bluuebunny/crossref_metadata_2025 huggingface dataset:
Title: Misdiagnosis in young females – Autism versus Borderline Personality Disorders
Authors: Sholinghur H.
Published: August 2024

Introduction

The diagnostic overlap between Autism Spectrum Disorder (ASD) and Emotionally Unstable Personality Disorder (EUPD), commonly referred to as Borderline Personality Disorder (BPD), presents a considerable challenge in psychiatric practice, particularly for young females. These complexities are amplified by gender biases in the healthcare system and can lead to misdiagnosis, affecting both treatment planning and long-term outcomes.

Objectives

There are differences and similarities between ASD and EUPD/BPD which encompass its own challenges in diagnosis and treatment

The presentation seeks to:

1.

Offer an in-depth overview of the relationship between ASD and EUPD/BPD in young females.

2.

Evaluate the diagnostic challenges associated with distinguishing between these two conditions.

3.

Discuss the practical implications of misdiagnosis on treatment and quality of life.

Methods

Drawing from a rich corpus of evidence, including longitudinal studies (e.g., Kerns et al., 2015; Gunderson et al., 2018), meta-analyses, and patient case studies, the presentation adopts a multidisciplinary approach. It utilises clinical interviews, validated diagnostic tools such as the Autism Diagnostic Observation Schedule (ADOS) and the Structured Clinical Interview for DSM-5 (SCID-5), as well as direct observation to provide a nuanced understanding of ASD and EUPD/BPD characteristics.

Results

Shared Characteristics: Both ASD and EUPD/BPD manifest challenges in social functioning and mood regulation, supported by studies indicating sensory sensitivities and affective dysregulation in both conditions (Zanarini et al., 2019; Happé et al., 2019).

Differentiating Factors: ASD individuals often struggle with verbal and non-verbal communication, whereas those with EUPD/BPD may excel in these areas but display emotional volatility and unstable relationships, substantiated by differing neurobiological markers (King-Casas et al., 2008; Minshew & Williams, 2007).

Misdiagnosis Risks: The failure to correctly diagnose these conditions may lead to ineffective or potentially harmful treatment plans (Zanarini et al., 2013; Solomon et al., 2012).

Necessity for Comprehensive Assessment: A multimodal and culturally sensitive diagnostic approach is essential for accurate clinical evaluation (Mandy et al., 2012; Betancur et al., 2009).

Conclusions

The complexities surrounding the accurate diagnosis of ASD and EUPD/BPD in young females necessitate a thorough and multifaceted approach. An incorrect diagnosis could have long-lasting implications, affecting not just the efficacy of therapeutic interventions but also the overall well-being and quality of life of the individual. This presentation underscores the critical importance of drawing from a robust body of evidence and utilising comprehensive diagnostic approaches to differentiate these conditions.

Disclosure of Interest

None Declared
Psychological immunity: A new mental health test for psychiatric samples
Authors: Zábó V. , Erát D. , Gonda X. , Harangozó J. , Iváncsics M. , Vincze Á. , Farkas J. , Balogh G. , Cowden R. , Oláh A. , Kéri S. , Purebl G. , Vargha A.
Published: August 2024

Introduction

The Mental Health Test serves as the operationalized, comprehensive measurement of Maintainable Positive Mental Theory which defines mental health (for either the non-clinical or psychiatric population) as a high level of global well-being, psychological, social and spiritual functioning, resilience, effective creative and executive functioning, savoring capacities, coping and enjoyment, regardless of the presence or absence of symptoms of psychopathology.

Objectives

To assist psychiatrists and clinical psychologists to assess their patients’ psychological immune competence–based capacities and resources, depending on the mental health disorder diagnosis and the severity of the symptoms, the present study examined the psychometric properties of the Mental Health Test in a psychiatric sample.

Methods

The research was carried out in four Hungarian healthcare facilities using a cross-sectional design. A total of 331 patients (140 male, 188 female, and 3 who preferred not to disclose their gender) completed the Mental Health Test, six well-being and mental health measures, and the Symptom Checklist-90. Clinical psychologists reported the mental disorder status of each participant.

Results

Confirmatory factor analysis showed a good fit of the five-factor model to the data for the clinical version of the Mental Health Test (CFI = 0.972, RMSEA = 0.034). High internal consistency coefficients (α: 0.70–0.84; ω: 0.71–0.85) and excellent external and content validity were reported. The Mental Health Test was not sensitive to sociodemographic indicators but was sensitive to correlates of well-being and symptoms of mental disorders in a psychiatric sample. Regression analyses demonstrated that unipolar depression and number of mental disorders were related to a lower overall Mental Health Test score. Personality disorders, unipolar depression, and the greater severity and higher number of mental disorders were associated with a lower global well-being score. Unipolar depression was related to lower savouring capacity. Self-regulation showed a correlation with the self-reported number of mental disorders only. Anxiety and somatization disorders, unipolar depression, and a higher number of self-reported mental disorders were related to a lower psychological resilience score. The regression model for the creative and executive efficiency subscale did not fit our data. The interaction of all combinations of psychotherapy and pharmacotherapy was significantly related to the overall Mental Health Test score and to the subscales. These results can later serve as a basis for designing intervention studies.

Conclusions

Our preliminary findings suggest that the Mental Health Test is a suitable measure for assessing mental health capacities and resources in psychiatric samples.

Disclosure of Interest

None Declared
Brain atrophy but not white matter lesions associate with ECT-related confusion
Authors: Politis A. A. , Kokras N. , Velonakis G. , Politis A. M.
Published: August 2024

Introduction

Patients undergoing electroconvulsive treatment (ECT) may display an acute confusional state, often characterized by transient disorientation, inattention, memory and cognitive deficits.

Objectives

In this retrospective medical chart naturalistic study, we sought the determine whether white mater lesions and brain atrophy associate with the emergence of confusion during ECT treatment and preliminary results are presented herein

Methods

Medical charts of 24 consecutive inpatients with depression admitted to a psychogeriatric ward and subjected to bilateral frontotemporal ECT were examined retrospectively for patient and clinical characteristics. Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores at admission and hospital discharge were retrospectively collected. Available brain Magnetic Resonance Imaging (MRI) scans were graded for lesions (white matter hyperintensities, WMH), parietal, temporal and global brain atrophy

Results

In this pilot study of mostly elderly patients, 50% displayed signs of confusion. All patients improved substantially, as indicated by MMSE and GDS scores, irrespectively of whether they experienced transient confusion during ECT. Preliminary results indicate that WMH are unrelated to the emergence of confusion. Instead, brain atrophy, and in particular temporal lobe and mostly frontal lobe atrophy associated with confusion

Conclusions

In our sample of elderly inpatients with depression subjected to bilateral ECT, preliminary results of this pilot study indicate that brain atrophy, as evidenced by MRI scans, appears as a predictor of post-ECT confusion. Moreover, the Pasquier scale, and specifically the scale sub-scores regarding brain atrophy in the frontal and temporal sulci, could prove useful in helping the clinician estimate the probability of ECT-related confusion during ECT treatment

Disclosure of Interest

None Declared
Alcohol and Sedative Use Disorders in the Lebanese Population: Role of Sleep and Psychiatric Factors
Authors: Chamoun K. , Wehbe N. , Salameh P. , Sacre H. , Atallah M. , Mouawad J. , Rabbaa L. , Megarbane B. , Hajj A.
Published: August 2024

Introduction

Alcohol and sedative substance use disorders are escalating global public health challenges. Lebanon has grappled with multiple crises, including economic, healthcare, and social issues.

Objectives

This study aimed to assess the correlates of the alcohol and sedative substance use risk scores with sociodemographic and clinical factors, including sleep disorders, chronotype, anxiety, and depression.

Methods

A cross-sectional study was conducted among the Lebanese population using several validated scales to assess the risk of alcohol and sedative substance use, including the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Other tools evaluated chronotype, sleep, and mood disturbances. Bivariate and multivariable analyses were then performed, taking the alcohol and sedative scores as dependent variables.

Results

A total of 646 participants were included. Multivariate analysis revealed positive and significant correlations between higher ASSIST-alcohol scores and personal history of alcohol abuse (B=4.61), family history of prescription substance abuse (B=1.763), psychiatric disorders (B=2.898), and worse Insomnia Severity Index scores (Beta=0.14). Conversely, ASSIST-alcohol scores negatively correlated with weight (B= -0.39) and morning chronotype (B=-0.084). Positive correlations were identified between higher ASSIST-alcohol scores and personal history of illicit substance abuse (B=2.834), prescription substance abuse (B=2.252), sleep quality (B=0.130), and sleep severity (B=0.082), while negatively correlating with cigarette smoking (B=-0.038).

Conclusions

This study elucidates the role of several predisposing factors to alcohol and sedative use disorders in Lebanon, including history of substance abuse, psychiatric disorders, sleep disorders, and chronotype. These findings advocate, in particular, for the integration of sleep disorder assessment and management into addiction rehabilitation programs.

Disclosure of Interest

None Declared
Impact of the Covid pandemic on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions: a systematic review and meta-analysis
Authors: Ching B. C. F. , Parlatini V. , Zhang S. , Abdul Cader H. , Penhallow J. , Voraite E. , Popnikolova T. , Wickersham A. , Downs J. , Simonoff E.
Published: August 2024

Introduction

Existing systematic reviews have suggested mixed effects of the Covid pandemic on the mental health of children and young people. Those with pre-existing mental health and neurodevelopmental conditions have been suggested to be disproportionately affected, but this has not been meta-analysed. Most reviews of studies in clinical populations to date only include cross-sectional studies during the first lockdown or longitudinal cohorts up to early 2021, which limits our understanding of causality and long-term effects. To our knowledge, this is the first systematic review and meta-analysis to examine the longitudinal impact of the pandemic on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions.

Objectives

To compare 1) mental health pre versus during Covid, and 2) mental health during Covid.

Methods

Medline, Embase, APA PsycInfo, and Global Health databases were searched up to August 2023. Longitudinal studies reporting mental health outcomes in children and young people (≤18 years old) with pre-Covid mental health and/or neurodevelopmental conditions were included. Cohorts were deemed eligible if children and young people were diagnosed using a diagnostic assessment, scored above clinical threshold on validated measures, or attended mental health services pre-Covid. Outcomes included internalising, externalising, and other symptoms. Studies were narratively synthesised by symptom category and meta-analyses performed where number of studies reporting the same outcomes were sufficient (≥5).

Results

6,083 records were identified and 21 studies (N=2,617) were included. These widely differed in country, setting, diagnosis, outcome, and timepoints under study. The narrative synthesis highlighted mixed findings in mental health changes during the pandemic for all three symptom categories showing increases, reductions, and no changes. Only studies reporting changes in internalising symptoms pre- versus during the pandemic were in sufficient number to be amenable to meta-analysis.

Conclusions

Our findings suggest the pandemic’s impact on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions were complex and varied. We highlight an urgent need for longitudinal Covid research on long-term mental health outcomes in this vulnerable group. Understanding risk factors and longitudinal trajectories is warranted to guide clinical practice and policy.

Disclosure of Interest

None Declared
A Challenging Conundrum; Learning Disability, Schizophrenia and Autism - a Case Report
Authors: Rouhani F. , Aperis G. , Digpal S.
Published: August 2024

Introduction

Psychiatric disorders are common in patients with learning disabilities. There are also patients with the triad of autism, schizophrenia and learning disability. Patients with this background can be admitted to general hospitals for psychiatric or non-psychiatric reasons.

We are presenting a case who had a very complicated clinical course and her discharge planning was challenging.

Objectives

The objective of this work was to show the challenges in the investigation, medical management, and discharge planning of the patients with concomitant learning disability, schizophrenia and autism.

Methods

We scrutinized the patient’s casenotes, including blood results and all relevant imaging. We paid a particular attention to all the entries from the psychiatry team, general medical doctors, oncologists, learning disability team and discharge planners.

Results

The lady had a protracted 4-month inpatient admission throughout which she was physically and verbally aggressive to hospital staff. She was deemed to lack capacity for hospital admission and treated in her best interests under Mental Capacity Act (MCA), frequently requiring sedation with Haloperidol and Lorazepam. Following consultation with the local Psychiatrist her medications were altered to: Risperidone 2 mg BD, Diazepam 5 mg OM, 5 mg afternoon and 10 mg evening, Procyclidine 5 mg BD, Chlorpromazine 25 mg BD, Promethazine 25 mg OD PRN, and Midazolam 10 mg buccal PRN.

A change in her clinical condition was noted by the Psychiatry team; increased agitation, confusion and dysarthria. A repeat blood test was advised, due to patient refusal this took weeks to achieve despite the use of buccal Midazolam following Anaesthesiologist advice. Although blood tests were not significantly deranged, she was treated for presumed urinary tract infection with a course of antibiotics. A urine sample was unobtainable.

She reported right breast pain and underwent a mammogram. This showed a hypoechoic lesion 8x7x9 mm. Following consultation with a Breast Surgeon and Oncologist, Letrozole was replaced with Tamoxifen. The Psychiatric team concluded that the clinical deterioration with dysarthria was related to anxiety, associated with Autistic patients. The movement disorder was deemed secondary to antipsychotics exacerbated by stress and anxiety.

The patient’s discharge planning was complex. She was declined by numerous care homes. At time of writing, she remains an inpatient.

Conclusions

The management of patients with a triad of Learning Disability, Schizophrenia and Autism is extremely difficult, particularly within an acute medical setting. Physical deterioration could be related to medication adverse effects or change in environment. Anxiety and stress are linked to these conditions. The challenging behaviour that these patients often have will make discharge planning very difficult as specialised care homes to accommodate these unique patients are very limite

Disclosure of Interest

None Declared
Sociodemographic and Clinical Profile of Perpetrators of conjugal Homicides
Authors: Haouari W. , Omri S. , Labyadh A. , Feki R. , Gassara I. , Zouari L. , Ben Thabet J. , Charfi N. , Maalej M. B. , Smaoui N. , Maalej M.
Published: August 2024

Introduction

Conjugal homicide refers to the act of killing a current or former intimate life partner, regardless of their marital status. This type of behavior is still inadequately addressed by prevention programs, as it is often regarded as exceptional compared to other forms of domestic violence.

Objectives

To describe the sociodemographic, clinical, and criminological data of individuals who commit spousal homicide.

Methods

This is a retrospective descriptive study of 21 psychiatric expertise files conducted between January 2002 and September 2023 in the psychiatric department of Hedi Chaker Hospital in Sfax. Sociodemographic, clinical, and criminological data were collected from criminal psychiatric expertise files and supplemented with information from medical records.

Results

The perpetrators of spousal homicide were predominantly male (85.7%), had an educational level above secondary school (57.1%), were married (85.7%), and had an average age at the time of the act of 40.3 years. Most of them had no psychiatric history (81%) or legal history(85%), and only 19% were using psychoactive substances.

Among the perpetrators, 66.7% had a history of violence against their partners, with threats of homicide in 19% of cases. The majority of homicides occurred during the day (42.9%), in a public place (28.6%), were perpetrated in isolation (95.2%), happened impulsively (47.6%), and employed a single method (81%), with knives being the primary weapon (42.9%). In 76.2% of cases, the perpetrators of spousal homicides were found criminally responsible, while 19% were hospitalized in a psychiatric setting as part of a judicial non-prosecution decision.

Conclusions

The study of specific characteristics of spousal homicides holds crucial importance for the early detection of domestic violence situations that carry a lethal risk. By highlighting these particularities, it enables the development of more targeted prevention strategies.

Disclosure of Interest

None Declared
Impact of social media on Working Memory and Academic Performance of Undergraduate Students- A Cross-sectional Study
Authors: Mgbedo N. E. , Musa M. E. , Chhikara P. , Chaturvedi R. , Vyas N. , Zavradashvili N.
Published: August 2024

Introduction

Over the course of the last decade social media has become a very important part of the human experience; it has become the main source of communication and entertainment for a lot of people young and old.

Objectives

This study aimed to examine the influence of social media on undergraduates working memory and academic performance. We assessed the association between the harmful use of social media on gender differences, physical activities, academic performance, and working memory.

Methods

This cross-sectional study was designed to examine the effect of social media on the working memory of undergraduate students from three different Universities in Georgia involving 722 participants. The collection survey form was distributed among Undergraduate students from the University of Georgia (UG), Eastern European University (EEU), and Batumi State University (BSU) through google forms from 14th June to 2nd July 2023. The questionnaire consisted of sociodemographic characteristics (e.g., age, gender, and institution), social media disorder scale (SMD), academic performance scale (APS), and working memory (WM).

Results

58.7% were female students, the mean age was 21.94 (SD ± 2.8), and most of the participants were international students. More students from Tbilisi had persistence (59.8%), escape (69%) complaints, and students from Batumi had more preoccupation (43%), persistence (62.5%) and escape (65.7%) complaints. 64.1% of female students are at increased risk of using social media as an ‘escape’ from negative feelings (OR 0.50; χ2 (18.206), p= 0.000, 95% Cl[0.368-0.692]). 51.6% of male students and 48.4% of female students had the risk of ‘conflict’ with families and friends because of social media (OR 1.65; χ2 (6.507), p= 0.011, 95% Cl[1.122-2.452]. 80.3% of students that had good academic performance are at risk of neglecting activities such as hobbies, sports, and class assignments because of social media (OR 0.63; χ2 (5.133), p= 0.023, 95% Cl[0.425-0.942]). 94% of students with good working memory had the risk of withdrawal complaints (OR 0.34; χ2 (6.865a), p= 0.009, 95% Cl[0.154-0.793]). As 93.4% of having conflicts with parents, siblings, and partners because of social media.

Conclusions

Our studies presented the prevalence of social media addiction and its effect on academic performance and working memory among undergraduate students. The influence of social media on students has been significant. Students should establish boundaries, use digital moderation, and seek treatment for emotional difficulties as further studies are recommended.

Disclosure of Interest

None Declared
Machine Learning Analysis of Artistic Characteristics for Schizophrenia Classification
Authors: Vasilchenko K. , Leonova A. , Kuznetsova E. , Zdanovich P. , Keren H.
Published: August 2024

Introduction

Schizophrenia is affecting multiple functions such as cognition, perception, emotion, and social behaviors, and it has also been shown to influence artistic works created by patients. Among the deviations observed in the art works are distinct characteristics like delusional themes, disordered shorter lines, and unique creativity. Such features, along with altered pictorial perceptions and possibly altered motoric function, suggest that it might be possible to differentiate art made by schizophrenic patients from that of healthy individuals. Given the shortcomings of existing diagnostic methods being very long and with a 25% error rate, we proposed a novel neural network model that leverages these artistic markers for classification to support diagnosis.

Objectives

To develop and train a neural network model leveraging unique artistic markers for the classification and support of diagnosing schizophrenia.

Methods

Our study involved 764 participants, 45% diagnosed with schizophrenia, while the others were either healthy or diagnosed with other mental disorders. The average age of the participants was 38.25 years (SD=13.43), and 43.88% of the participants were females. All participants were instructed to draw eight drawings of human faces. These drawings were digitized and categorized based on participants’ schizophrenia status to form the initial training dataset for our model. This data was processed using Python and converted into a NumPy array, which served as input for our model developed using the Keras library. The structure of the model is presented (Image 1).

Results

We used area under curve (AUC), specificity, and sensitivity as key evaluation metrics for our model. The model achieved an AUC of 0.90 on a test dataset that was new to the model and was not used in the preceding training phase. It exhibited a sensitivity of 0.84 and a specificity of 0.85, indicating its capacity to identify schizophrenic and non-schizophrenic individuals, respectively (Image 2).

Image:

Image 2:

Conclusions

The application of machine learning and AI tools to analyze art created by schizophrenia patients, can offer a promising methodology for exploring the differences between schizophrenic and healthy individuals, as well as a possible support for current diagnostic methods. This approach has the potential to provide an additional fast and more accurate diagnosis, enhancing individualized patient care. Future research will focus on refining and validating the model across diverse populations and various art forms.

Disclosure of Interest

None Declared
Athens Multifamily Group Therapy Project (A- MFGT) after FEP: Preliminary clinical results
Authors: Selakovic M. , Zartaloudi A. , Galanis D. , Valeria P.
Published: August 2024

Introduction

The Athens Multifamily Group Therapy Project (A- MFGT) aims to provide systemic multifamily therapy to youths who experienced a first psychotic episode and their families.

Objectives

Family interventions have been shown to reduce the likelihood of relapse for individuals across the spectrum of psychosis and are recommended in practice guidelines for psychosis internationally (Mc Farlane, 2016).

Methods

A group of 22 young adults who presented a first psychotic episode participated with their families to multi-family group systemic therapy, after discharged from in-patient treatment. Sessions were conducted by three therapists twice a month, for nine months and supervision meetings were provided once a month. Six groups of families have been conducted since 2017. Clinical outcome was assessed through PANSS at baseline, one month later after patient’s discharge from in-patient treatment, and one year after, at the end of the multifamily group treatment. Time intervals till relapse were also assessed. Participants’ clinical findings were compared with findings from a matched group of 42 patients who did not attend the multifamily therapy program and were treated as usual.

Results

Two-way mixed ANOVA was conducted to assess PANSS scores change over time (t1: at base line, t2: at one month and t3: one year), while differences were investigated between the two groups of patients and interactions were checked. Regarding PANSS-positive scale and PANSS-general scale, no differences were found between the two groups in neither of the three time points. Regarding PANSS-negative scale, patients attending MFGT presented statistically significantly lower scores in t3 than patients treated as usual, but not in t1 and in t2 (i.e., prior to therapy). Moreover, both patients’ group showed improvement from t1 to t2, but only patients attending MFGT further improved from t2 to t3. Among patients attending MFGT, two (9.1%) had a relapse compared to nine (22.5%) of the patients treated as usual, however this comparison did not reach statistical significance (p = 0.300).

Conclusions

In term to provide early intervention in psychosis, A-MFGT seems to be a viable way to support the patient as well as the whole system facing psychosis, with the aim of preventing relapse and improved quality of life for all the participants.

Disclosure of Interest

None Declared
Association of oral health related subjective quality of life and severity of negative symptoms of treatment-resistant schizophrenia: a cross-sectional study in Croatia
Authors: Mimica N. , Pupić I. , Bosak K. , Folnegović Grošić P. , Bajić Ž. , Filipčić I. , Grošić V. , Zoričić Z.
Published: August 2024

Introduction

Patients diagnosed with schizophrenia, particularly those with severe negative symptoms (NS) and treatment resistant schizophrenia (TRS), have poorer oral health than the general population, which can have serious consequences beyond oral and dental problems, but remains poorly addressed in psychiatric clinical practice and mental health research.

Objectives

To investigate the association between oral health-related subjective quality of life (OHR-sQoL) and severity of NS in TRS.

Methods

We conducted a cross-sectional study in a tertiary psychiatric clinic in Croatia during 2022-2023. The target population were patients diagnosed with TRS with more pronounced NS. The outcome was the Self-Evaluation of Negative Symptoms (SNS) scale and its five dimensions. Exposure was OHR-sQoL measured by the Oral Health Impact Profile questionnaire (OHR-sQoL). We tested the hypothesis using multivariable linear hierarchical regression analysis.

Results

We enrolled 130 participants with a median (interquartile range) age of 43 (36-51) years, with an equal number of women and men. Total SNS and OHR-sQoL scores were found to be significantly associated in both bivariate and multivariable analysis adjusted for a large number of covariates (R2 increase over the effect of covariates = 0.22; p < 0.001; false discovery rate < 5%). Total SNS score was significantly associated with the functional limitation dimension of the OHIP-49, as well as diminished emotional range with psychological discomfort, physical and psychological disability, and anhedonia with functional limitation.

Figure 1. Scatter plot of the correlation between the total score of the Self-evaluation of Negative Symptoms (SNS) and the Oral Health Impact Profile (OHIP-49); the solid line represents the 80% smoothed local polynomial regression curve; the dashed line represents the linear regression line (n = 130)

Image:

Conclusions

NS of TRS are relatively strongly associated with OHR-sQoL, especially with functional limitations. The robustness of this association was confirmed by controlling for a large number of covariates. If the relationship between NS and OHR-sQoL is bidirectional, which should be verified by future studies, perhaps for further progress in solving the serious problems of NS and TRS it will be necessary to include the comorbidity with oral diseases and oral functional disorders and OHR-sQoL.

Disclosure of Interest

None Declared
Awareness of psychiatrists regarding physician suicide and prevention in developed and less developed countries
Authors: Kostyál K. , Terje J. H. , Álmos P. Z.
Published: August 2024

Introduction

The World Health Organization estimates that more than 700,000 people worldwide die by suicide every year. Suicide is a complex issue, and occupation can be considered one of the risk factors. Data from the USA indicates that the suicide rate among doctors is higher compared to the general population. Among different specialties, general practitioners face the highest risk, followed by internal medicine, and then psychiatry. Apart from Anglo-Saxon countries, available data regarding physician suicide is limited; in some countries, the topic is considered taboo.

Objectives

The goal of this pilot study was to explore whether psychiatrists in different countries have access to suicide databases that include occupational information and to determine what prevention strategies and interventions are currently in use.

Methods

We distributed a short questionnaire to a group of psychiatrists (n=25) to assess the existing methods in their respective countries for collecting suicide data and implementing suicide prevention measures. The survey included both developed and less developed countries. Out of the 20 participating countries, 12 returned our questionnaire by the deadline. The final participating countries were Croatia, Czech Republic, Ethiopia, France, Germany, Hungary, Kazakhstan, Mexico, Qatar, Serbia, Sweden, and the UK.

Results

Based on our colleagues’ reports, none of the responding countries have publicly available data on the number of physicians who committed suicide in the last three years. The risk of suicide and substance abuse among doctors is not systematically assessed or published in any of the participating countries. Kazakhstan is the only country where burnout, anxiety, and depression among doctors are regularly assessed. Ethiopia is the only participating country without a hotline for individuals in a suicide crisis. Mexico, Qatar, and Kazakhstan are the only countries with dedicated hotlines for health workers. Regarding preventive strategies, colleagues from Hungary, Serbia, Sweden, and Ethiopia did not report any strategies specifically aimed at preventing physician suicides. Germany and the UK were the two countries with more than one prevention strategy, both providing a free toolkit to identify and support at-risk populations. There are significant differences in the amount of mental health support that doctors receive in each country.

Conclusions

Psychiatrists are not aware of physician suicide data and the utilization of preventive strategies vary widely among the participating countries. There is no standard practice for screening doctors for suicide risk, burnout, anxiety, depression, substance abuse, or adequate data collection on suicide. Based on these findings, it would be necessary to include more countries in the sample and conduct a more detailed examination of the issue in the future.

Disclosure of Interest

None Declared
Alcoholism is the mental health issue that best predicts the mortality of individuals experiencing homelessness.
Authors: Calvo F. , Giralt C. , Solench-Arco X. , Carbonell X. , Font-Mayolas S.
Published: August 2024

Introduction

The mortality rate among individuals experiencing homelessness tends to be premature and is linked to mental disorders and chronic diseases. In Spain, there is a significant gap in the study of mortality among individuals in situations of residential exclusion with real clinical data.

Objectives

This study aims to analyze mortality among individuals experiencing homelessness and its relationship with mental disorders and chronic diseases.

Methods

An observational and prospective longitudinal study was conducted on a cohort of 855 homeless individuals in the province of Girona over a 15-year period. Sociodemographic variables, mental health conditions, chronic diseases, and infections were analyzed, employing descriptive and inferential analyses. A binary logistic regression model was created to establish explanatory relationships between mortality and associated variables.

Results

Among the participants, 87.7% were males with an average age of 53.03 years. A majority of 62.8% were foreign-born, mainly from Africa and Europe. It was identified that 40.8% had mental disorders, with substance dependencies (41.3%) and other disorders (36.4%) being the most prevalent. A total of 30.6% presented chronic diseases, notably hypertension (12.8%) and type 2 diabetes (10.9%). Furthermore, 22.3% had infections, with hepatitis C virus (8.7%) and HIV (4.7%) being the most common. During the follow-up period, 81 individuals (16.4%) passed away, with causes such as cancer (25%), suicide (21.7%), and heart conditions (11.7%).

The regression analysis demonstrated that age (OR = 0.915; 95% CI 0.884-0.947), alcohol addiction (OR = 2.354; 95% CI 1.486-3.731), and being born in Spain (OR = 2.906; 95% CI 1.594-5.299) were significantly associated with mortality in the homeless population.

Conclusions

This study highlights the high prevalence of mental disorders, chronic diseases, and infections among individuals experiencing homelessness. Mortality was associated with factors such as age, alcohol addiction, and place of birth. These findings underscore the importance of developing interventions aimed at enhancing the health and care of individuals experiencing homelessness, particularly within the immigrant population.

Disclosure of Interest

None Declared
Mental health in challenging times: Psychological perspectives for practitioners and society
Authors: Steinebach C.
Published: August 2024

In general, resilience is a process in which the interplay of risk and protective factors of the system itself and its environment is balanced in such a way that positive development opportunities open up. The resilience of a person, a system and a profession is therefore reflected in the ability to shape conditions in such a way that positive coping with challenges and crises is possible as a basis for positive further development. The time of the pandemic and the war in Ukraine has led to a large number of adjustments to psychology as a science, as a profession and as a perspective on life. This is associated with opportunities for positive further development of the discipline. European psychology has so far mastered the challenge of the pandemic and the war in Ukraine very well. The task now is to harness its successes as a multifunctional hub for other sciences, professions and society as a whole. The aim is to develop an identity that strengthens the unity of psychology in its diversity. With wisdom and resilience, psychology is also increasingly facing up to the challenges expressed in the United Nations Sustainable Development Goals (UN SDGs). In the discussion of social and professional change, the possibilities for a joint positive development of all professions in these stressful times become clear.

Disclosure of Interest

None Declared
Community mental health services in Europe: the state of art
Authors: Rojnic Kuzman M.
Published: August 2024

In Europe there is significant variability of attitudes, procedure and strategies in clinical care between psychiatrists and settings across different regions and countries. However, there is a significant overrepresentation of data from mental health services from Western and Northern European countries, due a lack of data from Eastern and Central European countries as it has been suggested the Eastern and Central European regions are a “blind spot on the global mental health map”. In respect to community mental health services, Northern and Western countries introduced a large array of multidisciplinary community-based services for people with mental health problems and reorganized the mental health care services towards the community mental health care, replacing largely large hospitals and hospital-based care following recovery-oriented care models with introduction of numerous services which supported full recovery, including supported employment and housing. This process is only in the beginning in the majority of countries in the South and East of Europe. Here we present the data from these countries including the results of the RECOVER-E study (Large-scale implementation of community based mental health care for people with severe and enduring mental ill health in Europe), which incorporated the implementation of community mental health services in five South-eastern European countries.

Disclosure of Interest

None Declared
Opportunities and challenges of community mental health centers in Türkiye
Authors: Mutlu E.
Published: August 2024

In 2011, Türkiye restructured the mental health care system in community-based settings following the announcement of the National Mental Health Action Plan. Community mental health centers (CMHCs) are the major element of this approach. As of now, the total number of CMHC have reached 186, and the service users have almost reached 100.000.

Mental health care system gained significant advantages through CMHCs, such as 1) improvement in the conditions of mental health services, 2) better follow-up of patients with chronic severe mental disorders, 3) capability of in-home services, 4) decrease in the number of hospitalizations, 5) increased social involvement of patients with severe mental disorder. CMHCs also played a significant role in promoting social rehabilitation, including employment status, development of social relationships, and redress of stigmatization. All these advantages were put into practice by community mental health teams comprising a psychiatrist, psychologists, nurses, social workers and ergotherapists, if available.

Community mental health centers come with severe challenges and shortcomings despite their ameliorations. First, CMHCs need trained mental health professionals. However, only 52% of the CMHC teams completed the CMHC trainings currently. Second, standardized work flow algorithms should be developed for CMHCs. Third, there should be a strong relationship between CMHCs, primary health care system and inpatient units as a complementary part of essential mental health care. In addition, hospital administration should be trained in terms of CMHC policy since every CMHC is affiliated with a state hospital. For instance, the ongoing issue of defining quality standards for CMHCs contributes to a misconception, portraying these centers as profit-making units rather than dedicated rehabilitation facilities.

In conclusion, community-based settings and CMHCs significantly advance mental health services despite the challenges confronted in practice. To optimize the effectiveness of community mental health care facilitated by CMHCs, it is imperative to review the implementation process with the active involvement and support of non-governmental organizations, including patient-driven organizations and national psychiatric associations.

Disclosure of Interest

None Declared
Bipolar Disorder in the Elderly: Clinical Insights and Therapeutic Challenges
Authors: Borges A. F. , Domingues V.
Published: August 2024

Introduction

Bipolar Disorder (BD) is a mood disorder characterized by recurrent episodes of mania, hypomania, and depression. While it often manifests in early adulthood, it can persist or emerge in later life, posing unique diagnostic and therapeutic challenges in the elderly population. This abstract explores the clinical aspects, diagnostic intricacies, and therapeutic considerations of BD in older adults.

Objectives

This study aims to shed light on the epidemiology and clinical presentation of BD in the elderly, discuss the diagnostic challenges, and address the complexities of treatment and management in this age group.

Methods

A comprehensive review of the literature was conducted, encompassing epidemiological studies, clinical trials, case reports, and expert guidelines from the past decade. The search was performed using medical databases such as PubMed and Medline.

Results

BD in the elderly presents with a range of clinical complexities that differentiate it from presentations in younger adults. These complexities include atypical features as elderly individuals may exhibit less overt manic or hypomanic symptoms, resembling irritability rather than euphoria; depressive episodes can be more prevalent and prolonged, leading to potential misdiagnosis as unipolar depression; medical comorbidities: older adults with BD often have more medical conditions, complicating treatment; cognitive impairment: cognitive decline, including mild cognitive impairment and dementia, is common and distinguishing it from neurodegenerative conditions requires specialized assessment; mixed episodes, in older adults may experience mixed episodes, requiring intensive treatment; diagnostic challenges: overlapping symptoms with other disorders make accurate diagnosis challenging. Treatment includes mood stabilizers like lithium, valproate, or lamotrigine, and atypical antipsychotics like quetiapine or aripiprazole. Treatment response varies, requiring consideration of age-related pharmacokinetics, pharmacodynamics, and drug interactions. Non-pharmacological interventions, including psychoeducation, tailored cognitive-behavioural therapies, and psychosocial support, are essential.

Conclusions

In summary, BD in the elderly demands a customized, multidisciplinary approach to navigate diagnostic complexities and optimize treatment, considering comorbidities and cognitive factors. Enhanced clinical awareness and holistic care are essential for effective management in this population.

Disclosure of Interest

None Declared
Gender differences in the association of dementia symptoms severity and hospital anxiety
Authors: Bosak K. , Vuk Pisk S. , Grah M. , Folnegović Grošić P. , Bajić Ž. , Grošić V.
Published: August 2024

Introduction

Symptoms of anxiety can worsen cognitive decline in people with dementia, and symptoms of dementia and fears of further cognitive decline can cause anxiety. Advanced dementia is not necessarily associated with a loss of emotion, which means that people may still experience anxiety, but their ability to cope in a healthy way is reduced. The problem is exacerbated by the fact that hospital care alone can contribute to the severity of anxiety symptoms due to change in routine of daily activities, unfamiliar surroundings, uncertainty about health status, prognosis and various medical procedures. There are differences between women and men in the prevalence, course and manifestation of both dementia and anxiety disorders.

Objectives

To examine whether there are differences between women and men in the association of hospital anxiety with eight symptoms of dementia: difficulties with memory, orientation, judgement, problem solving, fulfilling social obligations, daily activities at home and with hobbies, or personal care, in patients with mild to moderate dementia.

Methods

A cross-sectional study was conducted at Sveti Ivan Psychiatric Clinic in Zagreb in June 2023. The target population were hospitalised patients diagnosed with dementia, both genderes, aged 60-90 years, without psychotic disorder. Anxiety during hospitalisation was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the severity of dementia symptoms was measured using the Dementia Assessment Instrument (CDR). The hypothesis was tested using Wald test of differences between women and men in unstandardised linear regression coefficients of the HADS-A on individual dementia symptoms, after adjustment for age, education, presence of a married or stable non-marital partner and duration of current hospitalisation.

Results

We enrolled 65 women and 35 men of comparable age. There were significant gender-related differences in the association between hospital anxiety and difficulties with judgement (P = 0.01), fulfilling social obligations (P < 0.001), difficulties with home and hobbies (P = 0.02), and personal care (P = 0.00). In women, more pronounced difficulties with judgement and with home and hobbies were associated with higher anxiety, and in men the presence of these two symptoms of dementia was associated with lower anxiety. Difficulties with fulfilling social obligations are associated with lower anxiety in women and higher anxiety in men. Difficulties with personal care were associated with lower anxiety in both genders, but this effect was stronger in men.

Conclusions

There are differences between women and men in the association between anxiety during hospital treatment and the severity of individual dementia symptoms. These differences are present in difficulties with judgement, fulfilling social obligations, home, hobbies and personal care.

Disclosure of Interest

None Declared