bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring of antipsychotic plasma levels in the assessment of poor response and nonadherence to antipsychotics in delusional disorder
Authors: González-Rodríguez A. , Guàrdia A. , Pedrero A. Alvarez , Betriu M. , Cobo J. , Sanz N. , Acebillo S. , Monreal J.A. , Vidal D. Palao , Labad J.
Published: February 2022

Introduction

Over the last decades, antipsychotic plasma levels have been used to evaluate therapeutic response, adherence and safety of antipsychotics in schizophrenia. Their clinical utility in delusional disorder (DD) has been poorly studied.

Objectives

To investigate the relationship between plasma concentrations of risperidone (R), 9-OH-risperidone (9-OH-R) and olanzapine (OLZ), and clinical outcomes in DD.

Methods

Case-series of inpatients and outpatients with DD receiving treatment with risperidone (n=19) or olanzapine (n=2). Determination of R, 9-OH-R (active metabolite) and OLZ levels were obtained by high-performance liquid chromatography with electrochemical detection. Clinical variables such as treatment response or adverse events were recorded for all patients. These variables were correlated with two plasmatic ratios in patients treated with R: R:9-OH-R concentration ratio and total concentration-to-dose (C: D) ratio, indicating CYP2D6 activity and R elimination respectively.

Results

Twenty-one patients were included: inpatients (n=10) and outpatients (n=11). Dose range: R, 1-6 mg/day; OLZ, 5-10 mg/day. Three outpatients (R, n=2; OLZ, n=1) presented antipsychotic levels under the detection limit (non-adherence). All R patients showed CYP2D6 activity (R: 9-OH-R ratio <1). Eight patients presented C: D > 14, indicating a reduction of R elimination, which was associated with poor clinical response (n=3), adverse events (n=3) and no clinical relevance (n=2). OLZ (n=2), no association between levels and clinical outcomes.

Conclusions

The determination of antipsychotic plasma levels may be of clinical utility in the assessment of treatment resistance, antipsychotic-adverse events or non-adherence in inpatients or outpatients with DD. Therapeutic drug monitoring should be further studied in future works.

Disclosure

AGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.
Preliminary results of a network meta-analysis on the efficacy of long-acting injectable antipsychotics in schizophrenia
Authors: Medrano R. , Carranza F. , Saucedo E. , Guerrero A.
Published: February 2022

Introduction

Long-acting injectable antipsychotics (LAIs) are currently the most effective alternative for patients with schizophrenia who exhibit poor adherence. Although a recent meta-analysis reported similar efficacy between first and second-generation LAIs, these results were only based on 3 studies due to the limited number of head-to-head comparisons.

Objectives

Present the preliminary results of a network meta-analysis on the comparative efficacy of LAIs in schizophrenia.

Methods

Studies were obtained from a previous study, where we carried out a systematic search from until May 2019 in various databases. Included trials of adults with schizophrenia compared the efficacy of LAI vs LAI or placebo through the Positive and Negative Syndrome Scale (PANSS). Efficacy was evaluated through the mean differences (MD) from baseline to endpoint in the PANSS total scores. Network meta-analysis was performed in MetaInsight through direct and indirect comparisons using a Bayesian approach.

Results

from 12 studies are presented in Figures 1 and 2. All LAIs except zuclopenthixol were more effective than placebo. There were no significant differences between LAIs except for aripiprazole and risperidone, which were more efficacious than zuclopenthixol. The largest change occurred with aripiprazole LAI, but was not significantly higher than haloperidol.

Figure 1. Comparison of treatment pairs. Effect sizes are presented as MD and 95% confidence intervals (*p<0.05).

Figure 1. Overall change in symptoms

Conclusions

Preliminary results from a network meta-analysis also suggest that in the long-term haloperidol decanoate is equally effective in overall symptom changes compared to other LAIs. Further analyses are needed to obtain a better perspective on these drugs.

Disclosure

No significant relationships.
Bipolar affective disorder
Authors: Young A.
Published: February 2022

Abstract Body

Abstract: Biomarkers for diagnosis and treatment of Bipolar Disorder: hope or hype? Professor Allan Young, Centre for Affective Disorders, IoPPN, KCL London, SE5 8AF. allan.young@kcl.ac.uk The use of “biomarkers” (biological markers) in basic and clinical research as well as in clinical practice has become so commonplace in many areas of medicine that their presence as primary endpoints in clinical trials is now widely accepted. In clinical disciplines where specific biomarkers have been well characterized and repeatedly shown to correctly predict relevant clinical outcomes across a variety of treatments and populations, this use is entirely justified and appropriate. However, the validity of biomarkers in most psychiatric disorders continues to be evaluated. This lecture will review the current conceptual status of biomarkers as clinical and diagnostic tools for bipolar disorder and as surrogate endpoints in clinical research in bipolar disorder. The conceptual background in terms of current diagnostic categories and research domain criteria will be discussed and the various approaches with putative value (e.g., brain imaging, genetics, and neuroendocrinology) reviewed (1, 2). The lecture will end with a discussion of approaches to evaluating biomarkers of lithium response (3).

References

Wise et al, Mol Psychiatry. 2016 May 24. doi: 10.1038/mp.2016.72. [Epub ahead of print]; Young AH. Harv Rev Psychiatry. 2014 Nov-Dec;22(6):331–3 Bellivier F, Young AH, et al, Bipolar Disord. 2020 Oct 23. doi: 10.1111/bdi.13023. Online ahead of print.

Disclosure

Paid lectures and advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS Principal Inve
Factors affecting cognitive remediation outcome in schizophrenia: The role of treatment resistance
Authors: Spangaro M. , Bosia M. , Martini F. , Bechi M. , Buonocore M. , Cavallaro R.
Published: February 2022

Introduction

Treatment-resistant schizophrenia (TRS) represents a major clinical issue, characterized by worse psychopathological outcome, a more disrupted neurobiological substrate and higher healthcare costs. Cognitive impairment is a core feature of schizophrenia, strongly associated with patients’ functional outcome. Different studies showed that TRS patients exhibit poorer neurocognitive performance, particularly on verbal domains. To date Cognitive Remediation Therapy (CRT) represents the best available tool for treating cognitive deficits in schizophrenia. However, CRT outcomes are highly heterogeneous and significant treatment predictors are still lacking.

Objectives

To investigate possible differences of CRT outcome among patients with schizophrenia, stratified according to antipsychotic response (TRSs vs. first-line responders - FLRs).

Methods

150 patients with schizophrenia, (95 FLRs, 55 TRSs) were assessed for neurocognition with BACS and WCST at baseline and after CRT. General Linear Models (GLMs) were performed to investigate possible differences between groups on basal cognition and CRT outcome (Cohen’s d Effect Size).

Results

At baseline, GLMs showed significant differences in Verbal Memory (F=4,66; p=0,03) and WCST–executive functions (F=5,59; p=0,02), both worse in TRS group. Effecr Sizes of CRT outcome resulted significantly different in domains of Verbal Memory (F=4,68; p=0,03) and WCST–executive functions (F=4,62; p=0,03), with greater improvements among TRS patients.

Conclusions

This is the first study to indicate treatment-resistance as a possible predictor of CRT outcome in schizophrenia. Moreover, we observed that CRT resulted able to fill the cognitive gap between treatment groups. Thus, these results further highlight the importance of early cognitive interventions in order to reduce the neuropsychological and functional burden associated with the disease, especially for TRS patients.

Disclosure

No significant relationships.
Negative symptoms in first episode schizophrenia: Results from the “parma early psychosis” program
Authors: Pelizza L. , Leuci E. , Maestri D. , Quattrone E. , Paulillo G. , Pellegrini P. , Azzali S.
Published: February 2022

Introduction

Identifying distinct dimensions of negative symptoms in First Episode Schizophrenia (FES) might result in a better understanding and treatment of this invalidating symptomatology.

Objectives

Aim of this study was to examine negative symptom structure in FES patients using the Positive and Negative Syndrome Scale (PANSS).

Methods

All 147 participants, aged 12–35 years, completed the PANSS and the Global Assessment of Functioning (GAF) scale. A principal component analysis with varimax rotation was performed to investigate PANSS negative symptom structure in the FES total sample.

Results

A 2-factor model (i.e. “Expressive Deficits” and “Asociality” dimensions) was identified. Only “Expressive Deficits” domain had a significant negative correlation with baseline GAF score.

Conclusions

This bipartite solution seems to be adequate to describe the phenomenological variety of negative symptoms experienced by FES individuals at the point of entry in early intervention services.

Disclosure

No significant relationships.
Does insomnia increase the risk of suicide in patients with major depressive disorders? national inpatient sample analysis
Authors: Reddy A. , Mansuri Z. , Vadukapuram R. , Thootkur M. , Trivedi C.
Published: February 2022

Introduction

Insomnia is strongly associated with Major depressive disorders (MDD). There is strong evidence that it is one of the risk factor for suicide. Studies have shown the relationship of suicidal behavior in MDD patients with insomnia. However, it has not been evaluated in a large inpatient sample.

Objectives

To evaluate suicidality in MDD patients with insomnia compared to those without insomnia.

Methods

From the National Inpatient Sample (NIS 2006-2015) database using ICD-9 code, we obtained patients with the primary diagnosis of MDD and comorbid diagnosis of insomnia disorders (MDD+S). We compared it with MDD patients without insomnia disorders (MDD-S) by performing a 1:2 match for primary diagnosis code in the unweighted dataset. Suicidal ideation/attempt data were compared between the groups by multivariate logistic regression analysis.

Results

After the diagnostic code matching, 139061 patients were included in the MDD+S group and 276496 patients in the MDD- S group. MDD+S patients were older (47 years vs 45 years, p < 0.001) compared to the MDD-S group. Prevalence of Suicidal ideation/attempt was 56.0% in the MDD+S group and 42.0% in the MDD-S group (p < 0.001). After adjusting for age, sex, and race, MDD+S was associated with 1.8 times higher odds of suicidal behavior compared to the MDD-S group. (Odds ratio: 1.79, 95% confidence interval 1.68-1.91, p < 0.001).

Conclusions

Insomnia in MDD patients is significantly associated with the risk of suicide. It is important to be watchful for insomnia in MDD patients.

Disclosure

No significant relationships.
The psychological determinants of internet gaming disorder: Vulnerability to stress, psychological well-being, and comorbidity
Authors: Cardoso J. , Ferreira T. , Dores A.R.
Published: February 2022

Introduction

A variety of psychological determinants, such as vulnerability to stress, low levels of psychological well-being and several comorbidities, have been hypothesized to play a role in the development, and maintenance of Internet Gaming Disorder (IGD). However, evidence has been insufficient to sustain an overarching model of the causal pathways leading to IGD.

Objectives

. This study aimed to depict a model of the causal links between vulnerability to stress, psychological well-being, and symptoms of common mental disorders (e.g., depression, generalized anxiety, phobic anxiety, obsessive-compulsive disorder, somatization, and hostility).

Methods

. A community-based sample of Portuguese gamers (N = 153; Mage = 21.92; 15.29% female) completed measures of IGD (IGDS9-SF), mental health (SCL-90-R), psychological well-being (EBEP), and vulnerability to stress (23QVS). A machine learning algorithm – Greedy Fast Causal Inference – was used to infer a model of the causal pathways linking those psychological determinants to IGD.

Results

. Hostility and psychological well-being were directly involved with a subgroup of IGD symptoms (i.e., gaming used as escape, tolerance, withdrawal, and loss of control). Stress vulnerability and symptoms of mental disorders were only indirectly implicated in the causal pathways leading to IGD.

Conclusions

. It is likely that several psychological factors implicated in the causal pathways leading to IGD, have not been yet identified. Future research should directly test specific models of the causal pathways involved in the development and maintenance of IGD symptoms.

Disclosure

No significant relationships.
Association of traumatic events in childhood, impulsivity and decision-making with previous suicide attempt and/or current suicidal ideation in adult patients with major depressive disorder
Authors: Roman A. , Rodríguez-Revuelta J. , Santo F. Dal , García-Alvarez L. , De La Fuente-Tomás L. , Martínez-Cao C. , Jiménez-Treviño L. , González-Blanco L. , García-Portilla M.P. , Bobes J. , Saiz P.A.
Published: February 2022

Introduction

Suicidal behavior has a great impact on world public health. The literature describes the possible existence of an association between neurobiological, clinical and cognitive factors in suicidal behavior.

Objectives

To determine the possible relationship between clinical variables (history of abuse/maltreatment in childhood), psychopathology (impulsivity traits) and cognitive (decision-making) with a history of suicide attempt and/or current suicidal idea in patients with major depressive disorder.

Methods

Cross-sectional study in a sample of adult patients with major depressive disorder in which two types of comparisons are made. In the first case, two groups were compared based on the presence or absence of history of suicide attempt. In the second case, two groups were compared based on the presence or absence of suicidal ideation in the same sample of patients. Finally, sociodemographic, clinical and cognitive variables were evaluated in that population sample.

Results

When the joint influence of sociodemographic, clinical and cognitive characteristics are present, it can be said that being single/divorced/separated, a history of sexual abuse in childhood and an alteration in decision-making, specifically a lower number of choices of deck D in the IGT test, are associated with a higher probability of a personal history of suicide attempt. While a higher score on the Barrat impulsivity scale is associated with a greater probability of presenting current suicidal ideation once the influence of sociodemographic, clinical and cognitive variables has been taken into account.

Conclusions

Different sociodemographic, clinical and cognitive factors are associated with the presence of a history of suicide attempt and/or current suicidal ideation.

Disclosure

No significant relationships.
Restraint theory: Significance of rumination
Authors: Brytek-Matera A. , Bronowicka P. , Walilko J.
Published: February 2022

Introduction

Restraint theory (Herman and Polivy, 1975) suggests that human eating behaviour is under cognitive control and this leads to reduced sensitivity to internal cues for satiety, resulting in overeating in situations where cognitive control is under-mined (Johnson et al., 2012). In other words, restraint theory suggests that restraint (dieting) actually leads to leads to an excessive intake of food.

Objectives

The present study sought to investigate the relationship between dieting, eating behaviours (uncontrolled eating, emotional eating, cognitive restraint) and rumination (repetitive negative thinking). The second objective was to determine whether rumination mediates the relationship between dieting and both uncontrolled eating and emotional eating.

Methods

The sample was composed of 188 women (Mage = 29.46 ± 8.94; MBMI = 23.16 ± 4.04). The Eating Attitudes Test, the Three-Factor Eating Questionnaire and the Perseverative Thinking Questionnaire were used in the present study.

Results

Dieting for weight control (intentional weight loss) was associated with higher levels of uncontrolled eating, emotional eating, cognitive restraint and repetitive negative thinking. Mediation analyses showed that the relationship between dieting and inappropriate eating behaviours was mediated by rumination. The direct effect of dieting on both uncontrolled eating and emotional eating was significant, suggesting partial mediation.

Conclusions

Our findings support the relevance of rumination in linking dieting and eating behaviours among women. The current study may have clinical applications such as the potential integration of rumination for the prevention and changes in inappropriate eating behaviours.

Disclosure

No significant relationships.
The ecological momentary assessment approach and the use of big data to analyse possible effects of urbanisation on mental health
Authors: Menculini G. , Pigliautile I. , Moretti P. , Cotana F. , Pisello A.L. , Tortorella A.
Published: February 2022

Introduction

Smart healthcare monitoring allows detecting health conditions using Big Data, namely aggregated data concerning physiological and behavioral parameters. The continuous collection of data from smart-devices performed by the Ecological Momentary Assessment approach represents a promising application of Big Data.

Objectives

This preliminary study was aimed at developing a research protocol focused on the use of Big Data in evaluating the impact of urban environment, affected by a variety of potentially damaging anthropogenic actions, on illness relapses in Bipolar Disorders (BD).

Methods

This pilot study was designed by researchers from Departments of Psychiatry and Engineering (CIRIAF), University of Perugia. Environmental, physiological, and behavioral parameters and smart-devices aimed at collecting Big Data were identified. Subjects aged 18-65, affected by BD in current euthymic state referring to the University/General Hospital of Perugia will be recruited.

Results

Subjects will undergo a baseline visit and three monitoring visits during one year. Wearable devices will be provided for collecting data about environmental and physiological parameters. Behavioral data will be collected through smartphone accelerometers, GPS, and overall smartphone use. Big data will be stored into an online platform that will provide real-time feedback concerning the recorded variables. Clinical information concerning BD relapses will be collected. Machine learning techniques, integrated to deterministic analysis of urban environmental conditions, will be used to create possible predictive models for BD relapses.

Conclusions

The present project could allow the creation of a new operative platform for a better health management system correlating real-time Big Data to specific clinical features of BD.

Disclosure

No significant relationships.
Anxiety in heart failure patients and its association with NYHA class
Authors: Costa F. , Martins S. , Moreira E. , Cardoso J. Silva , Fernandes L.
Published: February 2022

Introduction

Heart failure (HF) is a worldwide public health problem and the main cause of morbidity and mortality in older people. Previous studies have demonstrated that psychological symptoms are associated with worse cardiovascular outcomes. Nevertheless, the research regarding the association between anxiety and HF is still scarce.

Objectives

To analyse the levels of anxiety in HF patients and its association with New York Heart Association (NYHA) class in HF patients.

Methods

This study takes part of a wider project named Deus Ex-Machina project (NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Patient with inability to communicate, with severe visual impairment or with NYHA class IV were excluded. Sociodemographic data and NYHA class were recorded. Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7).

Results

Overall, 136 patients were included, with a mean age of 57(±13) years old. Most of them were men (66%) and married (76%), with mean education of 8 years (±4). Regarding NYHA class, 36%, 49% and 15% were at class I, II and III, respectively. The mean GAD-7 total score was 6.4 (±5.2) and 32% of patients showed moderate to severe anxiety symptoms. No association between the NYHA functional class and anxiety was found (p=0.106).

Conclusions

The results reveal that anxiety is frequent among HF patients. However, as found in previous studies, it was not associated with more severe HF symptoms. The coexistence of HF and anxiety deserves further studies, in order to build a better understanding of this association.
Impact of residual thymic symptoms in quality of life in bipolar patients in euthymia
Authors: Elleuch S. , Sellami R. , Ouali R. , Feki I. , Masmoudi J.
Published: February 2022

Introduction

Several studies have shown that residual mood symptoms affect the psychosocial functioning of patients with bipolar disorder (BD) in euthymia.

Objectives

To evaluate specific areas of functioning in this population and to explore the relationship with residual mood symptoms.

Methods

This is a descriptive and analytical cross-sectional study including patients with BD (DSM V) in euthymia followed on ambulatory basis to the Mood Disorders Unit of the Psychiatry A Department at Hedi Chaker Hospital in Sfax between January and April 2019. Patients were considered euthymic if they scored below 7 on the Young Mania Assessment Scale (YMRS) and under 8 on the Hamilton Depression scale (HDRS-17). Residual manic and depressive mood symptoms were assessed using YMRS and HDRS-17. The Short Function Evaluation Test (FAST) was used to evaluate the overall and specific functionning domains.The alteration of the domain-specific functioning is defined by the following thresholds: autonomy>1, professional functioning>1, cognitive functioning>2, financial problems>1, interpersonal relations>3 and leisure time>3.

Results

We recruited 62 patients with a mean age of 45.65 years (SD = 13.3) and a sex ratio 1.13.The medians of YMRS and HDRS scores were respectively 2[0-5] and 2[0-7]. Global functionning impairment was observed in 85.5% of patients. Marked impairment of professional and cognitive functioning was observed in 98.4% and 77.4%, respectively. Alteration of the relational sphere was significantly more frequent in patients with residual depressive symptoms (p=0.009); impairment of autonomy was significantly more frequent in subjects with manic residual symptoms (p=0.005).

Conclusions

Residual symptoms should be considered as specific targets of treatment to improve functioning.
Impulsivity and socio-demographic variables among bipolar disorder patients
Authors: Ajmi S. , Najjar S. , Baati I. , Masmoudi J.
Published: February 2022

Introduction

Impulsivity is a psychiatric symptom that seems to be more prevalent in some mental disorders such as bipolar disorders (BD). It is a trait that seems to be influenced by many socio-demographic variables across BD.

Objectives

The aim of our study is to examine the relationship between impulsivity and these variables.

Methods

We performed a cross sectional study on 30 patients diagnosed with BD and consulting at the Psychiatric department of Hedi Chaker Hospital. Patients were euthymic during the time of the study confirmed by administration Young Mania Rating Scale (YMRS) and Montgomery Depression Rating Scale (MDRS). The socio-demographic data was obtained. Impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11)

Results

The study sample consisted of 30 patients (10 men and 20 women). The mean age of the sample was 45.83 years (SD= 11. 63). Seventeen patients (56.7%) were married. More than half of the subjects (76.7%) were unemployed and 26.7% were not educated. Of the studied patients 83.3% were drug free, 43.3% were smoker and 16.7% were alcoholic. The mean BIS11 score was 75. 60 (SD=5.51) and 76.7% had a high level of impulsivity. No correlation was found between the level of impulsivity (BIS-11 scores) and age, gender, marital status, being a current smoker, using drug or alcohol or job status (p=0.082; p=0.760; p=0.087: p=0.977; p=0.847; p=0.708).

Conclusions

Further studies should be realized to fully characterize impulsivity in BD and, therefore, make it a target for future therapeutic models.
Bipolar disorder’s treatment and impulsivity
Authors: Ajmi S. , Najjar S. , Masmoudi J.
Published: February 2022

Introduction

Impulsivity is not a classical psychiatric diagnosis like schizophrenia, depression, bipolar or borderline personality disorder. It is a symptom that could occur in almost all psychiatric disorders and in some neurological or systemic diseases.

Objectives

In this study we examine the influence of bipolar disorder’s (BD) treatment on the impulsivity.

Methods

We performed a cross sectional study on 30 patients diagnosed with BD and consulting at the Psychiatric department of HediChaker Hospital. Patients were euthymic during the time of the study confirmed by administration Young Mania Rating Scale (YMRS) and Montgomery Depression Rating Scale (MDRS). The socio-demographic data and treatment models were obtained. Impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11).

Results

The study sample consisted of 30 patients (10 men and 20 women). The mean age of the sample was 45.83 years (SD= 11. 63). Seventeen patients (56.7%) were married. Half of the participants were using an association of mood stabilizer (MS) and an antipsychotic (AP), 36.7% and 13.3% were receiving respectively only mood stabilizer or an antipsychotic. The mean BIS11 score was 75. 60 (SD=5.51) and 76.7% had a high level of impulsivity. No correlation was found between the level of impulsivity (BIS-11 scores) and using MS, AP or MS+AP (p=0.199; p=0.933; p=0.195).

Conclusions

Further studies should be realized to identify pharmacological treatment of impulsivity among people with BD.
Pediatric bipolar disorder: Preliminary results of a retrospective study using a nationwide administrative database
Authors: Campos A. , Gonçalves-Pinho M. , Ferreira A.R. , Freitas A. , Fernandes L.
Published: February 2022

Introduction

Bipolar disorder (BD) is a severe and chronic illness characterized by episodic changes in mood. The average onset of BD symptoms is estimated between 18 and 22 years. However, many adults retrospectively report symptoms onset in childhood or adolescence. Over the last decades, pediatric bipolar disease (PBD) has been the focus of increased attention mainly due to controversies surrounding its prevalence, diagnosis and treatment in the pediatric population.

Objectives

To analyze pediatric hospitalizations related to BD held in mainland Portuguese public hospitals between 2000 and 2015.

Methods

This retrospective observational study analyzed all pediatric (<18 years old) inpatient episodes from 2000 to 2015 with a primary BD diagnosis, using an anonymized administrative database including all hospitalization from mainland Portuguese public hospitals. ICD-9-CM codes 296.x were used (excluding codes 296.2x; .3x and .9x). Age at admission, admission type and date, sex, charges and length of stay (LoS) were analyzed.

Results

A total of 348 hospitalizations were analyzed from 258 patients. Patients were mainly young girls (60.6%), with a mean age of 15.24±1.87 years. The majority of the admissions were urgent (81.0%), and the median LoS was 14 days (IQR: 7; 24). Mean hospitalization charges were 3503.1€ with a total sum of 1.2M€ for all the episodes.

Conclusions

PBD hospitalizations occur predominantly in female patients during adolescence. The majority of them are urgent admissions. Descriptive studies will help to describe and characterize sociodemographic and clinical trends in PBD in order to better prevent acute hospitalizations with inevitable social and economic implications.
The factors associated with chronic benzodiazepine use in bipolar patients
Authors: Charfi N. , Abdallah M. Ben , Omri S. , Smaoui N. , Feki R. , Thabet J. Ben , Zouari L. , Bouali M. Maalej , Maalej M.
Published: February 2022

Introduction

Benzodiazepines (BZD) are widely used in patients with bipolar disorder (BD) and their effectiveness is well documented. Therefore, there are major risks associated with BZD use including abuse and dependence. Those risks can be related to the patients’chacteristics, the particularities of BD and the prescribers.

Objectives

To determine the factors associated with chronic use of BZD in patients with BD.

Methods

We conducted a cross-sectional, descriptive and analytical study among a sample of patients with BD (DSM-5) followed in psychiatric outpatient of Hedi Chaker university hospital in Sfax. We used the Benzodiazepine Cognitive Attachment Scale (ECAB) to determine dependent patients

Results

Among the 61 included patients, 50 (82%) had a chronic use of BZD (> 3 months). They had a mean age of 49.3 years (± 14.02 years) and a low socio-economic level in 44%. The type of BD was dominated by type II (66%). Initial episode type was depressive in 78%. The average number of depressive episodes was 2.92±2.3. A rate of 65.5% of patients have already attempted BZD withdrawal. Chronic BZD use was significantly correlated with BZD dependence (p=0.000), low socioeconomic level (p=0.04), depressive type of the initial episode (p=0.011), the depressive recurrence (p=0.000) and the absence of any attempt to discontinue BZD (p=0.011).

Conclusions

Chronic use of BZD in patients with BD is prevalent. In order to minimize this problem in this population, it is important to enhance programs to improve psychiatrist-prescribing behavior and to use cognitive-behavioral therapies in combination with medication to help withdrawal.
The relationship between self-esteem and bullying behavior among adolescent in tunisia
Authors: Ayoub R. , Brahim T. , Salem N. Ben , Brigui N. , Guedria A. , Gaddour N.
Published: February 2022

Introduction

Bullying is a serious problem for school youth. It is prevalent across the elementary and secondary school years and it has serious consequences for both bullies and victims.

Objectives

The aim of this study was to investigate the relationship between self-esteem and bullying behavior.

Methods

We conducted a cross-sectional study including children enrolled in two high schools in Sousse, Tunisia. The students were asked to complete two questionnaires: the Adolescent Peer Relations Instrument witch is a multidimensional scale designed to assess bullying involvement both as target and perpetrator and the Rosenberg self-esteem scale.

Results

We recruited 600 adolescent. The mean age of our population was 13.76 ±1.37 and the sex ratio was 1. More than 95% of adolescent who reported that they had been victims of bullying had a very low self-esteem comparing to those who stated that they had never been bullied (4.4%). Our results have also shown that bullies had a lower self-esteem than children who had not bullied others.

Conclusions

We found that both victims and bullies tend to have low self-esteem. Our findings could help to understand better the role that individual characteristics and personal qualities such as self-esteem play on bullying, and provide the scientific knowledge to develop successful strategies to prevent this phenomenon.
Emotional dysregulation and attention deficit hyperactivity disorder (ADHD)
Authors: Turkia I. Ben , Brahim T. , Guedria A. , Bousleh S. , Gaddour N.
Published: February 2022

Introduction

Because emotional symptoms are common in attention-deficit/hyperactivity disorder (ADHD) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait.

Objectives

Assess the possibility that symptoms of emotional dysregulation should be considered as core diagnostic feature of ADHD.

Methods

It’s a cross sectional study, including 60 children with ADHD and 60 children without ADHD ranging from 6 to 19 years of age (mean age 10.43 years). We defined moderate emotional dysregulation if a child had an aggregate cut-off score of ˃180 on the Anxiety/Depression, Aggression, and Attention scales of the CBCL and severe emotionaldysregulation if a child had an aggregate cut-off score of ˃ 210. This profile was selected because of its conceptual congruence with the clinical concept of emotionaldysregulation.

Results

Sixty-three percent of children with ADHD had a severe emotional dysregulation versus 12% of controls (P˂0.001). Emotional dysregulation was associated with elevated rates of hyperactivity and impulsivity : Ninety-six percent of the children with hyperactivity-impulsivity, according to the Conners scale, had emotional dysregulation. With a significant correlation between emotional dysregulation and hyperactivity-impulsivity (p = 0.001). Also all children with attentional disorders exhibited emotional dysregulation and a significant correlation between emotional dysregulation and inattention has been found in both groups (p=0.000).

Conclusions

Emotional dysregulation is now known to play a causal role regarding ADHD symptomatology. It should therefore be included in future theoretical models of ADHD, as well as in clinical practice when identifying the major impairments in this diagnostic group and when deciding therapeutic strategies.
Moderator role of self-compassion in the relationship between borderline features and suicide ideation in adolescents
Authors: Pinto-Gouveia C. , Carreiras D. , Rocheteaux A. , Valente A. , Castilho P. , Cunha M.
Published: February 2022

Introduction

Borderline Personality Disorder (BPD) is an impairing disorder with distinct features such as instability in self-image, relationships and affect. Considering the developmental nature of BPD, borderline features are not rarely exhibited in adolescence. These features tend to be associated with depression and suicide ideation, as well as with a negative self-to-self relationship. Self-compassion has been consistently identified as a positive attitude with oneself when experiencing suffering.

Objectives

The aim of the current study was to explore the role of self-compassion in the relationship between borderline features and suicide ideation, when controlled depressive symptoms.

Methods

Sample was composed by 665 adolescents (58.5% females and 41.5% males), with a mean of 15.54 years of age (SD = 1.52), who completed self-report questionnaires. Data was analyzed using SPSS (version 23) and PROCESS Macro.

Results

showed that girls presented higher borderline features and suicide ideation and lower self-compassion compared to boys. The moderation model explained 66% of suicide ideation, with gender and depression as covariates. The interaction of borderline features and self-compassion had a unique and significant effect on suicide ideation, when controlled depression and gender. Adolescents with higher levels of borderline features and lower self-compassion presented significantly higher suicide ideation, compared to those with higher self-compassion.

Conclusions

These findings suggest that developing self-compassion in adolescents with evident borderline features might attenuate their tendency to think about committing suicide.
The relationship between bullism, depression and suicidal thought in adolescents in albania
Authors: Elezi F. , Tomori S. , Kaja K.
Published: February 2022

Introduction

The effects of bullying can be both physical and emotional, and they can last for many years. Children that experience verbal and physical bullying are at a greater risk of developing depression later on in life, compared with children who did not.

Objectives

This study aims to look into the relationship between bullying, depressive symptomatology and suicidal thoughts in adolescents of high schools in Lushnje.

Methods

Three questionaires (the Beck Depression Inventory; the Bully/victim Behavior / Victim Behavior Questionnaire by Olweus; the Suicide Questionnaire) were circulated online and were completed by 400 adolescents from 2 high schools in a small city in Albania between September-November 2019. Data has been analysed using the Software Package for Social Sciences for Windows v. 22.0 (SPSS Inc. Chicago, IL).

Results

We found significant positive correlation between bullying (victimization) and the level of depression (r (n = 400) =. 300, p≤.05), and significant positive correlation of bullying (cause) with level of depression (r (n = 400) =. 160, p≤.05) but lower than in victimes. The victims of bullying have higher levels of depression and vice versa. We found higher rate of depression in female adolescents with the average (M = 14.710, ds = 11.263) compared to boys with the average (M = 9.609, ds = 10.723). There is an important positive correlation of suicidal ideation with the level of depression (r (n = 400) =. 616, p≤.05).

Conclusions

Being either a bully or a victim of bullying seems to increase the chances of being affected by depression and suicidal thoughts
Psychiatric symptoms in neurofibromatosis type 2
Authors: Khouadja S. , Melki R. , Younes S. , Zarrouk L.
Published: February 2022

Introduction

Neurofibromatosis type 2 (NF2) is a rare disorder associated with significant morbidity such as hearing loss that can lead to many psychiatric disorders.

Objectives

Describe the psychiatric symptoms associated to NF2.

Methods

We report the case of a patient admitted to the locked unit of the psychiatric ward for agitation and persecutory delusion and diagnosed with NF2. The data was collected from the patient’s medical file. A review of the literature was performed by selecting articles from PubMed using ‘Psychosis acoustic neuromas’ and ‘Psychosis neurofibromatosis 2’ as key words.

Results

This is the case of a 21-year-old patient who was admitted for behavioral disorders. Our patient had a medical history of a one-sided deafness treated with a hearing prosthesis. He was also followed irregularly by a free-lance psychiatrist. The start of trouble dated back to 3 years marked by behavioral disorders such as fugue, agitation, irritability and sleep disorder. The symptoms worsen in the last 3 months with appearance of hostility and delusion of persecution towards his mother. The patient declines to eat the food that his mother cooked for him and threatened her with a knife. The clinical overview includes delirium, clastic agitation strikes, emotional lability, cerebral ataxia and conjunctival hyperemia. Brain scanner showed an association of bilateral acoustic neuromas, cavernous and intraventricular meningioma. These clinical and radiological signs met the diagnosis for NF2 according to the consensus conference of the National Institute of Health in Bethesda (USA 1988).

Conclusions

The psychiatric symptoms reported in acoustic neuroma patients are usually described as transient.
Psychiatric disorders and somatic comorbidities
Authors: Kerkeni A. , Abbes W. , Mejdoub Y. , Hmida M. Ben , Yaich S. , Dammak J. , Ghanmi L.
Published: February 2022

Introduction

People followed at the department of psychiatry have a high prevalence of somatic pathologies that are generally not taken optimal care of in time, which implies excess mortality rate among these patients.

Objectives

To study somatic comorbidities in patients followed at the department of psychiatry of the regional hospital of Gabes (Tunisia).

Methods

We conducted a retrospective, descriptive and analytical study carried out on a clinical population who consult for the first time at the psychiatry department at the Gabes regional hospital during the period from January 1st, 2010 to December 31, 2013. Sociodemographic, clinical and therapeutic data of the patients were assessed. Data were analysed using the software SPSS (20th edition).

Results

The number of patients consulting for the first time at the psychiatry department during the study’s period was 1601 patients, with a mean age of 34 years and a sex ratio (M / F) of 0.96. Among these patients, 399 (24.9%) had somatic comorbidity. The most common somatic comorbidity was arterial hypertension (8.1% of patients, n=129 patients). Diabetes mellitus was ranked second with 99 patients (6.2%). The analytical study showed that depressive disorders were significantly more frequent in patients with hypertension (p<0.001), diabetes mellitus (p<0.001) and asthma (p=0.026).

Conclusions

Somatic comorbidities were frequent in patients followed by the department of psychiatry. Paying attention to somatic comorbidities must be part of the evaluation of these patients in order to coordinate effectively with the somatic doctors.
Options for the recovery of mental activity in children after acute brain damage
Authors: Sidneva Y. , Zakrepina A. , Bratkova M. , Valiullina S.
Published: February 2022

Introduction

Children with acute brain damage make up a large group of patients who require multi-stage rehabilitation. Rehabilitation requires the creation of special conditions for psychiatric care and psychological and pedagogical correction of the consequences of severe damage to the nervous system.

Objectives

To identify the options for mental activity during the restoration of the level of consciousness in children after acute severe brain damage.

Methods

210 children under the age of 18 with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus). Clinical-psychopathological, pedagogical methods were used; additionally diagnostic scales, questionnaires.

Results

4 groups were formed: 1st 37 (18%) patients had manifestations of mental activity with physical, cognitive and social capabilities in the minimal consciousness “+” (a- / hyperkinetic mutism with emotional reactions, understanding of addressed speech); 2nd 67 (32%) - manifestations of physical and cognitive abilities with minimal consciousness “-” (a- / hyperkinetic mutism without reactions); 3rd 95 (40%) - only the manifestation of physical capabilities at the exit from the vegetative status. 4th 11 (10%) - a low manifestation of mental activity in the form of physical capabilities with a vegetative status.

Conclusions

4 variants of mental activity in children after acute severe brain damage have been identified: from minimal involuntary reactions or their absence in vegetative status to voluntary actions according to the instructions of an adult in minimal consciousness “+”. Taking into account the variability of mental activity helps to differentiate the methods of psychiatric and psychological-pedagogical assistance in the recovery of children already in the early stages of rehabilitation.
Functional neurological disorders in childhood and adolescence: Epidemiology and phenomenology of an emerging diagnostic and clinical challenge
Authors: Baglioni V. , Cesario S. , Gigliotti F. , Galosi S. , Maggio C. Di , Ferrara M. , Leuzzi V. , Santo F. Di
Published: February 2022

Introduction

Literature on childhood Functional Neurological Disorders (FNDs) is spare. Clinical presentations are vaguely characterized and often misdiagnosed in younger ages. Their main neurological features enrol: Psychogenic non-epileptic seizures (PNES), Functional movement disorders (FMDs), sensory alterations, cephalgia and feeding problems.

Objectives

The study was aimed to better characterize the childhood population of FND, because of they represent an emerging challenge for clinicians, giving its higher presentation in the younger age and the difficulties of an early and differential diagnosis as well as an effective management.

Methods

Our study retrospectively examined the characteristics of 82 FNDs children and adolescents (8 to 16 y.o.; 13 males; 29 females) referred as neurological inpatients of an urban academic neuropsychiatric department, from 2014 to 2019. Three main clinical aspects were analysed: type and pattern of symptoms manifestations (DSM-5 criteria); Life Events; family functioning.

Results

FND accounted for 2% of 5-years consultations of neurological inpatients (M: F=1:2). The clinical presentation was characterized in 70% by pattern of co-expressed neurological symptoms: FMDs (9.5%); PNES (12%); dizziness/lipothymia (12%); paraesthesia/anaesthesia (16%). Generalized pain was associated in 38% of the reported patterns while cephalgia in 44%. Sleep disorders were reported in 40%. Previous psychiatric diagnoses were uncommon (2 out 82). Antecedent stressors were identified in 97% of patients for personal illness history and in the 93% for chronic illness in the family anamnesis. Family problems were in 25% of cases.

Conclusions

Our data contributes to better characterize the childhood population of FND, describing clinical patterns of presentation, highlighting putative antecedent stressors and risk factors
Alexithymia among patients with unexplained physical symptoms
Authors: Rady A. , Alamrawy R. , Ramadan I. , Elmissiry M.
Published: February 2022

Introduction

Some research suggests that mental health problems can be brought on by the stress of having unexplained symptom. In non-western cultures especially, psychological distress is often communicated through multiple somatic complaints. The biopsychosocial model takes into consideration all factors affecting health and disease, supporting the integration of biological, psychological and social factors in the assessment and treatment.

Objectives

In our study we assess prevalence of alexithymia as a potential psychopathological attribute manifesting as unexplained somatic symptoms

Methods

196 patients aged 18 to 60 with unexplained physical symptoms for at least three months, after collection of demographic data, medical and psychiatric history, were subject to Arabic version of the following scales : patient health questionnaire PHQ-15 to assess severity of somatic symptoms, patient health questionnaire PHQ-9 to assess depressive symptoms, generalized anaxiety disorder GAD-7 to assess general anxiety disorder symptoms and Toronto Alexithymia scale TAS to assess alexithymia

Results

90% of ours ample were female patients, 49,5% showed alexithymia, 27,6% were borderline alexithymic and 23% had no alexithymia. Patients with unexplained physical symptoms showed moderate to high depressive symptoms in 81,1% of the sample, moderate to severe anxiety symptoms in 73,5%. Severity of somatic symptoms as assessed by PHQ-15 were significantly highly correlated to scores for Alexithymia (TAS), depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) p<0,001

Conclusions

Alexithymia is prevalent among patients with unexplained physical symptoms. This later population has high prevalence of depressive and anxiety symptoms that go with the severity of somatic manifestations