bluuebunny/crossref_metadata_2025 huggingface dataset:
QT interval and corrected QT interval in patients with sepsis in correlation with sepsis outcome and electrolytes
Authors: Fahmy A M , Abdelfattah M M , Hashim R M , Aboali M M A
Published: May 2020

Background

sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Common signs and symptoms of sepsis include fever, increased heart rate, increased breathing rate, and confusion. In the very young, old, and people with a weakened immune system, there may be no specific symptoms.

Aim

to study QT dispersion, QT interval abnormalities and corrected QT interval in septic patients in correlation with arrhythmias, hospital outcome (survival, mortality) and electrolytes.

Patients and Methodology

this is a prospective randomized study that was conducted on forty adult patients who were admitted in the ICU at Ahmed Maher Teaching Hospital with the diagnosis of sepsis to correlate Corrected QT interval (QTc) and QT dispersion (QTD) with arrhythmias, need for mechanical ventilation (MV), electrolytes and hospital outcome.

Results

forty patients were included in this study, their ages with a mean of 53.50± 13.7 years. Male patients were 24(60%) and female patients were 16 (40%). The most frequent risk factor was hypertension (62.5%).

Conclusions

the QTc duration may act as a risk marker in the septic patient. Patients with markedly prolonged QTc interval had significantly more episodes of inhospital ventricular tachycardia and hospital mortality.

Recommendations

QTc may add a useful, simple and accessible tool to be used in risk stratification of septic patients. Factors that cause QTc prolongation could be an avoidable or correctable factors; lifethreatening arrhythmia could be prevented.
Role of MSCT in Diagnosis of Interstitial Lung Disease in Children
Authors: Ahmad K A , Hegazy L A , Nasr M A , Matar A A A
Published: May 2020

Introduction

Children interstitial lung dieses (CHILD) is a heterogeneous group of disorders that overlap with ILD seen in adults, some are primary lung disorders while others are associated with systemic disease processes.

Objectives

This review aims to role of MSCT in Diagnosis of Interstitial Lung Disease in Children.

Data Sources

Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2018.

Study Selection

This search presented 55 articles. The articles studied the Role of MSCT in Diagnosis of Interstitial Lung Disease in Children.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Data Synthesis

Comparisons were made by structured review with the results tabulated.

Conclusions

MSCT continues to be the preferred imaging study for the initial evaluation of suspected child.
Role of Tomosynthesis with correlation to 2D Mammography in characterization of breast lesions in dense breast
Authors: Elshibiny A M , Abdelrahman M E , Abdelrahman L M
Published: May 2020

Background

Digital Breast Tomosythesis is a new technology of digital mammography that enables the acquisition of three dimensional volume of thin section data, and thus reduces or eliminates tissue overlap especially in dense breast, such ability allow visualization of cancers not apparent by digital mammography and differentiate between benign and malignant lesion.

Objectives

to compare the efficacy of digital breast Tomosynthesis (BDT) to digital Mammography (DM) in diagnosis of different breast lesions in dense breast.

Patients and Method

in this prospective study 30 patients with breast density ACR/C and ACR/D were assessed by Digital Mammography and Digital Breast Tomsynthesis. Each lesion was assigned a blinded category in an individual performance for each modality. The resultant BI-RADS categories were correlated with report of the pathology specimens or outcome follow up.

Results

Both modalities were compared regarding characterization, using Chi Square test (p value:0.035).The sensitivity, specificity and accuracy of digital mammography was 62.5%, 68.75% and 66% have significantly increase with tomosynthesis to be 100%,91% and 97% respectively.

Conclusion

Digital breast tomosythesis significantly enhanced characterization of breast lesions than digital mammography in dense breast parenchyma (ACR/C and ACR/D).
Role of CT Entrography in evaluation of small bowel disorders
Authors: Elgaafary S M , Abdelghany A F , Ali W R , Salah M , Youssief H F
Published: May 2020

The small bowel has always been considered a difficult structure for evaluation, because of its extensive length, its position in the digestive tract, its tortuosity and over lapping loops Purpose of this work is to study elteht of CT Enterography in the assessment of different small bowel diseases. CT Enterography offers superior small bowel visualization compared to standard Abdomino-pelvic CT and provides complementary diagnostic information to capsule endoscopy and MR Enterography more over it can detect the extraluminal pathology

Purpose of this work is to study elt eht of CT Enterography in the assessment of different small bowel diseases.

Patients & methods

the study was performed over 43 patients. Complaining from abdominal pain, chronic diarrhea, loss of weight and recurrent vomiting .all patient had full clinical assessment and laboratory investigations. Results were compared to the upper and lower GIT endoscopies as well as laboratory and histopathology results.

Results

the most frequent finding were inflammatory bowel disease with95% sensitivity, neoplastic with sensitivity 92%, malabsorption 83.4% sensitivity and vascular diseases

Conclusion

CT Entrography is a safe well tolerated imaging technique that represents simple and effective method in assessment of different small bowel diseases as it is sensitive to early intestinal wall changes and evaluating the associated mesenteric and extra intestinal alterations as well
Surface modification of small intestine submucosa in tissue engineering
Authors: Zhao Pan , Li Xiang , Fang Qin , Wang Fanglin , Ao Qiang , Wang Xiaohong , Tian Xiaohong , Tong Hao , Bai Shuling , Fan Jun
Published: May 2020

With the development of tissue engineering, the required biomaterials need to have the ability to promote cell adhesion and proliferation in vitro and in vivo. Especially, surface modification of the scaffold material has a great influence on biocompatibility and functionality of materials. The small intestine submucosa (SIS) is an extracellular matrix isolated from the submucosal layer of porcine jejunum, which has good tissue mechanical properties and regenerative activity, and is suitable for cell adhesion, proliferation and differentiation. In recent years, SIS is widely used in different areas of tissue reconstruction, such as blood vessels, bone, cartilage, bladder and ureter, etc. This paper discusses the main methods for surface modification of SIS to improve and optimize the performance of SIS bioscaffolds, including functional group bonding, protein adsorption, mineral coating, topography and formatting modification and drug combination. In addition, the reasonable combination of these methods also offers great improvement on SIS surface modification. This article makes a shallow review of the surface modification of SIS and its application in tissue engineering.
Managerial Delegation, Law Enforcement, and Aggregate Productivity
Authors: Grobovšek Jan
Published: May 2020

I propose a novel general equilibrium framework to quantify the impact of law enforcement on the internal organization of firms and thereby on aggregate outcomes. The model features an agency problem between the firm and its middle managers. Imperfect law enforcement allows middle managers to divert revenue from firms, which reduces delegation and constrains firm size. I use French matched employer–employee data for evidence of the model’s pattern of managerial wages. Relative to the French benchmark economy, reducing law enforcement to its minimum value decreases GDP (equivalently, total factor productivity; TFP) by 23% and triples the self-employment rate. Consistent with the model, I document cross-country empirical evidence of a positive correlation between law enforcement indicators and the aggregate share of managerial workers. Mapped across the world, the model explains 3–6% of the ratio in GDP per worker between the poorest and richest quintile of countries, and 6–11% of their TFP ratio.
Asset Insulators
Authors: Chodorow-Reich Gabriel , Ghent Andra , Haddad Valentin
Published: May 2020

We construct a new data set tracking the daily value of life insurers’ assets at the security level. Outside of the 2008–2009 crisis, a ${\$}$ 1 drop in the market value of assets reduces an insurer’s market equity by ${\$}$ 0.10. During the ?nancial crisis, this pass-through rises to ${\$}$ 1. We explain this pattern by viewing insurance companies as asset insulators, institutions with stable, long-term liabilities that can ride out transitory dislocations in market prices. Illustrating the macroeconomic importance of insulation, insurers’ market equity declined by ${\$}$50 billion less than the duration-adjusted value of their securities during the crisis.
Jumping on the ‘bad’wagon? How group membership influences responses to the social exclusion of others
Authors: Lelieveld Gert-Jan , Harris Lasana T , van Dillen Lotte F
Published: May 2020

In four studies, we addressed whether group membership influences behavioral and neural responses to the social exclusion of others. Participants played a modified three-player Cyberball game (Studies 1–3) or a team-selection task (Study 4) in the absence or presence of a minimal group setting. In the absence of a minimal group, when one player excluded another player, participants actively included the excluded target. When the excluder was from the in-group and the excluded player from the out-group, participants were less likely to intervene (Studies 1–3) and also more often went along with the exclusion (Study 4). Functional magnetic resonance imaging results (Study 3) showed that greater exclusion in the minimal group setting concurred with increased activation in the dorsolateral pre-frontal cortex, a region associated with overriding cognitive conflict. Self-reports from Study 4 supported these results by showing that participants’ responses to the target’s exclusion were motivated by group membership as well as participants’ general aversion to exclude others. Together, the findings suggest that when people witness social exclusion, group membership triggers a motivational conflict between favoring the in-group and including the out-group target. This underscores the importance of group composition for understanding the dynamics of social exclusion.
T92. POSSIBLE COMBINATIONS OF DSM-IV AND DSM-5 CRITERIA IN SCHIZOPHRENIA AND SCHIZOAFFECTIVE DISORDER VERSUS MAJOR DEPRESSIVE AND MANIC EPISODES
Authors: Kontis Dimitrios , Theochari Eirini , Giannoulis Alexandros , Louki Fedra , Tsaltas Eleftheria
Published: May 2020

Background

Psychiatric disorders diagnoses are based on the satisfaction of specific symptoms criteria. Although this categorical method of classification, which is based on the identification of clinical syndromes, has proven useful in terms of treatment, its validity has been criticized. The possible symptoms combinations for major psychotic and mood disorder diagnoses could be calculated using combinatorial mathematics and the results could provide indices of diagnostic heterogeneity.

Methods

Our calculations were conducted using the binomial coefficient. In mathematics, this coefficient calculates the number of an unordered and unrepetitive selection of k items from a set S (a subset of k items from S) with the following formula: n!/k!(n-k)!. We calculated the possible number of combinations of symptoms required for diagnosing a) two major psychotic disorders (a1. Schizophrenia-SCZ and a2. schizoaffective disorder-SAD), and b) two major mood disorders-episodes (b1. Major Depressive Episode-MDE and b2. Manic Episode- ME), implementing the DSM-5 and DSM-IV diagnostic criteria. For each diagnosis, k corresponds to the number of the necessary symptoms, where S to the total number of symptoms described in the relevant criteria. The following calculations were conservative, since they did not take into account all the possible combinations within each criterion, the effect of specifiers or the effect of SCZ, or SAD subtypes.

Results

We found the following combinations: DSM-5: SCZ=25, SAD=12,225, MDE=163, ME=326. DSM-IV: SCZ=74, SAD=2,762,198, MDE=163, ME=163. According to DSM-IV (but not to DSM-5), Criterion A for Schizophrenia could coexist with a mixed mood episode in SAD. Interestingly, the possible symptoms combinations for a mixed episode was 37,001. The possible symptoms combinations for the diagnosis of schizophrenia has been slightly reduced in DSM-5 as compared with DSM-IV, but the reduction in the number of relevant combinations for the diagnosis of SAD has been impressive. This reduction was driven by the removal of mixed mood episodes in DSM-5. The possible combinations in SCZ, albeit not in SAD, were fewer than those required for the diagnosis of a MDE and a ME.

Discussion

The above results indicated that the diagnostic heterogeneity of psychotic disorders differed from that of mood disorders. SAD appeared to be the most heterogeneous disorder. DSM-5 criteria have limited the possible combinations of symptoms and have therefore improved the heterogeneity of SCZ and SAD, but not that of major mood disorders. The extent and the clinical implications of diagnostic heterogeneity in different psychotic and mood disorders remain to be elucidated by future research.
T104. PSYCHOTIC-LIKE EXPERIENCES AND PROBLEMATIC GAMING BEHAVIOR IN ONLINE GAME FORUMS
Authors: Santesteban-Echarri Olga , Goreis Andreas , Kafka Johanna X , Scharinger Christian , Addington Jean , Felnhofer Anna , Mossaheb Nilufar , Plener Paul L , Kothgassner Oswald D
Published: May 2020

Background

Psychotic-like experiences (PLE) are reported in the general population, characterizing a non-clinical psychosis phenotype. Although those who report PLE have a higher probability of transitioning to psychosis, PLE are usually a transitory state, and most individuals will not transition to psychosis. However, PLE samples may experience symptoms such as social withdrawal, social anxiety, or social anhedonia. These symptoms may lead individuals with PLE to choose online gaming as a preferred means of social interaction.

Objective

This study aims to examine the relation between PLE and problematic online gaming.

Methods

An online questionnaire was posted in online game forums, on online fan-pages with German-speaking domains and in social media groups. Data from adolescents and young adults (14 to 30 years old; 55.4% males) from Austria and Germany (N=280) was analyzed. Measures: PLE were assessed with the Early Recognition Inventory based on the Interview for the Retrospective Assessment of the Onset of Schizophrenia (ERIraos); problematic gaming behavior was assessed with the Compulsive Internet Use Scale (CIUS) adapted for online gaming; social anxiety was assessed with the Mini-Social Phobia Inventory (Mini-SPIN); preference for online social interactions was assessed with the Preference for Online Social Interaction scale (POSI). Analyses: Problematic gaming behavior was divided into two groups based on the suggested cut-off point of ≥18 on the CIUS (i.e., ≥18 gaming disorder vs. ˂18 no gaming disorder). Multivariable logistic regression analyses were performed and adjusted for sex, age, gaming hours, POSI, and social anxiety.

Results

A total of 63 individuals reached the cutoff for a gaming disorder, while 217 did not reach the cutoff. The majority of subjects in the gaming disorder group were males, young adults (19–24 years old, M=23.1, SD=3.7), single, or had less than high school diploma. Individuals who experienced an increased amount of PLE had a higher probability of reaching the cut-off for a gaming disorder (AOR=1.35 [95% CI 1.19–1.53]). Males were three times as likely as females to have a gaming disorder.

Discussion

Results implicate a close relation between the phenomena of PLE and continued problematic gaming behavior.
T108. CASE REPORT OF A PATIENT WITH CATATONIA
Authors: Li Sin Gwen , Balakrishnan Tharmmambal
Published: May 2020

Background

Catatonia is a condition defined by the presence of marked psychomotor features that typically include decreased motor activity, decreased engagement or excessive or peculiar motor activity. It is frequently associated with schizophrenia, but also presents in individuals with mood disorders or other neurological or medical conditions.

Methods

We present the case of a 40 year old single Chinese female with borderline intellectual disability who was working as a sales assistant.

She presented to medical services with poor oral intake and 8kg weight loss over two months. There was transient fever over a day with a maximum of 38.1 C. No other physical symptoms were elicited.

There was a significant change in behaviour, with gradual decline in oral intake and decreased speech. She became more socially withdrawn and neglected self care, as a result she was unable to continue at work two weeks prior to presentation. There was no reported decreased mood, tearfulness or suicidality. She briefly expressed on different occasions that she was ‘already dead’, ‘lost all her blood’ and thought that food was poisoned. There were no reported hallucinations.

Mental state examination revealed a thin Chinese female who was staring blankly into space. She did not establish or maintain eye contact, nor did she respond to verbal or physical stimulation. There was minimal speech. She did not appear depressed. There was no stereotypy, mannerisms, echolalia, echopraxia, waxy flexibility or negativism.

Physical examination was unremarkable. Neurological examination in particular was normal.

Results

Brain Magnetic Resonance Imaging was unremarkable. Electroencephalogram studies showed bitemporal electrophysiologic abnormalities. Lumbar puncture Results: showed raised protein levels of 1.15G/L. Other investigations were essentially normal.

Working diagnosis was presumptive viral encephalitis, with catatonia.

For the catatonia, she was treated with lorazepam up to 6mg per day and had gradual improvement in her oral intake, speech and behaviour. She revealed later that she was stressed at work. She did not fulfil criteria for Major Depressive Disorder or Schizophrenia. She was discharged after six weeks of her initial presentation to medical services.

Discussion

Catatonia can be the main presenting symptom following psychosocial stress.
T118. A CROSS-SECTIONAL STUDY ON OUTCOMES OF INDIVIDUALS WITH FIRST HOSPITALIZATION AND PSYCHOSIS SPECTRUM DISORDER DIAGNOSIS
Authors: Fiori Nastro Federico , Pelle Martina , Di Michele Flavia , Talamo Alessandra , Niolu Cinzia , Siracusano Alberto
Published: May 2020

Background

Acute psychosis is one of the most frequent causes of hospital admission. One of the major challenges is how to manage with negative symptoms. Clinical efficacy of treatment of patients at their first hospitalization has been evaluated in several studies.

We carried out a cross sectional study focusing on the different outcomes considering the clinical relevance of positive and negative symptoms.

Methods

We analyzed all the admissions and discharges of patients at their first psychiatric hospitalization after psychosis onset (diagnosed with ICD-9 criteria) in our inpatient psychiatric acute unit of Policlinico Tor Vergata, (located in a suburb of Rome) considering the period of time between January 2017 and September 2019. We characterized all patients according to age, ethnicity, socioeconomic status, substance use/abuse, violent behaviours, voluntary or compulsory treatment, length of hospitalization and use of long acting injection (LAI). We included 73 patients (out of 626 admissions, 12%) with a diagnosis of spectrum psychosis disorder at first hospitalization.

We used items 10–11 and 16–17 from the Brief Psychiatric Rating Scale (BPRS) to obtain two groups of patients with different clinical features. Based on the score of these items, patients were divided into two groups: group One characterized by prevalent positive symptomatology and group Two characterized by negative symptoms. Then, we compared clinical outcomes through BPRS, days of Hospital stay and Clinical Global Impression at the end of the hospitalization.

Results

In our study we found out that patients with BPRS prevalent negative symptoms had longer hospital stays (mean 17.29 days); patients with BPRS positive prevalent symptoms had a mean stay of 15 days. Group Two patients used LAI treatment less frequently (37% of the times) compared to group One, which was treated with LAI 63% of the cases. At discharge, group Two had still higher scores in the Global Improvement Scale compared to group One.

Discussion

Our study confirms that the use of antipsychotic therapy does not improve negative symptoms. Moreover, psychosis characterized by negative symptoms has a worse outcomes. Furthermore, considering their first hospitalization, it is interesting to note that our participants’ mean age was 37.98 years old, much higher than the one reported in literature. Since our Hospital is located in a very peripheral area of Rome, where social disadvantage represents a critical issue, we hypothesized different reasons to explain this data such as lower level of education, marginalization and socioeconomic adversity that might increase difficulties to access to health care services. In conclusion, further studies are needed to find more useful and alternative treatments and to deepen relationship between sociodemographic context and the time of their first psychiatric assessment.
T153. THE ECONOMIC BURDEN OF MENTAL DISORDERS: A SYSTEMATIC REVIEW
Authors: Christensen Maria , Lim Carmen , Saha Sukanta , Cannon Danielle , Presley Finley , Iburg Kim , McGrath John
Published: May 2020

Background

About a third of the world’s population will develop a mental disorder over their lifetime. Having a mental disorder is a huge burden in health loss and cost for the individual, but also for society because of treatment cost, production loss and caregivers’ cost. The objective of this study is to synthesize the international published literature on the economic burden of mental disorders.

Methods

Systematic literature searches were conducted in the databases PubMed, Embase, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to 1980 until May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder (3) samples based on the general population; (4) outcome in monetary units.

13,640 publications were screened by their title/abstract and 439 articles were full-text screened by two independent reviewers. 113 articles were included from the systematic searches and 31 articles from snowball searching, giving a total of 144 included articles. Of these, 41 studies had estimates of the economic burden among people with schizophrenia.

Results

Information about diagnosis, diagnostic criteria, sample size, age, sex, data sources, study perspective, study period, costing approach, cost categories, discount rate and production loss method and cost unit was extracted. The preliminary results show a substantial variety in the used perspective, methodology, costs components and outcomes in the included studies.

An online tool is under development enabling the reader to explore the published information on costs by type of mental disorder, subgroups, country, methodology, and study quality.

Discussion

To the best of our knowledge, this is the first systematic review synthesizing the economic cost of mental disorders worldwide. The paper will provide an important and comprehensive overview over the economic burden of mental disorders, and the output from this review will inform policy-making.
T167. QUALITATIVE DIFFERENCES IN LONG ACTING INJECTABLE ANTIPSYCHOTIC MEDICATIONS AMONG SCHIZOPHRENIA PATIENTS
Authors: Karakasi Valeria , Pavlidis Pavlos , Vlachaki Aikaterini
Published: May 2020

Background

The purpose of this presentation is to investigate qualitative differences associated with treatment of Schizophrenia spectrum disorder patients with long acting injectable (LAI) antipsychotics, including adverse effects and efficacy.

Methods

Literature around LAI antipsychotics and their comparative data was reviewed and evaluated via all electronic databases up to December 2018.

Results

Metabolic, hepatic and cardiovascular complications in olanzapine treatment have been the major concern in most studies, despite the effectiveness of the medication, as coronary heart disease is strongly associated with a decrease in the life expectancy of schizophrenia patients (coupled with higher levels of smoking and malnutrition). Treatment with risperidone was associated with a worsening of depressive affect and suicidal ideation (except prolactin-related and extrapyramidal adverse effects), as well as sexual dysfunction. Hyperprolactinemia, extrapyramidal / neurological symptoms, and sexual dysfunction were the major problems with haloperidol treatment despite a good efficacy profile with respect to positive symptoms of schizophrenia. Sporadic effectiveness, agitation and, to a lesser extent, weight gain were some of the concerns in palimperidone treatment. Aripiprazole treatment was associated with a comparatively milder and in the long term more preferable adverse effect profile, while exhibiting similarly high levels of efficacy with olanzapine in controlling schizophrenia symptoms, but with a reported relatively higher rate in treatment discontinuation (drop-outs) in comparison to olanzapine and haloperidol in case of schizophrenia (in contrast to schizoaffective disorder in which high levels of both compliance and effectiveness are exhibited).

Discussion

The need for an individualized approach in psychiatric treatment highlighted so that the needs of each patient be taken into account by the therapist in choosing the optimal treatment within a given time frame.
T204. CLOZAPINE COMBINATION AND AUGMENTATION STRATEGIES IN PATIENTS WITH SCHIZOPHRENIA –RECOMMENDATIONS FROM AN INTERNATIONAL EXPERT SURVEY AMONG THE TREATMENT RESPONSE AND RESISTANCE IN PSYCHOSIS (TRRIP) WORKING GROUP
Authors: Wagner Elias , Kane John , Correll Christoph , Howes Oliver , Siskind Dan , Honer William G , Lee Jimmy , Falkai Peter , Schneider-Axmann Thomas , Hasan Alkomiet ,   TRRIP Network
Published: May 2020

Background

Evidence for the management of inadequate clinical response to clozapine in treatment-resistant schizophrenia is sparse. Accordingly, an international initiative aimed to develop consensus recommendations for treatment strategies for clozapine-refractory patients with schizophrenia.

Methods

We conducted an online survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group. An agreement threshold of ≥75% (responses “agree”+“strongly agree”) was set to define a first-round consensus. Questions achieving agreement or disagreement proportions of >50% in the first round, were re-presented to develop second-round final consensus recommendations.

Results

From a total of 61 TRRIP members 44 (first round) and 49 (second round) participated in the consensus-process. Expert recommendations included raising clozapine plasma levels to ≥350 ng/mL for refractory positive, negative and mixed symptoms. In case of ineffective plasma level-guided dose escalation waiting for a delayed response was recommended for persistent positive symptoms. For ongoing clozapine-refractory positive symptoms, combination with a second antipsychotic, (amisulpride and oral aripiprazole) and augmentation with ECT achieved consensus. For clozapine-refractory negative symptoms, waiting for a delayed response was recommended, and as an intervention, clozapine augmentation with an antidepressant reached consensus. For clozapine-refractory suicidality, augmentation with antidepressants or mood-stabilisers, and ECT met consensus criteria. For aggression, augmentation with a mood-stabiliser or combination with antipsychotic medication achieved consensus. Generally, cognitive-behavioural therapy (CBT) and psychosocial interventions reached consensus.

Discussion

This consensus-based series of recommendations provides a framework for decision-making to manage the challenging clinical situation of CRS, where the evidence from randomised-controlled trials remains sparse.
T213. TREND OF LONG-ACTING INJECTABLE ANTIPSYCHOTICS USE IN ASIA: FINDINGS FROM REAP ANTIPSYCHOTIC STUDIES
Authors: Lin Shih-Ku , Chung An-Nie
Published: May 2020

Background

Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia since 2001. At present, four studies on antipsychotics in schizophrenia, two antidepressants, one bipolar disorder and one mood disorder were completed. Previous studies have examined the use of Long-acting Injectable (LAI) antipsychotic in patients with schizophrenia and revealed major differences across countries. The aim of the study is to investigate the prescription trend of LAI antipsychotic use in four REAP schizophrenia surveys.

Methods

We analyzed the results from four times of REAP studies (AP1 to AP4, 2001, 2004, 2009 and 2016), to compare the trend of LAI prescriptions rates in China, Hong Kong, Japan, Korea, Singapore, and Taiwan, and also the rate of LAI use among 15 Asian countries in AP4.

Results

A total of 10505 patients were analyzed, with an average rate of 14.6% of patients received LAI antipsychotic treatment. For comparison of AP1 to AP4, there was a wide variation in the rate of LAI use among the six countries, with the highest prescription rate in Singapore (68.1%) and the lowest in Korea (1.6 %). Korean patients received no LAIs treatment in the first two surveys, and the rates in China and Japan were also very low. While in Hong Kong and Singapore, the rates were much higher. In AP4 survey, India, Malaysia, Thailand, Pakistan and Sri Lanka have a higher rate of LAI use, while in Indonesia, Myanmar, the rate is much lower. Vietnam does not use LAI at all. The prescription trend was also diverse, which increased in Korea and Japan and decreased in China, Hong Kong and Singapore. The overall prescription trend of LAI was in decrease. Besides, when analyzing cases with only using second generation antipsychotics, the usage of LAI was increased.

Discussion

Previous studies identified several factors associated with prescription of LAI, including demographic and clinical characteristics of patients, patients’ and physicians’ attitude towards LAI, availability of LAI, insurance coverage and related cultural factors. The prescription trend of first generation LAI was decreased in most of the six countries; on the other hand, second generation LAI usages maintain steady level and even slightly increased. In conclusion, LAI antipsychotic is still underuse in Asia, especially in some countries such as Korea, China, Japan, Indonesia and Myanmar. Various factors that influenced the prescription rate of LAI antipsychotic should be addressed further.
M94. NO EVIDENCE OF ASSOCIATIONS BETWEEN GENETIC LIABILITY FOR SCHIZOPHRENIA RISK OF CANNABIS USE DISORDER
Authors: Hjorthøj Carsten , Jamal Uddin Md , Wimberley Theresa , Dalsgaard Søren , Hougaard David , Børglum Anders , Werge Thomas , Nordentoft Merete
Published: May 2020

Background

Cannabis use and cannabis use disorder (CUD) is increased in patients with schizophrenia. It is important to establish if this is explained by non-causal factors, such as shared genetic vulnerability. We aimed to investigate whether the polygenic risk scores (PRS) for schizophrenia and other psychiatric disorders would predict CUD in controls, patients with schizophrenia, and patients with other psychiatric disorders.

Methods

We linked nationwide Danish registers and genetic information obtained from dried neonatal bloodspots in an observational analysis. We included people with schizophrenia, other psychiatric disorders, and controls. The exposures of interest were the polygenic risk scores for schizophrenia, ADHD autism spectrum disorder, and anorexia nervosa. The main outcome of interest was diagnosis of cannabis use disorder.

Results

The study included 88,637 individuals. PRS for schizophrenia did not predict CUD in controls (hazard ratio (HR)=1.16, 95% CI 0.95–1.43 per standard-deviation increase in PRS, or HR=1.47, 95% CI 0.72–3.00 comparing highest versus remaining decile), but PRS for ADHD did (HR=1.27, 95% CI 1.08–1.50 per standard-deviation increase, or HR=2.02, 95% CI 1.27–3.22 for the highest decile of PRS). . Among cases with schizophrenia, the PRS for schizophrenia was associated with CUD. While CUD was a strong predictor of schizophrenia (HR=4.91 (95% CI 4.36–5.53)), the inclusion of various PRS did not appreciably alter this association.

Discussion

The PRS for schizophrenia was not associated with CUD in controls or patients with other psychiatric disorders than schizophrenia. This speaks against the hypothesis that shared genetic vulnerability would explain the association between cannabis and schizophrenia.
M99. INVESTIGATING THE BEST PREDICTIVE CLINICAL FEATURES OF ANTI-N-METHYL-D-ASPARTATE RECEPTOR (NMDAR) ENCEPHALITIS IN THE 2010 AUSTRALIAN NATIONAL SURVEY OF HIGH IMPACT PSYCHOSIS (SHIP) COHORT
Authors: Rossell Susan , Meyer Denny , Shannon Weickert Cyndi , Phillipou Andrea , Galletly Cherrie , Morgan Vera , Harvey Carol , Tooney Paul , Castle David J
Published: May 2020

Background

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, a recently reported autoimmune disorder, can be mistakenly diagnosed as a psychotic disorder, especially schizophrenia, as patients can present with prominent psychotic symptoms, in particular persecutory ideation, hallucinations and disturbed speech. In this study we used machine learning of the clinical data in a large cohort of persons with a positive psychosis history to ascertain whether we could predict NMDAR-positive cases, and which variables most accurately distinguished between NMDAR-positive and -negative cases.

Methods

SHIP collected nationally representative data from 1825 individuals with a psychotic illness. Plasma samples were available for n=472. To investigate the prevalence of NMDAR autoantibodies a recombinant indirect immunofluorescence test was performed (EuroImmun AG, Lübeck, Germany), with NMDAR transfected human embryonic kidney (HEK) 293 cells quantified using NIS Elements software. NMDAR-positive cases were estimated. Gradient boosting machine learning (the data were randomly split: 60% for initial ascertainment and 40% for validation) was subsequently performed using the clinical data available: 120 variables in total across various domains of sociodemographic, medical history, psychiatric diagnosis and current psychiatric symptoms. Only the variables found to have significant (or near significant) association with being NMDAR-positive were used to develop rules for identifying cases.

Results

There were 38 NMDAR-positive cases. They were more likely to be associated with a schizophrenia /schizoaffective and a depressive psychosis diagnosis, and less likely to be associated with a bipolar diagnosis, than antibody-negative cases. They were also more likely to be associated with a single episode with good recovery, and with anxiety symptoms and dizziness in the prior 12 months (which included light headedness, feeling faint and unsteady). For the present state symptoms, restricted affect was more likely to be present whereas poverty of speech was rare. Initial insomnia and a medical history that included epilepsy were not present for any of the NMDAR-positive cases. The machine learning algorithm was able to successfully classify 94% of cases to the correct antibody group.

Discussion

In this significant Australian epidemiological cohort, we have identified key clinical features associated with anti-NMDAR encephalitis, including diagnosis, and symptoms and clinical course. The novel and insightful analyses afforded by using machine learning should be replicated in other samples to confirm the important clinical findings reported in the current work.
M146. NEUROCHEMICAL MODULATION OF AUDITORY CORTEX FUNCTIONAL CONNECTIVITY IN PATIENTS WITH AUDITORY VERBAL HALLUCINATIONS
Authors: Weber Sarah , Hjelmervik Helene , Craven Alexander R , Johnsen Erik , Kroken Rune , Løberg Else-Marie , Ersland Lars , Kompus Kristiina , Hugdahl Kenneth
Published: May 2020

Background

Auditory hallucinations have been linked to aberrant functioning of the left superior temporal gyrus (STG) and are associated with impaired cognitive control regulated by areas in the prefrontal cortex. However, the mechanisms behind these dysfunctions are still unclear.

Methods

The current study combined resting state connectivity fMRI with MR spectroscopy (MRS) in a sample of 81 psychosis patients to explore how neurochemical correlates of auditory hallucinations modulate left STG functioning. The analyses were focused on glutamate (Glu) and gamma-aminobutyric acid (GABA), two neurotransmitters with excitatory and inhibitory functions, respectively, since these have previously been implicated in psychosis.

Results

Glu and GABA showed differential relationships with left STG connectivity in patients with and without hallucinations. Specifically, Glu concentration in the anterior cingulate cortex (ACC) was positively related to functional connectivity between the left and right temporal lobe in hallucinating patients only. In contrast, GABA concentration in the ACC was negatively related to connectivity between the left and right temporal lobe in non-hallucinating patients only.

Discussion

These findings support a recently proposed model of interhemispheric temporal lobe miscommunication in auditory hallucinations and indicate prefrontal neurochemical modulation as a potential underlying mechanism. The results can further be integrated with previously suggested excitatory/inhibitory imbalances as neurochemical modulators in AVH.
M180. SUSCEPTIBILITY AND RESILIENCE IN A MOUSE MODEL OF MATERNAL IMMUNE ACTIVATION
Authors: Müller Flavia , Scarborough Joseph , Richetto Juliet , Schalbetter Sina , Weber-Stadlbauer Ulrike , Meyer Urs
Published: May 2020

Background

Epidemiological studies over the past decades have repeatedly implicated maternal immune activation (MIA) in the etiology of psychiatric illnesses, including schizophrenia and related psychotic disorders. Not all offspring exposed to MIA, however, develop overt pathologies, suggesting that some are susceptible while others are resilient to MIA. To elucidate susceptibility and resilience in MIA, we used a mouse model that is based on prenatal exposure to the viral mimic poly(I:C).

Methods

Poly(I:C)-based MIA was induced in C57BL6/N mice on gestation day 12. Control dams received vehicle solution only. Offspring of poly(I:C)- or vehicle-exposed dams were subjected to a comprehensive behavioral testing battery when they reached adulthood (12 weeks of age onwards). Next-generation mRNA sequencing and gene pathway analyses were conducted after behavioral testing to explore the molecular correlates of resilience and susceptibility to MIA.

Results

Behavioral characterization coupled with unbiased TwoStep cluster analysis of a large number offspring (N >150) revealed that offspring exposed to MIA could be stratified into susceptible and resilient subgroups. While the former was characterized by deficits in social interaction, sensorimotor gating, and working memory, the behavioral profile of the latter was indistinguishable from control offspring. Susceptible and resilient MIA offspring were also dissociable by the presence of distinct molecular profiles in cortical and subcortical brain areas. In the medial prefrontal cortex, susceptible MIA offspring displayed a more profound deregulation of genes relevant for oxidative phosphorylation and mitochondrial functions than resilient MIA offspring. In the amygdala, the susceptible and resilient offspring differed in gene transcription pertinent to opioid signaling, DARPP-32 signaling, and G protein-coupled receptor signaling.

Discussion

Our data show that MIA can result in substantial phenotypic and transcriptomic variability even in the context of genetic homogeneity and under identical experimental conditions. If extended further, our model system may help to explain why only a subgroup of offspring exposed to MIA develops overt neurodevelopmental sequelae.
M185. THE EFFECTS OF GROUP ARTS THERAPY BASED ON EMOTION MANAGEMENT TRAINING ON THE EMOTIONAL EXPRESSION, ALEXITHYMIA, DEPRESSION AND QUALITY OF LIFE IN PATIENTS WITH SCHIZOPHRENIA
Authors: Lim Eunsung , Park Sung-Yong , Jang Seung-Ho , Bahk Won-Myong , Kwon Young-Joon , Yoon Bo-Hyun , Lee Kwanghun , Lee Sang-Yeol
Published: May 2020

Background

The objective of this study was to investigate the effects of group arts therapy based on emotion management training on emotional expression, positive emotion and negative emotion, alexithymia, depression and quality of life in patients with schizophrenia.

Methods

24 of 160 in-patients with schizophrenia, according to DSM-IV from H Mental Health Hospital, were randomly assigned to either an experimental or control group. Each group were consisting of 12 patients. Group arts therapy was conducted on the experimental group twice a week, 60 minutes per session, for a total of 16 sessions, while the control group was left untreated. The following scales were used for assessment: Berkeley Expressivity Questionnaire (BEQ), Positive Affective and Negative Affect Schedule (PANAS), Toronto Alexithymia Scale-Korean vesion (TAS-20K), Depression Scale for Schizophrenia (K-CDSS), Positive and Negative Syndrome Scale (PANSS), and Schizophrenia Quality of Life Scale (SQLS-R4K). Independent t-test was conducted to confirm the homogeneity, and to find the effects of group arts therapy, Repeated measures ANOVA was conducted to confirm the differences for scores of each scales regarding groups, measuring timing, and also the interaction between groups and measuring timing by pre, post and follow-up test.

Results

The result of this study are as follows.

First, total score, expressivity factors and impulse strength factors of emotional expressivity were significantly increased after group arts therapy compared to the control group.

Second, positive emotion was significantly increased and negative emotion was significantly decreased after group integrative therapy compared to the control group.

Third, total score, difficulty identifying feelings of Alexithymia were significantly decreased after group arts therapy compared to the control group.

Fourth, depression was significantly decreased after group integrative arts therapy compared to the control group.

Fifth, negative syndromes and general psychopathology were significantly decreased after group arts therapy compared to the control group.

Sixth, quality of life was significantly increased after group arts therapy compared to the control group.

Discussion

The group arts therapy have significantly improved the emotional expression, positive emotion, negative emotion and Alexithymia in patients with schizophrenia and also improved negative syndromes, general psychopathology, depression and quality of life. These result suggest that group arts therapy based on emotion management training could be a useful intervention for emotional disturbance treatment for in patients with schizophrenia.
M196. CLINICAL CORRELATES OF SUBJECTIVE QUALITY OF LIFE IN ADULT PATIENTS WITH EARLY PSYCHOSIS IN HONG KONG
Authors: Tze Kwan Kam Candice , Chun Lau Fu , Ting Liu Tsz , Sau Man Wong Corine , Ming Hui Lai , Wa Chan Kit , Ming Lee Ho , Nam Suen Yi , Chen Eric , Chung Chang Wing
Published: May 2020

Background

Subjective quality of life (SQoL) is an important outcome domain in patients with early psychosis. In an attempt to better understand and maximize SQoL of early psychosis patients, an increasing number of research has been conducted to investigate factors associated with SQoL. Nonetheless, most previous studies focused on younger patients with early psychosis. In this study, the correlates of SQoL in adult patients who had completed 3-year specialized early intervention service for first-episode psychosis (FEP) in Hong Kong were investigated.

Methods

In total, one hundred and one Chinese patients aged 26–55 years who completed 3-year specialized early intervention service for psychosis in Hong Kong were recruited. Assessments on illness onset (DUP), clinical (PANSS, BNSS, SUMD), intrinsic motivation (by items in Quality of Life Scale, QLS), functional (SOFAS), antipsychotic-induced parkinsonism features (Simpson-Angus Scale, SAS) were conducted. SQoL was evaluated by Chinese version SF-12 which consist of physical and mental components for analysis.

Results

Correlation analyses showed that SF12 physical health score was correlated with PANSS depression component (p<0.001), QLS intrinsic motivation score (p=0.001) and SAS score (p<0.05) while SF12 mental health score was correlated with PANSS depression score (p<0.001), QLS intrinsic motivation score (p<0.05) and SAS score (p<0.05). Multiple linear regression analyses further revealed that lower PANSS depression score (p<0.001) and higher intrinsic motivation (measured by QLS, p<0.05) were independently associated with better physical SQoL, while lower PANSS depression score (p<0.001) and lower SAS side-effect score (p<0.05) were independently related to better mental SQoL.

Discussion

Our results are consistent with the literature which indicates that SQoL is significantly related to depressive symptoms. In addition, patients with higher intrinsic motivation and less antipsychotic-induced extrapyramidal side-effect have better SQoL. Further analysis on the longitudinal data will clarify variables predictive of SQoL at follow-up.
S129. REHOSPITALIZATION RATE IN PEOPLE WITH FIRST-EPISODE PSYCHOSIS IN THE CZECH REPUBLIC: A REGISTER-BASED STUDY
Authors: Kondrátová Lucie , Mladá Karolína
Published: May 2020

Background

Rehospitalization in a year after the first discharge for psychotic disorder is routinely considered as a principal health care outcome. However, there is a lack of data about the rehospitalization rate of people with first-episode psychosis in Central and Eastern Europe where the psychiatric care is predominantly based on inpatient care.

Methods

Data from nationwide register of inpatient hospitalizations were analysed. A retrospective analysis of first-ever admitted patients with psychosis (F2 according to ICD-10) in 2014 and younger than 60 years of age was conducted. Descriptive statistics aiming to identify the rehospitalization rate were performed.

Results

1 963 patients with psychosis who were first admitted to psychiatric hospitalization in 2014 and discharged between 2014 and 2016 were identified. Of those, 480 (24,5 %) were readmitted in the first year after the first discharge. 101 (21,0%) of those were readmitted within 14 days, 144 (30,0%) within a month and 241 (50,2%) within a 3-month period after the first discharge. An average time between the first discharge and readmission was 124 days, the mean age of those readmitted was 33 years at the time of first admission.

Discussion

This register-based study confirms the existence of the revolving door phenomenon in people with first-episode psychosis in the Czech Republic. Each rehospitalization is a burden not only for a patient, as each hospitalization significantly worsens the overall prognosis, but for the whole psychiatric care system as well. Considering the rehospitalization rate in people with first-episode psychosis, more attention should be paid to the development of services which have a potential to lower the risk of rehospitalization such as early detection and early intervention services.