been carried out and published on the following themes:
– longitudinal neuropsychological development of premature babies, a theme coordinated by Dr. S. Ionescu (1975-1977);
– screening questionnaire applicable in epidemiological studies of mental illnesses in urban infantile population (1977-1978), coordinated by Dr. St. Milea;
– epidemiology of enuresis (1978-1979), coordinated by Dr. S. Milea; – infantile autism (1979-1983) coordinated by Dr. Ştefan Margareta;
– the CENTAUR study on the epidemiology of neuropsychiatric disorders in children aged 0-16 years, coordinated by Dr. D. Cristodorescu Dan, a very large study whose results were kept secret, therefore the data were published only in 2003;
– psychopathology of descendants of parents with major affective disorders (1984-1990) coordinated by psychologist Maria Grigoroiu-Serbănescu. A first contract research refers to the “Study on Children in Long-term Foster Care in Hunedoara, Cluj and Timis Counties”. It was carried out between 01.12.1991 and 30.06.1993. It was proposed by the Médecins du monde Organization and the Romanian Mental Health League and accepted by the Commission of the European Community. It focused on a transversal descriptive epidemiological study assessing the situation of assisted children. St. Milea and. C. Berbescu were involved on behalf of the Child and Adolescent Clinic of Psychiatry, as scientific managers.
The study was completed with the elaboration of two volumes with the synthesis of the results published in 1993 and with the volume “Protocols for the orientation of children under protective measures”. The second contract research was funded by the Swiss National Science Foundation and the Children Action Foundation in Switzerland and was carried out between 1996 and 1999 in collaboration with the Geneva Clinic of Infantile Psychiatry. It focused on “Assessing and improving the care of children in foster homes, continuous training of the staff and assessing the effectiveness of the endeavour”. St. Milea, C. Oancea and M. Federiga, neuropsychiatrists, E. Bran, psychologist, Mariana Federiga nurse and Constanţa Pâslaru psycho-pedagogue participated on our behalf in this contract research. The study was completed with published syntheses and a volume issued in 1999, entitled: “Early Prevention and Education in the Field of Young Child Development”. The multinational study on the “Treatment with Adiuretin in primary nocturnal enuresis in young children” was requested by the company Ferring Pharmaceuticals and S. Milea participated in it on Romania’s behalf. The study was finalized with an article published in the Review of Therapeutics, Pharmacology and Clinical Toxicology, Volume 1, No. 3 of 1997 and with a Communication at the 20th National Conference of Child and Adolescent Neurology and Psychiatry, Buzau -Sapoca, 19-20 September, 1997.
In the period 1997-2000, the phase III study RISINT-41 was completed focusing on “The safety and efficacy of Risperdal as oral solution in the behavioural disorders of children with mild and moderate mental retardation aged 5 to 14 years”.
The multinational research funded by the Janssen Research Foundation required: implementation of neuropsychological and biological assessment techniques to international standards. The study was attended by: St. Milea, coordinator, C. Oancea, I. Dobrescu and M. Federiga paedopsychiatrists, Serbanescu Maria, psychologist and M. Federiga, medical assistant. Evolution has been monitored for at least 12 months. The rigorous observation of the very demanding conditions, the regular control of the imposed biological parameters and their repeated attestation in specialized laboratories in Belgium as well as by international neutral assessors allowed the team to be hired and for a second study entitled RIS-INT-70 with a duration of two years, a follow-up trial of the cases completed in the previous study.
In the period 2003-2004, a Post Marketing Surveillance Study LTG-003 / K was conducted, entitled: “Stabilization on, or change-over to Plexxo (Lamotrigine) in daily practice” with the participation of S Magureanu and St. Milea. An extensive research program was the contribution of the Romanian team to the COSIPOLG-4-CT-2001-02378 study funded by the European Community. The research was part of the 5th Framework Program Program: Quality of Life; Mental Health Prevention in a Target Group at Risk: Children of Somatically Ill Parents – COSIP. It was a multinational research, where teams of specialists from medical universities of Arhus (Denmark), Athens (Greece), Basel (Switzerland), Bucharest (Romania), London (England), Turku (Finland) and Vienna (Austria) collaborated. Each centre addressed different somatic disorders, while the methodology and most of the objectives were common. During the course of 3 years, our team, composed of: St Milea, coordinator, and C. Oancea, aimed to identify successively the problems and psychological difficulties faced by children and the support parent in 58 families with one parent admitted to hospital on an emergency basis for an acute, medium or severe illness of the central nervous system; specific needs for preventive intervention; availability to accept early psychological intervention; administering a program of early and indirect psychological counselling; and assessing its effectiveness. We point out that the study looks at the first six months of evolution of an illness with acute onset that cannot be denied or hidden to children, involving immediate vital risk and unexpectedly bringing a multitude of problems into the family’s everyday life. The research also envisaged the establishment and training of a team; collaboration with neurosurgery and neurology specialists; the acquisition of a European research and data processing method and 18 assessment tools. In 1965, within the Union of the Medical Science Societies (UMSS), the Infantile Neuropsychiatry Circle was established (Fig. 1), which was the RSCANP embryo.
The Infantile Neuropsychiatry Clinic organized some of the national conferences of RSCANP, as follows:
The 4th National Meeting of Infantile Neuropsychiatry was held in Bucharest in 1980 with the theme: News in paediatric psychiatry.
The 7th National Conference of Infantile Neuropsychiatry was held in Bucharest in 1984 on the topic: News in the diagnosis and therapy of infantile psychoses.
The 9th National Meeting of Infantile Neuropsychiatry was held in 1986 in Bucharest on the topic: Current data in the psychopathology of anxiety in children and adolescents.
It should be emphasized that the approach of a variety of themes and the involvement of as many territorial centres as possible was pursued, and that in 1996 the two clinical constituent specialties separated, the clinic became exclusive to the psychiatry of the child and adolescent. Of course, it is also actively involved in the scientific manifestations of adult psychiatrists. PUBLISHING ACTIVITY In 1975, at the Publishing House of the Socialist Republic of Romania, S. Ionescu published the monograph “Socio-professional Adaptation of the Mentally Disadvantaged People (Theoretical Aspects and Clinical-Experimental Research)” (Fig. 2).
Also noteworthy are the substantial chapters on the psychic pathology of the child and adolescent written by Măgureanu Sanda, St. Milea and C. Oancea in the volume “Psychiatry” issued in 1976 under the editing of Prof. Dr.V. Predescu. It was followed by the first publication at the level of a treatise accomplished by St. Milea, a contribution of almost 400 pages, that appeared in 1988 in volume 6 of the treatise on paediatry, edited by P. Meilă and S. Milea (Fig.3). In the same volume, the author, in collaboration with I. Roman, also published the chapters on the investigations of the child such as EEG, EMG, ultrasonoencephalography and electroneurography.
All of them are contributions at outstanding scientific level that are based on personal experience and, in spite of the difficulties typical of the period, they are accompanied by up to date bibliographic information.
BIBLIOGRAPHY
1. Meiu Gh. și col.. (1989), Dezvoltarea asistenţei de psihiatrie în ţara noastră în ultimii 50 de ani (1938-1988) Neurologie, Psihiatrie, Neurochirurgie nr.3, 181-186
2. Milea S. Repere ale istoriei neuropsihiatriei copilului și adolescentului din România. Revista SNPCAR vol.6, nr. 4, 2003, pg. 3-10; vol. 7, nr. 1, 2004, pg. 3-12; vol. 7, nr. 2, 2004, pg. 87-102.
3. Milea S. (2004) . Landmarks in the history of child and adolescent psychiatry in Romania. Modern trends. In: Images of Psychiatry Romania 21st Century Romanian Psychiatry Ed. Sorel E, Prelipceanu D.Ed. Medica. București pg:33-52
4. Predescu V.(1988). O sută cinci zeci de ani de asistenţă psihiatrică în România. Neurologie, Psihiatrie, Neurochirurgie, 3, 163-170