bluuebunny/crossref_metadata_2025 huggingface dataset:
Internally displaced persons and their mental health status
Authors: Maruta N. , Panko T. , Fedchenko V. , Semikina O.
Published: February 2022

Introduction

There are about 1.5 million internally displaced persons (IDPs) in Ukraine, which requires an assessment of their mental health.

Objectives

To develop a psychoeducational program aimed at informing about the clinical manifestations (markers of symptoms) of mental disorders, the possibilities of preventing their formation and options for action in conditions of the formation or exacerbation of a mental state.

Methods

270 IDPs were examined. Methods: clinical-psychopathological, psychometric, statistical.

Results

Evaluation of the mental state of IDPs with symptoms of mental disorders (risk group (31.92%)) indicates the presence of various emotional disorders that formed individual syndromes – asthenic (41.18%), agrypnic (45.59%), somato-vegetative (30.88%), anxiety-depressive (20, 59%). The risk factors for the development of mental disorders in IDPs were identified - the older age is from 50 to 59 and the average age is from 40 to 49 years; lack of a complete family, lack of work, low level of social employment, lack of satisfactory living conditions, a significant decrease in the level of well-being, the preservation of the significance of factors of mental trauma, the presence of certain prenosological syndromes. The proposed psychoeducational program is built on the principle of thematic seminars with elements of social and psychological training.

Conclusions

The implementation of the program provides a comprehensive impact on the cognitive, emotional, psychophysiological, behavioral and social aspects of personality functioning.
Paloma center of expertise - a national support system for refugees’ mental health
Authors: Rautiokoski M. , Mäki-Opas J. , Somersalo L. , Halla T.
Published: February 2022

Introduction

Previous migrant population studies have shown that immigrants experience high level of psychological load and difficulties in accessing care. This is especially prevalent in those with refugee background. To tackle this issue, the PALOMA2 project (National support system for refugee mental health work and the knowhow dissemination) establishes a National PALOMA Centre of Expertise (PALOMA COE) for mental health work among refugees.

Objectives

The PALOMA COE consists of all five University Hospital Areas and an NGO representative. The PALOMA COE work is becoming a permanent part of the Finnish health care structure. Each represented region has their own specific strengths and challenges, and the formation of Regional PALOMA COEs is planned accordingly. Together these Regional PALOMA COEs form the National PALOMA COE. Here we dive deeper into the Tampere University Hospital Region’s formation of PALOMA COE.

Methods

Psychiatric Clinic for Refugees (PCR) has been working for over 24 years in the Tampere City area. PCR has a long history of PALOMA COE work in forms of clinical work, consulting and training professionals working with refugee mental health. From the beginning of 2021, PCR is integrating with Tampere University Hospital.

Results

As a part of the integration process, the PALOMA COE work has a possibility to expand to the entire University Hospital area and better fulfill the specific needs of the entire region.

Conclusions

The integration will improve the resources, quality and access to mental health care among people with refugee background.
Emigration impact on psychiatric disorders
Authors: Pengili T.
Published: February 2022

Introduction

Emigration is a widespread phenomenon in our country for the last three decades.Various risk factors for mental disorders are related to emigration,like social-economic status,language,cultural shock,racism etc.

Objectives

The objectives of this study is assess how much of a risk factor is emigration in the development of psychiatric disorders.

Methods

This is retrospective study done on 178 patient charts from The Comunity Mental Health Center Nr.3 in Tirana,of patients who durin the last 20 years had their first episode of mental health disorder durin emigration.

Results

Emigrants before year 2004 had more psychotic disoders,whereas those after that year manifested more mood disorders.The mean age for starting MDD is 35 years old,and the mean age for schizophrenia is 25.Females develope more mood disorders,whereas males manifest more schizophrenia.

Conclusions

Emigration affects deeply mental health,and is a risk factor for developing psychiatric disorders,with females being prone to have mood disorders,whereas males schizophrenia.Schizophrenia start in an earlier age compared to depression.
Sex differences in total brain volume in a cognitively unimpaired elderly population
Authors: Buchpiguel M. , Busatto G. , Rosa P. , Squarzoni P. , Duran F. , Tamashiro-Duran J. , Leite C. , Lotufo P. , Scazufca M. , Alves T.
Published: February 2022

Introduction

Although a large number of studies have shown brain volumetric differences between men and women, only a few investigations to date have analyzed brain tissue volumes in representative samples of the general elderly population.

Objectives

We investigated differences in gray matter (GM), white matter (WM) and intracranial volumes (ICVs) between sexes in individuals above 66 years old using structural magnetic resonance imaging (MRI).

Methods

Using FreeSurfer version 5.3, we automatically obtained the ICVs, GM and WM volumes from MRI datasets of 84 men and 92 women. To correct for interindividual variations in ICV, GM and WM volumes were adjusted with a method using the residuals of a least-square-derived linear regression between raw volumes and ICVs. We then performed an ANCOVA comparing men and woman including age and years of schooling as confounding factors.

Results

Women had a lower socioeconomic status overall and fewer years of schooling than men. The comparison of unadjusted brain volumes showed larger GM and WM volumes in men. After the ICV correction, the adjusted volumes of GM and WM were larger in women.

Conclusions

After the ICV correction and taking into account differences in socioeconomic status and years of schooling, our results confirm previous findings of proportionally larger GM in women, as well as larger WM volumes. These results in an elderly population indicate that brain volumetric differences between sexes persist throughout the aging process. Additional studies combining MRI and other biomarkers are warranted to identify the hormonal and molecular bases influencing such differences.
Neuropsychiatric symptoms as first manifestation of olfactory groove meningioma - importance of neuroimaging evaluation
Authors: Vaz I. , Maia D.
Published: February 2022

Introduction

Neuropsychiatric symptoms may be the first and only manifestation of brain tumours, while classic neurological symptoms and signs may be minimal or absent at first. These patients will often receive psychiatric treatments for prolonged periods before correct diagnosis.

Objectives

To report the case of a patient with olfactory groove meningioma presenting with neuropsychiatric symptoms as a basis for discussion.

Methods

Retrospective review of clinical notes, neuroimaging results and house photos. Literature review.

Results

A 66-year-old woman was brought by police to the psychiatric emergency department Her neighbours had notified authorities of a bad smell, and police found the house was loaded with garbage. The patients reported depressive symptoms in the last 6 months, including apathy, anhedonia, social isolation, decreased appetite and insomnia; loss of basic skills such as cooking or cleaning; she also reported dizziness and two episodes of urinary and faecal incontinence in public. The patient had a history of being medicated for depression between 2000 and 2006. Currently she was taking only alprazolam 1 mg daily. During evaluation she was conscious, oriented and cooperative, with evident hypomimia, psychomotor inhibition and indifferent attitude. Cranial nerve function was preserved except for anosmia. Cranial CT and MRI showed a solid extra-axial tumour of 5.2x3.5x4.9 centimetres compatible with meningioma of the olfactory groove, and she was referred to Neurosurgery for surgical intervention.

Conclusions

This case illustrates the importance of a thorough organic evaluation, including neuroimaging, in the differential diagnosis of patients with atypical symptoms before making a psychiatric diagnosis and instituting treatment.
¡ I see presenters in my house !
Authors: De Llano M. Queipo , Vázquez E. Rodríguez , Meseguer C. Capella , Cerejeira J. Gonçalves , Carrasco I. Santos , Valera G. Guerra , Ramírez A. Gonzaga , Adame C. Vallecillo , De Andrés Lobo C. , Aparicio T. Jiménez
Published: February 2022

Introduction

Charles Bonnet syndrome (CBS) is characterized by the presence of visual hallucinations, generally complex, which occurs in patients with alterations in the visual pathway. The majority of affected patients are elderly. It appears in 15% of people with visual loss, predominantly in the 80-year-old female gender.

Objectives

To present a clinical case of a patient with visual hallucinations and a possible diagnosis of Charles Bonnet syndrome. Highlight the importance of an adequate differential diagnosis.

Methods

Bibliographic review of the treatment and diagnosis of CBS, from articles published in the last 5 years in Pubmed.

Results

Woman, 80 years old. No ophthalmological history except those associated with advanced age. She goes to the emergency room due to the presence of visual hallucinosis, in the form of “television presenters” of whom she makes partial criticism, being aware most of the time of their unreality. Hallucinations are not accompanied by anxiety or significant affective repercussions. Discarded delirium, intoxication by substances or drugs that cause the condition. Currently under follow-up to rule out other causes.

Conclusions

The diagnosis of SCB requires a multidisciplinary approach between neurologists, psychiatrists and ophthalmologists in order to avoid erroneous diagnoses. The differential diagnosis should be made with pathologies such as Lewy body dementia, Parkinson’s disease, delirium, substance intoxication, migraine aura, and metabolic encephalopathy, among others. It is important to involve the family in the treatment of the syndrome to reinforce the recognition of the unreality of these hallucinations in the patients. Antipsychotic treatment can be effective only if the condition is extremely distressing.
Neuron-specific enolase during the therapy in patients with alcohol use disorder and mood disorders
Authors: Levchuk L. , Roshchina O. , Simutkin G. , Bokhan N. , Ivanova S.
Published: February 2022

Introduction

Studies of the pathophysiology of mental disorders indicate the involvement of neurobiological processes, including the release of neurospecific proteins in biological substances.

Objectives

The purpose of this study was to research the level of neuron-specific enolase in patients with alcohol use disorder and mood disorders during the therapy.

Methods

The studied groups included patients with alcohol use disorder (AUD, F10.2, ICD-10; n=41), patients with mood disorders (MD, F32, F33, ICD-10; n=39), patients with co-morbidity of AUD and MD (n=31) and 20 healthy controls. Severity of depressive symptoms was assessed with HDRS-17 and CGI-S scales. The concentration of NSE were measured in serum by enzyme immunoassay. Рarticipants of the study were examined with clinical scales and laboratory analysis at baseline and on the 28th day of treatment. For statistical analysis we used the SPSS software.

Results

The results of the study showed that all patients are characterized by an increased level of NSE (p>0.005 compared with control). Patients with AUD characterized by changes in the concentration of NSE during therapy (p>0.005 compared with patients after therapy). In patients with MD revealed correlation between the level of NSE on the 28th day of antidepressive therapy and the HDRS-17 score before treatment (r=0,421; p=0,018). In patients with co-morbidity correlation between the level of NSE and the CGI-S score before therapy was found (r=-0,537; p=0,001).

Conclusions

The revealed correlations indicate the relationship between the severity of depressive symptoms and the level of NSE. Disclosure statement: This study was supported by the Russian Science Foundation, grant No. 19-15-00023.

Conflict of interest

Disclosure statement: This study was supported by the Russian Science Foundation, grant No. 19-15-00023.
Cognitive behavioral therapy in obsessive-compulsive disorder: A review
Authors: Duarte D.
Published: February 2022

Introduction

Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessive thoughts and recurring compulsive acts. The prevalence is 1-3% in the general population. The treatment consists of Cognitive Behavioral Therapy (CBT) alone, or in combination with antidepressants.

Objectives

Provide an overview of the elements of CBT in this disease and the techniques used.

Methods

The authors did a non-systematic review in Pubmed with the words: “Obsessive-Compulsive Disorder” and “Cognitive Behavioral Therapy”.

Results

According to the cognitive-behavioral model model, in this disease intrusive thoughts arise spontaneously, normally and universally, interrupting the normal flow of thought. They are usually neutral and form the basis for vulnerable people to develop obsessive problems. CBT uses techniques that aim to correct dysfunctional thoughts and beliefs, as well as behavioral techniques that aim to change compulsive behaviors. It aims to help people to come to the conclusion that the problem is not in the intrusive thoughts, but in the meaning they attribute to them, and in the various strategies they adopt to try to control them. It basically follows the following steps - patient assessment, through one or more semi-structured interviews; initial phase that includes the assessment of motivation for treatment and psychoeducation; intermediate phase, with the continuation of monitored exercises and reinforcement of cognitive and behavioral techniques; discharge, with discharge preparation working on relapse prevention and maintenance therapy.

Conclusions

Currently, CBT is considered the first-line therapy for the treatment of this disorder, however some patients are still refractory, and very little is known about its predictors of response.
Glutamatergic dysfunction in resistant obsessive-compulsive disorder: An auditory mismatch negativity study
Authors: Syed F. , Thatikonda N. , Arumugham S. , Narayanaswamy J. , Ganesan V. , Reddy Y.J.
Published: February 2022

Introduction

Obsessive-compulsive disorder (OCD) patients with poor response to serotonin reuptake inhibitors (SRIs) may have dysfunction involving other neurotransmitters, including glutamate. Mismatch negativity (MMN), an event-related potential dependent on glutamatergic functioning, has not been studied in the adult OCD population and SRI non-responders.

Objectives

To compare the amplitude of MMN between OCD subjects who have responded(R) and not responded(NR) to SRIs, with healthy volunteers(HV).

Methods

MMN was measured in 15 OCD subjects fulfilling DSM-IV criteria (8 non-responders and 7 responders) and 22 healthy volunteers. Auditory MMN was measured using a multi-feature paradigm consisting of two variants each in frequency, duration, and intensity domains. EEG was recorded using 64 channel electrodes at 1000Hz. Epochs of 700 ms were extracted for each stimulus. MMN was evaluated as peak difference between the deviant and standard stimulus. MMN amplitudes at Fz were used for comparison between the groups using Kruskal-Wallis test followed by posthoc analysis, with significance set at p<0.05.

Results

There was no significant difference in age/gender distribution between the three groups and duration of illness between the two OCD groups. There was a significant difference in MMN amplitude of a frequency deviant between the three groups (H=7.312,P=0.026). Post-hoc pairwise analyses revealed a significant reduction in MMN amplitude in NRs as compared to the HV group (H=10.9,P=0.04).

Conclusions

The results are suggestive of glutamatergic dysfunction in OCD subjects with poor response to SRIs. The findings have to be replicated in larger samples employing other paradigms to evaluate glutamatergic functioning and have future potential in understanding treatment response to SRIs.
Impaired emotion regulation in obsessive-compulsive disorder and hoarding disorder
Authors: Amieiro M. Puialto
Published: February 2022

Introduction

There is suggestive evidence linking hoarding with several problems in emotional regulation, and though this is shared with OCD patients, it may not correlate to the presence of obsessive symptoms.

Objectives

The present study aimed to examine self-reported deficits in emotion regulation (ER) and obsessiveness among individuals with hoarding disorder (HD) in comparison with others with obsessive compulsive disorder (OCD) and healthy controls

Methods

Twenty-two adult outpatients with HD, twenty-two with OCD and twenty-two age and gender matched healthy control (HC) participants completed the Emotion Regulation Questionnaire (ERQ) which measures respondents tendency to regulate their emotions in two ways: Cognitive Reappraisal and Expressive Suppression. They fulfilled as well the OCI-R which evaluates six groups of OCD symptoms: Washing, Checking, Ordering, Obsessing, Hoarding, and Neutralizing.

Results

The HD and OCD groups scored higher, (p 0.04), on Cognitive Reappraisal than did the HC group. There was no significant difference between groups in Expressive Suppression. HD and HC groups scored significantly lower, (p < 0.001), in OCI-R than OCD patients.

Conclusions

Results suggest that OCD and HD are characterized by self-reported deficits in ER, but this relationship in HD patients is not solely attributable to obsessive symptoms.
Management of behavioral and psychological symptoms of dementia
Authors: Cruz Da Fonseca I. , Franco A.M. Romão , Mendes R. , Gamito A.
Published: February 2022

Introduction

Behavioral and psychological symptoms of dementia (BPSD) are a heterogeneous group of clinical manifestations related to dementia, including apathy, depression, anxiety, delusions, hallucinations, disinhibition, sleep-wake cycle disturbances, aggression and agitation. BPSD have a negative impact on cognitive decline and increase complications.

Objectives

Review treatment management of BPSD including non-pharmacological and pharmacological options, but mainly interventional approaches, such as electroconvulsive therapy (ECT).

Methods

We conducted a search in PubMed and ClinicalKey with the terms: “Behavioral and psychological symptoms of dementia”; “Electroconvulsive therapy”.

Results

The vast majority of patients with dementia will develop one or more BPSD. The etiopathogenesis of BPSD is complex and multifactorial, with multiple direct and indirect factors, namely biological, psychological and social aspects and related to changes in cholinergic, dopaminergic, noradrenergic and serotoninergic circuits. Current guidelines recommend non-pharmacological interventions as the first-line approach for BPSD. Pharmacotherapy is often applied, but it carries out the risk of serious side-effects and pharmacologic interactions. There is now growing evidence that interventional approaches, such as ECT, could be safe and efficient when previous treatment options have been exhausted or ineffective, with few contraindications and transient/limited adverse effects.

Conclusions

BPSD represent a heterogeneous group of non-cognitive symptoms and behavior that affects most of dementia patients. Combination of non-pharmacological and pharmacological interventions is the recommended therapeutic for BPSD. However, there is usually limited clinical improvement and issues related to tolerability and effectiveness. Currently, ECT is considered a safe and effective option.
The use of methylphenidate in vascular dementia: A case report
Authors: Regueira P. , Cerejeira J.
Published: February 2022

Introduction

Patients diagnosed with vascular dementia often present with apathy, executive dysfunction or/and memory impairment. Some of these psychiatric domains are not responsive to antidepressants or acetylcholinesterase inhibitors. Since methylphenidate enhances frontal lobe function, it may be a valid therapeutic option.

Objectives

To report a case where methylphenidate was used as a therapeutic approach in vascular dementia.

Methods

We present a case of a patient diagnosed with vascular dementia with substantial clinical improvement after treatment with methylphenidate.

Results

A 67 year-old male was observed in a psychiatric consultation reporting memory loss, inability to retain information and inattention. According to her spouse, the patient has been mostly isolated at home and recently he has become unable to accomplish some daily living activities. There was no history of previous psychiatric disorder. Cognitive assessment was performed using MoCA test: 19/30 points (predominantly in executive, attention and delayed recall domains). After this evaluation, it was introduced bupropion 150mg od and donepezil 5mg od with insignificant clinical improvement. The patient underwent a routine workup which was unremarkable and a brain computed tomography scan that revealed ischemic leukoencephalopathy. Three months later no clinical benefit was reported. Attention and functional improvement were observed after introduction of methylphenidate with progressive dose adjusting till 30 mg/day.

Conclusions

Besides not being a consensual therapeutic approach, considering that there is a lack of efficient pharmacological strategies in vascular dementia, methylphenidate may play a significant role in this field contributing to clinical improving and ultimately to an enhanced quality of life.
A preliminary study of dyads of stroke patients and their female partners: Exploring the role of spirituality, religiousness and quality of life in rehabilitation
Authors: Giannouli V. , Giannoulis K.
Published: February 2022

Introduction

The concepts of spirituality and religiousness has not been investigated so far in patients after stroke.

Objectives

The aim of this study is to explore whether self-reports in two questionnaires measuring the personal experience of spirituality and religiousness can influence quality of life and estimations of rehabilitation in male older adult patients and their wives when compared with control dyads.

Methods

Fifteen male stroke patients and their wives participated one year after their hospitalization for stroke. The mean age of the patients and their wives was 75.58 years (SD = 7.50, range 61-90), level of education 15.47 years (SD = 3.82). In addition to that, fifteen married couples with similar demographics, were also measured. Depressive symptoms of the participants were assessed with the 15-item Geriatric Depression Scale. Family dyads consisting of an older adult and one family member, in all cases the wife, also responded to the Daily Spiritual Experience Scale, the Systems of Belief Inventory (SBI-15R), and the Satisfaction with Life Scale (SWLS). A 5-point Likert scale question was also administered examining the opinion of rehabilitation achieved.

Results

indicated that there was a statistically significant difference between the two groups regarding the levels of spirituality, religiousness and quality of life in both partners, with the stroke patient dyad showing lower scores, but positive stronger correlations.

Conclusions

Although spirituality, religiousness and quality of life are lower in the stroke patient dyad, they show significantly statistical positive correlations in older adults suffering from stroke as well as their wives.
Benzodiazepines prescribing in eldery patients: A study about the prescribing behaviour of tunisian psychiatrists
Authors: Lagha M. , Ouali U. , Nacef F.
Published: February 2022

Introduction

Prescribing benzodiazepines (BZD) in patients over 65 years old requires special precautions in view of the frequency and the severity of their side effects, especially in this age group.

Objectives

The objectives of our work were to evaluate the modalities of BZDs prescribing in elderly patients in psychiatry and to assess their compliance with international recommendations.

Methods

This is a descriptive cross-sectional study conducted through a Google-forms self-administered questionnaire, intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.

Results

One hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. Special precautions were taken in elderly patients by 96.5% of the participants. In eldery patients, long half-life BZDs were prescribed in 15% of cases. The majority of the participants indicated that the risk of falls (98.1%) and memory impairments (75.2%) were the main risks to which they were particularly vigilant during the prescribing of BZDs in eldery patients. In the elderly, 20% of the participants said they did not take special precautions when stopping BZDs.

Conclusions

The frequency and severity of side effects associated with BZDs in the elderly are the cause of strict prescribing rules in this age group. According to the results of our study and to the literature data, the prescribing practices of these molecules in the elderly remain insufficiently in accordance with the guidelines.
Patient and staff satisfaction with remote psychiatry assessments using mobile tablets in long-stay facilities in rural north-west Ireland
Authors: Patel S. , Maye E. , Gannon A. , Cryan M. , Dolan C. , Mccarthy G.
Published: February 2022

Introduction

The COVID-19 pandemic has required services to evolve quickly to continue routine care and telemedicine has been rapidly implemented to facilitate this. Older persons are at high risk of serious complications of COVID-19 and it is essential that their exposure to COVID-19 is minimized.

Objectives

Our aim was to assess staff and patient satisfaction with remote psychiatric assessments using mobile tablets in long-stay facilities.

Methods

Remote clinics using Skype video on mobile tablets were conducted with patients in long-stay facilities attending psychiatry in rural North-West Ireland between April and July 2020. At each review, a satisfaction survey was administered to the patient, their keyworker and the clinician. The patient/keyworker survey instrument had four yes/no statements and the clinician survey had four statements with 5-point likert scale responses (1=very low to 5=very high). Open feedback was also obtained for thematic analysis. Descriptive analyses were completed using SPSS software.

Results

23 patients (mean age 80.9yrs) were assessed in 10 long-stay facilities. All patients were agreeable to participating in video consultation although only 13 patients were able to respond to survey due to cognitive impairment. There was a 92.3% positive patient response (12/13) and 95.7% positive keyworker response (N=22/23) for all statements. The mean score on the assessor response ranged from 3.43 to 4.04 with the lowest rate for quality of transmission. The main themes identified were related to the quality of connection and sensory difficulties.

Conclusions

Video consultations using mobile tablets offer an acceptable form of remote psychiatry assessment for older persons in long-stay facilities.
Use of antipsychotics with tamoxifen
Authors: Ghabi H. , Karoui M. , Ellouz F.
Published: February 2022

Introduction

Bipolar disorder is a frequent and serious psychiatric disease. Antipsychotics are habitually required for its management especially during an acute manic episode. The association of cancer with bipolar disorder may impact psychiatric management. The choice of the adequate antipsychotic drug remains a challenge in this case. The clinical benefit of tamoxifen is obtained after the hepatic metabolism with cytochrome P450 2D6 which generates endoxifen, the potent metabolite of tamoxifen. Evidence has emerged that antipsychotics may potentially inhibit the CYP2D6. Study data supporting this interaction are rare.

Objectives

In this work, we aimed to illustrate the modalities of care of bipolar disorder in a patient receiving tamoxifen.

Methods

Presentation of a clinical case of a patient treated by Tamoxifen for her breast cancer and who was admitted in our department for acute mania with psychotics features, followed by a literature review.

Results

A 53-year-old woman with past history of breast cancer diagnosed in 2018, treated with lumpectomy and radiation, followed by tamoxifen. She has been admitted in 2019 in our department for an acute mania with psychotics features. Olanzapine was prescribed with good clinical evolution. The psychiatric and oncologic status of the patient was stable after one year under tamoxifen and olanzapine.

Conclusions

Psychiatrists must be aware that some of the prescribed medications co-administered with tamoxifen interfere with the CYP2D6 function, which may potentially increase the risk of breast cancer recurrence. A close collaboration between psychiatrists and oncologists is required to adapt therapeutic protocols.
Acute mania in patient under tamoxifen
Authors: Ghabi H. , Karoui M. , Salem S. Ben , Kamoun R. , Ellouz F.
Published: February 2022

Introduction

Tamoxifen is an antioestrogen agent used in breast cancer treatment. According to some guidelines, this molecular was also proposed for the treatment of acute mania. In fact, Tamoxifen inhibits the intracellular action of the protein kinase C (PKC), which is the direct target in the treatment of mania episodes. Lithium and valproate have also the same action.

Objectives

We aimed to show the case of an acute mania under an inhibitor PKC treatment and insisted that other studies are recommended.

Methods

Case report description and research on medline, pubmed with the keywords: Tamoxifen, Bipolar disorder, protein kinase C,mania.

Results

We reported a case of a 53-year-old woman with past history of unipolar depression. In 2018 when she was diagnosed with breast cancer. She received antidepressant drugs but she interrupted the treatment after a few months. She was treated for her breast cancer with mastectomy, radiotherapy, and 20 mg per day of Tamoxifen prescribed since Mars 2018. She had been admitted in June 2019 in our department for acute mania. The patient received Tamoxifen as it was prescribed. She was not taking any concomitant medications. No history of drug abuse was reported. Medical examination, laboratory, and radiological investigations did not indicate any medical pathology.

Conclusions

In our case, Tamoxifen had not ovoid the acute mania in spite of its Known anti-manic properties as reported in the literature. Possible neurobiological effect of tamoxifen on the nervous system should be studied to evaluate the safety of this treatment mainly in patients with bipolar disorder.
Which antidepressant agent can be used in patients receiving tamoxifen?
Authors: Maamri A. , Ghabi H. , Zalila H.
Published: February 2022

Introduction

Depression is frequently observed in carcinology. Many patients with breast cancer, receiving Tamoxifen, may need antidepressants to treat depression. Tamoxifen is a synthetic non-steroidal antioestrogen metabolized by the cytochrome P450 2D6(CYP2D6) to endoxifen which is the active metabolite of this drug. It was reported that the concomitant prescription of Tamoxifen and some antidepressant agents such as paroxetine and fluoxetine may decrease the anticancer effect of tamoxifen as they may inhibit the CYP2D6 pathway.

Objectives

The objective of this case was to highlight the particularity of management of depression in patients under tamoxifen.

Methods

Case report description of a patient treated with Tamoxifen for her breast cancer and who was admitted for major depression, followed by a literature review.

Results

A 36 –year- old woman, had breast cancer and she underwent a mastectomy followed by chemotherapy. Since September 2016, she received 20 mg per day of Tamoxifen as an antihormonal treatment. In November 2018, she was referred to our psychiatry department for depressive symptoms. The patient was sad, she reported social withdrawal, insomnia, anhedonia, and low self-esteem. She had no history of mania or hypomania. A major depressive episode was diagnosed. We prescribed Escitalopram 10 mg per day with clinical improvement. The psychiatric and oncologic status of the patient was stable after two years under tamoxifen and Escitalopram.

Conclusions

The choice of the adequate antidepressant agent in patients under Tamoxifen remains a challenge and requires a thorough knowledge of drug interactions.
Distresses reported by physicians and nurses toward peculiarities of patients with head and neck cancer at a university general hospital in Brazil: A qualitative study
Authors: Turato E. , Bispo A.C. , Rodrigues J.R. , Lima C.S.
Published: February 2022

Introduction

Contextualization: health professionals’ anguish towards the patient with head and neck cancer (HNC) permeates clinical issues: the location of the tumour, if advanced diagnosis, the psychosocial features of the patient. The perception, coming from patients as undesirable, refers to the conflict of how to deal with one’s own anguishes.

Objectives

AIM: To explore and interpret how anguish experienced by physicians and nurses are mobilized regarding to the clinical and psychosocial peculiarities of patients with HNC.

Methods

Strategies: Clinical-qualitative design; semi-directed interview with open-ended questions in depth. Trigger question: “Tell me about the management of the patient with …”. Ten interviewees (06 nurses and 04 resident doctors) from a university oncology outpatient. Intentional sample. Clinical-Qualitative Content Analysis with psychodynamic concepts. Findings validated by peers at the Laboratory of Clinical-Qualitative Research at the University of Campinas, Brazil.

Results

Topics: the treatment of the speeches resulted in three emerging categories: (1) Cancer is literally on the face: self-perception of peculiarities; (2) An appalling illness: dealing with the ‘deteriorated’; (3) To naturalize without trivializing: handling with their own anguish.

Conclusions

Final considerations: The anguish of health professionals who deals with the HNC patient consists of the feelings, which are not exposed, because they are not organized and neither understood as natural feelings. It is up to them to seek neutrality to minimize the anguish present in the conflict of not manifesting thoughts considered inadequate by the patient, avoiding moral judgments and conflicts. Balint groups are recommended to attend emotional demands of health professionals.
Acceptance and commitment therapy for chronic pain: A systematic review
Authors: Ramos S. Freitas , Dias A.
Published: February 2022

Introduction

Chronic pain is common, costly, and associated with significant disability and negative effects on well-being and mental health. The treatment is challenging, requiring a multidisciplinary approach. Acceptance and commitment therapy (ACT) aims to help patients in engaging in a flexible and persistent pattern of values-directed behavior while in contact with continuing pain and discomfort.

Objectives

To provide an updated review on the efficacy of ACT for the management of chronic pain.

Methods

We conducted a systematic review based on the PubMed® and EBSCO databases up to April 2020.

Results

Fifteen trials were included. The results were in favour of ACT in pain acceptance, functioning and pain intensity with small to large effect sizes. Few studies evaluated quality of life, but half of those were favourable to ACT. We also focused our analysis on ACT online interventions, considering the current demands due to the COVID-19 pandemic.

Conclusions

The current systematic review points in favour of ACT for the management of chronic pain conditions, though the studies included suffered from methodological limitations, which may have led to overestimated effects. Methodologically robust trials are required to further understand the clinical efficacy of ACT for chronic pain and which patients most benefit from this intervention.
Lessons learned from the coronavirus health crisis in the nordic countries
Authors: Valdimarsdóttir U.
Published: February 2022

Abstract Body

The COVID-19 pandemic has had an unprecedented influence on the global economy and population health. Vigorous, well-designed studies with complete, long-term follow-up of high risk groups including COVID-19 patients, their families and frontline workers are imperative for a comprehensive understanding of the mental health impact of the pandemic. The Nordic-Baltic national registries and biobank resources provide a unique opportunity to gain critical insight into the interplay between mental and somatic health during the COVID-19 pandemic. The COVIDMENT consortium leverages an extensive research experience and infrastructure from ongoing collaborations between four Nordic countries and Estonia, including national registry resources (est. >24 million individuals) and new COVID-19 cohorts with questionnaire data (est. > 220.000 individuals), to significantly advance current knowledge of mental morbidity trajectories in the COVID-19 pandemic. This program will address the following specific aims: 1) The role of preexisting psychiatric disorders in subsequent risk and progression of a COVID-19 infection. 2) The impact of COVID-19 on short and long-term psychiatric sequel among COVID-19 patients, their families and frontline workers. 3) The impact of the COVID-19 pandemic on population mental health by the varying mitigating responses and corresponding COVID-19 related mortality rates across 4 Nordic countries and Estonia. These data sources and research plan, along with preliminary results will be presented.

Disclosure

No significant relationships.
Borderline personality disorder and psychotic symptoms. report of two cases
Authors: Mata A. Hernández , Gómez A. Sotillos , Barandiarán M. Esparza , Coscujuela P. Marco
Published: February 2022

Introduction

DSM-V includes near-psychotic symptoms as new criteria in borderline personality disorder (BPD). This change makes more difficult the differential diagnosis between considering psychotic symptoms as part of the BPD or as part of a comorbid psychotic disorder.

Objectives

Recognize the difficulty of the differential diagnosis in clinical practice between BPD and comorbid diagnosis of BPD with psychotic disorders, and how it can affect the patient’s outcome.

Methods

Patients’ data is obtained from medical history and psychiatric interviews carried out during their hospitalizations.

Results

32 year-old female patient with previous diagnosis of BPD, psychotic episodes and cannabis abuse, was admitted due to paranoid ideation and aggressiveness, with massive borderline defense mechanisms (frequent displays of anger, high impulsivity, low frustration tolerance, self-destructive behavior…). Psychotic symptoms ceased two weeks after admission, and considering the patient’s individual characteristic it was believed BPD fitted more with this clinical case, although different psychotic disorders were considered. 30 year-old female patient began intensive psychiatric treatment with previous diagnosis of BPD, psychotic disorder and cannabis abuse. It was observed that the paranoid ideation and bodily experiences she suffered lasted months and were characterized by a strong belief. These two reasons were put into consideration when it was decided to judge this clinical case as a comorbid diagnosis of BPD with a psychotic disorder.

Conclusions

It is necessary to assess the difficulty of the differential diagnosis in these patients, and offer them specialized treatment depending on the diagnosis, as it can affect the patient’s outcome.
Moral disengagement and social distancing of people with a personality disorder
Authors: Heissler R. , Doubková N. , Jonáš J. , Preiss M.
Published: February 2022

Introduction

People with personality disorders (PD) share some impairments in personality functioning (e.g. identity, intimacy, empathy) that are also associated with inner or interpersonal conflicts, and sometimes also with different strategies of moral disengagement (MD). It is unclear whether MD strategies are related to individuals with/without PD and their willingness to have social contacts with representatives of otherness (like minorities, physically handicapped, etc.).

Objectives

Comparison of the differences in MD strategies and social distance to the otherness of healthy controls and people with PD, and the influence of personality functioning.

Methods

Moral Disengagement Scale which measures eight MD strategies, the Semi-Structured Interview for Personality Functioning DSM-5 assessing the Self and Interpersonal functioning, and Bogardus Social Distance Scale measuring perceived social distance toward various representatives of otherness are applied in two samples (general population and personality disorders).

Results

People with PD showed a significantly higher propensity to use various MD strategies than healthy controls with moderate effect size (.34–.49). Moral disengagement is facilitated by different aspects of personality functioning in both samples, sharing the impairments in maintaining close relationships. Both samples differed in MD strategies connected with higher social distancing.

Conclusions

People with PD are more prone to moral disengagement than healthy adults. MD appears to be facilitated by different aspects of personality functioning in both samples. Some representants of otherness are more related to specific MD strategies. We hypothesize that understanding of specific MD strategies used by people with PD can provide insight and explain some of their behavior.
Generalized problematic internet use and perfectionism in portuguese university students
Authors: Maia B. Rodrigues , Soares M.J. , Pereira A.T. , Marques M. , Carvalho F. , Macedo A.
Published: February 2022

Introduction

Although there are several empirical studies exploring the relationship between problematic Internet use and personality traits, few had considered perfectionism.

Objectives

To explore the association between generalized problematic Internet use and perfectionism.

Methods

A sample of 433 Portuguese university students (Mage = 20.15 years, SD = 1.77, range = 18-25 years) completed the Generalized Problematic Internet Use Scale 2/GPIU and the Multidimensional Perfectionism Composite Scale – short version.

Results

GPIU total score (rs=.16**), Mood Regulation (rs=.22**), and Deficient Self-Regulation (rs=.13**) were correlated with Positive Striving factor. GPIU total score (rs=.38**), Preference for Online Social Interaction (rs=.16**), Mood Regulation (rs=.28**), Deficient Self-Regulation (rs = .33**), and Negative Consequences (rs=.41**) were significantly correlated with Evaluative Concerns factor. A one-way between groups analysis of variance was conducted to explore the relation between GPIU and perfectionism. Subjects were divided into three groups according to their GPIU risk levels (Group1:low-risk; Group2:medium-risk; Group3:high-risk). There was a statistically difference at p >.05 level in Positive Striving scores for the three risk level groups: F (2,430)=4.39, p=.013, and in Evaluative Concerns scores, F (2,430)=28.83, p=<.001. Post-hoc comparisons using the Tukey USD test, for Positive Striving, indicated that the mean score for Group1 (M=39.21, SD=8.56) was significantly different from Group3 (M=43.69, SD=9.74). Considering Evaluative Concerns, the mean score for Group1 (M=39.86, SD=11.31) was significantly different from Group2 (M=46.91, SD=11.42) and from Group3 (M=51.75, SD=8.54).

Conclusions

GPIU is consistently related to maladaptive perfectionism. Future longitudinal studies are needed to clarify the bidirectional association between GPIU and perfectionism traits.
The portuguese version of the big three perfectionism scale – further validation with adults from the general population
Authors: Oliveira J. , Pereira A.T. , Araujo A. , Cabaços C. , Azevedo J. , Carvalho F. , Macedo A.
Published: February 2022

Introduction

Both original Big Three Perfectionism Scale (BTPS; Smith et al. 2016), and the Portuguese version validated with a sample of university students (Lino et al. 2018) evaluates three second-order factors (rigid, self-oriented and narcissistic perfectionism) and ten facets.

Objectives

To confirm the BTPS three-factors-ten-dimensions’ structure in a sample of Portuguese adults from the general population.

Methods

A sample of 467 adults (70.7% females; Mean age=38.44±12.27; range: 25-82) answered the BTPS Portuguese version and other validated perfectionism measures (Multidimensional Perfectionism Scales from Frost and Hewitt & Flett; Self-Presentation Perfectionism Scale). To study the temporal stability a sub-sample of 132 participants completed the BTPS again after approximately five weeks. SPSS and AMOS software was used.

Results

The second order model presented an acceptable fit (X²/df=3.115; TLI=.811; CFI=.825; RMSEA=.067). There was also evidence of a general factor comprising all the 45 items (X²/df=3.127; TLI=.809; CFI=.823; [JA1] RMSEA=.068). The Cronbach alphas of the three factors ranged from a=.88 to a=.92; and facets had a>.70 showing a total of a=.94. Total and dimensional scores showed significant positive and moderate to high correlations with the other perfectionism measures and their test-retest correlation coefficients were r=.85 (p<0.001).

Conclusions

This study confirms the validity and reliability of the Portuguese BTPS underlying three-factors structure. Additionally, we found, for the first time, that BTPS can also be validly and reliably used to measure a global perfectionism construct. It is our intention to develop a shorter version the Portuguese BTPS in the near future.
Epigenetic pathways in PTSD
Authors: Klengel T.
Published: February 2022

Abstract Body

Nonhuman primates (NHPs) are critical for translational research due to their close genetic, physiological, and behavioral similarity to humans. In particular, higher brain functions depend on brain regions and neural circuits that evolved differently between primates and rodents. Thus, NHPs are a strong translational model system to investigate the pathophysiology and relevant biological correlates of mental disorders. This talk will focus on translational approaches leveraging NHP models to advance our understanding of environmentally induced epigenetic changes in post-traumatic stress disorder (PTSD). Environmental factors including early life stress significantly contribute to risk and resilience for psychiatric disorders including PTSD. However, human studies are often confounded, and it remains challenging to identify robust epigenetic signals in clinical populations even in large studies. We investigate the natural spectrum of behavioral phenotypes in rhesus macaques to complement human studies with a focus on stress and fear. This talk will present data on epigenetic signatures of fear and the effects of early life stress in rhesus monkeys and their relationship to human studies.

Disclosure

No significant relationships.