bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of long-acting treatments in adult social care. Experience of an Acute Inpatient Mental Health Unit
Authors: Rodríguez Gómez-Carreño C. , Sarrió Yuste A.
Published: August 2024

Introduction

In recents years, the number of social exclusion patients who go to the emergency room for psychiatric evaluation, has increased significantly. This fact may be due to the circumstances associated with migration: economic problems, house searching, moving away from the family origin,… These situations can cause stress before, during and after adaptation, which is a risk factor for presenting psychotic symptoms.

Objectives

The objective of this study is present another alternative treatment for adults with social exclusion with psychotic symptoms or Psychotic Disorder. Presenting through a case of Acute Inpatient Mental Health Unit.

Methods

A 25 year old men was referred to the emergency deparment due to an episode of agitation. As relevant psychiatric history, a previous admission to psychiatry’s hospitalitation with a diagnosis of Schizophrenia. Upon discharge, the patient has not been followed up in Mental Health, although he has gone to the emergency room on several ocassions where ir is reflected that no psychotic decompensation has been observed. He emigrated to Spain two years ago, since then he has been homeless, working intermittenly in agriculture.

At our assessment, after having ruled out consumption of toxic substances, the patient presented a neglected and cachetic appearance. He says that he is worried because some people can not see him and others can.

We admit the patient for study and treatment. Involuntary admission.

Results

During the hospitalitation, a join approach was carried out with Social Work and it was decided to start depot treatment in order to promote therapeutic adherence. In this case, it was decided to apply paliperidone depot every sin month. For this, an induction regimen was followed: fisrt, monthly paliperdione 100mg depot was administered, 4 days later, monthly paliperidone 150mg depot and 4 days later, the biannual injection.

Other depot treatment alternatives would have been aripripazole or risperidone. However, the duration of the depot treatment is shorter than in the case of paliperidone, since today the presentation formulas are monthly and quarterly, respectively.

Conclusions

Long-acting antipsychotics are an effective alternative for the treatment of patients with Schizophrenia, especially for those in whom we can not ensure good therapeutic adherence. In addition, the induction regimen allows treatment to be administered more quickly than that carried out in Mental Health outpatient programs, thus reducing the average hospital stay.

In recent years, great advances have been made in the treatment of psychotic symptoms thanks to depot drugs, which allows for numerous effective alternatives for the treatment of these patients. The figure of the Social Worker for the evaluation of the patient and subsequent follow-up is essential in this case.

Disclosure of Interest

None Declared
A patient`s trajectory with autism spectrum disorder leading to forensic psychiatric institutionalisation
Authors: Déri J. A. , Dvorak A. , Oberndorfer R.
Published: August 2024

Introduction

Autism-spectrum-disorder (ASD) is a heterogenous neurodevelopmental condition with a wide range of symptoms. Typical deficits, such as impairment in social communication and interactions, can lead to violent behaviours. However, ASD is often underdiagnosed and little is known about patients with ASD in forensic institutions.

Objectives

To highlight the diagnostic challenges and offending behaviour of people with ASD in the context of the criminal justice system (CJS) through a case report.

Methods

The case report is based on exploration, third party anamnesis, medical documentations and court files

Results

A 25-year-old man was placed in detention in 2021 after having committed a dangerous threat to unknown persons and was considered not guilty by reason of insanity. Since early childhood the patient presented with extreme mood swings and impulsive-aggressive outbursts that led to criminal mischief later on. During elementary school he developed concentration problems as well as specific learning deficits. Due to his deviant social behaviour, he was rejected from his peer group. Over the course of the years, he showed no significant responses to different psychopharmacological treatment approaches. His social anxiety grew and ultimately, he started experimenting with various drugs and drinking excessive amounts of alcohol, which induced multiple psychotic episodes. Due to the psychotic exacerbations, he was repeatedly admitted to psychiatric units for acute treatment, however the autistic disorder remained untreated. At the time of the crime an independent psychiatric assessor diagnosed schizophrenia simplex and multiple drug abuse. The patient had been in psychiatric treatment since the age of 5 and received multiple diagnoses such as combined personality disorder, different subtypes of schizophrenia, ADHD, Tourette syndrome, depressive disorder and ASD at the age of 14. Nevertheless, prior to his detention he had never received a complex therapy focusing on his ASD. According to the verdict he was admitted to a medium secure forensic ward in Lower Austria, where he was treated with antipsychotic and anxiolytic medication. Furthermore, he participated in the day-structuring treatment program ensuring routine.

Conclusions

Neurodevelopmental disorders such as ASD often impose a diagnostic challenge, particularly without intellectual disability. This can lead to under- and misdiagnosis, inadequate treatment or even criminal behaviour. Impaired theory of mind, poor emotional regulation and problems with moral reasoning should be recognized and treated specifically early on to prevent further damage to both the individual and society.

Disclosure of Interest

None Declared
The results of Wisconsin Card Sorting Test in patients under forensic observation of their mental states in violent and non-violent subgroups
Authors: Kőszegi N. , Lisincki A. , Baran B. , Jekkel É.
Published: August 2024

Introduction

Previous studies showed, that reduced executive function can be associated with antisocial and aggressive behavior. For the measurement of executive functions numerous standardized neuropsychological tests are available.

Objectives

We thought to compare the results of an executive function examination with Wisconsin Card Sorting Test (WCST) of patients observed at the Semmelweis University’s Department of Psychiatry and Psychotherapy to normative data from published database. We also performed a subgroup analysis between the violent and non-violent groups of the patients.

Methods

After data clearance our dataset consisted of 20 patients, who were divided into two groups based on whether the crime they committed before their admission was violent according to the Cornell scale.The analyzed parameters were the number of perseverative errors, the percentage of perseverative errors, and the number of completed categories. For comparison, the data bank from the 1993 edition of the WCST manual as normative data was used. The deviation from the healthy average for all three parameters was compared between the violent and non-violent groups using a two-sample T-test.

Results

There was significant difference between the patient and normal populations in all the 3 analyzed WCST parameters: the mean difference was 9,37+2,764, (p=0,0008) in the number of perseverative errors, 14,04+2,21 (p<0,0001) in the percentage of perseverative errors and -2,39+0,34 (p<0,0001) in the number of completed categories (Table 1).
Table 1:

The difference between the average scores of healthy individuals grouped by age (from the 1993 WCST manual) and the scores of the patients.

Observed parameter
Average difference
(Patient-normal)
SD
Confidence interval (95%)P valuenumber of completed categories-2,390,343-3,064 ─ 1,716<0,0001number of perseverative errors9,372,7643,936 ─ 14,8040,0008percentage of perseverative errors14,042,2129,692─18,388<0,0001

On the other hand, there were no significant differences between the violent and non-violent subgroups in the average deviations (from the normative data) of the number of perseverative errors, the percentage of perseverative errors and the number of completed categories (with p-values of 0.092, 0.34 and 0.59, respectively).

Conclusions

As a limitation, it is important to note that due to the low sample size, and our sample’s heterogeneity in terms of psychiatric diagnosis, drawing reliable conclusions is not possible. However, our results were in line with previous similar research in the forensic psychiatric population (though not under forensic mental state observation) regarding the significant deviations in two examined WCST parameters when compared to normative data. Additionally our study did not find significant difference between the violent and non-violent subgroups of the patients.

Disclosure of Interest

None Declared
What effects does peer support work have and how to implement it into forensic hospitals? A Review of Reviews
Authors: Walde P. , Völlm B. A.
Published: August 2024

Introduction

Despite promising research there is still hesitation in implementing peer support work in some hospitals. Especially in forensic hospitals reservations are held against peer support workers.

Objectives

We aim to give an overview of reviews about the effects of peer support work in psychiatric settings and its implementation. Special emphasis on implications for forensic psychiatric settings shall be given.

Methods

Five electronic databases and archives of four relevant journals were searched in December 2019 and updated in April 2022. In addition, references of articles were searched and relevant authors were contacted for unpublished data. Results of reviews were clustered by one author and checked by another.

Results

22 reviews were identified of which 15 reported on effects of peer support work and six on factors influencing its implementation and one review on both. Several effects of peer support work on clinical, psychosocial, organizational and other outcomes (e.g., cost savings) were described. Psychosocial outcomes were the most promising ones whereas no effects were described in most reviews for clinical, organizational and other outcomes. Factors influencing the implementation of peer support work were described during preparation, recruitment, early employment and further development of the peer support worker’s roles. Most factors, beneficial and challenging, were described for the preparation stage of the implementation process.

Conclusions

The authors of the reviews often reported concerns about the low quality of the included studies. Therefore, the present results have to be considered as preliminary. Nevertheless, it is clear that peer support has a positive influence on psychosocial factors and thus complements classic therapeutic approaches. To achieve the best possible effect, the implementation of peer support needs to be carefully planned. Further studies are necessary in order to be able to consider the effect of recovery support in a more differentiated way.

Disclosure of Interest

None Declared
Interaction analysis of monoaminergic polymorphisms and childhood environment related to personality functioning in patients with Borderline Personality Disorder
Authors: Salgo E. , Nemoda Z. , Kenézlői E. , Lévay E. , Balogh L. , Bajzát B. , Réthelyi J. , Unoka Z. S.
Published: August 2024

Introduction

Neurobiological studies have shown that genetic variations affecting the intensity of monoamine neurotransmission play an important role in aggressive behavior and borderline personality traits. Also, the effect of family environment has been repeatedly shown on aggressive behavior and interpersonal functioning. Population-based longitudinal studies pointed out interactions between the so-called monoaminergic sensitivity alleles and childhood adversities.

Objectives

Our study aimed to analyze the associations between the most studied variable number tandem repeats of monoaminergic genes and the different psychological factors in adult patient and healthy control groups, checking for the moderating effects of the parental occupation and education, childhood abuse and trauma.

Methods

The recruited 73 patients with BPD diagnosis and 98 healthy controls were assessed by the Structured Clinical Interview for DSM-5. Participants filled out online questionnaires including the Level of Personality Functioning Scale – short version (LPFS-SR) and the Buss-Perry Aggression Questionnaire (BPQ). Childhood social environment and traumatic experiences were assessed by the Barratt Simplified Measure of Social Status and the Early Trauma Inventory or the Childhood Trauma Questionnaire. Genomic DNA samples were obtained either from peripheral blood, saliva or buccal swabs using the desalting technique. Functional dopaminergic and serotonergic polymorphisms were chosen based on previous findings, implicating them as sensitivity gene variants, e.g., the variable-number tandem-repeats of the dopamine D4 receptor, serotonin transporter and the monoamine oxidase-A (MAO-A) genes. Since the MAO-A gene is located on the X chromosome, sex-stratified analyses were also carried out.

Results

Family environment indexed by the Barratt Simplified Measure Social Status had significant effect on anger, hostility and interpersonal functioning (p < 0.01). In the pooled sample of patients and controls, individuals carrying the high activity alleles of MAOA had elevated scores on the BPQ subscales. When analysis was limited to female participants, the genetic effect stayed significant only at the anger scale of the BPQ.

Conclusions

Family environment had pronounced effect on aggressive behavior and personality functioning, interaction with common monoaminergic genetic variants was detected only in women.

This study was supported by the National Research Development and Innovation Office grants NKFI K 129195 and NKFI K 135437.

Disclosure of Interest

None Declared
Korean Medication Algorithm Project for Bipolar Disorder 2022: Treatment Strategy According to Safety and Tolerability
Authors: Park S. Y. , Bahk W.-M. , Woo Y. S. , Jon D.-I. , Kim M.-D. , Sohn I.
Published: August 2024

Introduction

Accordingly, the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) working committee, composed of domestic experts, developed Korea’s first KMAP-BP in 2002 and later in 2006, 2010, and 2010. A revised version of KMAP-BP was announced every four years four times in 2014 and 2018.6-10). The treatment strategy considering the safety and tolerability of KMAP-BP 2022 was developed by collecting opinions from domestic bipolar disorder experts.

Objectives

Safety and tolerability of drugs are very important factors in the treatment of bipolar disorder. An expert opinion survey was conducted on treatment strategies in various special clinical situations, such as significant weight gain, characteristic drug side effects, low drug adherence, pregnant and reproductive women, and genetic counseling.

Methods

A written survey about treatment strategies related to safety and tolerability was prepared and focused on significant weight gain, characteristic drug side effects, low drug adherence, pregnant and reproductive women, and genetic counseling. Ninety-three experts of the review committee completed the survey.

Results

In the case of weight gain occurring during drug treatment, it was preferred to replace it with a drug that caused less weight gain, such as lamotrigine, aripiprazole, or ziprasidone. If there was a significant weight gain due to the treatment drug, it was preferred to intervene as soon as possible. In the case of hyperprolactinemia, it was selected to change the medication and discontinue it for benign rash caused by lamotrigine. In improving drug adherence, the preference for long-acting injections increased. Antipsychotics can be used with great caution in pregnant or reproductive women.

Conclusions

Treatment strategies in various clinical situations related to safety and tolerability in drug treatment for bipolar disorder were described. It is hoped that it will be useful in practical clinical situations.

Disclosure of Interest

None Declared
Implementation of the self-sufficiency matrix (SSM) to support diagnosing people with complex social needs at the Social Services of Catalonia
Authors: Salrach C.
Published: August 2024

The Department of Social Rights of the Generalitat de Catalunya considered using a unique tool to identify people with complex social needs at Social Services centres and to support the diagnosis processes. After conducting a thorough search and selection process for various tools, the self-sufficiency matrix (SSM), a Dutch tool, was ultimately chosen.

The tool was adapted to the Catalan context through a transcultural translation process, which included a pilot and validation process. This resulted in the creation of the Catalan matrix (SSM-CAT).

A comprehensive implementation program was defined to start the adoption of the tool at basic social services. This program included training trainers and providing online training with practical cases. The implementation process was accompanied by support and monitoring to ensure success.

Through this process, over 3,468 professionals (including 334 trainers) received training on the self-sufficiency matrix, and 31,354 individuals who received basic social services in Catalonia were evaluated. In Barcelona, a more thorough monitoring of the implementation was conducted, assessing a representative sample of the care provided (6,916 individuals attended) generating a more accurate description of the situation of the people attended by social services in the city of Barcelona.

Disclosure of Interest

None Declared
Augmenting pharmacotherapy with physical exercise: review of the principles
Authors: Szczegielniak A. R. , Pudlo R.
Published: August 2024

Introduction

Observed structural and functional changes in the central nervous system as a result of physical exercise are beneficial from biological, psychological and social standpoint. The studies published so far confirm that physical exercise, understood as planned, ordered and repetitive activity, can improve severity of symptoms, general functioning, and quality of life in patients with mood disorders, schizophrenia/psychotic disorders, anxiety, PTSD or addictions. This seems to be particularly important in relation to the growing number of patients facing resistance to classical pharmacological treatment as well as its side effects (e.g. metabolic syndrome, cardiovascular complications).

Objectives

Review of effective implementation of treatment programs based on physical exercise within mental health services.

Methods

Scoping review was performed by identifying relevant studies available in the PubMed and Scopus databases that were 1) peer-reviewed 2) in English language 3) focused on physical exercises 4) published within the last 10 years. Selection of the studies from the initial group of search results was performed manually.

Results

Majority of studies present programs covering relatively small, diverse groups of patients with mixed types of physical exercise modalities and intensity introduced, which makes generalization to basic principles very difficult. Needs assessment of patients from various diagnostic categories is vital in the process of implementation and evaluation. Barriers indicated by service users include lack of psychoeducation on perceived benefits, limitations within healthcare system (e.g., time limits, cost, access), side effects of medication, and psychosocial factors such as isolation. The assessment of factors engaging and motivating to maintain physical activity seems particularly important.

Conclusions

Identification of patients that may especially benefit from the inclusion of physical exercise, and recognition of therapeutic programs’ elements that ensure the maintenance of the physical activity require further research.

Disclosure of Interest

None Declared
The impact of working conditions on the mental health of workers in a confectionery factory
Authors: Daoud H. , Sellami I. , Ben Chabene C. , Ghrab M. A. , Haddar A. , Hajjaji M. , Jmal Hammami K. , Masmoudi M. L.
Published: August 2024

Introduction

Mental health is a critical factor influencing employee well-being and performance in companies. However, many factors within professional environments can either positively or negatively impact employees’ psychological well-being.

Objectives

This study aims to assess mental health among workers in a confectionery factory and its association with job satisfaction.

Methods

We conducted a cross-sectional study among workers in a private confectionery in Sfax. Questionnaires and workplace assessments were collected over a period from December 2022 to July 2023 using a pre-established questionnaire. Mental health assessment was performed using the 21-item Depression, Anxiety, and Stress Questionnaire (DASS21). The degree of job satisfaction was assessed using a visual analog scale ranging from 0 to 10.

Results

Our study included 200 participants, with 61% being female. Severe to very severe symptoms of depression, anxiety, and stress were found in 4.5%, 17%, and 10.5% of our participants, respectively. Among our workers, 22.5% reported being not very satisfied or not satisfied. Bivariate analysis revealed lower levels of satisfaction among the most anxious (p = 0.000), the most depressed (p = 0.000), and the most stressed (p = 0.000) workers.

Conclusions

The decline in mental health is closely linked to job dissatisfaction. Implementing measures to enhance employee job satisfaction and providing adequate support resources for mental well-being are essential steps to promote a healthier workplace and improve employee well-being.

Disclosure of Interest

None Declared
The impact of natural disaster on mental health and how to deal with it?
Authors: Rojnic Kuzman M.
Published: August 2024

Natural disasters are and will continue to represent a great challenge in addressing mental health issues globally. The most devastating recent (earthquakes on 6th February 2023 in Turkey and Syria) caused death of more than 55,000 people, injury of about 100,000 people and loss of property, overall affecting millions of people. Moreover, in the last several years in Europe, they came in a form of double disasters (for example coupled with the COVID-19 pandemic) and pointed out the unpreparedness of the health (including mental health) sectors for the emergency situations.

However, in going through these experiences, we also learnt some of the practices that proved effective – including the fast creation of collaborative networks on a larger scale that also allowed fast spread of good practices and practical organisation of help. As a practical example of it - verbalized by the mental health professionals from Turkey through the Council of National Psychiatric Associations of the European Psychiatric Association, we organized a webinar delivered by experienced clincians, trauma experts and experts with lived experince in the earthquake zones. However, structural -implementation of mental health policies that focus on prevention and improving crisis response in care delivery are important to support populations affected by natural disasters to prevent the trauma sequel.

Disclosure of Interest

None Declared
Improving Mental Health of Medical Students through Movement, Art, and Interpersonal Relations
Authors: Ajándék E. , Boros V.
Published: August 2024

Introduction

Burnout, and symptoms of distress amongst medical students is becoming increasingly common due to the uncertainty of the Hungarian healthcare system. Change itself may be the cause of stress. Since the pandemic, the workload has been growing among health care workers. Anxiety is increasing even for beginner practitioners.

Objectives

Our examination intends to improve the mental health of the students with a variety of methods to help them develop resilience towards everyday stress, such as:

1.

increasing body awareness

2.

exploring the inner drivers of vocations by self-esteem, worth symbols and emblems

3.

supporting relationships and interpersonality

Methods

We had advertised a monthly course in the mailing system of the students of the Semmelweis University (Neptun). Each occasion would go as far as 240 minutes in length. Selection criteria were: guaranteeing participation in the sessions. Any applicant suffering from mental health problems requiring medical attention, or the applicant regularly skipping occasions of the session would lead to his or her getting dismissed. Courses consists of musical aerob movement and receptive art therapy tools (exl. „Self-exhibition”). The aim was to interpret ones identity via images individually. In advance of the first occasion, the applicants were interviewed to talk about themselves their career, mental health and issues, why they want to participate in the sessions. The closing interviews are still in progress. The examination was permitted by the SE-RKEB.

Method of examination

Qualitative: personal interviews, exploring talks about the artworks (“Self-Exhibition” collage), made during the course.

Results

20 individuals started the course and 10 of them finished. The Body and Mind movements (Body Art - fusion of functional and breathing exercises, yoga and therapeutic exercises) has proven to have great importance throughout the session. The prescribed length of it in time was the third of each occasion. The joint analysation and interpretation of various artworks, images, visual narratives, even, the discussion of experiences in form of structured group activities has noticeably helped the interpersonality and social connections being formed for each individual who participated. The homeworks (eg.: Self Exhibition-collage, own worth emblem-collage etc.) and the active conduction of a diary has helped both to achieve results and have more involvement in the group.

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Conclusions

Closing interviews are still in progress.

Disclosure of Interest

None Declared
An Observational Study of the Progression of Patients’ Mental Health Symptoms Six Weeks Following Discharge From the Hospital
Authors: Mao W. , Shalaby R. , Eboreime E. , Owusu E. , Elgendy H. , Shalaby N. , Agyapong B. , Nkire N. , Nichols A. , Agyapong V. I.
Published: August 2024

Introduction

Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise.

Objectives

The objective of this paper was to evaluate the progression of mental health symptoms in patients six weeks after their discharge from the hospital as the first phase of an ongoing innovative supportive program. In this study, factors that may contribute to the presence or absence of anxiety and depression symptoms, and the quality of life following a return to the community were examined. The results of this study provide evidence and baseline data for future phases of the project.

Methods

An observational design was used in this study. We collected sociodemographic and clinical data using REDCap at discharge and six weeks later. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5) respectively. Descriptive, Chi-square, independent T-test, and multivariate regression analyses were conducted.

Results

The survey was completed by 88 participants out of 144 (61.1% response rate). A statistically non-significant reduction in anxiety and depression symptoms was found six weeks after returning to the community based on the Chi-squared/Fisher exact test and independent t-test. As well, the mean anxiety and depression scores showed a non-significant marginal reduction after discharge compared to baseline. In the period following discharge, a non-significant increase in participants experiencing low well-being symptoms was observed, as well as a decline in the mean well-being scores. Based on logistic regression models, only baseline symptoms were significant predictors of symptoms six weeks after inpatient discharge.

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Conclusions

In the short term following hospital discharge, no significant changes were observed in mental health conditions. A collaboration between researchers and policymakers is essential for the implementation and maintenance of effective interventions to support and maintain the mental health of patients following discharge.

Disclosure of Interest

None Declared
Microaggressions towards People with Mental Illness
Authors: Ayhan C. H. , Sukut O. , Bilgin H. , Tanhan F. , Aslan K.
Published: August 2024

Introduction

Microaggressions, or subtle expressions of discrimination directed towards individuals because of their membership in marginalized social groups, are the subject of a growing body of literature (Sue, 2010). As a result of growing understanding of politically correct beliefs over time, they’ve been defined as subtler types of discrimination that have replaced formerly overt discrimination. Microaggressions differ from traditional prejudice in that they are frequently perpetrated by well-intentioned people who are oblivious of the negative implications and consequences of their conduct. Microaggressions have been documented in a variety of social groups, including racial/ethnic minorities (Sue et al., 2008; Torres et al., 2010), gender (Swim et al., 2001), sexual orientation (Shelton and Delgado-Romero, 2011), and ability status (Shelton and Delgado-Romero, 2011). Many people with mental illnesses have reported social rejection experiences that are similar to microaggressions, according to research (Cechnicki et al., 2011; Lundberg et al., 2009; Wright et al., 2000; Yanos et al., 2001).

Objectives

Existing measures of stigmatizing attitudes and behaviors may not capture much of the nuance in behavior that people with mental illness report to be particularly upsetting, so we thought it would be important to examine reliability and validity of the mental illness microaggressions scale-perpetrator version (MIMS-P) for measuring microaggression behavior in the general public in Turkey.

Methods

The methodological study will be conducted to establish the validity and reliability of the The mental illness microaggressions scale-perpetrator version (MIMS-P) scale to Turkish Culture and to determine the microaggression levels against individuals with mental illness in the general population. The sample of the study will consist of individuals who are reached through an online questionnaire and who agree to participate in the study. Individuals who have psychiatric disorders will not be included in the study.

Results

Data collection process is still ongoing. Description of studies and the key findings will be presented.

Conclusions

The MIMS-P is designed to aid future study on the frequency of endorsement of microaggressions performed against people with mental illnesses, with the ultimate goal of understanding the mechanisms that lead to these acts.

The development of an extra scale to measure microaggressions from the perspective of people with mental illnesses who encounter them is one of the future research objectives.

With a better knowledge of these viewpoints and how they interact, effective therapies and public policy initiatives for reducing stigma against mental illness can be developed.

Disclosure of Interest

None Declared
Sociodemographic and clinical profile of immigrants hospitalized in psychiatric facilities in Tunisia
Authors: Tabib F. , Omri S. , Bouaziz R. , Feki R. , Gassara I. , Zouari L. , Ben Thabet J. , Charfi N. , Maalej M. , Smaoui N. , Bouali M. M.
Published: August 2024

Introduction

In an increasingly interconnected world, migration has become a defining characteristic of the 21st century. While immigration offers new beginnings and prospects, it also presents unique challenges, particularly concerning mental health.

The experience of migrating can exert pressure on mental health through factors such as acculturation stress, discrimination, and economic hardships. These challenges can, in turn, contribute to the development of mental health issues.

Objectives

To study the socio-demographic and clinical profile of immigrants hospitalized in the “C” psychiatry department, Hedi Chaker Hospital, in Sfax, Tunisia.

Methods

We conducted a retrospective descriptive study of immigrants hospitalized in the psychiatry department “C”, Hedi Chaker Hospital, Sfax Tunisia from 2011 to 2023. Socioeconomic data and clinical profiles of immigrants were collected from archived files.

Results

The total number of immigrants hospitalized during these 12 years was 32, with an average age of 28.81 years ±7.8 years, all of them were males, as the psychiatric department “C” only hospitalizes men.

All were of African origin, of whom 21.9% (n=7) had Libyan nationality, 15.6% (n=5) had Somali nationality and 12.5% (n=4) had Sudanese nationality. Communication with them was possible in 87.5% of cases, primarily through the native Arabic language in 56.3% of instances. Illegal immigration was the most prevalent form, accounting for 75% of cases. During the immigration process, 18.8% of individuals reported experiencing violence.”

The majority of hospitalized immigrants were single (71.9%), had a primary school education (37.5%), a low socio-economic level (81.3%), and no profession (59.4%). 21.9% of them had received social assistance, and 59.4% lived in a refugee camp. Psychoactive substance consumption was reported by 53.1% of our study population.

Regarding the clinical profile of the population, 21.9% had a history of somatic conditions, 43.8% had a psychiatric history, including 9.4% who had attempted suicide, and 34.4% who had experienced traumatic events since arriving in Tunisia. The primary reason for hospitalization was behavioral disorders in 71.9% of cases and suicide attempts in 15.6%. The most prevalent diagnoses were schizophrenia (50%), and bipolar disorder (18.8%). Upon discharge, 15.6% encountered administrative issues.

Conclusions

Hospitalized immigrants exhibit diverse socio-demographic and clinical profiles. These findings underscore the significance of acquiring a deeper understanding of the mental health needs and existing barriers to healthcare within various immigrant communities. This is particularly crucial as immigration continues to be a central focus in Tunisia’s public policies and discussions.

Disclosure of Interest

None Declared
Widespread cortical and subcortical gray matter loss and an increase of globus pallidus volume in treatment-resistant schizophrenia
Authors: Dudina A. , Tikhonov D. , Kaleda V. , Lebedeva I.
Published: August 2024

Introduction

It is still being discussed whether treatment-resistant schizophrenia (TRS) is a biological subtype which differs from non-treatment-resistant schizophrenia or is it a more severe condition that affects brain worse than non-treatment-resistant schizophrenia. However, there are few and heterogeneous studies and the etiology of TRS remains quite unclear.

Objectives

This study aimed to explore cortical and subcortical morphometric characteristics in TRS patients and its associations with the clinical features. The pilot stage comprises the comparison to the mentally healthy subjects.

Methods

21 right-handed male patients (mean age 28.99 ± 8.08 years) fulfilling TRS criteria and 21 matched healthy controls (mean age 29.35 ± 7.41 years) underwent T1-weighted structural MRI at 3T Philips scanner and clinical examination. Images were processed using FreeSurfer 7.1.1. Cortical thickness and area, volumes of subcortical structures and separately volumes of the amygdala nuclei and hippocampal subregions were compared between groups. The morphometry data, PANSS (Positive and Negative Syndrome Scale), CDSS (Calgary Depression Scale for Schizophrenia) and daily chlorpromazine equivalent doses of antipsychotics were included in correlational analysis. Results were considered significant if they retained significance after correction for multiple comparisons.

Results

Compared to healthy controls, TRS patients showed decreased gray matter thickness in frontal, temporal, parietal, occipital, cingulate and insular regions (Figure 1). The temporal lobe showed the most prominent thinning of the cortex. The volumes of the amygdala, hippocampus (Figure 2) and nucleus accumbens, a number of amygdala nuclei and hippocampal subregions bilaterally were also decreased in TRS patients. The volume of the right globus pallidus, on the contrary, was increased (Figure 2). No correlations between altered cortical thickness, PANSS (positive, negative, general psychopathology scales and total score), CDSS and chlorpromazine equivalent doses of antipsychotics were found.

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Conclusions

The widespread gray matter cortical and subcortical loss in TRS finds confirmation in the literature. The increased globus pallidus volume is an unexpected and intriguing result. Other studies demonstrated conflicting results on that point. Some studies reported possible therapy influence, others suggested possible associations with symptoms. We did not find any correlations with psychometric or therapy characteristics. It is possible that there are non-linear relationships or relationships that exist only at a certain stage of the disease. As for therapy, patients took individual medication, consisting of various antipsychotics and drugs from other pharmacological groups, and such heterogeneity could affect the results of the study. Further research is going to be carried out.

Disclosure of Interest

None Declared
Neurofeedback treatment for Attention Deficit Hyperactivity Disorder in adults
Authors: Fernández B. , Barros J. , Machado E. , Maldonado E. , Moreira A. R. , Gomes H. J.
Published: August 2024

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopment disorders in the world. Clinical guidelines for ADHD recommend multimodal treatment approaches, with current evidence suggesting that medication, including methylphenidate and various amphetamine formulations, in conjunction with psychosocial treatment are most effective in the short-term and long term. Over the last decade, an increasing number of studies investigating non-pharmacological treatments have been published, such as cognitive therapy, Neurofeedback (NF), Transcranial direct current stimulation with the aim of treating ADHD patients.

Objectives

We comprehensively reviewed literature searching for studies on the effectiveness and specificity of NF for the treatment of ADHD. The aim of this review is to understand if there is scientific evidence in using of electroencephalogram (EEG)-Neurofeedback for treating patients with ADHD.

Methods

We did a non systemathic review using pubmed and google schoolar databases in order to analyze the influence and effects of therapy in patients diagnosed with ADHD and under treatment based on EEG Neurofeedback. We analyzed 18 systhematic reviews and metha-analysis and 2 case control studies.

Results

Accourding to the systhematic reviews results showed positive and significant effects in the visual memory, attention and visual recognition (spatial working memory). EEG also showed improvement in upper alpha activity in a resting state (open-eyed) measured from the occipital area, which similarly indicated improvement in the cognitive domain (attention). Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment.

Conclusions

In conclusion, it is possible to affirm that a neuromodulating effect of the therapy positively influences cognitive processes, mood, and anxiety levels in patients with ADHD and is associated with significant long-term reduction in symptoms. Though limitations exist regarding conclusions about the specific effects of NF, the review documents improvements in school, social, and family environments. However, future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer and more studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects.

Disclosure of Interest

None Declared
Gut Microorganisms, Neuroinflammation and Behavioral Changes
Authors: Adebisi B. T.
Published: August 2024

Introduction

Recent clinical and preclinical evidences suggested that neuroinflammation is a key factor which interacts with the neurobiological correlates of major depressive disorder, which are the (i) dysregulation of the hypothalamic-pituitary-adrenal axis, (ii) depletion of brain serotonin and (iii) alteration of neurogenesis in the dentate gyrus of the hippocampus.

The gut bacterial has major impact on the brain development, behaviour and host immune system through the microbiota-gut-brain
axis.

Objectives

The objective of the research is to establish the role inflammation induced by gut dysbiosis plays in behavioural changes of patients suffering from major depressive disorders.

Methods

Clinical data and preclinical experiments were used to elucidate the role gastrointestinal bacterial play in the development and functional physiology of the nervous system and because of the bidirectional communication between the enteric nervous system in the gut and the central nervous system, through the vagal plexus, blood circulation and endocrine system; it was discovered that the appropriate population of intestinal microbiota affect the immunological state of the brain.

Results

The intestinal microbiota has been able to maintain the attenuation and regulation of pro-inflammatory biomarkers in the brain and such had assisted in the healthy state of the brain; however, a disruption of gastrointestinal organisms in a condition called dysbiosis could result in breakdown of protective gastrointestinal mucosa barrier resulting in leaky gut and consequently, the permeability of the gut lining and migration of some bacteria, to the brain through the vagal networks and other channels.

These pathophysiological cascades appear to be triggered or sustained and reinforced by chronic inflammatory condition involving increased circulating markers of inflammation, which are able to cross the blood brain barrier to activate the microglia.

Conclusions

Studies in depression suggest that inflammatory biomarkers such as C-reactive protein can be used to enrich samples for anti-inflammatory clinical trials for depression that target inflammation-related symptoms such as anhedonia and anxiety.

Although, still at the developmental stages, imaging of neuroinflammation will help establish a target in the brain to further facilitate the testing of anti-inflammatory therapies for depression.

Disclosure of Interest

None Declared
The Impulsivity-Compulsivity Spectrum: Understanding Brain Mechanisms and Clinical Implications
Authors: Pinheiro Ramos C. , Baptista C. , Nogueira J. , Mendes S. , Gamito A.
Published: August 2024

Introduction

Impulsivity and compulsivity are natural behaviors controlled by brain mechanisms that are essential for survival in all species. Understanding these brain mechanisms may lead to targeted treatment strategies for these symptom domains when impulsivity and compulsivity become dysfunctional.

Pathological impulsivity and compulsivity characterise a broad range of mental disorders.

Objectives

This study aimed to synthesise the latest evidence about the conceptualization of the impulsivity-compulsivity spectrum.

Methods

A review was conducted, drawing on reputable sources (PubMed and Web of Science databases).

Results

The concept of impulsivity can be defined as a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to the impulsive individual or to others. However, impulsivity is not always unplanned. Impulsive behaviours can be conceptualised as the core symptoms of a broad range of psychiatric disorders.

In contrast, compulsivity refers to repetitive behaviours that are performed according to certain rules or in a stereotypical fashion. Compulsivity is a tendency to repeat the same, often purposeless acts, which are sometimes associated with undesirable consequences.

Impulsivity and compulsivity may be viewed as diametrically opposed, or alternatively, as similar, in that each implies a dysfunction of impulse control. Each involves alterations within a wide range of neural processes, including attention, perception, and coordination of motor or cognitive responses.

Conclusions

The neurobiology of impulsivity and compulsivity may involve inhibitory neurotransmitters, excitatory neurotransmitters, the prefrontal cortex, and/or limbic dysfunction.

Impulsive and compulsive features may present at the same time or at different times during the same illness. Although both compulsive and impulsive disorders may be related to prefrontal cortex dysfunction, compulsive disorders would be related to hyperactivity and impulsive disorders to hypoactivity of the prefrontal cortex. Compulsiveness appears to be associated with increased frontal lobe activity, while impulsiveness may be associated with reduced frontal lobe activity.

Disclosure of Interest

None Declared
Navigating Information Technologies in Everyday Psychiatry Practice: A Guide for Early Career Psychiatrists
Authors: Vasilchenko K.
Published: August 2024

This presentation provides an overview of the impact of information technologies on contemporary psychiatric practice, focusing on resources and strategies beneficial for early career psychiatrists. Considering the increasing role of digital technologies in diagnosing and treating mental disorders, the presentation emphasizes the practical applications of artificial intelligence (AI) and machine learning. These technologies offer novel approaches for analyzing large volumes of clinical data, enhancing diagnostic accuracy, and personalizing treatment.

The presentation further examines ethical and legal issues associated with using digital technologies in psychiatry, including ensuring data confidentiality and complying with patient rights. The importance of developing competencies in information security and ethical principles when using digital tools is highlighted.

The talk concludes with an overview of the current and future trends in the use of digital technologies in psychiatry, including the development of virtual therapeutic environments and mobile applications for monitoring and supporting mental health. Examples of successful integration of these technologies into clinical practice are presented, emphasizing their potential to improve the quality of patient care.

Overall, the presentation underscores the importance for early career psychiatrists of mastering information technologies, highlighting their role in enhancing diagnosis, treatment, and patient care, as well as discussing the challenges and opportunities they present.

Disclosure of Interest

None Declared