bluuebunny/crossref_metadata_2025 huggingface dataset:
Online versus in-person Eating Disorder Examination for adolescents with eating disorders: Empirical verification of data equivalency
Authors: Besse-Fluetsch N. , Mayr L. , Smigielski L. , Buehlmann C. , Pauli D.
Published: August 2023

Introduction

In the last ten to fifteen years, it has become common for researchers to collect both quantitative (Sue & Ritter, 2012) and qualitative data (Jowett, Peel, & Shaw, 2011) online. The Covid-19 pandemic has increased the importance of this process and accelerated it in many disciplines (Torrentira, 2022).

In addition to convenience, recent work suggests that online data collection may be more valid than face-to-face data collection for some populations. This would mean that online data collection may be the most valid and effective for this age group (Barratt, 2012).

Objectives

Adolescents with an eating disorder tend to be more open about their symptoms via impersonal online data collection than they are in a face-to-face conversation. Symptom underrating has been documented in face-to-face interviews, because “of feelings of shame elicited by the loss of anonymity during face to-face interviews” leading to face-to-face denial, whereas a self-report questionnaire allows for more privacy and hence honesty while answering questions (Berg et al. 2011). This is especially key in the diagnosis of Anorexia Nervosa (AN), as AN patients minimize, deny, and/or fail to recognize their symptoms (Passi, Bryson and Lock 2003).

Given the benefits of collecting data online for both researchers and participants, it is important to determine the quality of the data collected online to guide its use and interpretation. More evidence is needed to confirm the equivalence of online and face-to-face interview data. The current study examines the equivalence of semi-structured interview data collected online versus original face-to-face interviews.

Methods

The Eating Disorder Examination (EDE), assessing psychopathology of eating disorders, was administered to 49 adolescents meeting ICD 10 criteria for anorexia nervosa or atypical anorexia nervosa. The same diagnostic interview was administered twice, once via face-to-face and once as an online version, within a week. Method order was counterbalanced among participants and temporal stability was controlled. The Eating Disorder Inventory-2 (EDI-2) was used as a control variable.

Results

Both the equivalence test and the null hypothesis test were significant for the sum score of the EDE. Measures of psychopathology in eating disorders demonstrated equivalence across face-to-face and online format of the EDE.

Conclusions

The aim was to examine the equivalence of face-to-face and online methodologies, controlling for temporal change in the variable under investigation over one week and order of administration. Results demonstrate equivalence across face-to-face and online format of the EDE. These findings suggest that data obtained using EDE online can be interpreted in comparison with normative data obtained in the face-to-face Interview and that corrections trough transformations are not necessary.

Disclosure of Interest

None Declared
GnRh agonists as precipitating components of psychiatric pathology. A case report.
Authors: Guerrero Medina A. , García Eslava J. S. , Martín Rodriguez A. C. , Martinez Salvador L. , Alvarez Alonso M. J. , Aubareda Magriña M.
Published: August 2023

Introduction

GnRh agonists are drugs used in various gynecological pathologies, among which is endometriosis. They act by stimulating GnRh receptors in the pituitary gland. This sustained and continuous stimulation of GnRh, will initially generate an increase in the release of luteinizing hormones and follicle-stimulating hormones, subsequently losing sensitivity to the receptors, internalizing them, and thus suppressing the release of these hormones, which would entail an ovarian suppression, thereby inhibiting the release of estrogens and progesterone. Psychiatric adverse effects have been described. Gonzalez-Rodriguez et al (Front Psychiatry 2020; 11:479), described this association with changes in mood, and the presence of a series of cases where the link between GnRh agonist and the possibility of presenting psychotic symptoms is observed. Wieck (Curr Top Behav Neurosci 2011;8:173-87), Frokjaer (J Neurosci Res 2020;98(7):1283-1292), Brzezinski-Sinai et al (Front Psychiatry 2020;11:693) reported that this association could be related with the relationship of the hypothalamic-pituitary-gonadal axis, hormonal fluctuation and its relationship with the dopaminergic regulation, a genetic component that would increase the predisposition to trigger psychiatric pathology in patients with greater sensitivity to hormonal fluctuations, and the loss of neuroprotection generated by the decrease of estrogens in the central nervous system. All of this in the context of multiple environmental and genetic factors that participate together in the appearance of the disease.

Objectives

To describe the importance of detecting the risk factors that can precipitate a psychotic episode, including the use of certain drugs, such as GnRh agonists.

Methods

We describe a case of a 45 year old patient with endometriosis with multiple organ involvement who went to the emergency room due to behavioral changes in the context of a brief psychotic disorder with “ad-integrum” recovery.

Results

A retrospective analysis of the case is conducted, observing an association between the introduction of GnRh agonists and the presentation of a first psychotic episode.

Conclusions

The importance of this case lies in the limited evidence of this association in the literature, and the implication of these drugs in the triggering of psychiatric pathology, being an aspect to be considered by psychiatrists in their patient’s follow-up.

Disclosure of Interest

None Declared
Stigma and self-stigma in patients with delusional disorder: a systematic review.
Authors: González- Rodríguez A. , Alvarez A. , Román E. , Guàrdia A. , Natividad M. , Alberto Marcus M. , Calvo E. , Labad J. , Monreal J. A.
Published: August 2023

Introduction

The association between insight, stigma and self-concept has been considered as a potential predictor of poor clinical outcomes and global functioning in psychosis. In patients with delusional disorder (DD), the effects of stigma and self-stigma have been poorly explored.

Objectives

Our main goal was to systematically review studies addressing stigma and self-stigma in DD to assess whether these phenomena have an impact on clinical symptoms.

Methods

A systematic review was conducted through PubMed and Google Scholar databases from inception to 2022 (PRISMA guidelines). Search terms: (Stigma OR self-stigma) AND (“delusional disorder” OR psychosis OR paranoia). Studies were considered eligible if they included patients with DD.

Results

A total of 875 records were retrieved, from which 18 were included.

Stigma: (1) Stigma is associated with poor quality of life, poor adherence to medications and acceptation of diagnosis. (2) Support at workplaces would improve stigma and discrimination in DD. (3) Poor interpersonal competence may increase stigma experience in DD.

Self-stigma: (1) Women show higher level of self-stigma than men. (2) Higher rates of psychiatric hospitalizations and higher severity of symptoms associated with greater degree of self-stigma. (3) Suicidal ideation was associated with negative self-schema but not self-stigma, particularly in patients with persecutory delusions. (4) Self-stigmatization negatively associated with quality of life. (5) Depressive symptoms associated with higher levels of self-stigma. (6) Promotion interventions should address self-stigma content.

Conclusions

Further longitudinal studies are needed to test the influence of stigma and self-stigma on adherence to follow-up and specific interventions to improve them.

Disclosure of Interest

None Declared
Post Cerebrovascular Stroke Catatonic Psychosis: A Case Report
Authors: Hasan H. , Abdo M. , Rabei S.
Published: August 2023

Introduction

Catatonia due to cerebrovascular stroke is a rare condition that needs further observation and research.

Objectives

To review the opinions of psychotic disorders experts worldwide as to this issue based on evidence and clinical experience and to consider strategies for future investigations.

Methods

This case shows a 64 years old female who suddenly developed wish for isolation, followed 10 days later by discontinuity of ideas, hallucinatory behavior and food refusal. She had verbal and physical aggression due to a fixed belief that family members are conspiring somehow to harm her.

Results

On examination she was mute with waxy flexibility and negativism. Extensor plantar reflex was evident. MRI Brain showed small vessel disease and right basal ganglia acute ischemic infarction. On IV midazolam 7.5 mg, patient’s mutism, negativism and waxy flexibility improved. Lower limb Venous Duplex revealed acute right popliteal and left soleal veins thrombosis. CT angiography showed Bilateral pulmonary embolism with no pulmonary infarction. D dimer was positive.

Conclusions

Early diagnosis and intervention improves outcome if psychiatric teams gives attention and has enough awareness with warning symptoms and prompt necessary interventions.

Disclosure of Interest

None Declared
Brexpiprazole augmentation in a clozapine-resistant young schizophrenic patient: a successful case report.
Authors: Martiadis V. , Raffone F. , Russo M.
Published: August 2023

Introduction

Although clozapine is considered the most effective drug for Treatment Resistant Schizophrenia (TRS), only 40% of patients treated will meet clinical response. Literature reviews and meta-analytic data offer no definite conclusions about the most effective clozapine augmentation strategies. Nevertheless, it has been suggested that the lack of evidence should not discourage clinicians from trying out new strategies in individual patients. Brexpiprazole is a novel 5-HT and DA modulator antipsychotic that exhibits partial agonism to D2/D3 and 5HT1A receptors, antagonism to 5HT2A and α-1B/2C receptors and represents a promising new drug in the pharmacotherapy of schizophrenia for both acute and maintenance treatment. In current literature there is no evidence of experiences in brexpiprazole augmentation for clozapine resistant patients.

Objectives

This case report describes a successful clinical experience of brexpiprazole augmentation in a complicated case of clozapine resistant paranoid schizophrenia with consistent negative symptoms, the clinical evolution and metabolic improvement consequent to this therapy combination.

Methods

In a 27 male TRS patient, sequentially treated with adequate doses of risperidone, cariprazine, aripiprazole and olanzapine monotherapy, prescribed for adequate time, clozapine treatment was started, with a gradual titration from 25 to 300 mg/day, without significant clinical response on both positive and negative symptoms. Successively was introduced fluoxetine, from 10 to 30 mg/day, with no relevant clinical improvement. After 2 months of pharmacological stabilization with clozapine and fluoxetine described dosages, brexpiprazole was introduced starting from 1 mg/day and rapidly increasing till 4 mg/day.

Results

After 6 weeks of treatment, PANSS positive and negative subscales showed a significant decrease, respectively from 28 to 17 and from 42 to 20, while general psychopathology subscale decreased from 66 to 34. Negative sub-items with major improvement were those regarding blunted affect, emotional withdrawal, poor rapport, and passive/apathetic social withdrawal. Brexpiprazole augmentation also allowed to slowly decrease (in 6 months) clozapine dose till actual 150 mg/day, with a significant improvement in general tolerability and a slow decline in metabolic parameters (BMI from 36.5 to 30.3; fasting glucose from 112 to 92 mg/dL; total cholesterol from 248 to 182 mg/dL; total triglycerides from 392 to 198 mg/dL).

Conclusions

In this case report brexpiprazole augmentation in a clozapine resistant young schizophrenic patient was an effective strategy with significant symptoms improvement, in particular in PANSS general psychopathology and PANSS negative subscales. The consequent clozapine dose reduction contribute to the slow decrease in metabolic parameters considered.

Disclosure of Interest

None Declared
The manifestation of anxiety in patients undergoing elective coronary angiography
Authors: Kokalj Palandacic A. , Ucman S. , Novak Sarotar B. , Lainscak M.
Published: August 2023

Introduction

Prevalence of anxiety disorders in coronary artery disease reaches up to 15% and about half of patients with coronary artery disease have anxiety or depression comorbidity. Prevalence of anxiety in patients undergoing percutaneous coronary intervention ranges from 24% to 72%. Anxiety can be the source of distress and is associated with poor prognosis, impaired health-related quality of life and can cause cardiac dysfunction.

Objectives

We aimed to determine the prevalence of anxiety and its association to coping strategies and personality traits in non-depressed patients undergoing elective coronary angiography, a diagnostic procedure for coronary artery disease. We also aimed to determine the correlation of state anxiety to elective coronary angiography finding and its expression over time.

Methods

This was a single-center, cross-sectional, prospective study. Anxiety was evaluated at four-time points using self-rating questionnaires: 14 days prior to and 2–4h before procedure; 24h after procedure and 6 weeks after discharge. The association between anxiety and psychological variables was assessed by multiple linear regression and by linear mixed effect model.

Results

A total of 259 non-depressed patients were included in the final analysis (median age 65, 32% were female). Prevalence of anxiety was 35% and was higher in patients with avoidance-oriented coping style (p<0.001), meanwhile low neuroticism (p<0.001) and extrovertive personality trait (p=0.032) were protective factors. Patients that had no intervention (p=0.022) or had percutaneous coronary intervention (p=0.010) during elective coronary angiography, had lower anxiety than patients in need for coronary artery bypass graft surgery.

Conclusions

Personality traits emotional stability and extroversion are protective factors against anxiety. More than one third of patients experienced clinically significant anxiety before procedure. Our results suggest that recognising anxiety in patients undergoing elective coronary angiography is important. Further on, application of effective interventions for reducing/treating anxiety before or after procedure is needed.

Disclosure of Interest

None Declared
Daytime sleepiness among health workers affected by COVID-19 during the “OMICRON” wave
Authors: Athimni Z. , Mersni M. , Ben Said H. , Bahri G. , Brahim D. , Mechergui N. , Yousssef I. , Ernez S. , Ladhari N.
Published: August 2023

Introduction

Excessive daytime sleepiness is a frequent symptom in the general population. It may be fleeting, due to transient circumstances, or it may be related to certain pathologies. Indeed, following their infection with SARS-COV2, several healthcare workers (HCWs) have complained of excessive daytime sleepiness.

Objectives

This study was conducted to assess excessive daytime sleepiness in the SARS-COV2-affected HCWs during the “OMICRON” wave.

Methods

Cross-sectional descriptive study, conducted among the HCWs of Charles Nicolle Hospital with COVID-19 during the period from 22 December 2021 to 31 January 2022. Sleepiness was assessed using the Epworth Sleepiness Scale administered during the return to work medical visit.

Results

During the “OMICRON” wave, 58 HCWs joined our study. The average age was 39 +/- 10 years. The sex ratio (M/F) was 0.2. The participants had no previous history of sleep disorders. Excessive daytime sleepiness was found in 21 participants (36% of cases). Excessive daytime sleepiness was mild in 81% of cases, moderate in 14%, and severe in 5%. The category most affected was senior technicians in 57% of cases. Most of the HCWs suffering from daytime sleepiness were working in the gynecology department (19%) and the neurology department (19%).

Conclusions

Early and systematic screening for sleep disorders after any SARS-COV2 infection is necessary to ensure the good health of the HCWs and to reduce accidents and errors in professional procedures.

Disclosure of Interest

None Declared
Clinical covariates of self-harm and suicidality in a community sample of Irish Travellers
Authors: Tong K. , McGovern M. , McManus R. , O’Brien J. , Doherty A. M.
Published: August 2023

Introduction

Irish Travellers are an indigenous minority group in Ireland. Health inequalities have been widely reported within the Traveller community, with a shorter life expectancy of 11 years less than the general population. Travellers also have higher mortality rates of 3.5 times higher than the general population in Ireland. Suicide is a serious problem in the Traveller community with a suicide rate of 11% among Travellers: 6 times higher in women and 7 times higher in men compared with their counterparts in the general population.

Objectives

There is a paucity of research into the clinical characteristics of self-harm and suicidality among Irish Travellers despite the elevated suicide rates in this community. This study aims to bridge the knowledge gap in the mental health of Irish Travellers, focusing on the clinical factors associated with self-harm and suicidality in a community sample of Irish Travellers.

Methods

This is a cross-sectional study. Study participants completed self-report and interview-based validated questionnaires that screen for anxiety (General Anxiety Disorder assessment: GAD-7), depression (Patient Health Questionnaire: PHQ-9), and suicidality (Suicide Behaviours Questionnaire-Revised: SBQ-R and Adult Suicidal Ideation Questionnaire: ASIQ). Ethical approval was granted through the Clinical Research Ethics Committee, University College Dublin.

Results

Despite an active recruitment campaign, participation rate from Irish Travellers in this study was low, with only five participants completing this study. Three were male. The mean age of the study participants was 39±14.7 years. All had pre-existing mental health diagnoses, most commonly anxiety disorder. All had at least one previous episode of self-harm and 80% had a positive family history of self-harming behaviour. No participants reported a history of alcohol or substance misuse. Over half of the participants reported severe anxiety and depressive symptoms with median GAD-7 score of 19 and PHQ-9 score of 21 respectively. All participants demonstrated significant risk of suicidal behaviour based on their SBQ-R and ASIQ scores.

Conclusions

Despite elevated rates of suicidality and mental illness in this ethnic minority group, Irish Travellers demonstrated lower participation in mental health research, including this study. These recruitment challenges suggest that factors such as stigma, shame and lack of trust may be contributory. These factors may also act as barriers to them accessing mental healthcare when they develop mental health symptoms such as anxiety and depression, associated with increased risk of self-harm and suicidal behaviours. There is a need for better engagement strategies with Travellers to promote awareness into their needs and reduce mental health problems in this population.

Disclosure of Interest

None Declared
Journey of young self-harm survivors from being vulnerable to resilient: Participants’ perspective on a culturally-adapted self-harm prevention intervention
Authors: Chaudhry N. , Tofique S. , Kiran T. , Chaudhry I. B. , Husain N. , Colucci E.
Published: August 2023

Introduction

Repeated self-harm represents the single strongest risk factor for suicide. Worldwide, suicide is the second leading cause of death in young people aged 15-29 year, and the leading cause of death in many Asian countries.

Objectives

This qualitative study was nested in a multi-center effectiveness trial of a Youth Culturally-adapted Manual Assisted Problem-solving intervention (Y-CMAP) for prevention of self-harm in Pakistan and aimed to explore young people’s perspective on the intervention.

Methods

One-to-one in-depth qualitative interviews were conducted with 20 participants from 5 cities across Pakistan, using a semi-structured topic guide to explore their views about self-harm, Y-CMAP intervention content, perceived effectiveness and challenges. Interviews were conducted in Urdu language, digitally recorded, transcribed verbatim and translated into English. Thematic analysis was conducted by the trained qualitative researchers.

Results

Interpersonal conflicts including relationship difficulties, financial problems, and lack of social support were highlighted as precipitating factors of self-harm. Participants reported that Y-CMAP intervention is structured and easy to understand. They acknowledged the role of distraction techniques, cost-benefit analysis, discussion on thinking pattern, problem-solving and anger management in improving their mental health and wellbeing and reduce self-harm. Participants also shared their initial fears regarding the intervention, such as fear of disclosure of information to media. School and job timings were described as potential challenges for participation in the intervention.

Conclusions

Exploring the perspectives of young people about culturally-appropriate intervention is imperative in their journey towards preventing suicide, which is a preventable cause of premature death. Findings are particularly relevant for Pakistan, one of the youngest nations in the world with limited resources for suicide prevention.

Disclosure of Interest

None Declared
Suicide among physicians: what do we know about it?
Authors: Vaz R. P. , Martins J. , Costa A. L. , Brás J. , Sousa R. , Almeida E. , Abreu J. , Castro N. , Andrade R. , Gil N.
Published: August 2023

Introduction

The prevalence of mental illness has increased worldwide over the past few years. At the same time, and even in the sense, there is also an increase in suicide rates with special incidence in certain risk groups, among which health professionals stand out.

In this particular group, physicians seem to represent a class particularly vulnerable by the stress and demand associated with it, but also by access and knowledge about potentially lethal means.

For this very part, they have a higher risk of suicide than the general population.

Objectives

This paper aims to better understand the phenomenon of suicide among physicians and identify which medical specialties are most vulnerable.

Methods

Bibliographic research in the Pubmed® database using the terms “suicide and physicians”.

Results

The data obtained from the scientific literature consulted indicate that physicians have a higher risk of suicide than the general population, with greater emphasis on females who have higher rates compared to males.

Work factors that translate into higher levels of demand and stress combined with easy access and knowledge about the use of potentially lethal means seem to contribute very significantly to this phenomenon. Perfectionist personality traits with a high sense of responsibility and duty are also important characteristics that place these professionals in a position of greater vulnerability.

With regard to the different medical specialties, anesthesiology, psychiatry and general and family medicine are the ones with higher suicide rates among the medical class.

Conclusions

The risk of suicide, although admittedly high in the medical class, is not homogeneous among different countries, being naturally influenced by the satisfaction/gratification obtained in the performance of their profession. In this sense, countries such as Switzerland and Canada show higher levels of professional satisfaction. In the opposite direction, dissatisfaction in the exercise of clinical activity is associated with higher levels of fatigue and burnout.

Medical women, due to the need to combine the responsibility of family tasks with professional responsibility, are at greater risk.

In this sense, it is necessary to develop strategies that are more appropriate for the prevention and early identification of suicide risk situations that can be experienced not only by improving working conditions but also by better addressing professionals suffering from mental disorders.

Disclosure of Interest

None Declared
MOTHER-CHILD RELATIONSHIP IN THE CONTEXT OF DOMESTIC VIOLENCE
Authors: Boukdir A.
Published: August 2023

Introduction

Mother-child relationship has a major role in a child’s cognitive, emotional and behavior shaping. Unfortunately, in the context of domestic violence, this relationship can be negatively impacted becoming strained or distant.

Objectives

To assess the quality of Mother-Child Relationship in the context of domestic violence or intimate partner violence. And to investigate the factors influencing negatively the Mother-Child Relationship.

Methods

This is a descriptive and analytical cross-sectional study, conducted among abused women and their children, recruited from associations combatting violence against women, from Moulay abdellah hospital of Salé, and from consultation at the university psychiatric hospital Arrazi of Salé, through a hetero-questionnaire that includes socio-demographic characteristics and scales measuring the quality of mother-child relationship (IPA, CAM) and psychological distress of the mother and the child (EMMDP).

Results

From the results observed in women and children recruited in our study, we retain that various elements are impacting the mother-child relationship, such as psychological maternal functioning, child’s behavior functioning, parenting qualities, insecurity of child’s attachment, unhealthy internalized representations…

Conclusions

A better understanding of the factors influencing mother-child relationship, can allow us to offer more tailored supports and could enable interventions promoting recovery and women’s and children’s well-being in the context of domestic violence.

Disclosure of Interest

None Declared
Mental health, Reproductive health and contraception: pharmacological interaction, current evidence and challenges
Authors: Pinto Osório C. , Macedo P.
Published: August 2023

Introduction

Mental pathology is relatively prevalent in the women, and there is often a need for treatment with psychotropic drugs, with an impact on women’s reproductive health. The use of contraception is widely spread among this population and the choice between these methods must be considered carefully.

Objectives

This review aims to present the main interactions between contraceptive methods and psychotropic therapy and its impact on psychiatric disorders, in addition to the precautions to be taken in their choice.

Methods

Literature review of relevant articles on Pubmed. Query: Contraceptive+(psychiatric disorder, depression, anxiety, schizophrenia, bipolar disorder, psychotropic drugs).

Results

Based on current evidence, no statistically significant differences regarding unplanned pregnancy rates or the psychotropic treatment outcomes were found when using combined oral contraceptives and antidepressants, benzodiazepines or atypical antipsychotics (being clozapine the exception). The impact of contraceptive methods on mood was unclear, as some articles showed an association between contraceptive use and a higher risk of beginning antidepressants and others showing no differences or even as a protective factor. Although the interactions of the aforementioned drugs are infrequent, there are cases where important interactions occur, such as clozapine, valproic acid, lamotrigine and carbamazepine, as some herbal products as the St.John’s wort. With clozapine, there is an increased serum concentrations, while the opposite occurs in the case of valproate and lamotrigine with a decrease of 32.6% and 23.4%, respectively. Treatment with valproic acid in women of childbearing age has been discouraged because of its association with polycystic ovary syndrome, elevated testosterone concentrations and menstrual irregularities, in addition to the risk of fetal malformations. In cases where this drug is prescribed, it is recommended to use highly effective methods such as subcutaneous implants or intrauterine devices. Lamotrigine and carbamazepine reduce the effectiveness of some contraceptive methods, such as oral contraceptives, transdermal patch and vaginal ring, in which case the placement of a subcutaneous implant or intrauterine device is indicated.

Conclusions

The magnitude of the impact between contraceptives, regarding depressive disorders, is unclear. The evidence shows that some women report the appearance and recrudescence of depressive symptoms, evidencing the need of further studies to identify the risk factors in these cases. The importance of clear and simple information and a shared decision on which contraception to choose is crucial, as clarification about their interactions with psychiatric treatment. The clinician must also be aware of the implications for reproductive health, in order to reduce the risks and side effects associated with some drugs.

Disclosure of Interest

None Declared
Sex-related differences in medical cannabis use: A nation-wide database study
Authors: Yakirevich Amir N. , Treves N. , Reuveni I. , Davidson E. , Bonne O. , Matok I.
Published: August 2023

Introduction

Cannabis use is associated with mental illness among men and women, especially induction or exacerbation of psychosis, anxiety, and depression. Although safety and efficacy of cannabis in most medical conditions have not been established, use of medical cannabis is growing exponentially. In particular, albeit sex-related differences in the activity of the endocannabinoid system in animals and humans, differential effects of cannabis on men and women have rarely been sought.

Objectives

To characterize patterns of use and adverse effects experienced by men and women using medical cannabis.

Methods

Data from the Israeli national database of patients licensed to use medical cannabis in Israel from January 2014 to December 2021 was analyzed. The database includes indications for cannabis use, monthly cannabis quantities, Tetrahydrocannabinol (THC) and Cannabidiol (CBD) concentrations, and reports of adverse effects. Comparative statistics were used to evaluate the sex related differences.

Results

161,644 persons (62% men) were issued a license to use medical cannabis during the study period. Men are significantly younger than women (50.5±19.1 vs. 56.5±18.4). The leading indications among both men and women are chronic pain (58% of men, 57% of women), symptoms related to oncological disease and chemotherapy treatment (21% of men, 24% of women) and post-traumatic stress disorder (9% of men, 6% of women). Men consume significantly higher monthly quantities at the beginning of treatment compared to women (31.6 gram vs. 29.3 gram) with a higher THC concentration (13.9% vs. 11.6%) and lower CBD concentration (5.3% vs. 6.7%). Over two years of use, there is an increase among both men and women in the amount and THC concentration, and a decrease in the CBD concentration. The differences between men and women remain significant throughout the whole period. Data on adverse effects are available for 28,629 men and 17,204 women (28.6% of men, 28.0% of women). Women report significantly more physical adverse effects (RR 1.48 [95%CI 1.39-1.57]), anxiety (RR 1.45 [95%CI 1.35-1.56]), depression (RR 1.36 [95%CI 0.95-1.96]) and derealization (RR 3.44 [95%CI 2.42-4.89]).

Conclusions

Although the prevalence of medical conditions for which medical cannabis is indicated are similar for both genders, approximately 60% more men consume medical cannabis. While consuming lower cannabis amount and THC concentration, women report more physical and psychiatric adverse effects than men. Understanding the differences in usage patterns and adverse effects between men and women will enable more accurate policy determinations and more effective and safer treatment strategies.

Disclosure of Interest

None Declared
Inflammatory signature of post-COVID-19 depression
Authors: Palladini M. , Mazza M. G. , Aggio V. , Spadini S. , Calesella F. , Poletti S. , Rovere-Querini P. , Benedetti F.
Published: August 2023

Introduction

Persisting and disabling depressive symptomatology represent a prominent feature of the post-acute COVID-19 syndrome. Sars-CoV-2-induced immune system dysregulation mainly result in a cytokine storm. Once in the brain, inflammatory mediators negatively affect neurotransmission, microglia activation, and oxidative stress, possibly disrupting critical brain neurocircuits which underpin depressive symptoms. So far, only inflammatory markers based on leukocyte counts have been linked to depressive outcome in COVID survivors. However, an accurate immune profile of post-COVID depression has yet to be elucidated.

Objectives

Identify inflammatory mediators that predict post-COVID depression among a panel of cytokines, chemokines, and growth factors, with a machine learning routine.

Methods

88 COVID age- and sex-matched survivors’ (age 52.01 ± 9.32) were screened for depressive symptomatology one month after the virus clearance through the Beck Depression Inventory (BDI-13), with 12.5% of the individuals scoring in the clinical range (BDI-13 ≥ 9). Immune assay was performed through Luminex system on blood sampling obtained in the same context. We entered 42 analytes into an elastic net penalized regression model predicting presence of clinical depression, applied within a 5-fold nested cross-validation machine learning routine running in MATLAB. Significance of predictors was evaluated according to variable inclusion probability (VIP), as returned by 5000 bootstraps. Socio-demographics, previous psychiatric history, hospitalization, time after discharge were used as covariates.

Results

The model reached a balance accuracy of 73% and AUC of 77%, correctly identifying 73% of people suffering from clinically relevant depressive symptoms (Figure1). Depressive symptomatology was predicted by high levels of CCL17, ICAM-1, MIF, whereas CXCL13, CXCL12, CXCL10, CXCL5, CXCL2, CCL23, CCL15, CCL8, GM-CSF showed a protective effect (Figure2).

Image:

Image 2:

Conclusions

This is the first study highlighting a putative inflammatory signature of post-COVID depression. Consistently to the immune profile of Major Depressive disorder, upregulation of innate immunity mediators seems to foster depressive symptoms in the aftermath of COVID. Interestingly, recruiters of B and T cells promoting a physiological adaptive response to viral infection also mitigate its psychiatric sequelae. Understanding the biological basis of post-COVID depression could pave the way for personalized treatments capable of reducing its add-on burden.

Disclosure of Interest

None Declared
Continuous Theta-Burst Stimulation in a 9-year-old girl with a history of neurotoxicity after Acute Lymphoblastic Leukemia B
Authors: Moleon A. , Martín-Bejarano M. , Javier T. , Pérez I. , Rosa T. , Garcia-Ferriol M. , Rocío P. , Oropesa J. M. , Javier N.
Published: August 2023

Introduction

Transcranial Magnetic Stimulation is a non invasive brain stimulation technique used for several neuropsychiatric conditions. The treatment of Acute Lymphoblastic Leukaemia (ALL) involves many cytotoxic drugs that inhibit the rapid growth of cancer cells, but also damage healthy cells, resulting in a wide range of adverse effects (Śliwa-Tytko et al., 2022). Studies have shown that approximately 10-30% of paediatric ALL patients suffer from psychiatric disorders. Therefore, new therapeutic tools are needed, and repetitive transcranial magnetic stimulation (rTMS) has demonstrated tolerability, effectiveness and safety in children (Allen et al., 2017).

Objectives

We discuss the first case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in who underwent Continuous Theta-Burst Stimulation

Methods

Case Presentation. In this study, we describe a case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in November 2016 who completed treatment in July 2019. Since April 2018 she presented symptoms of intracranial hypertension and encephalopathy with behavioural alterations, attention deficit secondary to toxicity. Psychotic outbreaks after toxicity from different treatments was also present. Since starting pericyazine (July 2022) there has been a slight improvement, but her symptoms continue to have a severe impact in her daily functioning. Baseline developmental profile assessed with the Battelle Inventory was significantly below the expected level in all developmental areas except for gross motor skills. Treatment. The TMS intervention consisted of the application on right DLPFC (F4), inhibitory cTBS protocol (5Hz bursts and 3 pulses of 50 Hz each). The protocol consisted in delivering 2 sessions per day for 15 days (separated by 55 minutes), 4 minutes per session (3600 pulses/session), 30 sessions in total. An intensity of 100% of resting motor threshold (C4). TMS was performed with the Magventure Magpro X100 MagOption equipment, Cool DB-80 double cone coil. The Child Behaviour Checklist (CBCL) for parents was used to assess intervention effects.

Results

CBCL results reflect improvements in both internalising and externalising total scores after treatment. Specifically, the patient presents clinically significant decreases in several dimensions such as anxious/depressed symptoms, somatic complaints, and social problems. No adverse effects have been reported since the beginning of the intervention.

Conclusions

Internalising and externalising behaviours severity were reduced after 30 TMS sessions. In accordance with the latest systematic reviews on the safety of TMS in the paediatric patient (Zewdie et al, 2020) we propose the development of paediatric guidelines to offer this technique to patients with a history of intolerability or poor drug response.

Disclosure of Interest

None Declared
Investigating the Impact of Perceived Discrimination on the Integration and Life Satisfaction of New Wave Turkish Immigrants Living in Germany
Authors: Cindik-Herbrüggen D. E. D. , Icer E. , Kara G. , Daryal S.
Published: August 2023

Introduction

Approximately 21.2 million people with im- migrant backgrounds live in Germany, which constituted 26% of its total population in 2020. Approximately 67% of immigrants are from European countries, including Turkey. Turks account for 13.2% of immigrants and constitute one of the largest immigrant groups (Statistisches Bundesamt, 2020). The integration processes and life satisfaction of new wave Turkish immigrants are differ from the first and second generation Turkish immigrants.

Objectives

The aim of this study was to investigate the impact of perceived discrimination on their integration process and life satisfaction of new wave Turkish immigrants living in Germany.

Methods

The Community Integration Measure (CIM), Satisfaction with Life Scale (SWLS), The Perceived Discrimination Scale (PDS) were used. Pearson correlation and Regression tests were used in our analyses to observe the differences in scale scores according to the variables. The relationship between the scale scores was analysed with the Pearson correlation test. The effect between the scale scores was analysed with the regression test.

Results

The findings demonstrated that there was a significant negative relationship between perceived discrimination and social integration (p=0,05) as well as life satisfaction (p=0,05). In addition, there was a significant and positive relationship between social integration and life satisfaction of new wave Turkish immigrant participants.

Conclusions

The integration process and life satisfaction of new wave Turkish immigrants decreased when they perceive discrimination in their daily lives. However, the level of life satisfaction increased when they integrate into German society without any perceived discrimination.

Disclosure of Interest

None Declared
Health and care system assessment aimed at cultural adaptation of MhGAP modules
Authors: Dozio E. , Caron L.
Published: August 2023

Introduction

As part of the Global Mental Health (GMH) movement, WHO launched the Mental Health Gap Action Program (mhGAP). One of the key initiatives of the MhGAP is to train lay health professionals to meet the mental health needs of populations, particularly in low- and middle-income countries (LMICs) where the need far exceeds the availability and quality of services. Training modules are standardized and designed for use in many countries and settings. In practice, there is often a stereotyped reproduction of modules without consideration of specific cultural adaptation needs.

Objectives

As part of a psychosocial support program in two provinces of the eastern Democratic Republic of Congo (Ituri and North Kivu), the NGO Action contre la Faim proposed a health and care system assessment aimed at adapting MhGAP modules for health center staff. The objective was to know the local practices in terms of psychic care as well as to identify the competences already existing to reinforce them, but also to contextualize the tools and the contents of the trainings.

Methods

The methodology used was mixed.

A questionnaire based on the WHO situation analysis tools was revised, simplified and adapted to the zone, allowing us to obtain quantitative data on the health centers, the care provided, referrals and supervision. Health care workers were interviewed using the questionnaire from ACF’s “Strengthening the Health Care System” guide, focusing on care methods, knowledge of mental health and the most frequently encountered symptoms. Focus Group Discussions with the Community Relais in the area allowed for the collection of information on the level of knowledge of the population in terms of mental health, their awareness on this subject, their cultural vision and the means of care.

Results

The data collected from 9 health centers in the two provinces allowed us to learn about:

- Poor knowledge of mental health and school readiness

- Identification of barriers to access to care

- Beliefs around mental health, mental suffering and care

- Details about the different pathologies and symptoms as well as the issues related to the therapeutic framework.

Conclusions

The evaluation was fundamental to have a better knowledge of the context, which made it possible to adapt the content of the MhGap training modules les, to design tools more adherent to reality. The data collected may also be the subject of advocacy aimed at mobilizing the country’s policies in terms of mental health, as well as raising awareness in the international community.

Disclosure of Interest

None Declared
Digital transcultural psychiatry in times of crisis: the Help for helpers webinar series
Authors: Rojnic Kuzman M.
Published: August 2023

The COVID-19 pandemics brought numerus changes in the European mental health systems. One of the major, was the widespread introduction of digital psychiatry across the globe, as the only possible option to maintain the psychiatric care. On February 28th 2022, the European Psychiatric Association has started a network of solidarity for Ukraine to respond to the needs of people in Ukraine as verbalized by the Ukrainian mental health professionals, but also to the need of surrounding countries where people from Ukraine fled to. As verbalized by the colleagues from Ukraine and surrounding countries, one of the unmet educational needs was the education for first line helpers and volunteers from Ukraine and countries surrounding Ukraine where displaced persons fled to. This resulted in the series of webinars on the topics detected as unmet needs (what is normal response to trauma, how to triage dispaced persons in need of help, how to provide first psychological help, how to approach to children of different ages, how to take care of one-self and what is the role of supervision). The webinars were delivered by experienced clincians, trauma experts and experts with lived experince in the war zones, incliding the ones from Ukraine. These are available freely at the EPA website https://www.europsy.net/resource-page/, in several languages.

Disclosure of Interest

None Declared
The Contribution of Childhood Adversity and Potentially Traumatic Events During Military Service to PTSD and Complex PTSD Symptoms Among Israeli Women Veterans
Authors: Zerach G.
Published: August 2023

Introduction

Adverse childhood experiences (ACEs) and exposure to potentially traumatic events (PTEs) during military service are associated with mental health problems. However, knowledge about relative contributions of these factors to non-U.S women combat veterans’ posttraumatic sequalae is sparse.

Objectives

To examine associations between ACEs, combat exposure, military sexual trauma (MST), potentially morally injurious events (PMIEs), posttraumatic stress disorder (PTSD) and complex PTSD symptoms among women veterans.

Methods

A volunteer sample of Israeli women combat veterans (n=885) and non-combat veterans (n=728) responded to self-report questionnaires in a cross-sectional design study.

Results

Combat veterans reported more total average ACEs, were more likely to experience 3 or more ACEs and specific ACEs of physical abuse and emotional neglect, as compared to non-combat veterans. Combat veterans also reported higher levels of combat exposure, PMIEs, higher prevalence of MST and higher levels of PTSD symptoms, but not CPTSD symptoms, as compared to non-combat veterans. Importantly, ACEs, combat exposure, MST-assault and PMIEs of betrayal predicted PTSD symptoms, while only ACEs and PMIEs of betrayal predicted complex PTSD symptoms.

Conclusions

This study emphasized the relatively high exposure to PTEs and PTSD symptoms of women combat veterans as compared to non-combat veterans. Our findings also confirm prior studies demonstrating associations between ACEs, combat exposure, MST and mental health problems. Importantly, we demonstrated the unique contribution of betrayal based PMIEs and the differential associations of PTEs with PTSD and Complex PTSD symptoms among combat veterans.

Disclosure of Interest

None Declared