bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of treatment resistant schizophrenia according to minima TRRIP criteria in a mental health catchment area in southern Spain
Authors: Muñoz-Manchado L.I. , Pascual Paño J.M. , Rodríguez-Gómez C. , Mongil-Sanjuan J.M. , Pérez-Revuelta J.I. , Torrecilla-Olavarrieta R. , González-Saiz F. , Villagrán-Moreno J.M.
Published: September 2022

Introduction

The response to antipsychotic treatment in patients with schizophrenia varies from 14 to 34% in first episodes, and from 45 to 61% in more chronic patients. Nevertheless, the concept of treatment resistant schizophrenia (TRS) is still a matter of great controversy. Recently, an international group of experts has developed the TRRIP criteria to define treatment resistant schizophrenia (TRS), including an ultra-resistance category for clozapine resistant patients. Up till now, there is a scarcity of epidemiological data of TRS with TRRIP criteria.

Objectives

This study attempts to identify the population diagnosed of schizophrenia that fulfils the minima TRRIP criteria for TRS in our mental health catchment area.

Methods

A descriptive and retrospective study has been developed on the patients diagnosed of schizophrenia (ICD.10, F.20) in the catchment area of the Mental Health Service at Jerez Hospital between 2018 and 2019. TRRIP criteria were applied for two independent researchers and, in case of disagreement, consensus was reached by using the LEAD procedure.

Results

The total number of ICD-10 schizophrenic patients identified was 590, from a population of 456.752 in 2019. A group of these, 206 patients (35%) qualified as TRS according to the minima TRRIP criteria, 50% were positive subtype and the rest the negative one. 46.8% were treated with clozapine.

Conclusions

Consensus criteria of TRS minimise the heterogeneity of epidemiological data in literature. Our data suggest a prevalence rate of TRS lower than that of similar studies. Accordingly, a comprehensive understanding of this population would undoubtedly contribute to improve preventive and therapeutic strategies.

Disclosure

No significant relationships.
Exploring the association between brain-derived neurotrophic factor (BDNF) levels and longitudinal psychopathological and cognitive changes in Sardinian psychotic patients
Authors: Isayeva U. , Manchia M. , Primavera D. , Deriu L. , Caboni E. , Iaselli N. , Sundas D. , Tusconi M. , Collu R. , Scherma M. , Squassina A. , Congiu D. , Fratta W. , Fadda P. , Carpiniello B.
Published: September 2022

Introduction

Schizophrenia spectrum disorders are among the most debilitating mental disorders and evidence on its pathophysiological underpinnings is scant. The brain-derived neurotrophic factor (BDNF) appears to be involved in the pathophysiology of these complex psychiatric disorders.

Objectives

The present study investigates the longitudinal variation of serum BDNF levels in a 24-month observational cohort study of Sardinian psychotic patients (LABSP). This study assessed the variation in BDNF serum levels and its relationship with psychopathological and cognitive changes. Further, we also examined if genetic variations within the BDNF gene could moderate these relationships.

Methods

Every six months 105 LABSP patients were assessed for their BDNF serum levels, as well as for a series of psychopathological, cognitive, and drug-related measures. Four tag single nucleotide polymorphisms (SNPs) within the BDNF gene were selected and analyzed using Polymerase Chain Reaction (PCR). Longitudinal data were analyzed using mixed-effects linear regression models (MLRM).

Results

Analysis showed significantly lower peripheral BDNF levels in psychotic patients with depressive and negative symptoms. BDNF levels were also decreased in patients scoring lower in cognitive measures such as symbol coding and semantic fluency. In addition, Val66Met polymorphism within the BDNF gene significantly moderated the relationship between the severity of negative symptoms and BDNF levels.

Conclusions

Our findings are consistent with previous literature suggesting that peripheral BDNF levels are associated with some cognitive domains and mood disruption in major psychosis. The results also suggest the lack of association between most BDNF genetic variants, except Val66Met polymorphism, with the severity of negative symptoms.

Disclosure

No significant relationships.
Point-of-care test for rapid assessment of blood lithium levels in women with bipolar disorder during perinatal period
Authors: Imaz M.L. , Torra M. , Martin M. , Aliart I. , Martin-Santos R. , Vieta E. , Garcia-Esteve L.
Published: September 2022

Introduction

Determination of lithium levels in serum has become a standard of care due to its narrow therapeutic rang, thus an immediate test for determination of blood lithium may contribute to minimize toxicit, to avoid relapse and to ensure treatment adherence. This is particularly relevant during pregnancy and early postpartum because pharmaokinetic changes in renal physiology.

Objectives

The aim of this study is verify Medimate point-of-care method performance and systematically compare it with the routine laboratory measurement of lithium.

Methods

This cross-sectional method comparison study was conductec in the Unit of Perinatal Mental Health in the Hospital Clinic of Barcelona. Pearson and Bland-Altman analyses were performed to assess the accuracy, precision and correlation between the capillary electrophoresis technology (Medimate MiniLab) and the ion selective electrode (ISE) potentiometry method (AVL 9180).

Results

Twenty-five women with bipolar disorder in treatment with lithium during perinatal period were enrolled, corresponding to 75 blood specimens for analyses. Correlation (r), mean difference (bias), and 95% limit of agreement (LOA) of the point-of-care method [r=0.917; bias 0.0021 (95% LOA; 0.440, 0.619) mEq/L], showed that difference between ISE method and capillary electrophoresis technology was not statistically significant.

Conclusions

Considering the practicality, the microchip capillary electrophoresis technology provides a simple and highly affordable way of measuring lithium levels in a single drop of blood outside the clinical laboratory. The Medimate point-of-care system (POC) appears well adapted for the rapid and specific detection of lithium as an alternative to the current ISE procedure.

Disclosure

No significant relationships.
Applying existing clinical staging models in a sample of Italian bipolar patients over a 10-years follow-up
Authors: Macellaro M. , Girone N. , Cremaschi L. , Bosi M. , Cesana B. , Ambrogi F. , Dell’Osso B.
Published: September 2022

Introduction

Bipolar Disorder (BD) is a life-course illness with evidence of a progressive nature. Although different staging models have been proposed from a theoretical perspective,longitudinal studies are scarce.

Objectives

The aim of the present study was to apply four staging models in a sample of BD patients and to observe their progression in 10 years of retrospective evaluation.

Methods

In a naturalistic sample of 100 BD patients, a retrospective assessment of clinical stages across 10 years of observation at six time points (T0: 2010; T1: 2013; T2: 2015; T3: 2018; T4: 2019; T5:2020) was performed according to the BD staging models (Berk et al., 2007; Kapczinski et al., 2009; Kupka et al., 2012 and Duffy et al., 2014). Socio-demographic and clinical variables were collected and the staging progression across time was analyzed.

Results

A significant progressive staging worsening emerged over 10 years of BD observation for each examined model (p<0.001). Moreover, for all considered staging approaches, stage values were lower over the time points for BD II, lower number of lifetime episodes and hospitalizations (p<0.05). Finally, the stage increase was associated with a lower age at first elevated episode (p<0.05).

Conclusions

Present preliminary results confirm the relevance of illness onset and early intervention in BD, given their role in patients classified into worse clinical staging. There is an emerging need of a standardized universal staging model in order to better characterize BD patients, their treatment and their clinical course.

Disclosure

No significant relationships.
Social Hypersensitivity in Bipolar Disorder: An ERP Study
Authors: Kwan Y. , Lee J. , Hwang S. , Choi S.
Published: September 2022

Introduction

Bipolar Disorder (BD) is a disorder in which cognitive function is relatively preserved but social functioning is markedly impaired. Interestingly, studies on BD show that the patients have a strong desire for social rewards. Hypersensitivity to social rewards in BD has not yet been sufficiently examined through experimental methods, although recent studies have pointed out that their reward hypersensitivity is the cause of symptoms and dysfunction.

Objectives

The purpose of this study was to investigate whether patients with BD are hypersensitive to social rewards using the social value capture task.

Methods

Groups of 25 BD and healthy control (HC) each completed the social value attention capture task. This task consists of a practice phase in which associative learning of social rewards with specific stimuli occurs, and a test phase in which the stimuli associated with rewards appear as distractors during the participants performing a selective attention task. We also recorded event-related potential (ERP) in the practice phase in order to investigate BDs’ cortical activity for social reward.

Results

showed significantly decreased accuracy rate and increased reaction time in the high social reward-associated distractor trials of the test phase in the BD compared to the HC. As a result of analysis in ERP components, P3 amplitude for social reward was significantly greater in the BD than the HC.

Conclusions

BD patients exhibit behavioral and physiological hypersensitivity to social rewards that might contribute to social dysfunction.

Disclosure

No significant relationships.
Do Clinicians Need to Rethink Antipsychotic Maintenance Treatment?
Authors: Kane J.
Published: September 2022

Schizophrenia remains a challenging illness to treat despite considerable progress. The heterogeneity of symptoms and variability in course, outcome, and treatment response lead to considerable uncertainties in treatment guidelines. One of the most challenging issues is how to determine the need for and duration of the maintenance treatment that is intended to reduce the risk of exacerbation, relapse, and hospitalization. It is clear that in large populations, antipsychotic medication is very effective in reducing those risks, however, there is likely a subpopulation of patients with diminished risk for such outcomes even when medication is discontinued. Although attempts have been made to utilize “intermittent” or “targeted” treatment, those randomized controlled trials that have been conducted show a statistically significant advantage for continuous treatment. At the same time, many patients continue to receive higher than necessary doses of antipsychotic medication and practice needs to be reevaluated in terms of dosage requirements. The challenge remains that there are no good biomarkers or predictors of who is at risk and, therefore, dosage reduction is only titrated against exacerbation or relapse. We need to proactively reconsider who requires maintenance treatment by establishing predictive biomarkers (clinical or biological) that can help us to have a more personalized approach.

Disclosure

Consultant to or receives honoraria: Alkermes, Allergan, Dainippon Sumitomo, H. Lundbeck, Indivior, Intracellular Therapies, Janssen Pharmaceutical, Johnson & Johnson, LB Pharmaceuticals, Merck, Minerva, Neurocrine, Novartis Pharmaceuticals,
Forced Normalization and other neuro-psychiatric manifestations of epilepsy - Case series and A literature review
Authors: Deol Y. , Morales M. , San Gabriel M. , Du Boulay M.
Published: September 2022

Introduction

Psychosis of epilepsy has intrigued many neurologists and psychiatrists. We attempt to summarize the phenomenon, suggested diagnostic criteria and distinguishing features between different clinical entities linked with epilepsy.This case series is unique and rare as we include the case that meets full criteria of forced normalization.

Objectives

1) To understand the concept and diagnostic criteria of Forced Normalization 2) To differentiate different psychiatric manifestations of epilepsy

Methods

A total of 13 studies were reviewed using the key words from 1999 –2021 using different search engines- Google scholar, Pub-med, Elsevier, Dynamed.

Results

Patients with epilepsy have an eightfold increased risk of psychosis (6). Forced Normalization has been described as the onset of psychotic or mood symptoms after the resolution or remission of >50% of seizures, evidenced by normal EEG. It was first described in 1950’s and has been extensively studied since 19thcentury. The age of onset can be 8 years to 71 years of age (mean - 28.3). The exact mechanism is still unknown. Different factors have been linked to this phenomenon like kindling, neurotransmitters etc.

Conclusions

It is interesting to understand the antagonistic relationship between epilepsy and psychosis. Forced normalization is a rare entity because it is hard to diagnose due to possible overlap with other clinical entities like post-ictal or side effects of AED. The prognosis seems to be favorable depending on the trigger for the symptoms with better prognosis if the resolution of seizures was achieved AED. Mood disorders had worse prognosis than dissociation and psychosis.

Disclosure

No significant relationships.
The Management and Supervision Tool (MaST): an electronic crisis risk prediction tool to support safe and effective mental healthcare
Authors: Patel R. , Oram J. , Hebden N. , Payne Z. , Morse M. , Gadd C.
Published: September 2022

Introduction

The increasing global burden of mental disorders has led to rising demand for mental healthcare services. Effective resource management is essential to ensure safe and timely access to care. Electronic health records (EHRs) provide a real-time source of data on clinical presentation and prognostic factors that could be harnessed to provide clinicians with actionable insights to prioritise mental healthcare delivery. We describe the development and evaluation of MaST, an EHR data visualisation tool that provides information to clinicians on risk of mental health crisis defined as an admission to a psychiatric hospital or acceptance into a community crisis service.

Objectives

(i) To develop an EHR-data driven risk prediction tool for risk of crisis. (ii) To evaluate predictive performance in a real-world clinical setting.

Methods

The risk of crisis algorithm was developed and evaluated with EHR data from six UK NHS mental health providers using Ordered Predictor List propensity scores grouped into 5 quintiles. The predictor variables were clinical and sociodemographic factors including previous mental health service contacts.

Results

Data from 2,620 patients contributed to algorithm development which was subsequently tested on data from 107,879 patients. The risk of crisis algorithm performed well with an overall accuracy for predicting the greatest risk of crisis (top quintile) ranging from 64% to 80%.

Conclusions

The MaST algorithm accurately predicted risk of mental health crisis in UK community mental health services. EHR data visualisation tools can provide actionable insights to clinicians to prioritise mental healthcare delivery in real-world clinical practice.

Disclosure

This study was funded in full by Holmusk.
Relational factors predict telepsychotherapy acceptance in patients: The role of therapeutic relationship and attachment
Authors: Békés V. , Aafjes-Van Doorn K.
Published: September 2022

Introduction

During the early months of the COVID-19 pandemic, patients receiving individual psychotherapy needed to transition to telepsychotherapy (TP). Since telemental health appears to be here to stay after the pandemic ends, it is crucial to understand factors that determine whether telemental health is a good fit for patients.

Objectives

The aim of the present study was to (1) explore patients’ perception of the therapeutic relationship and attitudes towards TP, and (2) identify predictors of patients’ TP acceptance.

Methods

We used a longitudinal design, where patients (N = 719) receiving individual TP during the pandemic participated in an online survey, in which they responded to demographic questions and completed measures of symptom severity, Covid-related distress, attachment style (avoidant/anxious), perceived quality of the therapeutic relationship (working alliance and real relationship), and TP acceptance.

Results

We found that (1) patients perceived the quality of the therapeutic relationship as reasonably good, and patients’ TP acceptance was moderately high. (2) patients’ TP acceptance was predicted by their attachment avoidance and their perception of the real relationship, whereas attachment anxiety, working alliance, as well as demographic variables, symptom severity, and Covid-related distress were unrelated to TP acceptance. The final model showed that perceived strength of the real relationship mediated the relationship between attachment avoidance and TP acceptance.

Conclusions

Both general (attachment) and situational (therapeutic relationship) relational variables are important predictors of patient’s acceptance of TP, and should be considered during decision making about suitability of TP to patients.

Disclosure

No significant relationships.
A case study for assessing the utility of a decision tree based learning algorithm in mental health inpatient care quality management
Authors: Wernigg R. , Wernigg M.
Published: September 2022

Introduction

There is limited knowledge about the potential role of machine learning (ML) in quality improvement of psychiatric care.

Objectives

Our case study was to determine whether ML decision trees used on patient databases are suitable for focussing on specific patient population samples of mental healthcare quality audits. Populations were identified by patient and care provider variables, and the time of treatment. Outcomes were defined as hospital mortality, over-long hospitalization (over average +1SD or +2SD); and short hospitalization (under average -1SD; under 3 days).

Methods

We conducted a Split Train Test in Python for our outcomes on national mental health inpatient turnover data (2010 through 2018 for training and 2019 for testing). A well-fitting decision tree had the area under the curve (AUC) of the receiver operating characteristic (ROC) >= 0.7, and specificity >= 0.9. Performing qualitative analyses of decision trees, we rejected the ones with little clinical relevance.

Results

Decision trees fit well (AUC = 0.7 to 0.9; specificity = 0.7 to 1.0; sensitivity = 0 to 0.69). For hospital death cases, the decision tree had AUC = 0.86, no difference after controlling for the types of hospital units, and was clinically relevant. Models predicting over-long hospitalization fit well (AUC=0,9); however, controlling for care pathways, good fit and sensitivity both vanished. No valid models emerged for undertime discharges. The decision trees revealed unique combinations of variables.

Conclusions

Our ML decision trees used on healthcare databases proved promising for focussing quality audit efforts. Narrative analysis for the clinical contexts of the decision trees is indispensable.

Disclosure

No significant relationships.
The impact of Mild Behavioral Impairment on the individual’s level of psychological, social, and occupational functioning
Authors: Elefante C. , Brancati G.E. , Gemmellaro T. , Ricciardulli S. , Romeo F. , Torrigiani S. , Pistolesi G. , Amadori S. , Lattanzi L. , Perugi G.
Published: September 2022

Introduction

Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later-life emergent neuropsychiatric symptoms, which represent an at-risk state for incident cognitive decline and dementia.

Objectives

Our obective was to prospectively evaluate the impact of MBI on global functioning in patients ≥ 50 years with a major depressive episode (MDE) at baseline.

Methods

We recruited 51 patients ≥ 50 years presenting with a MDE at the outpatient clinic of the 2nd Psychiatric Unit of the University of Pisa. Then we selected those patients who had a follow-up of at least two months and excluded subjects with a neurodegenerative disease. The included patients (N = 25) were subdivided in a subgroup with MBI and a subgroup without MBI. The subgroups have been compared for the difference between baseline and follow-up score in global functioning according Global Assessment of Functioning (GAF) scale. Comparative analyses were conducted by means of mixed anova.

Results

There was a significant interaction effect between time and the MBI condition (F[1, 23] = 4.12, p = 0.05 η p 2 = 0.15). Descriptive statistics showed that while patients without MBI showed higher GAF score at follow-up (mean = 65.12) compared to GAF score at baseline (mean = 54.37), patients with MBI showed, on average, the same GAF score at follow-up (mean = 54.44) and at baseline (mean = 54.44).

Conclusions

In patients with MDE, the presence of MBI is related to a lack of improvement in psychological, social, and occupational functioning in the short-term

Disclosure

No significant relationships.
Diagnosing dementia in the Arctic: translating tools and developing and validating an algorithm for assessment of impaired cognitive function in Greenland Inuit
Authors: Kleist I. , Noahsen P. , Gredal O. , Riis J. , Andersen S.
Published: September 2022

Introduction

The ageing Arctic populations raise the need for work-up of cognitive function that reflects language and cultural understandings.

Objectives

To translate and evaluate tools for work-up of cognitive impairment in Greenland.

Methods

Step A: An expert panel was established to select tools suitable for the work-up of cognitive impairment at three different settings in Greenland. Step B: Tools were translated in a multiple-step process of independent translations with back-translation and adaptations by two independent translators and two Greenlandic physicians. Step C: a testing and validation process of the tools at three locations: the national hospital in the capital city; regional hospital in a town; health care centre in a small town.

Results

Tools selected were Mini-Cog and RUDAS. Participants for testing of tools were 43 of 61 invited, of which six had dementia. RUDAS and Mini-Cog scores were associated (p < 0.001). The smoothed AUC was 0.87 (95%-CI, 0.65–0.95) for Mini-Cog and 0.90 (95%-CI, 0.76–0.97) for RUDAS. The sensitivity of Mini-Cog with a cut-off at ≤3 was 83.3%, and specificity was 62.2%. For RUDAS with a cut-off at ≤23, these were 100% and 75.7%, respectively.

Conclusions

Requested tools have been translated for assessing cognitive function in the native Arctic setting. Small town residents with a Mini-Cog score of 3 or lower should be referred to a regional hospital for RUDAS, and a score of 23 or less should cause referral to the national hospital for a full work-up of cognitive function.

Disclosure

No significant relationships.
Measuring neuropsychiatric symptoms in early dementia patients using speech analysis
Authors: König A. , Mallick E. , Linz N. , Zegahri R. , Manera V. , Robert P.
Published: September 2022

Introduction

Certain neuropsychiatric symptoms (NPS), namely apathy, depression and anxiety demonstrated great value in predicting dementia progression representing eventually an opportunity window for timely diagnosis and treatment. However, sensitive and objective markers of these symptoms are still missing.

Objectives

To investigate the association between automatically extracted speech features and NPS in early-stage dementia patients.

Methods

Speech of 141 patients aged 65 or older with neurocognitive disorder was recorded while performing two short narrative speech tasks. Presence of NPS was assessed by the Neuropsychiatric Inventory. Paralinguistic markers relating to prosodic, formant, source, and temporal qualities of speech were automatically extracted, correlated with NPS. Machine learning experiments were carried out to validate the diagnostic power of extracted markers.

Results

Different speech variables seem to be associated with specific neuropsychiatric symptoms of dementia; apathy correlates with temporal aspects, anxiety with voice quality and this was mostly consistent between male and female after correction for cognitive impairment. Machine learning regressors are able to extract information from speech features and perform above baseline in predicting anxiety, apathy and depression scores.

Conclusions

Different NPS seem to be characterized by distinct speech features which in turn were easily extractable automatically from short vocal tasks. These findings support the use of speech analysis for detecting subtypes of NPS. This could have great implications for future clinical trials.

Disclosure

No significant relationships.
Prosocial behavior according to sex in school adolescents immersed in violent contexts in the department of Córdoba, Colombia
Authors: Ruiz Gonzalez E.P. , Romero Otalvaro A.M. , Velez Carvajal J. , Seña Giraldo K. , Tuiran Catalan M.
Published: September 2022

Introduction

Four specific forms of violence have been identified in the socialization process of children, and these are: “violent discipline and exposure to domestic abuse; violence at school; violent deaths among adolescents; and sexual violence ”. (UNICEF, 2017, p2), In this regard Redondo & Inglés (2014) affirm that it is increasingly evident the need to promote prosocial behavior models based on empathy and assertiveness in educational institutions, in order to avoid the appearance of violent demonstrations.

Objectives

Analyze the levels of prosocial behavior according to sex in adolescents

Methods

A descriptive, cross-sectional study was conducted in 105 (N = 105) adolescents. A sociodemographic survey was used to investigate aspects related to the study objective and the Prosocial Behavior questionnaire by Martorell and Gonzales (1922) to measure prosocial behavior.

Results

57.7% of the adolescents evaluated presented adequate prosocial behaviors. When examining the difference between sex, the expected values were initially verified, which indicated the feasibility of performing a student’s T; As can be seen in Table 1, the mean corresponding to the female sex was 49.62%, in contrast to a mean of 49.93% for the male sex, indicating the absence of statistically significant differences.

Conclusions

It was concluded that the higher the optimal levels of empathy, the lower the aggressive behavior presented by teenagers.

Disclosure

No significant relationships.
EEG Markers of Suicidal Ideation in Depressive Female Adolescents
Authors: Iznak A. , Iznak E. , Medvedeva T. , Damyanovich E. , Oleichik I.
Published: September 2022

Introduction

Timely detection of suicidal thoughts is one of the ways to prevent suicide. Use the psychiatric interview only for this purpose in adolescents is often insufficient due to poor compliance. Thus, the search for objective neurophysiological markers of suicidal ideation in adolescents seems to be actual.

Objectives

The aim of the study was to reveal the relationships between pre-treatment EEG parameters and intensity of suicidal ideation in depressive female adolescents.

Methods

72 female depressive patients (all right-handed, age 16–25, mean 18,2±2.6 years old) were enrolled in the study. Pre-treatment total HDRS-17 scores varied from 13 to 43 (mean 26,9±7.5). Multichannel eyes closed EEG was recorded, and absolute spectral power was calculated in 8 narrow frequency sub-bands. All patients answered the inventory on intensity of suicidal thoughts. Spearman’s correlations between pre-treatment EEG parameters and suicidal ideation scores were analyzed.

Results

Scores of intensity of suicidal ideation correlated positively (p<0.05÷0.01) with values of EEG alpha2 (9-11 Hz) spectral power in F7, F8, F4, C3, C4, T4, P4 and O2 EEG leads, as well as with values of EEG delta (2-4 Hz) spectral power in F7, F3 and C3 EEG leads (p<0.05).

Conclusions

The intensity of suicidal ideation in depressive female adolescents associates with wide propagation of EEG alpha2, especially over the right hemisphere, and with EEG signs of decreased functional state of anterior regions of the left hemisphere. The study supported by RBRF grant No.20-013-00129a.

Disclosure

No significant relationships.
An 8-year longitudinal study of long-acting injectable (LAI) antipsychotics. Prescription trends and therapeutic drug monitoring to inform precision dosing
Authors: Piacentino D. , Carpi F. , Giupponi G. , Conca A.
Published: September 2022

Introduction

Despite the widespread use of long-acting injectable (LAI) antipsychotics in schizophrenia and other disorders, there is a lack of longitudinal studies evaluating prescription trends and the usefulness of therapeutic drug monitoring (TDM) to inform dosing. Indeed, LAI prescription varies greatly among different areas of the world and over the years.

Objectives

Assess trends in LAI prescription in 2013-2020 at the Psychiatry Department of Bozen, Italy, and (2) analyze the correlation between dose of prescribed LAIs and blood levels measured via TDM.

Methods

Parametric statistics.

Results

LAIs were administered to 471 patients (x̅ age±SD=47.2±16.3 years; 56.3% men). The pie chart shows LAI treatment duration, i.e., from 1 to 7 consecutive years. The most used LAIs were haloperidol in 2013-2104 (26.5-31.8%) and paliperidone in 2015-2020 (22.5-25.7%). Dose adjustments were rather frequent, whereas the switch between LAI, due to moderate-to-side effects or unsatisfactory improvement of clinical status, was infrequent (41 cases/8 years). LAI interruption for the same reasons or non-compliance was even more infrequent (10 cases), but in 8 cases it happened for opposite reasons, i.e., achievement of patients’ stabilization and good compliance. The Table shows doses and plasma levels of LAIs. Correlations between doses and plasma levels were: haloperidol: r=-0.037, p=0.620; paliperidone: r=0.290; p=0.000; risperidone: r=0.219, p=0.006; fluphenazine r=0.358, p=0.000; aripiprazole: r=-0.051, p=0.610; olanzapine: r=-0.090, p=0.634.

Conclusions

Haloperidol and paliperidone were the most used LAIs. Drug prescription trends and doses were stable over time. A significant positive correlation between dose and plasma level was found for paliperidone, fluphenazine, and aripiprazole.

Disclosure

No significant relationships.
Impact of central antagonist of cholecystokinin-1 receptors GB-115 on cognitive functions in patients with Generalized Anxiety Disorder
Authors: Dorofeeva O. , Metlina M. , Chepeliuk A. , Vinogradova M.
Published: September 2022

Introduction

Generalized anxiety disorder (GAD) is associated with reduced attention, inhibition, decrease of processing speed. The impact of a new peptide antagonist of central cholecystokinin-1 receptors (GB-115) on cognitive processes in patients with GAD is reported.

Objectives

To research the cognitive effects of GB-115 in patients with GAD.

Methods

25 patients with GAD in ICD-10 (mean age 35,76±8,55 years) treated with GB-115 in clinically relevant dose (6 mg/d) were enrolled to the study. The evaluation of cognitive functions was conducted at background, Day 3, Day 7, Day 14 and Day 21. The laboratory test toolkit included reaction time test, Shulte-Platonov tables, attention tests (using hardware and software complex “NeuroSoft-PsychoTest”). Statistical significance was ascertained by Wilcoxon signed-rank
test.

Results

Speed of reaction time increased on the Day 7 (418,17±61,49 msec, p≤0,01), the Day 14 (422,25±70,69 msec, p≤0,01) and the Day 21 of treatment (406,5±52,79 msec, p≤0,01) in comparison with background (449,19±64,91). Attention parameters improved on the Day 3 (305,95±45,31 msec, p≤0,05) and the Day 21 of treatment (300,14±47,74 msec, p≤0,05) in comparison with the background (316,41±42,35 msec). Decrease of time in performance of tables of Shulte-Platonov was also observed on the Day 7 (59,40±13,71 sec, p≤0,01), the Day 14 (57,88±12,82 sec, p≤0,01) and the Day 21 (53,40±13,19 sec, p≤0,01) in comparison with the background (68,84±16,78 sec).

Conclusions

GB-115 revealed cognitive effects such as an increase of processing speed and improvement of different aspects of attention (attentional resource allocation, attention span and switching) after the Day 7 of treatment.

Disclosure

No significant relationships.
Practicing Psychiatry in the Transitional Period: Lessons Learnt and Issues of the Steps Towards the New Normal
Authors: Al-Uzri M.
Published: September 2022

The arrival of Covid-19 had huge impact on all aspects of life and psychiatry was no exception. Significant changes to mental health services were introduced to reduce the risk of infection among the inpatient population, patients in the community and in outpatients consultations. Use of virtual consultations in the community and stringent infection control in inpatient setting are examples of many. Those changes were associated with significant differences in patients’ presentation and access to services. Multiple studies reported increased proportion of psychotic patients being admitted to inpatient care. However, there were no reports on increased suicide contrary to the expectation. This is despite increased reports of mental distress, depression, and anxiety in the wider population. These reports are consistent with our knowledge of mental health problems reported in times of wars and disasters. Hence, some of the learning from experience proved relevant when facing this pandemic. Unfortunately, Covid-19 continues to represent a challenge and relaxing of the restrictions introduced were short-lived with every variant reported. In addition, some of the changes adopted by mental health services proved to be innovative and more efficient way of delivering care in psychiatry. Therefore, the early indications suggest that some of those changes would become the new normal.

Disclosure

No significant relationships.
Effects of Covid-19 restrictions on IPS service delivery in Northern Norway
Authors: Wittlund S.
Published: September 2022

Introduction

Individual Placement and Support (IPS) is an evidence-based supported employment program that helps people with severe mental illness to achieve steady meaningful employment in competitive mainstream jobs. Employment specialists are an integral part of IPS service delivery. The primary goal of an employment specialist is to help IPS users obtain competitive employment by providing targeted job development and ongoing support to workers and employers for as long as it is required.

Objectives

This study aims to investigate the impact of the covid-19 restrictions on the delivery of IPS services in Northern Norway and how this may have affected the employment specialists’ perception their work environment.

Methods

We conducted four phases of a longitudinal work environment panel survey with the IPS employment specialists in Northern Norway. Phase 1: January-February 2020 (pre-covid), phase 2: June-July 2020 (during covid) and phase 3: October-November 2020 (during covid) were not related to covid and collected data on fourteen work environment indicators. Phase 4: October 2020 was a covid specific survey and collected data about the impact of covid-19 restrictions on IPS service delivery.

Results

Employment specialists perceived that they had less collaborative engagement with clinical teams and employers after covid-19 restrictions were introduced. This was accompanied by a significant decline in four of the employment specialists’ work environment indicators.

Conclusions

The covid-19 restrictions appear to have created obstacles for IPS service delivery in Northern Norway. These challenges may have negatively impacted the employment specialists’ perception of their work environment, creating job dissatisfaction and potentially increasing employee attrition.

Disclosure

No significant relationships.
The impact of constitutive mTORC1 hyperactivity on structural synaptic plasticity and social behaviour under standard conditions and environmental enrichment
Authors: Granak S. , Tuckova K. , Kutna V. , Vojtechova I. , Bajkova L. , Petrasek T. , Ovsepian S.
Published: September 2022

Introduction

Autism spectrum disorders (ASD) are a group of neurodevelopmental disabilities causing major social, communication, and behavioural challenges. Although causative roles of altered genes and environment are recognized, the underlying mechanisms remain elusive.

Objectives

We carried out a longitudinal analysis of morphological correlates of synaptic plasticity in the cortex with an array of neuro-behavioural tests in Tsc2 loss-of-function ASD rats with persistent mTORC1 hyperactivity.

Methods

Dendritic spine density and morphology with astroglial response were analysed along with behavioural tests in 45 d.o., 90 d.o. and 12 m.o. age groups maintained under standard or enriched conditions.

Results

We report a higher density of spines, with a bigger proportion of thin spines in 90 d. o. Tsc2+/- rats, while under enrichment the spine density in 12 m.o groups was lower. In behavioural tests, rats under enrichment showed higher activity in open arms and anogenital contact tests in the second and third age groups. They also showed enhanced self-grooming. Total distance travelled in the open field by Tsc2+/- rats was less in the first and second age groups. Confocal imaging showed an increase in pS6 expression in second and third Tsc2+/- groups, implying mTORC1 hyperactivity.

Conclusions

Our results show that the environment may have differential neuro-behavioural impacts in rats with unleashed mTORC1, in agreement with the two-hit mechanisms of the underlying neuro-behavioural effects in this model. Although the results of the morphometric analysis suggest a causal link between behavioural changes with altered synaptic plasticity, the mechanisms and involved signalling remain to be defined.

Disclosure

No significant relationships.
Correlation between social functioning and quality of life in patients diagnosed with schizophrenia
Authors: Ristic B. , Batinic B.
Published: September 2022

Introduction

Social dysfunction is a significant feature of schizophrenia leading to deminution of quality of life (QoL).

Objectives

To explore the correlation between social functioning and quality of life in patients diagnosed with schizophrenia.

Methods

The study sample comprised 32 patients diagnosed with schizophrenia (24 males and 8 females) recruited from the Clinic for mental disorders “Dr Laza Lazarevic” in Belgrade, with a mean age of 41.28 years (min 24, max 62), assessed by the Social Functioning Scale (SFS) and the World Health Organization Quality of Life questionnaire (WHOQOL-BREF).

Results

There were two significant quasi-canonical positive correlations between social functioning and QoL (1: f-test=16.4, p=.001; 2: f-test=23, p=0.0001.) The first structure is formed through the set of SFS subscales- Recreation, Independence-performance and Independence-competence and set of QoL subscales- Mental health, Physical health, Environment and General assessment of QoL. The second structure is formed through the set of SFS subscales- Interpersonal functioning and Social engagement/withdrawal and the set of QoL subscales- General assessment of QoL and Environment. Furthermore, the first canonical component indicates a greater overlap of the opposition set by social functioning (23%) which leads to the assumption that the direction of influence goes from social functioning to QoL. Due to the equality of redundancy in the second canonical component, the direction of influence can only be inferred on the basis of the first canonical component.

Conclusions

Social functioning and quality of life are related in patients diagnosed with schizophrenia, and this relationship is based on specific subfactors within those areas.

Disclosure

No significant relationships.
Digitised remote delivery of simulation in psychiatry during the pandemic and for the future
Authors: Mudunkotuwe J. , Mannali V. , Henry J. , Clift J. , Strickland P.
Published: September 2022

Introduction

Surrey and Borders NHS Foundation Trust’s AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient simulation system, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents.

During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ’out-of-body’ perspective, immersed in a customdesigned interactive virtual environment. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. During the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams.

Objectives

To evaluate the feedback from Doctors in training taking part on the education sessions.

Methods

We collected qualitiative and quanttaive infromation from participants after the teaching session.

Results

We received strongly positive reults in all parameters measured. the presenters will show a detailed breakdoen in the session.

Conclusions

The digitalised delivery of the virtual patient simulation, has been pivotal in limiting interruptions to communication skills training in mental health.

Disclosure

The NHS trust has co produced the simulation platform with a private software firm Xenadu Virtual Environments
Perceived clinical challenges when treating patients from another culture: a study among doctors training in psychiatry in Norway
Authors: Tyssen R. , Sandbu M. , Thapa S. , Rø K. , Jávo C. , Preljevic V.
Published: September 2022

Introduction

There is increased migration of patients and physicians worldwide. In Norway, psychiatry is the medical discipline with highest proportion of foreign doctors (24%). We need empirical studies on transcultural clinical challenges among doctors training in psychiatry.

Objectives

What perceived clinical challenges do foreign and native Norwegian young doctors meet when they treat patients from another culture, and what independent factors are associated with such challenges?

Methods

We developed a new 6-item instrument (alpha=0.80), Clinical Transcultural Challenges (CTC), with items about assessing psychosis, risk of suicide, violence etc. The doctors were recruited at mandatory training courses, and they filled in questionnaires about individual factors (age, gender, foreign/native) and work-related factors (training stage, frequency of transcultural meetings, number of working hours, work stress). Associations with CTC were analyzed by linear multiple regression.

Results

The response rate was 93% (216/233), of whom 83% were native and 17% were foreign doctors, 68% were women. Native doctors reported higher levels of CTC than did foreign doctors, 28.8 (6.2) vs 23.8 (7.2), p<0.001, d=0.73. Both native and foreign doctors rated “assessing psychosis” and “lack of helping tools” as most demanding. Independent factors associated with CTC were being a native doctor, Beta 3.9, p<0.01, and high levels of work-home stress, Beta 0.29, p<0.05.

Conclusions

Native doctors training in psychiatry report higher levels of transcultural clinical challenges than foreign doctors do. Both groups of doctors may need more training in transcultural assessment of psychotic disorders. They also report needs for more helping tools, and we should explore this further.

Disclosure

No significant relationships.
Dealing with the Pandemic and After for Children and Adolescents, and their Families
Authors: Apter G.
Published: September 2022

France has been severely impacted by the pandemic. The first wave imposed a major lockdown, never seen before. The second and third wave lockdown responses were somewhat less dramatic. People were allowed to travel to work. Nursery and elementary schools were left open while high schools had part-time attendance. Spring 2021, still presented with a terrible death toll of 300/day, for a 67million population country. For many months the spotlights were focused on the high levels of mortality and morbidity of the elderly. This somehow obliterated the younger generation’s mental health issues. It now appears that children and adolescents have had to pay a steep price to Covid 19. In France, during the first lockdown, child and adolescent morbidity and mortality due to abuse heightened considerably compared to 2019 during the same period. And during the second and mostly the third lockdown, pediatric emergency wards have been underwater with youth mental health issues ranging form suicidal ideation to acute dissociation. Different hypotheses have emerged on how the pandemic has so dramatically impacted the mental health of children and adolescents, specifically the most vulnerable ones. The consequences this might have for child development and mental health during the years to come will be debated.

Disclosure

No significant relationships.
Cross-cultural analysis of the stigmatising attitudes of psychiatrists across Europe and measurement invariance of the Opening Minds Stigma Scale for healthcare providers
Authors: Ori D. , Szocsics P. , Molnar T. , Rozsa S. , Wallies M. , Kazakova O. , Bankovska-Motlova L. , Boivin S. , Raaj S. , Overgaard Ingeholm Klinkby I.M. , Cabacos C. , Pereira A.T. , Matheiken S. , Kakar S. , Greguras S. , Maslak J. , Nechepurenko N. , Kotsis K. , Yilmaz Kafali H. , Mirkovic A. , Rus Prelog P. , Bruna K. , Guevara K. , Strumila R. , Mörkl S. , Abdulhakim M. , Carbone E.A. , Panayi A. , Ivanović I. , Dashi E. , Grech G. , Vircik M. , Schuster F. , Soler-Vidal J. , Pomarol-Clotet E. , Ahmadova G. , Hargi A. , Kisand H. , Grinko N. , Gyorffy Z.
Published: September 2022

Introduction

Since the literature investigating the stigmatising attitudes of psychiatrists is scarce, this is the first study which examines the phenomena across Europe. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a widely used questionnaire to measure stigma in healthcare providers towards people with mental illness, although it has not been validated in many European countries.

Objectives

A cross-sectional, observational, multi-centre study was conducted in 32 European countries to investigate the attitudes towards patients among specialists and trainees in general adult and child psychiatry. In order to be able to compare stigma scores across cultures, we aimed to calculate measurement invariance.

Methods

An internet-based, anonymous survey was distributed in the participating countries, which was completed by n=4245 psychiatrists. The factor structure of the scale was investigated by using separate confirmatory factor analyses for each country. The cross-cultural validation was based on multigroup confirmatory factor analyses.

Results

When country data were analysed separately, the three dimensions of the OMS-HC were confirmed, and the bifactor model showed the best model fit. However, in some countries, a few items were found to be weak. The attitudes towards patients seemed favourable since stigma scores were less than half of the reachable maximum. Results allowed comparison to be made between stigma scores in different countries and subgroups.

Conclusions

This international cooperation has led to the cross-cultural validation of the OMS-HC on a large sample of practicing psychiatrists. The results will be useful in the evaluation of future anti-stigma interventions and will contribute to the knowledge of stigma.

Disclosure

No significant relationships.