bluuebunny/crossref_metadata_2025 huggingface dataset:
Positive and Negative Syndrome Scale (PANSS) predictors of hospitalization during home treatment on 1045 patients with schizophrenia in acute crisis
Authors: Talisa R. , Sabaté A. , Córcoles D. , Leon J. , Malagón A. , González A. M. , Bellsolà M. , Samos P. , Jerónimo M. Á. , Martín L. M. , Pérez V.
Published: August 2023

Introduction

Several factors related to the risk of requiring psychiatric hospitalization have been described in patients diagnosed with schizophrenia treated with methods other than home treatment. With regard to the symptoms, high global illness severity and positive symptoms of schizophrenia have been most frequently related to the risk of hospitalization in patients with schizophrenia. However, there are no studies describing which clinical factors increase the likelihood of being hospitalized while undergoing home follow-up.

Objectives

To determine which of the clinical factors assessed in the PANSS predict the risk of hospitalization in patients diagnosed with schizophrenia following a home treatment program.

Methods

All patients with schizophrenia who were visited by a home treatment team in Barcelona between January 2017 and December 2021 were included in the study. A comparative, bivariate analysis of each item of the PANSS and of the global results of each category was conducted on those who were hospitalized and those who were not hospitalized. Finally, a logistic regression of each category of the PANSS was done on both groups, controlling for other socio-demographic and clinical factors.

Results

A total of 1045 patients with schizophrenia were evaluated in this study. PANSS positive symptom subscale (PANSS-S), PANSS General Psychopathology, PANSS Excited Component and PANSS Global Score scored higher in patients who were finally hospitalized in a conventional acute treatment unit. Regarding the PANSS negative symptom subscale, no significant differences were found between the two groups.

In patients who required hospitalization, the scores of all the PANSS positive symptom subscale (PANSS-P) items and all items on the PANSS excited component (excitement, tension, hostility, uncooperativeness and poor impulse control) were significantly higher. Some items regarding general psychopathology (Somatic concern, anxiety, guilt feelings, tension, and mannerisms) were also significantly higher in the hospitalization group. Only 3 items—blunted affect, guilt feelings and motor retardation—scored significantly higher in patients who did not require hospitalization. In the logistic regression, only the global score of the PANSS-P reached statistical significance (P = 0.001).

Conclusions

Positive symptoms scored in the PANSS seem to be the most predictive factors of hospitalization regarding clinical symptoms in patients with Schizophrenia following home treatment. Other items regarding exciting symptoms and general psychopathology also showed as relevant regarding the risk of conventional hospitalization in those patients.

Disclosure of Interest

None Declared
Common beliefs about sexuality: a Tunisian survey among pregnant women
Authors: Zouari A. , Guermazi F. , Amamou B. , Hentati S. , Feki I. , Baati I. , Gaha L. , Masmoudi J.
Published: August 2023

Introduction

Sexual relationship is affected by the emotional factors, changes in women’s body, sexual dysfunctionsand also common beliefs about sex in pregnancy. Couples might tend to avoid sexual intercourse in pregnancy due to different beliefs.

Objectives

Our objective was the evaluation of sexual related and common beliefs among pregnant womens.

Methods

We conducted a cross-sectional and descriptive study. We targeted Tunisian pregnant women whatever the term of pregnancy. We collected data using a self-questionnaire performed with Google Forms and posted regularly on social networks over a period of six months. In order to assess the most common beliefs, we used a panel of questions inspired by the literature.

Results

34 pregnant women participated to the study. Mean age was 31,56 years (SD =3,25). All the participants had a secondry or university education (5.9% and 94.1% respectively). Ninteen women (55.9%) were multiparous with 44% in the third trimester.

Among participants, 20.6% believe that sexual intercourse can be harmful to the baby, 41.2% believe that the number of intercourse should be limited during pregnancy and 17.6% thought that sexual intercourse should be stopped in the first three months.

In relation to body image, 11.8% of women approve that pregnancy takes women’s all beauty and 8.8% thought that their bodies weren’t attractives as before for spouses. About a quarter of our population (23.5%) agreed that pregnant women lose sexual desires and 14.7% approved that intercourse satisfies only men. Only one women (2.9%) reported that intercourse during pregnancy is considered a sin.

Conclusions

We have identified through this study different beliefs about sexuality during pregnancy, sometimes aberrant and which can affect the sexuality of couples. Attention of health professionals should be attracted to this issue and sexuality should definitely be integrated into prenatal care and counselling.

Disclosure of Interest

None Declared
Women during the war - stress, resilience and self-efficacy during the Russian-Ukrainian war (May 2022) among women from Ukraine, Poland, Slovakia and Romania
Authors: Piotrowski A. , Boe O. , Sygit-Kowalkowska E. , Petrovska I. , Predoiu A. , Predoiu R. , Görner K. , Rawat S. , Makarowski R.
Published: August 2023

Introduction

The sudden and large-scale Russian invasion of Ukraine has caused significant stress not only in Ukrainians but also in citizens of countries which have received the largest numbers of refugees.

Objectives

The aim of the current study was to identify stress, resilience, and self-efficacy levels, as well as to examine the relationships between these variables, in a sample of women from Ukraine, Poland, Slovakia, and Romania during the third month of Russian aggression on Ukraine.

Methods

The study involved measuring a sample of Ukrainian (N = 82), Polish (N = 102), Slovak (N = 79), and Romanian (N = 42) women using the Perception of Stress Questionnaire, the Brief Resilience Scale, and the Generalized Self-Efficacy Scale in May 2022.

Results

The results showed that during the third month of Russian aggression on Ukraine, stress levels and its components (emotional tension, external stress, and intrapsychic stress) were the highest among Ukrainian women and the lowest among Polish women. The sense of self-efficacy was the lowest among Ukrainian women and highest among Polish women, while resilience was the lowest among Ukrainian women and the highest among Slovak women.

Conclusions

Women from Ukraine reported being in the worst mental state compared to the rest of the sample. Moreover, a path analysis of the measured variables points to a multifaceted relationship between stress, resilience, and self-efficacy among women from Ukraine, Poland, Slovakia, and Romania during the third month of the Russian invasion.

Disclosure of Interest

None Declared
Neurobiology and neuroimaging of the maternal brain
Authors: Sutter-Dallay A.-L.
Published: August 2023

Introduction

The epidemiology of psychiatric disorders of the perinatal period and their mainly thymic dimension are now well established. However, the underlying physiopathology remains uncertain and poorly explored.

Objectives

The purpose of this presentation is to explore the current knowledge in terms of neurobiology/neuroimaging underlying the modifications in maternal brain functioning and the links with perinatal psychiatric disorders.

Methods

A narrative review of the current international literature was carried out.

Results

Results of the current studies suggest that during pregnancy and the postpartum period, hormones and sensory interactions with the offspring relate to complex structural and functional changes in the brain. This reproduction-related brain plasticity embraces various areas implicated in maternal caregiving, primarily regions involved in reward/motivation, salience/threat detection, emotional regulation, and social cognition such as the ability to empathize and infer the mental state of the baby. Some structural irregularities and differences in activation patterns potentially involved in the triggering of disorders are starting to be identified.

Conclusions

The survival of newborns is largely dependent on the mother, and her brain appears to have evolved to support mother-infant bonding and sensitive care. Brain research offers a growing scientific understanding of the neural correlates of these disorders and opens a window to their prevention and treatment.

Disclosure of Interest

None Declared
Impact of psychiatric disorders on pregnancy and its management. A French retrospective cohort study
Authors: Briaud E. , Doolub D. , Guinot S. , Deparis J. , Jaafari N.
Published: August 2023

Introduction

Every pregnancy and birth is unique, and despite this, few studies exist on the condition of pregnant women with mental disorders.

Objectives

This study analyzes the impact of prevalent mental disorders in pregnant women to determine which clinical or socio-demographic characteristics significantly impact pregnancy.

Methods

This retrospective and naturalistic cohort study is based on the medical records of 99 patients managed in a university hospital. All patients had an ICD-10 mental disorder (psychiatric and/or substance use disorders) diagnosed before pregnancy.

Results

Only 24.2% of the pregnant women had no adverse outcomes throughout pregnancy, labor, and delivery. The remaining mothers had violence issues, and mothers with psychotrauma were likelier to have stillborn babies. Pregnant women with mental disorders were less keen to screen for Down’s syndrome and more likely to have artificial delivery in case of comorbid drug addiction and alcohol use disorder (AUD). Anonymous birth and placement of newborns were related to substance abuse and pre-pregnancy AUD comorbidities or AUD alone before pregnancy. Besides, four clinical characteristics were found to be predictive of adverse pregnancy outcomes: young maternal age (β
=-1,15,p<.03), late-term first contact with the maternity hospital (β=0.08,
p<.02), advanced term of delivery (β=4.01,
p<.03), and a history of psychiatric disorders associated with an AUD but without smoking before pregnancy (β
=-1,07,p<.03). Despite all, pregnant women had a relatively sustained follow-up of their pregnancies.

Conclusions

Mental disorders have a negative impact on pregnancy. More studies should be promoted to raise the attention of professionals to manage and improve women’s pregnancy and motherhood with psychiatric conditions.

Disclosure of Interest

None Declared
ADHD Dimension, Childhood trauma and Perceived Stress: an observational study on peripartum women affected by mood and anxiety disorders
Authors: Bilotta I. , Anibaldi G. , Stampatore L. , Concolato C. , Medugno M. , Fattorini A. , Cutillo L. , Bernardi S. , Culicchia G. , Bassi de Toni A. , Del Casale A. , Pompili M. , Angeletti G.
Published: August 2023

Introduction

Pregnancy is an important life event, involving body and mind transformation as well as brain reorganization. ADHD dimension is an additional aggravating factor, albeit poorly studied in the literature, in patients with mental health disorders in the peripartum.

Objectives

The purpose of this study was to evaluate the correlation among ADHD dimension, trauma in childhood, and anxiety-depressive symptomatology to assess whether the ADHD dimension may affect the quality of life of peripartum patients, and to identify vulnerability factors and self-harm
risk.

Methods

The sample included 74 women aged 21-46 years, recruited from Sant’Andrea Hospital in Rome between 2015 and 2019. All recruited women were administered the following scales: Adult ADHD Self Report Scale (ASRS), Edinburgh Postnatal Depression Scale (EPDS); Childhood Trauma Questionnaire (CTQ), Perceived Stress Scale (PSS); Minnesota Multiphasic Personality Inventory (MMPI). Statistical analysis was performed by Pearson’s correlation with SPSS software to verify the presence of linear relationships (p<0.05) among theADHD dimension, assessed by the ASRS scale, and the other psychopathological dimensions.

Results

The sample was divided into two groups depending on the results of ASRS: 26 patients were positive for at least one of the ASRS scale items, while 48 patients were negative. The groups did not statistically differ in socio-demographic variables examined. The medium score at EPDS was 15,11 (± 8,43). It was found that the severity of ADHD dimension directly correlated with the duration of mental symptoms in peripartum (r=0.324;p=0.013), with the total CTQ scale score (r=0.342; p=0.004), with emotional abuse detected by CTQ (r=0.415; p<0.001), with emotional neglect detected by CTQ (r=0.291; p=0.014) and with perceived stress detected by PSS scale (r=0.456; p<0.001). Furthermore, we identified a correlation between self-injurious ideation and ADHD symptomatology (r=0.269; p =0.049) evaluating the item 10 of EPDS.

Conclusions

The severity of ADHD traits directly correlates with the symptomatology and duration of mental disorder in peripartum. Specifically, ADHD patients who develop anxious-depressive symptoms are more likely to have experienced emotional abuse and emotional neglect in childhood.

Disclosure of Interest

None Declared
Neuropsychiatric effects of Synthetic Cathinones - a review
Authors: Mendes Coelho J. , Bicho M. , Peixoto C. , Fontes H.
Published: August 2023

Introduction

The emergence of new psychoactive substances (NPS) has had a substantial impact worldwide. NPS mimic the effect of “existing” drugs and are specifically manufactured so that the new substances fall out of regulatory frameworks. Although the structural changes might be minimal, NPS often have marked differences in potency and subsequent harm.

The population of the Azores archipelago has been particularly affected by the rapid growing and changing nature of this phenomenon, mainly caused by the introduction and spread of the “newly” synthetic cathinones as a inexpensive and easily available street drug.

Before any educational, public health and socioeconomic policy changes be proposed to accurately tackle the problem, the basic step of knowing how these substances have been affecting their users, specially their neuropsychiatric effects, must be taken.

Objectives

This project aims to characterize the neuropsychiatric side effects caused by the acute intoxication of NPS with a psychostimulant profile, namely synthetic cathinones.

Methods

Description of the neuropsychiatric symptoms of intoxicated users of stimulant NPS that present to non-governmental organizations specialized in addictions and also to the psychiatry emergency department in Sao Miguel - Azores.

Review of the forensic records of the deaths by suicide in 2021 in Sao Miguel, looking for evidence of recent abuse of NPS or previous history of “NPS use disorder”.

Non-systematic review of the recent and relevant scientific literature on this topic.

Results

The desired effects are increased energy, mood enhancement, euphoria, mental clarity, improved concentration, improved sociability, increased talkativeness, empathy inducing effects, amplification of sound and colour and prosexual effects. Nevertheless, in the case of intoxication, the frequent neuropsychiatric side effects tend to be agitation, agressiveness, irritability, altered consciousness, brief psychosis with paranoid delusion, visual and auditive hallucinations, transient mania, enhanced sensorial experiences, headaches, dizzyness, seizures, confusion and amnesia. Usually, the acjute intoxication period tend to be followed by a “crash” with depression, craving, anxiety, panic, suicidal ideation and behaviours. A third of the deaths by suicides in Sao Miguel Island in 2021, 7 out of 21, were in stimulant NPS active or recent users.

Conclusions

Review of the neuropsychiatric effects of New Psychoactive Substances with a psychostimulant profile. Further studies of this population of synthetic cathinone users in the Azores are due, namely studying their socioeconomic background, looking for risk and protective factors, and also the long-term side effects.

Disclosure of Interest

None Declared
Post-migration trajectories and psychopathological vulnerability
Authors: Tarricone I. , Tarricone Ilaria , D’Andrea Giuseppe , Jongsma Hannah E , Tosato Sarah , Gayer-Anderson Charlotte , Stilo Simona A. , Suprani Federico , Iyegbe Conrad , van der Ven Els , Quattrone Diego , di Forti Marta , Velthorst Eva , Menezes Paulo Rossi , Arango Celso , Parel Mara
Published: August 2023

Abstract: Background

Psychosis rates are higher among some migrant groups. We hypothesized that psychosis in migrants is associated with cumulative social disadvantage during different phases of migration.

Methods

We used data from the EUropean Network of National Schizophrenia Networks studying Gene-Environment Interactions (EU-GEI) case-control study. We defined a set of 3 indicators of social disadvantage for each phase: pre-migration, migration, and post-migration.

Results

249 cases and 219 controls were assessed. Pre-migration (OR 1.61, 95%CI 1.06-2.44, p=0.027) and postmigration social disadvantages (OR 1.89, 95%CI 1.02-3.51, p=0.044), along with expectations/achievements mismatch (OR 1.14, 95%CI 1.03-1.26, p=0.014) were all significantly associated with psychosis. We found a dose-response effect between number of adversities across all phases and odds of psychosis (≥6: OR 14.09, 95%CI 2.06-96-47, p=0.007).

Conclusions

The cumulative effect of social disadvantages before, during and after migration was associated with increased odds of psychosis in migrants, independently of ethnicity or length of stay in the country of arrival. Public health initiatives that address the social disadvantages that many migrants face during the whole migration process and post-migration psychological support may be reduce the excess of psychosis in migrants.

Disclosure of Interest

None Declared
Tobacco and alcohol use in Tunisian young doctors: a way to evade occupational stressors
Authors: Ghrab M. A. , Sellami I. , Abbes A. , Hajjaji M. , Jmal Hammami K. , Masmoudi M. L.
Published: August 2023

Introduction

The medical field is very stressful. To reduce stress, healthcare workers may resort to different habits, including smoking and drinking.

Objectives

We aimed to assess the smoking and drinking habits of interns and fellows in Tunisian hospitals.

Methods

A cross-sectional study was conducted in April 2022 through online platforms. A pre-established questionnaire was sent to Tunisian medical interns and fellows, working in public hospitals, and collected sociodemographic and occupational data. The Fagerstörm test was used to evaluate nicotine dependence.

Results

Our population consisted of 182 Tunisian interns and fellows. Their mean age was 26.38±2.03 years. Females represented 71.4% of the total population. One hundred of them (54.95%) were fellows, out of which 18% specialized in surgery. Sixty-one per cent of these young doctors were single. Twenty-two individuals were smokers with male predominance (59.1%). Smoking was associated with age (p<0.001) and female sex (p=0.001). Fagerstörm test score’s mean was 4.09±2.52. High to very high nicotine dependency was found in 31.8% of cases. Thirty-five interns and fellows consumed alcohol and 51.4% of them were females. Alcohol use was associated with sex (p<0.001).

Conclusions

Despite knowing their hazard, young doctors still resort to drinking and smoking as a coping mechanism. The promotion of healthier coping mechanisms is essential.

Disclosure of Interest

None Declared
Assessment of self-esteem among Tunisian cannabis users
Authors: Kacem M. , Bouali W. , Henia M. , Brahim S. , Zarrouk L.
Published: August 2023

Introduction

Self-esteem plays a role in the adaptive functioning of the human being. It could be a protective factor regarding multiple risks particularly substance use.

Objectives

The aim of this study is to assess self-esteem among a group of young Tunisian users of cannabis.

Methods

The total study sample was composed of 137 participants, who took part of a transversal descriptive study during two months (January and February 2020). These partakers were comprehensively recruited among Emergency patients of Mahdia Hospital. Thereupon, the main criteria for the selection of these patients was their consumption of cannabis, regardless of their primary health care seeking reason or purpose.

The research was carried out upon their declaration of cannabis consumption and their compliance to be part of such a study. Thus, Data were collected on a pre-determined data sheet that included various information (age, sex, lifestyle, personal and family psychiatric history, age at which they started their cannabis consumption and the rate of cannabis use …).

Accordingly, Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). Consequently, the interview took place after the subject’s verbal and informed consent and the assurance of anonymity and confidentiality of the interview content.

Results

In our study population, the cannabis consumers were young adults aged between 18 and 35 years old, with a male predominance of 71%. Among those users, 65.9% were single and 29.7% dropped out of school or experienced academic failure. On a socio-economic level, we concluded to a rate of 5.8% (lower class), 60.9% (middle class) and 33.3% (upper class).

Besides, 40.8% were employed. In total, 23.2% had a psychiatric history. Furthermore, the use of other substances was also prominent and frequent as follows: alcohol 72.5%, tobacco 74.6%, ecstasy 41.3% and 25.4% cocaine. The use of cannabis was considered as a means of indulgence and pleasure for 66.7%, as an anxiolytic for 26.8% and as a sedative for 23.9%.

Self-esteem, among those cannabis users, was very low in 20% of cases, low in 38% of cases, medium in 15% of cases and high in 25% of cases. Consequently, more than half of the study population remains below the medium average according to RSES.

Conclusions

These results lead us to question the relation between cannabis and self-esteem. The question that is evolved about the use of cannabis is the following: Is it used as a remedy or is it the cause of self-esteem deficiency?

Disclosure of Interest

None Declared
Are antidepressants addictive? a literature review
Authors: Turki M. , Elleuch O. , Sahnoun F. , Mhiri H. E. , Guermazi A. , Ellouze S. , Halouani N. , Aloulou J.
Published: August 2023

Introduction

Nowadays, the rates of antidepressant prescription are high and increasing. In this context, the issue of whether these medications are addictive has been increasingly discussed.

Objectives

The aim of this review was to explore the debate about the addictive property of antidepressants.

Methods

We conducted a literature review in the Pubmed database, using the search terms “antidepressants”, “SSRI”, “tricyclic”, “addiction”, “dependence” in various combinations, and narrowing the search to the last 10 years, to identify articles about the addiction to antidepressants.

Results

All the articles included in our study highlighted the fact that antidepressants were associated with withdrawal symptoms. These symptoms are heterogeneous, and long-lasting in some cases, and Paroxetine was shown to have particularly high rates of withdrawal symptoms.

Some articles reported a psychological and physical dependence on antidepressants. However, the most recent studies agreed that, using established classification systems and concepts and after integrating neurobiological and behavioral criteria, antidepressants are shown to have no addictive property.

Conclusions

Antidepressants are proven to be associated with withdrawal symptoms. Whether or not these symptoms are enough to constitute an “addiction” remains controversial, as recent studies agree that antidepressants should not be classified as addictive substances.

Disclosure of Interest

None Declared
Gluten and anxiety: a difficult balance in people with celiac disease
Authors: Robea M. A. , Ciobica A. , Stanciu C. , Trifan A.
Published: August 2023

Introduction

Celiac disease (CD), triggered by gluten ingestion, occurs in people genetically predisposed to develop this chronic autoimmune condition. The triggering environmental factor, gluten, is known as a protein present in wheat, rye and barley. In recent decades, specialists have found more knowledge about the disease mechanisms, how it develops and other disturbances which accompany it. The CD was considered a pediatric main gastrointestinal disorder, associated with symptoms of abdominal pain, diarrhea, constipation and bloating, and characterized by damage to the villi of the small intestine. People with CD may experience anemia, fatigue, osteopenia or osteoporosis, bone fracture, neurological and psychiatric problems beside anxiety as depression, ataxia, neuropathy. However, the results of several studies conducted on the fact that people with CD have an increased level of anxiety are mixed.

Objectives

The present work is highlighting the importance of observing the anxiety levels in people diagnosed with CD beside the suitable interventions in reducing it.

Methods

For our study scientific databases were screened using certain keywords and combinations of it as: ”celiac disease”, ”gluten”, ”gastrointestinal disorder”, ”treatment”, ”neurological problems”, ”anxiety”. Inclusion criteria were studies that (1) investigated anxiety levels in CD people, (2) reported gender results, (3) were written in English, and (4) were published within the last 20 years.

Results

In some cases, as main intervention in CD, gluten removal from the people’s diet usually reported improvements of the present symptoms. In addition, data from literature are describing a higher level of anxiety in females compared to males diagnosed with CD. This can be a consequence of females concerns about how they can manage the CD issues and, especially, what this is bringing in their lifestyle. On the opposite, there are reports which showed that demographic parameters (gender, age, education) are not associated with CD presence.

Conclusions

The balance between CD and anxiety needs to be more investigated in order to identify and fully understand what is the background mechanism and how this can be regulated through specific interventions.

Disclosure of Interest

M. Robea Grant / Research support from: ,Platformă multidisciplinară de cercetare-dezvoltare medicală în regiunea N-E,,, acronim: CENEMED, cod mySMIS: 127606, proiect cofinanțat prin Programul Operațional Competitivitate, Axa Prioritară: Cercetare, Dezvoltare tehnologică și Inovare (CDI)., A. Ciobica: None Declared, C. Stanciu: None Declared, A. Trifan: None Declared
The Relationship between Systolic Blood Pressure with Anxiety and Depression in Family Caregiver of Hemodialysis Patients at Soehadi Prijonegoro Regional Public Hospital: A Cross-Sectional Study
Authors: Osman A. Z. , Susanti E. A. P. , Estiko R. I. , Widyadhana A. D.
Published: August 2023

Introduction

The global toll of chronic kidney disease (CKD) is significantly rising and unevenly distributed. In Indonesia, CKD is primarily managed by hemodialysis (HD) because limited resources rule out the possibility of renal transplantation. HD patients are commonly accompanied by caregivers but most studies show neglected the physical and mental health of caregivers.

Objectives

This work aims to know the relationship between anxiety and depression with systolic blood pressure (SBP) in HD caregivers at Soehadi Prijonegoro Regional Public Hospital.

Methods

A cross-sectional study design was conducted to assess the population. This research took place in Soehadi Prijonegoro Regional Public Hospital Sragen Indonesia, at the Hemodialysis department in November 2022, with 31 participants. We assessed their SBP using a sphygmomanometer, and then we interviewed the caregivers using Hamilton Depression Rating Scale (HAM-D or HDRS) and Hamilton Anxiety Rating Scale (HAM-A).

Results

We found that 38,8% of caregivers have hypertension with SBP above 140 mmHg. Around 93.5% and 6.5% of caregivers were found to be mild and mild-moderate anxious. Also, 22.6% were found to have mild depression, while the rest showed the normal result. There is a relationship between SBP and anxiety (p=0.037), while depression is not (p=0.302). However, there is a strong relationship between anxiety and depression (p<0.05), with a correlation coefficient of 0.69.

Conclusions

One-third of the caregivers were found to have hypertension, which is significantly related to anxiety. Furthermore, depression could occur in a patient with anxiety. Thus, caregivers need to maintain their physical and mental health.

Disclosure of Interest

None Declared
Somatoform disorders in out-patient psychiatric setting: An overview
Authors: Yaseen Y. A.
Published: August 2023

Introduction

The somatoform disorders are a group of psychiatric disorders that present with unexplained physical symptoms.

Objectives

This study aimed at assessing the prevalence and risk factors of somatoform disorders (SD) and their types among patients attending a major psychiatric clinic in Duhok Governorate/Kurdistan Region of Iraq. Our secondary aim was to assess the common presenting symptoms of conversion disorder (CD).

Methods

637 subjects were randomly selected from the outpatient psychiatric clinic at Azadi Teaching Hospital in Duhok Governorate/Kurdistan Region of Iraq. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (Version 2.0) was applied to diagnose patients with SDs.

Results

In our sample the prevalence of SD was 24%. CD comprised the vast majority of SD at 75.8%, followed by somatization disorder at 7.8% and undifferentiated SD at 5.2%. SD was most common (60.1%) in adolescents and young adults (ages 15-25 y.o.); (p <0.05), and female gender comprised most of the SD in our sample (75.8%; p <0.001)

Although, more than two-third of the cases were from lower educational levels (illiterate and primary educational level) (67.3%), more than fifty percent were married (52.3%), majority were housewives (39.2%) and more than half of the cases were from urban areas (52.3%), but no significant association were found between SD and educational level, marital status, occupation, and residence (p-values were 0.218, 0.659, 0.072, 0.090 respectively). Regarding the symptomatic presentation of CD, vast majority of the cases presented with pseudo-seizures which comprised (81%), followed by motor symptoms which comprised (17.2%), and sensory symptoms which constituted (1.7%) only.

Conclusions

SD was highly prevalent among patients attending a major outpatient psychiatric clinic in Duhok Governorate/Kurdistan Region of Iraq, and CD was the most common presenting form of SD. Younger age (adolescents and young adults) and female gender comprised the majority of cases. Interestingly, the most common presenting symptom of CD in our sample was pseudo-seizures.

Disclosure of Interest

None Declared
New-Onset Bipolar Disorder in Late Life: a case report and review of literature
Authors: Sanz Giancola A. , Arroyo Sánchez E. , Setién Preciados P. , Martín Velasco M. , Romero Gerechter I. , Díaz Mayoral C.
Published: August 2023

Introduction

The elderly represents the fastest growing group of the population. It is fair to assume that the portion of old age patients suffering from bipolar disorder will grow in a similar manner. Elderly patients represent approximately 25% of the bipolar population. Summarizing, 5–10% of patients were 50 years of age when they experienced their first manic episode, constituting the subgroup of late onset bipolar disorder (LOBD).

Objectives

The purpose of this case report and literature review is to emphasise the importance of LOBD in old population and to highlight its still sparse-knowledge.

Methods

Descriptive case study and review of literature (Arnold,I. et al. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021,57,587; Baldessarini et al. Onset-age of bipolar disorders at six international sites. J Affect Disord 2010;121(1-2):143-6).

Results

A 60-year-old woman is brought to the emergency department for evaluation by her family. Over the past 7 days, the patient has become increasingly irritable and argumentative, is sleeping less, is talking faster than usual and has begun to express paranoid concerns about her students “stealing my exam”. The patient is a university professor.

In the assessment interview she is hyperverbal, expansive, and grandiose. The family has also just recently discovered that she has spent a large sum of money on the Internet.

She has no history of psychiatric contact or substance use disorders; however, she has a family history of severe depression.

In the absence of any plausible non-psychiatric condition that could mimic or induce mania, the working diagnosis is bipolar I disorder, most recent episode (MRE) manic with psychotic features.

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Conclusions

The share of older age bipolar disorder will grow constantly in the next decades and further research on this neglected patient group is urgently required.

Disclosure of Interest

None Declared
Course of bipolar disorder in patients with Childhood maltreatment
Authors: Mellouli A. , Masmoudi R. , Guermazi F. , Cherif F. , Feki I. , Sellami R. , Masmoudi J.
Published: August 2023

Introduction

Patients with mood disorders have the greater frequency of childhood trauma compared with the general population, and adverse childhood experiences can exert a negative impact on their clinical course. Therefore, many studies confirmed the relationship between childhood traumas and the disadvantageous features of the illness course.

Objectives

The aim of this study was to determine the impact of negative childhood experiences on the clinical course of bipolar disorder.

Methods

It was a cross-sectional descriptive and analytical study involving patients diagnosed with bipolar disorder and followed in the psychiatric department at the University Hospital of Sfax (Tunisia).Personal information form and Childhood trauma questionnaire (CTQ) were used for data acquisition. Euthymia was defined as a score on the Montgomery-Åsberg Depression Rating Scale (MADRS) not higher than 14 and by a score on the Young Mania Rating Scale (YMRS) not higher than seven.

Results

We included 35 patients. Their mean age was 46.69 ± 12.01 years with a sex ratio (M/F)=0.45.

The average onset of bipolar disorder was 28.37±10.26 years and the average disease duration was 18.26 ± 11.55 years.

Almost the third of our population had a suicidal attempt (31.42%) and a violence history (28.57%). A family history of bipolar disorder was found in 57.14% of the patients.

The patients have been hospitalized at least once in 42.85% of cases.

Our patients have presented psychotic symptoms in 51.42% of cases and mixed characteristics in 57.14% of cases.

Emotional, physical and sexual abuse were reported by 42.85%, 37.14% , 31,42% of patients, respectively, while 74,28% and 42.85% of patients reported physical neglect and emotional neglect.

Early age at illness onset was significantly associated with total CTQ score (p=0.014) and the subtype sexual abuse (p=0.009). The presence of psychotic symptomswas significantly associated with total CTQ score (p=0.003) and emotional neglect (p=0.025). Physical neglect was associated with mixed characteristics (p=0.015). Emotional abuse was associated with a greater number of hospitalisations (p=0.023).

Conclusions

Our results suggest that childhood trauma is associated with a more severe course of bipolar illness. Clinical assessment of patients with bipolar disorder should include investigation of exposure to childhood trauma in order to determine appropriate therapeutic strategies.

Disclosure of Interest

None Declared
Case report: Improvement of chronic mania after Steven-Johnson syndrome
Authors: Pardo González C. , Tellez Gomez A. , Sanjuán Ortiz C. , Ribes Cuenca J. , Beltrán Cristancho D. M. , Ribes Jordán G.
Published: August 2023

Introduction

Stevens-Johnson Syndrome is a rare life-threatening condition characterized by severe mucocutaneous epidermal necrolysis and detachment of the epidermis. The condition centers around a delayed-type hypersensitivity reaction with a complex etiology stemming from a variety of causes.

Objectives

To present the case of a patient with a diagnosis of intellectual disability, bipolar disorder and epilepsy who, 14 days after starting treatment with Cariprazine, presented with pseudovesicular skin lesions suggestive of Steven-Johnson syndrome.

Methods

A non-systematic literature review on PubMed database on Steven-Johnson syndrome and other autoimmune processes in patients with bipolar disorder, and the impact on the affective symptoms of the former, was conducted. The clinical case report was prepared through the review of clinical records of the patient.

Results

The authors present the case of a 50-year-old woman, undergoing psychiatric follow-up for more than 30 years with a diagnosis of bipolar disorder. She has a moderate intellectual disability and generalized epilepsy diagnosed at the age of 13. Since the age of 20, the patient has presented clinical manifestations compatible with bipolar disorder.

On a dermatological level, the patient had medical records of hypersensitivity reaction to amoxicillin-clavulanic acid, intolerance to carbamazepine; and toxicoderma and hepatitis after treatment with Lamotrigine, compatible with DRESS syndrome.

At the time of the study, psychopharmacological treatment consisted in valproic acid, lithium and cariprazine (the latter being introduced 14 days earlier). Pseudovesicular and papular skin lesions were observed, with a dianiform appearance and central necrosis.

Prior to the debut of the dermatological condition, the patient showed a decompensation of her bipolar disorder, with escalating irritability, soliloquies, verbosity and hostility towards her parents, with episodes of psychomotor agitation.

After the appearance of the skin lesions, a striking clinical change was observed, with an almost complete remission of affective symptoms, temporally coincident with DRESS syndrome and cariprazine withdrawal.

Conclusions

In recent years, research on autoimmune diseases and their relationship with mental disorders, such as bipolar disorder, schizophrenia and depression, has become increasingly abundant. The conclusions point to the fact that both disorders could be interrelated even at an etiopathogenic level. In this case report, we discuss a patient with a diagnosis of bipolar disorder with an important component of autoimmune response to different drugs, which seems to have influenced the clinical course of the mental illness.

Disclosure of Interest

None Declared
Resting-state Fronto-limbic Connectivity in Unipolar Depressive Patients as a Predictor for Sporadic Conversion to (Hypo)mania
Authors: Tajioui I. , van Neerven T. , van Tol M. J. , Bas-Hoogendam J. M. , Veltman D. , van der Wee N. , de Leeuw M.
Published: August 2023

Introduction

Patients with a bipolar disorder (BD) may experience one or several episodes of major depression before transitioning into a manic phase. Given that treatment with common antidepressants may exacerbate symptoms of mania in patients with BD, initial diagnosis of major depressive disorder (MDD) is a significant issue affecting BD patients. Currently, a family history of BD is used as an early identifier for BD, but as genetic factors associated with BD confer susceptibility to a wide range of psychiatric illnesses, this approach lacks specificity. Thus, there is a pressing need for a biomarker which specifically predicts development of bipolar symptoms in patients with MDD, rather than a trait vulnerability to psychiatric disorder

Objectives

The aim of this study is to assess alterations in fronto-limbic function that exist prior to the manifestation of the first manic episode in BD patients without familial predisposition for BD.

Methods

To identify a biomarker for conversion to BD we performed a study in a naturalistic sample of MDD patients without a familial risk for BD, which were followed for 9 years. We used a seed-based functional connectivity analysis to assess differences in resting-state fronto-limbic connectivity between MDD patients who converted to BD during the follow-up period (n = 11), and non-converting MDD patients (n = 56).

Results

Clusters of significantly reduced functional connectivity were found in the fronto-limbic network of prospective converters relative to non-converters.

Conclusions

Findings suggest that alterations of fronto-limbic functional connectivity during episodes of depression predate and associate with conversion to BD later in life, in the absence of familial risk. These fronto-limbic functional connectivity disturbances may be of interest for diagnosing early-stage BD, and may offer insight in the mechanisms that drive conversion in the absence of familial predisposition. Findings from this study need to be verified through large-scale longitudinal imaging studies in naturalistic cohorts of MDD patients.

Disclosure of Interest

None Declared
Bipolar Disorder and Borderline Personality Disorder: A Diagnostic Challenge
Authors: Lopes L. M. , Matias M. , Marques M. , Lopes I. M. , Reis J.
Published: August 2023

Introduction

Bipolar disorder (BD) and borderline personality disorder (BPD) appear as prevalent psychiatric conditions, with both being associated with increased morbidity and elevated suicide rates.

Borderline personality disorder is characterized by emotional instability and impulsivity, and patients are susceptible to dangerous behaviors such as unsafe sexual behavior, eating disorders and substance abuse. On the other hand, mania in BD patients contributes to impulsivity, hypersexuality and poor judgment, as well as a lack of inhibition. In both cases, individuals are at a higher risk of committing suicide due to emotional dysregulation and impulsive behaviours.

The symptomatic overlap in BPD and BD is prone to discussion and may lead to misdiagnosis. Some studies suggest that BPD and BD may lie on a spectrum, while others advocate them as separate entities that may coexist.

Objectives

To explore the clinical challenges associated with both the differential diagnosis and the comorbidity of BD and BPD.

Methods

We performed a non-systematic review of the literature using the database PubMed and the following keywords: bipolar disorder borderline personality disorder comorbidity

Results

Patients with borderline personality disorder seem to have significantly greater odds of a previous bipolar misdiagnosis, but no specific borderline criterion was shown unique in predicting this outcome.

Nonetheless, research studies have reported that approximately 20% of BPD were also diagnosed with BD and, similarly, 10% of people with BD I and 20% with BD II were diagnosed with BPD.

Comorbid BPD and BD are associated with marked psychosocial disability, with patients being more impulsive and aggressive than those with BPD and BD alone. They are also highly susceptible to anxiety disorders like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and somatoform disorders. Studies have shown that comorbid BPD has a negative impact on the clinical course of Bipolar Disorder, as the patients have an unfavorable illness trajectory, with earlier onset of mood symptoms,higher likelihood of hospitalization, longer treatment duration and worse response to treatment. They are also at higher risk for depression and persistent unemployment, increased risk drug abuse, higher suicide risk, and greater utilization of ECT, compared to patients with BPD or BD alone.

Conclusions

A careful review of the patient’s history must be done to properly distinguish between BPD and BD and to make the right diagnosis. Further studies are needed to clarify the risk factors associated with the comorbidity between these two disorders, in order to develop effective clinical strategies for optimal outcomes for patients with both disorders, improve their clinical course and prevent the increased risk of suicidality.

Disclosure of Interest

None Declared
Bipolar disorder type II - will the new classification help in setting an adequate diagnosis
Authors: Vuk Pisk S. , Ivezic E. , Senjug Mance L. , Matic K. , Svetinovic D. , Grosic V. , Filipcic I.
Published: August 2023

Introduction

Bipolar affective disorder type II is often misunderstood, neglected and rarely receives the attention it deserves and often remains undiagnosed. Despite its neglect and insufficient diagnosis, it is an important diagnostic entity because it causes significant suffering and functional impairment, a chronic course of the disease and a high suicide rate. Cognitive impairments and multiple comorbidities that significantly affect the course and outcome of the disease are common.

Objectives

The purpose of this research was to determine the extent of the deficiency in diagnosing bipolar affective disorder type II in daily clinical work.

Methods

A total of 82 adult psychiatric inpatients diagnosed with affective disorders (depressive disorders and bipolar affective disorders) and borderline disorders participated in this study. They completed HCL-32, MDQ and PHQ-9 questionairres. The average age of the sample is 43.9 years. A total of 76.8% were women in the sample.

Results

72.8% of respondents achieved a score above 14 on the HCL-32 questionnaire and thus met the criteria for possible hypomania. All three criteria for mania on the MDQ questionnaire were satisfied by 27.5% of respondents. 68% of respondents have moderate or severe symptoms of depression according to PHQ-9.

Conclusions

The results confirmed our assumption about the lack of recognition and diagnosis of bipolar affective disorder type II. Only 5 respondents (6.1%) were diagnosed with BAP II upon arrival. After the research, 73% of them met the criteria for diagnosing BAP II. As a correctly established diagnosis affects the selection of adequate therapy, we have tried to emphasize the importance of correct recognition of BAP II.

Disclosure of Interest

None Declared
Trichotillomania with trichobezoar in 11-year-old girl - difficulties of recognizing the disorder and possible complications: case report
Authors: Klobučar A. , Dobrić L. T. , Drmić S. , Mišak Z.
Published: August 2023

Introduction

Trichobezoar is a rare entity that primarily occurs as a complication of psychiatric disorders, most often in adolescent and young females suffering from trichotillomania (TTM) and trichophagia. In many cases, children with TTM unwillingly admit hair pulling, deny ingesting hair and often feel ashamed of their disease and try to hide it.

Objectives

Our main aim was to present an uncommon complication of TTM and trichophagia and to point out the importance of early diagnosis and prevention of complications of the disorder. Furthermore, we describe the role of a child’s psychological features and family dynamics in etiopathogenesis of TTM, as well as comorbidities and specific clinical presentation.

Methods

Case report.

Results

An 11-year-old girl was admitted to the pediatric department due to abdominal pain. After detailed pediatric differential diagnosis, trichobezoar was diagnosed and she was treated surgically. While she did not deny ingesting her hair, three months after surgery (TTM was dermatologically verified from the beginning of the treatment) she mentioned focused hair pulling for the first time. During individual cognitive behavioral psychotherapy the following was recognized in the patient: perfectionism traits, inhibition in expressing emotions, elements of depression, anxiety. During family psychotherapy elements of alexithymia were observed.

Conclusions

Cooperation among medical experts (pediatrician, dermatologist, child psychiatrist, pediatric surgeon etc.) and awareness of this disorder is important for recognizing it at an early stage and starting the treatment, especially considering habit-forming mechanism, psychiatric comorbidity, emotional distress and preventing other complications including trichobezoars.

Keywords

adolescents, trichobezoar, trichophagia, trichotillomania

Disclosure of Interest

None Declared