bluuebunny/crossref_metadata_2025 huggingface dataset:
Descriptive analysis of unfavorable mental health opinions of candidates for bariatric surgery
Authors: Pereira R. C. , Delgado A. , Ferreira F. M.
Published: August 2023

Introduction

In recent years, there has been an increase in the number of candidates for bariatric surgery and a decrease in psychiatric contraindications.

Objectives

We aim to make an descriptive evaluation of unfavorable feedback concerning mental health of the candidates for bariatric surgery of the Local Health Unit of Matosinhos (Porto, Portugal).

Methods

Descriptive analysis of unfavorable feedback of mental health of candidates for surgical treatment of obesity.

Results

From March 2017 to August 2022, the Mental Health Service of the Local Health Unit of Matosinhos issued 347 pre-surgical feedback. In 63 cases the initial opinion issued was unfavorable: 11 cases due to a psychiatric contraindication (not meeting conditions for intervention) and 52 cases had a conditional opinion (requiring pre-surgical interventions in order to become eligible for the intervention). Regarding contraindications, these were due to alcohol use disorder (n=3), binge eating (n=3), intellectual development disorder (n=2), purgative behavior (n=1), psychotic disorder (n=1) and mood disturbance (n=1). In terms of conditional opinions, the issues mencioned were lack of motivation for surgery (n=22), psychopathology (n=20), doubts about informed consent (n=8) and need for multidisciplinary discussion/coordination (n= 7).

Conclusions

There was an increase in eligibility of candidates for surgical treatment as most of the initial unfavorable opinions were conditional. This could be explained by the decline of complications associated with bariatric surgery, but also because psychiatric disorders are now being viewed as treatable. Notably people with eating disorders are now fit for surgery after a medical or psychotherapeutic intervention.

Disclosure of Interest

None Declared
Effect of antidepressant therapy on the severity of COVID 19 symptomatology in the hospitalized patients
Authors: Spirkoska L. , Spasovska Trajkovska A. , Mitik Z.
Published: August 2023

Introduction

Some studies reported that vaccines are extremely good at preventing serious illness but that many countries have had difficulty vaccinating their citizens, and even some vaccinated people may still be at risk for serious COVID-19 symptoms due to underlying medical illness or reduced immunity over time.

Objectives

Some researches reported that drugs known as selective serotonin-reuptake inhibitors (SSRIs) interacts strongly with the sigma-1 receptor, a protein inside cells that helps regulate the body’s inflammatory response. So its believe that this drug most likely is interacting with the sigma-1 receptor to reduce the production of inflammatory molecules in the body, So treatment with this therapy may be highly effective to reducing severe of COVID symptomatology.

Methods

The cross-section study included two groups of patients (N = 30) of different sex ±49,2 age, all were treated in Covid Centre , Skopje. The study was conducted for 6 months all the patients was writing informed consent. The first group consisted of COVID patients who had previously suffered from psychiatric illness and had been treated with antidepressant therapy (SSRi). The second group are the COVID patients who had not been treated with antidepressant before. The severity of COVID 19 symptomatology (based on medical documentation- classification of disease severity) was determined using the Modified Early Warning Score (MEWS scale) . MEWS score 0-2 mild or asymptomatic (stable patients), 3-4 moderately severe (unstable patients), ≥ 5 highly critical(critical patients). The obtained data were processed by descriptive method and Student t-test.

Results

. The results in our study show that the patients who were treated with antidepressants before covid disease showed a lower score on the NEWS scale but there is a not statistically significant results p=0,06 when compare with another examination group

Conclusions

: The results in our study supports considerations about the possible impact of antidepressant therapy on alleviating COVID 19 symptomatology.

Disclosure of Interest

None Declared
Social connection and depression: an umbrella review of meta-analyses assessing the magnitude of risk and protection
Authors: Pettorruso M. , Collevecchio R. , Zoratto F. , Collacchi B. , Boffa M. , Santorelli M. , Clerici M. , Martinotti G. , Borgi M.
Published: August 2023

Introduction

Depression is a severe mental disorder with an estimated 3.8% of the population affected, representing a leading cause of disability worldwide. Being linked to reduced quality of life and individual functioning, medical morbidity and mortality, depression has a huge social and economic impact. A wide range of potentially modifiable factors for depression has been identified. Among these, social factors (e.g. support/engagement) appear to play a major role in the emergence and severity of depression.

Objectives

We aimed at providing a quantitative synthesis of the consistency and magnitude of the association between measures of social connection and depression. Social connection included both quantitative (i.e. existence/absence of social relationships) and functional (i.e. support provided) measures of social relationships, as well as measures focusing on social inequalities related to participation in community spaces/activities (i.e. social discrimination).

Methods

We searched PubMed, PsycINFO, Cochrane Library and EMBASE. The strength of the association between exposure factors (social measures) and depression was extracted and equivalent odds ratios were computed to compare the strength of the effect sizes among meta-analyses. The quality of each review was assessed using AMSTAR-2.

Results

As a result of the selection process 47 studies were included in the umbrella review. Social support was found to have a protective role on depression, with an observed moderate/strong effect in peripartum population and a weaker effect in clinical populations (e.g. AIDS/HIV patients). A moderate association between stigma/discrimination and depression emerged in clinical populations (e.g. epilepsy, mental illness, post-stroke), while a weaker effect was found in (ethnic) minorities. There are still few studies quantitatively investigating the link between depression and other social measures (e.g. community connectedness).

Conclusions

Our findings align with the literature on social connection and mental health, confirming the role of social determinants in the emergence and severity of depression, particularly in the case of vulnerable populations. Social factors emerge as important modifiable targets in the context of depression prevention. Efforts to counteract disconnection at the societal and individual levels and to reduce stigma should be central to an effective depression prevention agenda.

Disclosure of Interest

None Declared
Is the most really the best: a review for the most selective SSRI concept three decades later
Authors: Allam M. A.
Published: August 2023

Introduction

Pharmaceutical slogans presuming a particular antidepressant molecule being the best solely based on a core concept could be proved “not accurate” especially following patients’ actual exposure to the antidepressant for longer than the usual six or twelve weeks’ trials

Objectives

Reviewing the current situations of SSRI induced anhedonia recognition and its management. Distinguishing anhedonia as a core symptoms of depression from SSRI induced anhedonia and the combination of both.

Methods

Review of literatures including theses related to the same topic

Results

Research suggests that, SSRIs might be more effective at treating some symptoms than others. More specifically, it has been suggested that, SSRIs might be more effective at improving symptoms such as low mood and anxiety but not anhedonia (Argyropoulos et al. psych.pharmaology, 2013; 27(10), 869-877). It has been proposed that, catecholaminergic antidepressants might be more effective treatments for anhedonia and emotional blunting in MDD than SSRIs (McCabe et al. Biological psychiatry, 2010; 67(5), 439–445. The primary effect of SSRIs is reduced processing of negative stimuli rather than increased positive stimuli. Emotional blunting is related to SSRI dose and possibly serotonergic effects on the frontal lobes and/or serotonergic modulation of midbrain dopaminergic systems projecting to the prefrontal cortex (PFC). By enhancing serotonergic transmission, SSRIs can activate the inhibitory Gamma Aminobutyric Acid (GABA) interneurons, thereby dampening the noradrenergic and dopaminergic input ( Blier. Int J Neuropsychopharmacol., 2014; 17:997–1008).

Management of SSRI induced anhedonia includes lowering the current SSRI dose. Adding non SSRI antidepressant to the current SSRI dose or to a lowered SSRI dose. Gradual discontinuation of the SSRI and switching to another antidepressant with a different profile (SNRI) that might improve the patient’s emotional response (Koenigs. Behav Brain Res., 2009;201:239–43).

Bupropion is an antidepressant with less possibility to give rise to emotional blunting. (Tomoko et al. Neuroscience Letters., 2021; 749, 135716. agomelatine(Thome et al. Journal of neural transmission., 2015; 122(1), 3-7.Vortioxetine and others (Bing et al. frontiers in psychiatry., Jan, 2019; 10-17. are of inrerest in this regard.

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Conclusions

The most selective SSRI concept assumes that most selective means less affinity to other receptors or secondary binding sites which might suggest less side effects and perhaps being the most efficacious. Not only serotonin but multiple neurotransmitters are in action at the downstream part of a cascade of events underpinning the etiology of MDD. MDD has heterogeneous etiology and this explains why patients respond differently. SSRI induced anhedonia could be tackled and we need to explore how many patients would benefit from that now and have not yet.

Disclosure of Interest

None Declared
Prevalence of Treatment Resistant Psychoses in a Complete National Forensic Mental Health Service: A Dundrum Forensic Redevelopment Evaluation Study (D-FOREST)
Authors: Waqar M. U. , Amin H. , Ní Mhuircheartaigh E. , Kennedy H. G. , Davoren M.
Published: August 2023

Introduction

Treatment resistant schizophrenia and other treatment resistant psychotic disorders are believed to be over-represented in forensic patient clusters. The true rates of treatment resistant psychoses in secure forensic hospitals remain unexplored.

Objectives

This study aimed to ascertain the prevalence of treatment resistant psychoses within a complete national forensic mental health service. In addition, the study sought to examine the relationships between treatment resistance for psychotic symptoms and treatment resistance in other domains, such as offending behaviour.

Methods

This is a cross-sectional study of a complete cohort of patients admitted to the National Forensic Mental Health Service in Ireland during the period 01/11/2021 to 31/01/2022. All inpatients at the time of the study were included. Demographic details, data appertaining to diagnosis, medication, measures of risk (HCR-20), recovery (DUNDRUM toolkit), functioning (GAF), and symptoms (PANSS) were collated. Data were gathered as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST).

Results

The sample consisted of 170 patients. Majority (n=162) 95.3% were male. The majority (n=116), 68.2%, were admitted from prisons, while a smaller number (n=35), 20.6%, were admitted from other psychiatric facilities. The insanity defense (n=94) 55.3% was the most common legal status, followed by unfit to plead (n=16) 9.4%. The commonest diagnosis was schizophrenia (n=97) 57.1%, followed by schizoaffective disorder (n=27) 15.9% and autism spectrum disorder (n=5) 2.9%. The mean age at admission was 35.52 years and the median age was 34.37 ± 9.43 SD.

Of the total sample, 25.9% of patients were on more than 1000 mg per day chlorpromazine equivalent (CPZE) doses. Those whose psychotic symptoms required treatment with CPZE doses over 1000 mg per day scored poorly on DUNDRUM-3 programme completion, DUNDRUM-4 recovery scale, HCR-20 historical, HCR-20 clinical, HCR-20 risk, HCR-20 dynamic, and had poorer overall functioning (all P<0.001) than those who required lower antipsychotic doses. On binary logistic regression, correcting for age and gender, the only variable that remained significant was GAF (adjusted odds ratio = 0.979, 95% CI 0.962-0.996, P=0.014). In forward entry model regression, only the DUNDRUM-4 recovery scale (odds ratio = 1.13, 95% CI 1.07-1.19, P<0.001) and GAF (adjusted odds ratio = 0.979, 95% CI 0.962-0.996, P<0.001) were significant. This model had a robust forward and backward likelihood ratio.

Conclusions

Rates of treatment resistant psychoses in forensic hospital groups are indeed elevated. Overall functioning on GAF and recovery across a wide range of components in the DUNDRUM-4 scale are the best predictors of treatment resistant psychosis.

Disclosure of Interest

None Declared
Co-producing a physical activity intervention in two forensic psychiatry settings in the UK: The IMPACT study
Authors: Walker T.
Published: August 2023

Introduction

In the UK there are 3500 individuals detained in medium secure forensic psychiatry units. Service users in such settings have complex and serious mental illness (SMI), often with co-morbid physical health problems and a life expectancy of at least 10 years shorter than the general population. They often have low levels of physical activity. There is little evidence about physical activity interventions for medium secure service users in the United Kingdom.

Objectives

Our objective is to co-produce, with medium secure service users, the content and delivery of an intervention to increase physical activity. We shall assess feasibility, acceptability and pilot data collection methods for outcomes relevant for a future randomised controlled trial.

Methods

This is a 24-month mixed-methods project that will follow the Medical Research Council (MRC) framework Developing and Evaluating Complex Interventions. The study has 4 phases.

- Phases 1-2 will gather information required to co-develop an evidence based intervention in Phase 3.

- Phase 4 will assess the intervention in a feasibility study, evaluating and testing the intervention for a future pilot study.

Study settings: Two NHS Medium Secure In-Patient Psychiatric Hospitals in the UK.

Results

This paper presents the findings from the Phase 1 questionnaire and focus groups with service users and hospital staff that identified the barriers and facilitators to physical activity in such settings. The results are then discussed in relation to the Phase 2 qualitative results that explored stakeholders’ and service users’ opinions into how to increase physical activity among medium secure service users by identifying potential elements for inclusion in a physical activity intervention, to gain insight into how we can establish engagement of this group with the intervention, maintain commitment, avoid drop-out and develop the intervention design. All findings are presented using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model), which is widely used to identify what needs to change for a behaviour change intervention to be effective.

Conclusions

The findings of Phases 1-2 are allowing the team to move forward with Phase 3 that is currently developing an intervention to increase physical activity for adult inpatient service users in the medium secure units. This phase will be guided by the MRC framework and the COM-B model to define the target behaviours and select the most suitable intervention components (functions and techniques) and implementation approach.

Disclosure of Interest

None Declared
From “cutaneous anthrax” to “primary delusional infestation”
Authors: Ferreira I. A. , Ponte A.
Published: August 2023

Introduction

Primary delusional infestation is a rare psychiatric condition in which patients mistakenly believe that their skin or other body parts are infested by small, living organisms, despite the fact that no organisms can be found upon investigation. The delusion occurs concurrently with abnormal cutaneous sensations. Therefore, they typically have a history of prior negative evaluations by dermatologists and general practice physicians. In addition, patients may have also received repeated courses of dermatologic and anti-infective therapies, despite the lack of an objective diagnosis.

Objectives

To describe the clinical case of a patient who suffered from an undiagnosed primary delusional infestation for 12 years.

Methods

Description of a clinical case and a non-systematic review of the literature.

Results

We describe the clinical case of a 65-year-old woman who spent 12 years being evaluated by multiple medical and surgical specialties for the following complaint: “sensation of something moving beneath the skin.” At the onset of the complaint, the patient believed that this “strange sensation” was due to a recent tooth procedure. However, as she felt the discomfort not improving, she believed it to be a consequence of a cutaneous anthrax infection. Thus, the patient started using tweezers to grasp the living organism that was bothering her and that behavior caused intense scaring in her face. Meanwhile, the patient was also submitted to 3 cutaneous biopsies (prescribed by a dermatologist) that refuted the hypothesis of any living organism underneath her skin. In addition, the patient was prescribed sertraline, bromazepam and lorazepam that, although improved her sleep and anxiety levels, were inefficient to treat the root of her suffering. Finally, after 12 years of dispersed medical follow-up, this patient was evaluated by a new psychiatrist and prescribed paliperidone that rapidly made the agonizing “strange sensation” disappear.

Conclusions

Even though primary delusional infestations are a rare psychiatric diagnosis, all medical doctors should consider it when their patients report bothersome dermatologic complaints associated with the belief of infestation and negative diagnostic examinations. It is incredibly important to consider this diagnostic, as the early treatment of this entity might prevent the patient from undergoing multiple years of suffering and discomfort.

Disclosure of Interest

None Declared
The relationship between visual hallucinations, functioning and suicidality over the course of illness: a 10-year follow-up study in first-episode psychosis
Authors: Kreis I. , Fjelnseth Wold K. , Åsbø G. , Simonsen C. , Melle I.
Published: August 2023

Introduction

Visual hallucinations are a common symptom across psychotic disorders and have been linked to illness severity, impaired functioning, and increased suicide risk. However, little is known about the stability of this relationship over the long-term course of illness.

Objectives

This study aims to assess whether the presence of visual hallucinations is associated with illness severity, functioning and suicidality, early and late in the course of illness. It further explores the potential role of childhood trauma in this context, which has been linked to both visual hallucinations and suicidality.

Methods

A sample of 185 individuals with first-episode psychosis was assessed with structured clinical interviews and self-report questionnaires at time of study inclusion and at 10-year follow-up. Those with lifetime experience of visual hallucinations at inclusion (VH+/+) as well as those where visual hallucinations first developed during the follow-up period (VH-/+) were compared to a group without such experiences (VH-/-). To this end, multinomial logistic regression models were applied, with a range of clinical and demographic variables as predictors.

Results

At time of inclusion, the VH+/+ group had significantly higher symptom severity scores, lower functioning scores, and were more likely to have a history of multiple suicide attempts. There were no such differences between the VH-/+ and the VH-/- group. At follow-up, this pattern of findings partially reversed. Here, only the VH-/+ group differed from the VH-/- group in terms of higher symptom severity scores and lower functioning scores. However, the VH+/+ group was still more likely to report multiple suicide attempts during the follow-up period, whereas VH-/+ did not differ from VH-/-. Notably, childhood trauma scores did not differ between groups.

Conclusions

In line with previous studies, these findings point to an association between visual hallucinations and illness severity, functioning and suicidality. However, this association seems to change over the course of illness. Together, this highlights the relevance of assessing visual hallucinations in the clinical setting and monitoring their development over time.

Disclosure of Interest

None Declared
Psychotic depression and the risk of death due to suicide
Authors: Paljarvi T. , Tiihonen J. , Lähteenvuo M. , Tanskanen A. , Fazel S. , Taipale H.
Published: August 2023

Introduction

Depression markedly increases the risk of suicide, and depression is the most common psychiatric disorder diagnosed in persons with a completed suicide, but the interplay between depression and psychotic symptoms in suicides has remained unsettled.

Objectives

The purpose of this study was to establish the risk of suicide associated with incident psychotic depression (PD) compared to incident non-psychotic severe depression (NPD) in a large nationwide cohort.

Methods

This cohort study used routine data from nationwide health registers in Finland. Eligible participants were aged 18 ̶ 59 years at the index diagnosis. Causes of death were defined by the International Classification of Diseases, 10th revision codes. The follow-up time was up to five years. Adjusted Cox regression models were used to analyse risk of death by method of suicide.

Results

We included 17331 individuals with incident PD and 85989 individuals with incident NPD. Most of the deaths due to suicides occurred within the first two years after the index diagnosis. Compared to NPD, PD was associated with an overall two-fold increased risk of suicide (adjusted hazard ratio, (aHR) 2.19, 95% confidence interval (CI) 1.95, 2.46), after adjusting for psychiatric comorbidities. In PD, the highest relative risks were for impact-related suicides (aHR 3.03, 95%CI 2.23, 4.13) and for suffocation-related suicides (aHR 2.72, 95%CI 2.23, 3.30), whereas the lowest relative risk was for intentional poisonings (aHR 1.66, 95%CI 1.37, 2.02).

Conclusions

Psychotic symptoms increased the risk of suicide 2-fold of the risk that was associated with severe depression, after controlling for comorbid psychiatric disorders. The severity of suicidal ideation may be higher in PD than in NPD, which then leads to more lethal methods of self-harm.

Disclosure of Interest

T. Paljarvi: None Declared, J. Tiihonen Grant / Research support from: Janssen-Cilag, Eli Lilly, Consultant of: HLS Therapeutics, Orion, and WebMed Global, Speakers bureau of: Eli Lilly, Evidera, Janssen-Cilag, Lundbeck, Mediuutiset, Otsuka, Sidera, and Sunovion, M. Lähteenvuo Shareolder of: Genomi Solutions ltd, Nursie Health ltd, Springflux ltd, Grant / Research support from: Finnish Medical Foundation, Emil Aaltonen Foundation, Speakers bureau of: Sunovion, Lundbeck, Otsuka Pharma, Orion Pharma, Recordati, Janssen, Janssen-Cilag, A. Tanskanen Grant / Research support from: Janssen-Cilag, Eli Lilly, S. Fazel Grant / Research support from: Wellcome Trust, H. Taipale Grant / Research support from: Janssen-Cilag, Eli Lilly, Academy of Finland, Speakers bureau of: Janssen-Cilag, Otsuka
Identifying early signs of Treatment Resistance in First Episode Psychosis to revise and aid further treatment
Authors: Wold K. F. , Flaaten C. B. , Åsbø G. , Widing L. , Melle I.
Published: August 2023

Introduction

Approximately 1/3 of patients with first episode psychosis (FEP) will not benefit from antipsychotic medications and are considered treatment resistant (TR). TR is currently defined as sustained lack of remission with functional loss in the context of two adequate trials of different antipsychotics. Studies suggest that early initiation of clozapine treatment support a better course of illness in TR. Most treatment guidelines recommend clozapine after two antipsychotic failures. In practice, increased dosages of other antipsychotics or polypharmacy are tried out first. Identifying early signs of TR and revising treatment is thus important. Since the TR definition requires adequate lengths of treatment attempts, they are difficult to apply in FEP.

Objectives

The aim of the current study is to 1) investigate if a shorter observation period can be used to identify subgroups of FEP patients with early signs of TR (no indication of early clinical recovery - NoECR) and 2) investigate differences in antipsychotic treatments over the first year compared to patients in full or partial early recovery (ECR/ partial ECR).

Methods

Participants 18 to 65 years in their first year of treatment were recruited from major hospitals in Oslo. The participants met the DSM-IV criteria for schizophrenia, schizophreniform disorder, schizoaffective disorder, and psychotic disorder NOS. A total of 387 completed baseline clinical assessments and 207 one-year follow-up. The SCID-I for DSM-IV was used for diagnosis, symptoms were measured with the SCI-PANSS. Treatment history was gathered through interviews and medical charts. No-ECR was defined as a) Not meeting remission criteria for at least 12 weeks at follow-up, and b) Not regained functioning, i.e., a GFS score < 60. ECR was defined as a) Meeting the criteria for remission and b) Regained functioning, i.e., a GFS score >=61. Partial ECR did not meet these criteria.

Results

At one year follow-up, 47% met the criteria for no-ECR, 29% the criteria for ECR and 24% the criteria for partial ECR. Baseline predictors of the no-ECR group corresponded to previously identified predictors of long-term TR. Only 35 (17%) participants met the full criteria for TR at this point. Of the 97 in the no-ECR group, 18 (19%) were in an ongoing trial (p<0.001 vs ECR/partial ECR) and 21 (22%) were using the same medication over the whole follow-up year (p =.008 vs ECR /partial ECR) despite lack of significant clinical effect.

Conclusions

We show that the mostly used consensus definition of TR identifies only a proportion of FEP patients without sufficient clinical and functional improvement at one year follow-up. The main reason for not meeting the criteria is a lack of two adequate antipsychotic trials at this point of time. However, only half of these were in an ongoing trial despite recommendations in clinical guidelines.

Disclosure of Interest

None Declared
Analysis of the predictive potential of good clinical response of plasma levels of clozapine in patients with resistant schizophrenia in an area of southern Spain
Authors: Muñoz-Manchado L. I. , González-Saiz F. , Pérez-Revuelta J. I. , Laherrán-Cantera N. , Pardo-Velasco R. J.
Published: August 2023

Introduction

Resistant schizophrenia is a schizophrenia subtype characterized by a non-ability to respond to an appropriate antipsychotic treatment in dosage and duration by the patients. These patients show a lower prognostic and symptomatology. The unique drug which has shown efficacy for resistant schizophrenia treatment is clozapine, which is effective in suicide and aggressive behaviour prevention too. Whereas clozapine has numerous and serious adverse effects such as agranulocytosis risk. Because of this, and for guaranteeing an accurate diagnosis of resistant schizophrenia, distinguishing this from pseudo-resistance due to a poor tracing of schizophrenia, clozapine’s plasmatic levels monitoring is recommended in Spain by many clinical practise-guidelines.

Objectives

This studio has the objective of determining if altered clozapine’s plasmatic levels have predictive potential of therapeutical response and answering what clinical and sociodemographic variables are associated to these anormal plasmatic levels.

Methods

In this work, a cross-sectional observational study was carried out in which clinical and sociodemographic data obtained by the Mental Health Unit of the Jerez de la Frontera University Hospital were collected within the research project entitled: "Role of social cognition as a factor psychosocial functioning of the schizophrenic patient” (ECOFUN), of all the participating patients (in total the sample was 141 patients, of which 40 are in treatment with clozapine).

Results

The sample of patients has a mean age of 44 years and medium-high educational levels. The vast majority are men and do not currently consume substances of abuse, and when this consumption occurs, tobacco and alcohol are the most consumed substances. Their total scores on the PANSS and Markova Barrios scales are generally very disparate, but with average values of 55 and 16. It has been obtained as results that there is no significant statistical correlation between the plasma levels of clozapine and the values of the PANSS scale and its subscales in the patients. On the other hand, patients treated with clozapine would present clinical and sociodemographic characteristics practically identical to those of patients treated with other antipsychotics, especially their values on the PANSS scale. In addition, plasma levels of clozapine are correlated, although not significantly, with an improvement in the positive symptomatology of schizophrenia.

Conclusions

As a conclusion, unusually higher values of clozapine are correlated significantly with lower values in positive symptomatology in schizophrenia, but plasmatic levels are not correlated significantly with values of PANSS scale.

Disclosure of Interest

None Declared
Work Stress, Overcommitment and Somatization among Early Childhood Professionals during COVID-19: A Cross-sectional Study
Authors: Gritzka S. , Angerer P. , Diebig M.
Published: August 2023

Introduction

In addition to posing major public health challenges, the COVID-19 pandemic has affected psychological and physical stressors in workplaces as well as strain by workers worldwide. Even prior COVID-19, the working conditions of early childhood professionals (ECPs) were described as critical leading to (psycho)somatic complaints. Despite the high societal relevance of ECPs and the potential increase in stressors caused by COVID-19, there is a lack of empirical evidence to which extent work-related demands had an adverse effect on ECPs health during COVID-19.

Objectives

We aimed to obtain updated prevalence rates of somatic symptoms of ECPs as well as unfavourable working conditions inducing stress (in terms of an effort-reward imbalance; ERI) in childcare. The overall objective was to establish associations between work stress and health during the early phase of the pandemic. Given the tendency of ECPs to overcommit themselves, we further explored the potential moderating role of overcommitment.

Methods

Between June 2020 and May 2021, questionnaire data was collected using validated instruments (i.e., ERI, PHQ-15) from ECPs in childcare centers as well as from family providers (N = 1.009). ECPs were informed about the study and contacted through the youth welfare office. Multiple logistic regression tested the influence of ERI and overcommitment on the severity of somatic symptoms. It was controlled for age, gender as well as leadership position. SPSS 28.0 was used to analyze the data.

Results

The ERI ratio of the sample averaged 1.28 (SD = 0.45), with 72.7% of subjects exceeding the critical cut-off value > 1, indicating a gratification crisis. The averaged sum score of the PHQ-15 was 8.99 (SD = 5.43). Based on a PHQ-15 cut-off ≥ 10, the overall prevalence of somatization at a moderate to high level is estimated to be 44.6%. The mean overcommitment score was 15.14 (SD = 3.55) and 23.4% of ECPs were in the highest overcommitment tertile. ERI (OR = 4.12, 95% CI: 2.73 - 6.22) and overcommitment (OR = 5.20, 95% CI: 2.17 - 12.47) were associated with an increased likelihood of greater severity of somatic symptoms. Yet, the interaction effect between both predictors remained non-signifcant. Being female and having no leadership position were predictors for a moderate to high level of somatization.

Conclusions

The results demonstrate the high relevance of work stress for somatic health among ECPs in the midst of a pandemic. Given the high overall prevalence of somatic symptoms and the female-dominated work sector, ECPs may be at high risk for somatoform disorders. There remains a strong need for action to reduce work-related stress in order to decrease the somatic symptom burden. Large-scale and longitudinal studies are needed to further investigate coping with and persistence of somatic symptoms among this occupational group.

Disclosure of Interest

None Declared
The behavior of Tunisian students toward people with mental illness
Authors: Ben Amor M. , Zgueb Y. , Aissa A. , SchöBerlein Ouali U. , Zaibi Jomli R.
Published: August 2023

Introduction

Over the years, several studies have shown the high rate of discrimination experienced in particular by mental health service users. Stigma is composed of three elements: knowledge, behaviors, and attitudes. Although behaviors are the core of discrimination, this element has often been overlooked or intertwined with the other components.

Objectives

Our study aimed to assess Tunisian students’ behavior toward people with mental illness

Methods

This was a cross-sectional study conducted on 2501 Tunisian students who anonymously completed a form circulated online through social network groups and pages related to each academic institution. We have used the validated Arabic version of the “Reported and Intended Behaviour Scale” (RIBS) which assesses self-reported mental health behaviors and future intentions.

Results

The median RIBS score was 15 out of 20, ranging from 4 to 20. Among the participants, 40% were living or have lived with someone with a mental health problem and 49.7% would be willing to live with someone with a mental health problem. Moreover, 24% were working or have worked with a person with a mental health problem and 53.4% would be willing to work with him or her. In addition, 34% were having or have had a neighbor with a mental illness and 58% would be willing to have a neighbor with a mental illness. Finally, 51% were having or have had a close friend with a mental health problem and 83.7% answered that they would be able to maintain a relationship with a friend who had developed a mental health problem.

Conclusions

The assessment of behavior toward people with mental illness is fundamental as it has the most impact on individuals. However, behavior may be mediated by knowledge. Thus, it would be interesting to evaluate mental health knowledge to study the relationships between these constructs and optimize anti-stigma interventions.

Disclosure of Interest

None Declared
Integrating Artificial Intelligence with Quality by Design in the Formulation of Lecithin/Chitosan Nanoparticles of a Poorly Water-Soluble Drug
Authors: Dawoud Marwa H. S. , Mannaa Islam S. , Abdel-Daim Amira , Sweed Nabila M.
Published: August 2023

The aim of the current study is to explore the potential of artificial intelligence (AI) when integrated with Quality by Design (QbD) approach in the formulation of a poorly water-soluble drug, for its potential use in carcinoma. Silymarin is used as a model drug for its potential effectiveness in liver cancer. A detailed QbD approach was applied. The effect of the critical process parameters was studied on each of the particle size, size distribution, and entrapment efficiency. Response surface designs were applied in the screening and optimization of lecithin/chitosan nanoparticles, to obtain an optimized formula. The release rate was tested, where artificial neural network models were used to predict the % release of the drug from the optimized formula at different time intervals. The optimized formula was tested for its cytotoxicity. A design space was established, with an optimized formula having a molar ratio of 18.33:1 lecithin:chitosan and 38.35 mg silymarin. This resulted in nanoparticles with a size of 161 nm, a polydispersity index of 0.2, and an entrapment efficiency of 97%. The optimized formula showed a zeta potential of +38 mV, with well-developed spherical particles. AI successfully showed high prediction ability of the drug’s release rate. The optimized formula showed an enhancement in the cytotoxic effect of silymarin with a decreased IC50 compared to standard silymarin. Lecithin/chitosan nanoparticles were successfully formulated, with deep process and product understanding. Several tools were used as AI which could shift pharmaceutical formulations from experience-dependent studies to data-driven methodologies in the future.

Graphical abstract
Systematic Review—Type B Insulin Resistance With Isolated Hypoglycemia and Suppressed Insulin
Authors: Brown Natasha , Elston Marianne S
Published: August 2023

Objective

Type B insulin resistance syndrome is a rare autoimmune disorder affecting glucose homeostasis, characterized by serum autoantibodies to the insulin receptor (AIRAbs). Patients typically present with severe insulin resistance. A mixed hyper- and hypoglycemia phenotype may also occur, as may isolated hypoglycemia. The classic biochemical pattern comprises elevated insulin levels despite hypoglycemia; however, a small proportion of cases demonstrate “isolated hypoglycemia with low insulin.” The primary objectives of this systematic review were to identify the clinical characteristics and outcome of this subgroup.

Design

Systematic review of cases with hypoglycemia with suppressed insulin. Exclusions: hyperglycemia, elevated insulin, AIRAbs not confirmed.

Methods

PubMed, Medline, and Embase databases were searched up until February 2023 and complemented by manual citation search. The Joanna Briggs Institute critical appraisal checklist for case reports was used to assess bias.

Results

A total of 5342 articles were identified after duplicate removal. Eleven, all case reports, met all inclusion criteria and were included. Cases belonging to this subgroup were more diverse in sex, age, and ethnicity when compared with type B insulin resistance as a whole. Of the 11 cases, 3 developed lymphoma. High-dose corticosteroid therapy appeared to be effective therapy for the hypoglycemia, with often rapid response.

Conclusions

Isolated hypoglycemia with low insulin forms a rare subgroup of type B insulin resistance. These patients lack the common characteristics of hyperinsulinemic hypoglycemia and hyperglycemia/insulin resistance. Furthermore, while coexisting autoimmune disease is commonly observed, there is potentially an association with aggressive lymphoma, the onset of which may be delayed.
Serum MicroRNA-191-5p Levels in Vascular Complications of Type 1 Diabetes: The EURODIAB Prospective Complications Study
Authors: Bellini Stefania , Guarrera Simonetta , Matullo Giuseppe , Schalkwijk Casper , Stehouwer Coen D , Chaturvedi Nish , Soedamah-Muthu Sabita S , Barutta Federica , Gruden Gabriella
Published: August 2023

Context

MicroRNA-191-5p regulates key cellular processes involved in the pathogenesis of diabetic complications such as angiogenesis, extracellular matrix deposition, and inflammation. However, no data on circulating microRNA-191-5p in the chronic complications of diabetes are available.

Objective

To assess whether serum levels of microRNA-191-5p were associated with micro- and macrovascular disease in a large cohort of subjects with type 1 diabetes mellitus (DM1) from the EURODIAB Prospective Complication Study.

Design and Setting

Levels of microRNA-191-5p were measured by quantitative PCR in 420 patients with DM1 recruited as part of the cross-sectional analysis of the EURODIAB Prospective Complication Study. Cases (n = 277) were subjects with nephropathy and/or retinopathy and/or cardiovascular disease (CVD). Controls (n = 143) were patients without complications. Logistic regression analysis was performed to evaluate the potential independent association of microRNA-191-5p levels with chronic complications of diabetes.

Results

Levels of microRNA-191-5p were significantly reduced (P < .001) in cases compared with controls even after adjustment for age, sex, and diabetes duration. Logistic regression analysis revealed that microRNA-191-5p was negatively associated with a 58% reduced odds ratio (OR) of chronic diabetes complications, specifically CVD, micro-macroalbuminuria, and retinopathy (OR, 0.42; 95% CI, 0.23-0.77), independent of age, sex, physical activity, educational levels, diabetes duration, glycated hemoglobin, total insulin dose, hypertension, smoking, total cholesterol, albumin excretion rate, estimated glomerular filtration rate, serum vascular cell adhesion molecule-1, and tumor necrosis factor-α. Analyses performed separately for each complication demonstrated a significant independent association with albuminuria (OR, 0.36; 95% CI, (0.18-0.75) and CVD (OR, 0.34; 95% CI, 0.16-0.70).

Conclusions

In DM1 subjects, microRNA-191-5p is inversely associated with vascular chronic complications of diabetes.
Downregulated Adipose Tissue Expression of Browning Genes With Increased Environmental Temperatures
Authors: Oliveras-Cañellas Núria , Moreno-Navarrete José María , Lorenzo Paula M , Garrido-Sánchez Lourdes , Becerril Sara , Rangel Oriol , Latorre Jèssica , de la Calle Vargas Elena , Pardo Maria , Valentí Victor , Romero-Cabrera Juan L , Oliva-Olivera Wilfredo , Silva Camilo , Diéguez Carlos , Villarroya Francesc , López Miguel , Crujeiras Ana B , Seoane Luisa-Maria , López-Miranda José , Frühbeck Gema , Tinahones Francisco José , Fernández-Real José-Manuel
Published: August 2023

Context

Climate change and global warming have been hypothesized to influence the increased prevalence of obesity worldwide. However, the evidence is scarce.

Objective

We aimed to investigate how outside temperature might affect adipose tissue physiology and metabolic traits.

Methods

The expression of genes involved in thermogenesis/browning and adipogenesis were evaluated (through quantitative polymerase chain reaction) in the subcutaneous adipose tissue (SAT) from 1083 individuals recruited in 5 different regions of Spain (3 in the North and 2 in the South). Plasma biochemical variables and adiponectin (enzyme-linked immunosorbent assay) were collected through standardized protocols. Mean environmental outdoor temperatures were obtained from the National Agency of Meteorology. Univariate, multivariate, and artificial intelligence analyses (Boruta algorithm) were performed.

Results

The SAT expression of genes associated with browning (UCP1, PRDM16, and CIDEA) and ADIPOQ were significantly and negatively associated with minimum, average, and maximum temperatures. The latter temperatures were also negatively associated with the expression of genes involved in adipogenesis (FASN, SLC2A4, and PLIN1). Decreased SAT expression of UCP1 and ADIPOQ messenger RNA and circulating adiponectin were observed with increasing temperatures in all individuals as a whole and within participants with obesity in univariate, multivariate, and artificial intelligence analyses. The differences remained statistically significant in individuals without type 2 diabetes and in samples collected during winter.

Conclusion

Decreased adipose tissue expression of genes involved in browning and adiponectin with increased environmental temperatures were observed. Given the North-South gradient of obesity prevalence in these same regions, the present observations could have implications for the relationship of the obesity pandemic with global warming.
Treating Primary Aldosteronism-Induced Hypertension: Novel Approaches and Future Outlooks
Authors: Mullen Nathan , Curneen James , Donlon Padraig T , Prakash Punit , Bancos Irina , Gurnell Mark , Dennedy Michael C
Published: August 2023

Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with increased morbidity and mortality when compared with blood pressure–matched cases of primary hypertension. Current limitations in patient care stem from delayed recognition of the condition, limited access to key diagnostic procedures, and lack of a definitive therapy option for nonsurgical candidates. However, several recent advances have the potential to address these barriers to optimal care. From a diagnostic perspective, machine-learning algorithms have shown promise in the prediction of PA subtypes, while the development of noninvasive alternatives to adrenal vein sampling (including molecular positron emission tomography imaging) has made accurate localization of functioning adrenal nodules possible. In parallel, more selective approaches to targeting the causative aldosterone-producing adrenal adenoma/nodule (APA/APN) have emerged with the advent of partial adrenalectomy or precision ablation. Additionally, the development of novel pharmacological agents may help to mitigate off-target effects of aldosterone and improve clinical efficacy and outcomes. Here, we consider how each of these innovations might change our approach to the patient with PA, to allow more tailored investigation and treatment plans, with corresponding improvement in clinical outcomes and resource utilization, for this highly prevalent disorder.
Detection of Postpartum Hemorrhage Using Compensatory Reserve Index in Patients Undergoing Cesarean Delivery
Authors: Reppucci Marina L. , Rogerson Jonathan Seth , Pickett Kaci , Kierstead Stephanie , Nolan Margo M. , Moulton Steven L. , Wood Cristina L.
Published: August 2023

BACKGROUND:

Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. Early recognition and management are imperative for improved outcomes. The compensatory reserve index (CRI) is a novel physiological parameter that trends changes in intravascular volume, by continuously comparing extracted photoplethysmogram waveforms to a reference model that was derived from a human model of acute blood loss. This study sought to determine whether the CRI pattern was differential between those who do and do not experience PPH during cesarean delivery and compare these results to the American Society of Anesthesiologists (ASA) standards for noninvasive monitoring.

METHODS:

Parturients undergoing cesarean delivery were enrolled between February 2020 and May 2021. A noninvasive CRI monitor was applied to collect continuous CRI values throughout the intraoperative and immediate postpartum periods. Patients were stratified based on blood loss into PPH versus non-PPH groups. PPH was defined as a quantitative blood loss >1000 mL. Function-on-scalar (FoS) regression was used to compare trends in CRI between groups (PPH versus non-PPH) during the 10 to 60-minute window after delivery. Two subanalyses excluding patients who received general anesthesia and preeclamptics were performed.

RESULTS:

Fifty-one patients were enrolled in the study. Thirteen (25.5%) patients experienced PPH. Pregnant patients who experienced PPH had, on average, lower postdelivery CRI values (−0.13; 95% CI, −0.13 to −0.12; P < .001) than those who did not experience PPH. This persisted even when adjusting for preeclampsia and administration of uterotonics. The average mean arterial pressure (MAP) measurements were not statistically significant (−1.67; 95% CI, −3.57 to 0.22; P = .09). Similar trends were seen when excluding patients who underwent general anesthesia. When excluding preeclamptics, CRI values remained lower in those who hemorrhaged (−0.18; 95% CI, −0.19 to −0.17; P < .001).

CONCLUSIONS:

CRI detects changes in central volume status not distinguished by MAP. It has the potential to serve as a continuous, informative metric, notifying providers of acute changes in central volume status due to PPH during cesarean delivery.