bluuebunny/crossref_metadata_2025 huggingface dataset:
Anxiety and depressive disorders in patients with Covid-19
Authors: Stolyarova A. , Tyvina N. , Golovkina D. , Vysokova V. , Zhao J. , Zhang K. , Kinkulkina M.
Published: August 2023

Introduction

Coronavirus infection has shown a significant impact not only on physical health but also on mental health. Among the long-term consequences in the post-COVID period, depressive and anxiety disorders are well observed. A potential mechanism for developing mental disorders after undergoing SARS-CoV-2 is a neuroinflammatory process in the central nervous system.

Objectives

This study aimed to discover the features of anxiety and depressive disorders in people who suffered from COVID-19.

Methods

The study was conducted from October 2021 to September 2022 in outpatient and inpatient conditions of the S. S. Korsakov Psychiatric Clinic of Sechenov University. 58 patients (17 (29.3%) men and 41 (70.7%) women) with a diagnosis of F32, F34.1, F41-F48.0, or F06.3-06.4 according to ICD-10 who underwent COVID-19, mainly of mild and moderate severity (46 (79,3%) and (8 (13,8%) consequently), were examined clinically.

Results

The median age among the respondents was 34 years. Mental illness in the family history had 38 (65.5%) people. Among the examined patients, 21 ((36.2%) people had psychasthenic traits premorbid, 13 (22.4%) – hyperthymic, 9 (15.5%) – hysterical. 15 patients (25.9%) had a history of maternal disorders during pregnancy and childbirth – 16 (27,6%) had neurotic disorders in childhood, 27 (46.6%) had a traumatic brain injury or general anesthesia. 2 patients (3.4%) reported substance abuse, 7 (12.1%) abused alcohol. The median period from somatic well-being after infection to the onset of mental illness was 3 months. The duration from the onset of symptoms of a mental disorder to treatment with a psychiatrist was 3 months. The main symptoms in the clinical picture were impaired concentration (100.0%), decreased productivity (98.3%), sleep disorders (96.6%), decreased mood (98.3%), anxiety (89.7%), anhedonia (75.9%), decreased appetite (65.5%), asthenia (65.5%), emotional lability (44.8%), self-blame ideas (43.1%), obsessive thoughts (39.7%), irritability (37.9%), suicidal thoughts (19.0%).

Conclusions

About two-thirds of respondents were female. The main reasons for consulting a psychiatrist were decreased concentration, sleep disorders, and reduced productivity. In addition, symptoms of anxiety, asthenia, and low mood were revealed, and more than half of the patients complained of apathy. Although the severity of depression was moderate, and the level of anxiety was mild, all these disorders were accompanied by clinically significant fatigue.

Disclosure of Interest

None Declared
Outcomes of a community-based wellness screening tool administered by mental health professionals and religious leaders in the Ketu South Municipality in Ghana
Authors: Wolthusen R. P. F. , Andrä P.
Published: August 2023

Introduction

Ghanaian community members with mental health conditions are usually not identified until their families cannot handle their care at home anymore, for example, due to mistrust in medical institutions. From community-based and global mental health research, we know why we should act (for example, early interventions improve the treatment outcomes) and what we should do (for example, task-sharing in community settings). How any of these activities can be implemented on the community level to decrease the delay of access to evidence-based care remains unclear.

Objectives

The study explored the “how” for a specific identified problem (collaboration between mental health professionals and religious leaders) in the Ketu South Municipality in Ghana; additionally, the study explored the feasibilty and the results of a community-based wellness screening.

Methods

We used a human-centered design approach to tackle this challenge in the Ketu South Municipality in Ghana. We invited 80 mental health professionals, religious leaders, and service users to participate in this exercise. The participants innovated the so-called Brain Spirit Desk, which builds collaboration between mental health professionals and religious leaders. The participants also designed a 9-question wellness screening tool, including four validated screening scales in Ghana: PHQ-2, GAD-2, one question about suicidality, and CAGE-AID. The participating religious leaders were trained to use this screening tool and administer it by themselves or allow mental health professionals to administer it in their respective institutions. Referral pathways were established for community members who screened positive on the wellness screening tool.

Results

1065 community members (787 females, 278 males, mean age: 32.42 years) were screened using the wellness screening tool over five months (January - May 2022); 215 of these community members were already connected to mental health clinics in hospitals. 60 community members out of 203 who screened positive on the PHQ-2 were not receiving treatment at the time of screening and were referred for further assessment and treatment. Another 52, 53, and 142 community members were referred for further evaluation and treatment based on their answers to the GAD-2, suicidality, and CAGE-AID screening questions, respectively. Completed referrals across conditions averaged around 55%.

Conclusions

Our activities explored, guided through principles of a human-centered design approach, how the delay in access to evidence-based mental health care in the Ketu South Municipality in Ghana can be decreased through a collaborative effort of mental health professionals and religious leaders. A developed screening tool identified potential cases of mental health conditions. Importantly, religious leaders’ involvement and endorsement built trust in the activities.

Disclosure of Interest

None Declared
Attitude Toward Depression in Thai Physicians compared with general population
Authors: Charnsil C.
Published: August 2023

Introduction

High stigma has been considered an important cause for the low rates of help-seeking,
lack of access to care, undertreatment, material poverty, and social
marginalization.Physicians commonly know about depression but are reluctant to seek mental
health treatment.

Objectives

This study aimed to examine the attitude toward depression in Thai physicians compared
with the general population.

Methods

A cross-sectional descriptive study was conducted on Thai physicians and the general
population. We used the Depression Stigma Scale in the Thai version to assess stigma. The
Depression stigma scale was distributed via the internet with a google form program.

Results

Two thousand eighty-three participants responded to the questionnaire. Comparing the
Depression Stigma Scale of the general population and physicians by using an independent test
demonstrated that there was a significant difference between the two groups (p < 0.001)
with an average total score of physicians higher than the general population (37.47 and
35.73, respectively). There was a significant difference in the Perceived Stigma Subscale in
the general population p < 0.001 and physicians but not in the Personal Stigma Subscale. A
significant difference was shown between the Personal Stigma Subscale of male and female
physicians (P < 0.05). No significant difference was demonstrated between the Perceived
Stigma Subscale of male and female physicians. However, the male and female general
population had no significant differences in the Depression Stigma Scale.

Conclusions

Physicians had higher depression stigma than the general population, especially in
perceived stigma.

Disclosure of Interest

None Declared
How co-production helped to shape Well Parent Japan: A culturally appropriate parenting intervention for mothers of children with ADHD
Authors: Shimabukuro S.
Published: August 2023

This presentation will talk about co-production findings from three completed studies to develop and evaluate a culturally appropriate Japanese version of the New Forest Parent Training Programme (NFPP), named Well Parent Japan (WPJ). Dr Shimabukuro will also present an on-going prospective study aiming to provide support for Japanese mothers and teachers of children with ADHD in a school setting. Dr. Shimabukuro will share the experiences worked with different stakeholders at the different stage of the study and highlight the benefits of co-production in the research and how WPJ was shaped. This presentation will also discuss difficulties and challenges when evidence-based parent training intervention is transferred from research to practice.

Disclosure of Interest

None Declared
Emotionally Unstable Personality Disorder and Severity of Suicide Attempt are related to Epigenetic Hypermethylation of Brain-Derived Neurotrophic Factor in Women
Authors: Jokinen J. , Jamshidi E. , Nilsonne Å. , Wilczek A. , Boström A. , Åsberg M.
Published: August 2023

Introduction

Brain-derived neurotrophic factor (BDNF) has been associated with both emotionally unstable personality disorder (EUPD) and suicidal behavior. No study has yet investigated BDNF-associated epigenetic alterations in severely impaired EUPD and suicidal patients.

Objectives

The main goal of the present study was to investigate whether epigenetic dysregulation in BDNF, CRP, IL-1, IL-2 and IL-6 were associated with EUPD and severity of suicidal behavior.

Methods

The discovery cohort consisted of 97 women with emotionally unstable personality disorder (EUPD) with at least two serious suicide attempts (SA) and 32 healthy women. The genome-wide methylation pattern was measured by the Illumina EPIC BeadChip and analyzed by robust linear regression models to investigate mean BDNF methylation levels in a targeted analysis conditioned upon severity of suicide attempt. The validation cohort consisted of 60 female suicide attempters, stratified into low- (n=45)and high-risk groups (n=15) based on degree of intent-to-die and lethality of suicide attempt method, and occurrence of death-by-suicide at follow-up.

Results

Mean BDNF methylation levels exhibited hypermethylation in relation to EUPD(p=0.0343, percentage mean group difference ~3.8%). Similarly, this locus was confirmed as hypermethylated in an independent cohort of women with severe suicidal behavior (p=0.0469). Results were independent of age and BMI.

Conclusions

This study elicits emerging evidence of epigenetic dysregulation of BDNF in relation to phenotypes known to increase risk of suicide (lethality of suicide-attempt method and presence of EUPD diagnosis with history of recent SA). Further studies investigating epigenetic and genetic effects of BDNF on severe suicidal behavior and EUPD are needed to elucidate the role of epigenetic regulatory mechanisms and neurotrophic factors in relation to suicide risk.

Disclosure of Interest

None Declared
Mental Health Services Utilization among Suicidal Patients: Comparing the Impact of Co-Occurring Opioid or Other Substance Use Disorders
Authors: Pathak J.
Published: August 2023

Introduction

Prior literature establishes bidirectional associations between suicide and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, the context of mental health services utilization remains under-investigated. This analysis examined patterns of mental health services utilization in patients with SUDs and suicidality, identified associated risk factors, and evaluated the impact of patient engagement on subsequent mental health outcomes

Objectives

See above.

Methods

Electronic health records (EHRs) derived from 7 health systems across New York City between 2010-2019 were analyzed. Suicidality was identified as any ICD-9/10 diagnosis of suicide attempt, suicidal ideation, or self-harm injury. SUDs were identified as any opioid, cannabis, cocaine, hallucinogen, inhalant, sedative/hypnotic/anxiolytic, amphetamine, or other substance abuse or dependence. Quasi-Poisson regression adjusted for age, gender, and chronic diseases was used to model associations between OUD exposure and the frequency of encounters and estimate the relative risk (RR) of significant covariates.

Results

A total of 6977 adults with suicidality and any comorbid SUD were selected, including 2203 (31.6%) with a diagnosis of OUD and 4774 (68.4%) without a diagnosis of OUD. Most patients were male (54.8%) and aged between 25-64 years (79.3%). Many (61.3%) had over 3 chronic diseases, including depression (80.8%), hypertension (60.6%), anemia (43.0%), and hyperlipidemia (41.9%). Compared to patients with other SUDs, those with OUD had higher odds of self-harm injury [OR: 1.26 (95% CI: 1.13-1.41)], depressive disorders [1.47 (1.29-1.67)], anxiety disorders [1.65 (1.48-1.84)], psychotic disorders [1.23 (1.11-1.37)], personality disorders [1.30 (1.16-1.48)], and post-traumatic stress disorder [1.37 (1.20-1.57)]. Patients with OUD were more likely to utilize all-cause outpatient (RR: 1.16), emergency department (ED) (RR: 1.43), and inpatient (RR: 1.60) services (p<0.001). Among OUD patients, males were less likely to have outpatient visits (RR: 0.79) and inpatient hospitalizations (RR: 0.88), and older age was protective against ED admissions (RR range: 0.62-0.71). Additionally, individuals with OUD were more likely than those with other SUDs to have SUD-related encounters, as well as suicide-related ED admissions and inpatient hospitalizations (p<0.0001). Those who had more mental health outpatient visits were less likely to have suicide-related ED admissions (RR: 0.85), however this association was weaker among younger or male patients with comorbid OUD.

Conclusions

Among suicidal adults with comorbid SUDs, those with a diagnosis of OUD were more likely to utilize mental health services and have psychiatric comorbidity. Males and older adults were less likely to utilize services.

Disclosure of Interest

None Declared
Borderline personality disorder and attention deficit/hyperactivity disorder in adolescence: overlap and differences in a clinical setting
Authors: Akca O. F. , Wall K. , Sharp C.
Published: August 2023

Introduction

With increased consensus regarding the validity and reliability of diagnosing Borderline Personality

Disorder (BPD) in adolescents, clinicians express concern over the distinction between BPD and Attention-Deficit/Hyperactivity Disorder (ADHD), and its co-morbidity in clinical settings.

Objectives

The goal of this study was to evaluate differences between BPD, ADHD and BPD + ADHD in terms of co-morbid psychiatric disorders and a range of selfreported behavioral problems in adolescents.

Methods

Our sample consisted of N = 550 inpatient adolescents with behavioral and emotional disorders that have not responded to prior intervention. We took a person-centered approach (for increase clinical relevance) and compared adolescents with ADHD, BPD and ADHD+BPD in terms of co-occurring psychiatric disorders and behavioral problems. We performed a regression analysis to test whether BPD symptoms make an incremental contribution to the prediction of psychiatric symptoms over ADHD symptoms.

Results

The severity of almost all co-occurring disorders, aggression, self-harm, suicidal thoughts, and substance use, were higher in the ADHD+BPD group. Borderline symptoms made an incremental contribution to the prediction of psychiatric symptoms beyond the contribution of ADHD.

Conclusions

The findings of this study demonstrated that ADHD and BPD have different psychiatric symptomatology. In addition, subjects who meet criteria for both the BPD and ADHD diagnoses may have more severe psychiatric and behavioral problems compared to individuals with only ADHD or BPD.

Disclosure of Interest

None Declared
The influence of paternity leave uptake on parental post-partum depression: An ELFE cohort study
Authors: Barry K. M. , Gomajee R. , Benarous X. , Dufourg M.-N. , Courtin E. , Melchior M.
Published: August 2023

Introduction

Many countries are currently expanding their paternity leave policies, which have positive effects on parental mental health.

Objectives

We examined whether two weeks of paid paternity leave are associated with post-partum depression (PPD) in mothers and fathers at two months after the birth of their child.

Methods

Data originated from The Etude Longitudinale Française depuis l’Enfance (ELFE) cohort study. A total of 10 975 fathers and 13 075 mothers with reported information on paternity leave and PPD at two months were included in the statistical analyses. Logistic regression models, using survey-weighted data and adjusted for confounders using Inverse Probability Weights (IPW), yielded Odds Ratios.

Results

Fathers had a median age of 32∙6 (inter-quartile range (IQR) 36∙9 – 22∙6 years), and mothers had a median age of 30∙5 years (IQR 34∙0 – 27∙1 years) at the time of the ELFE child’s birth. Fathers who took paternity leave had reduced odds of PPD [0∙74 (95% CI: 0∙70 -0∙78)] as well as fathers who intended to take paternity leave [0∙76 (95 CI%: 0∙70 – 0∙82)] compared to fathers who did not take paternity leave. Mothers had an increased likelihood of PPD at two months if their partners took paternity leave [1∙13 (95 CI%: 1∙05 – 1∙20)]. Fathers’ educational level, work contract type nor the number of children in the family were found to be interactions (p>0.25).

Conclusions

Taking and intending to take a two-week paid paternity leave is associated with lower odds of PPD in fathers. Mothers whose partners take paternity leave experience borderline higher odds of PPD at two months. Offering only a two-week paternity leave may protect fathers against PPD but does not significantly protect may increase mothers’ risk of against PPD onset.

Disclosure of Interest

None Declared
Implementation of Early Intervention Services (OPUS) in Denmark and results of 20 year follow-up of the OPUS trial
Authors: Nordentoft M.
Published: August 2023

Abstract: Background

The OPUS trial is the largest randomized controlled trial (RCT) testing early intervention services with 20-years of follow-up among individuals with a first episode of psychosis in the schizophrenia spectrum.

Methods

A total of 547 individuals with first episode psychosis in the schizophrenia spectrum were included into the OPUS I trial between January 1998 - December 2000 and allocated to either two years of early intervention services or treatment as usual. Clinical and trained staff, blinded to the original treatment allocation, performed the five, ten and 20-year follow-up assessments.

The early intervention service consisted of two years of assertive community treatment including social skill training, psychoeducation and family involvement delivered by a multi-disciplinary team (staff patient ratio 1:10). The standard treatment was based on the available community mental health treatment (1:20 –1:30).

Results

A total of 164 participants (30%) of 547 were interviewed at the 20-year follow-up. No significant differences were found between the early intervention group (OPUS-group) compared to the Treatment As Usual group (TAU-group) on global functional levels, psychotic and negative symptom scores after 20 years. Likewise, no differences was found ten to 20-years after randomization between the OPUS-group and TAU-group on days of psychiatric hospitalizations (Incidence Rate Ratio (IRR), 1.202, 95% CI 0.733 - 1.997, P=0.46), or number of outpatient contacts (IRR: 1.197, 95% CI 0.889 - 1.612, P=0.24). Of the entire cohort, 40% were in symptom remission and 18% were in clinical recovery at the 20-year follow-up. The mortality rate 20 years after randomization was 13.1% in the OPUS-group and 15.1% in the TAU group, P=.47.

Conclusions and Relevance

New initiatives are needed to maintain the positive outcomes achieved after two years of early intervention services

Disclosure of Interest

None Declared
Learning how relationships work: a thematic analysis of young people and relationship professionals’ perspectives on relationships and relationship education
Authors: Benham-Clarke S. R. , Ewing J. , Barlow A. , Newlove-Delgado T.
Published: August 2023

Introduction

Relationships in various forms are an important source of meaning in people’s lives that can benefit their health, wellbeing and happiness. Relationship distress is associated with public health problems such as alcohol misuse, obesity, poor mental health, and child poverty, whilst safe, stable, and nurturing relationships are potential protective factors. Despite increased emphasis on relationship education (RE) in schools, little is known about the views of relationship professionals on relationship education specifically, and how this contrasts with the views of young people (YP).

Objectives

This Wellcome Centre for the Cultures and Environments of Health funded Beacon project seeks to fill this gap by exploring their perspectives and inform the future development of relationship education.

Methods

We conducted focus groups with YP (n=4) and interviews with relationship professionals (n=10). The data was then thematically analysed.

Results

Themes from YP focus groups included: ‘Good and bad relationships’; ‘Learning about relationships’; ‘the role of schools’ and ‘Beyond Relationship Education’. Themes from interviews with relationship professionals included: ‘essential qualities of healthy relationships’; ‘how YP learn to relate’ and ‘the role of RE in schools’.

Conclusions

YP and relationship professionals recognised the importance of building YP’s relational capability in schools with a healthy relationship with oneself at its foundation. Relationship professionals emphasised the need for a developmental approach, stressing the need for flexibility, adaptability, commitment and resilience to maintain relationships over the life course. YP often presented dichotomous views, such as relationships being either good or bad relationships, and perceived a link between relationships and mental health. Although not the focus of current curriculum guidance, managing relationship breakdowns and relationship transitions through the life course were viewed as important with an emphasis on building relational skills. This research suggests that schools need improved RE support, including specialist expertise and resources, and guidance on signposting YP to external sources of help. There is also potential for positive relationship behaviours being modelled and integrated throughout curriculums and reflected in a school’s ethos. Future research should explore co-development, evaluation and implementation of RE programmes with a range of stakeholders.

Disclosure of Interest

None Declared
The different effect of adverse childhood experiences on Theory of Mind brain networks in schizophrenia and healthy controls
Authors: Pelucchi A. , Calesella F. , Bechi M. , Cavallaro R. , Poletti S. , Vai B. , Benedetti F.
Published: August 2023

Introduction

Deficit in Theory of Mind (ToM) is a core feature of schizophrenia (SZ), while adverse childhood experiences (ACEs) can contribute to worsen ToM abilities through their effect on brain functioning, structure and connectivity.

Objectives

Here, we investigated the effects of ACEs on brain functional connectivity (FC) during an affective and cognitive ToM task (AToM, CToM) in healthy control (HC) and SZ, and whether FC can predict the performance at the ToM task and patients’ symptoms severity.

Methods

The sample included 26 HC and 33 SZ. In an fMRI session, participants performed a ToM task targeting affective and cognitive domains. Whole-brain FC patterns of local correlation (LC) and multivariate pattern analysis (MVPA) were extracted. The significant MVPA clusters were used as seeds in further seed-based connectivity analyses. Second-level analyses were modelled to investigate the interaction between ACEs, the diagnosis, and the task, corrected for age, sex, and equivalent doses of chlorpromazine (p<0.05 FWE). FC values significantly affected by ACEs (Risky Family Questionnaire) were entered in a cross-validated LASSO regression predicting symptoms severity (Positive and Negative Syndrome Scale, PANSS) and task performance measures (accuracy and response time).

Results

In AToM, LC showed significant different effects of ACE between HC and SZ in frontal pole, caudate and cerebellum. MVPA showed significant widespread interaction in cortico-limbic regions, including prefrontal cortex, precuneus, insula, parahippocampus, cingulate cortex, temporal pole, thalamus, and cerebellum in AToM and CToM. SBC analyses found significant target regions in the frontal pole, cerebellum, pre and postcentral gyrus, precuneus, lateral occipital cortex, angular gyrus, and paracingulate gyrus. LASSO regression predicted PANSS score (R2=0.49) and AToM response latency time (R2=0.37).

Conclusions

Our findings highlighted a widespread different effect of ACEs on brain FC in ToM networks in HC and SZ. Notably, the FC in these regions is predictive of behavioral ToM performance and clinical outcomes.

Disclosure of Interest

None Declared
Multimorbidity patterns and health care utilization among older adults with schizophrenia
Authors: Hwong A. , Li Y. , Morin R. , Byers A.
Published: August 2023

Introduction

Older adults with schizophrenia often have multiple chronic conditions, or multimorbidity, yet most prior research has focused on single medical conditions.

Objectives

To characterize multimorbidity patterns and utilization among older adults with schizophrenia to understand how multimorbidity affects this population and their clinical service needs.

Methods

This retrospective cohort study included veterans aged 50 years and older with schizophrenia and followed their comorbid diagnoses and utilization (outpatient, inpatient, and emergency) from 2012 to 2019. Comorbid diagnoses included myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease (COPD), cancer, dementia, traumatic brain injury, hepatitis C, osteoarthritis, renal disease, chronic pain, sleep disorder, depression, dysthymia, posttraumatic stress disorder (PTSD), general anxiety disorder, alcohol use disorder, other substance use disorder, and tobacco use disorder. Latent class analysis was used to identify latent profiles of psychiatric and medical comorbidity. Chi-square and F-tests were used to assess differences in demographics, comorbidities, and utilization across the latent classes.

Results

The cohort included 82,495 adults with schizophrenia. Three distinct multimorbidity classes were identified: Minimal Comorbidity (67.0% of the cohort), High Comorbidity (17.6%) and Substance Use Disorders and Related Conditions (SUDRC) (15.4%). The Minimal Comorbidity class had <10% prevalence of all comorbid diagnoses. The High Comorbidity class had >20% prevalence of congestive heart failure, COPD, dementia, renal disease, sleep disorder, and depression. The SUDRC class had >70% prevalence of alcohol and drug use disorders and >20% prevalence of COPD, hepatitis C, depression, and PTSD. Although the High Comorbidity class had the highest rates of chronic medical conditions, the SUDRC class had the highest rates of emergency and inpatient medical care and emergency, inpatient, and outpatient mental health care utilization. Comparing across classes, all p-values were <.001 for utilization.

Conclusions

Older adults with schizophrenia are a heterogeneous group with distinct multimorbidity classes and different patterns of utilization. Those with high prevalence of substance use disorders had the highest rates of emergency and inpatient medical and overall mental health care utilization. Tailoring integrated care services to target specific clinical needs could improve outcomes for this population.

Disclosure of Interest

None Declared
Osteopenia and osteoporosis associated with hyperprolactinemic antipsychotics
Authors: Montejo A. L. , Buch B. , Santana Y. , Matías J. , Matias-Polo J. , Martín-Pinto T. , Matos C. , Cortés B. , de Alarcón R. , Fombellida C. , Acosta J. M.
Published: August 2023

Introduction

The main role of prolactin is associated mainly with lactogenesis but additionally it participates in several endocrinological and metabolic processes. The prolactin level may be increased with some antipsychotics such as risperidone, paliperidone, and amisulpride increasing the risk of Bone Mineral Mass (BMM) decrease leading to osteopenia and osteoporosis.

Objectives

To determine the loss of BMM associated with antipsychotic-related iatrogenic hyperprolactinemia (iHPRL) in a sample of patients suffering of chronic psychotic mental disorder and treated with antipsychotics at least for one year.

Methods

A cross-sectional observational and epidemiological study in a sample of 140 patients (males 56.9%; females 43.1%; mean age 48 years), receiving antipsychotics was carried out. After giving informed consent, personal data, prolactin level, antipsychotic use and lifestyle were collected. An evaluation of BMM with a central DEXA Scan was performed. The bone mineral density considering the subject´s age and the peak bone mass in the neck of the femur, hip and in the lumbar vertebrae (L1-L4) was obtained. Inclusion criteria: presence of psychotic disorder, age between 18-65 years and treatment with an antipsychotic at least for one year. Statistical analysis was carried out using the statistical software SPSS version 26.0. A significance level α=0.05 was considered throughout the study.

Results

45 out of 140 patients (32,13%) had some BMM lost (osteopenia). The prevalence of osteoporosis was 5.71% (n=8). The median prolactin level in the sample was 46.1 ng/dL ± 33.1. Patients with hyperprolactinaemia showed a higher frequency of osteopenia/osteoporosis (50% with mild iHPRL and 48% with moderate/severe iHPRL) than those with normal prolactin levels (25.7%). A strong and significant relationship between the presence of osteoporosis and the treatment with risperidone was found (p=0.007).

Conclusions

Osteopenia and osteoporosis are associated with hyperprolactinemic antipsychotic. Risperidone was related with a significant increased osteoporosis risk. The rutinary and systematic control of the BMM is crucial in these patients to avoid progressive bone demineralization. Managing strategies should be individualized to avoid bone demineralization and to preserve physical health.

Disclosure of Interest

None Declared
High dose piracetam on alcoholic cerebellar degeneration: A case report
Authors: Öksüz G. , Ergelen M.
Published: August 2023

Introduction

Chronic alcohol use is related to alcoholic cerebellar degeneration that is caused by B1 (thiamine) deficiency and associated with the degeneration of Purkinje cells in the cerebellar cortex.

Objectives

This report aims to present a case with cerebellar ataxia and tremor due to alcoholic cerebellar degeneration that is unexpectedly regressed after starting piracetam infusion treatment in the inpatient Alcohol and Drug Addiction Research, Treatment and Education Center (AMATEM).

Methods

We investigated the case prospectively. The patient was informed and consent was obtained.

A 57-year-old, divorced, retired, male with alcohol use disorder for 48 years (mostly high alcohol, cologne for 2 years) presented to our hospital with upper and lower limb tremors and balance problems for 2 years. Neurological examination revealed dysmetria, cerebellar tremor, hypoesthesia of lower extremities, ataxia so he was unable to tandem-walk. CIWA-Ar score:13. The blood test, including hemogram, biochemical, HbA1C, TFT, serum copper and ceruloplasmin levels, results were all normal. Diazepam 50 mg was started and titrated down by 5 mg per day and discontinued, 600 mg parenteral and 250 mg p.o thiamine initiated for 3 days and continued orally, propranolol 20 mg/day and ecopirin 100 mg/day were continued. Cranial CT, cranial MRI, and EMG were ordered.The patient was consulted to the neurologist for movement disorder.

Results

MRI appearance of the cortical sulcus, fissure, cisterna, and cerebellar folia were obvious. The ventricular system was assessed as ecstatic secondary to atrophy. Therefore the alcoholic cerebellar degeneration was diagnosed and increased propranolol to 30 mg/day dose. Furthermore iv infussion piracetam was empirically started at secuencely dose of 60 g/day for 3 days, 45 g/day for 3 days, 30 g/day for 3 days. Upper and lower limb tremor disappeared and ataxa regressed after the treatment was arranged.

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Conclusions

Several authors proposed that serotonergic system among other neurotransmitters in the cerebellum might be affected in ACD. Recent studies investigating the use of buspirone in the treatment of ataxia has showed positive results (1-3).

The mechanism of action of the piracetam is unclear. Supposed that piracetam binds to the polar head groups of membrane bilayers and induces distinct changes in membrane structure. Its actions in the nervous tissue include indirect modulation of several neurotransmitter systems, neuroprotective and anticonvulsant effects and positive influence on neuronal plasticity.

In conclusion, we suggest that high dose piracetam has a potential antiataxic effect in ACD.

Cessation of drinking and nutritional supplementation are the only treatments available for ACD. However, gait does not improve in most patients. Pysical therapy, canes, walkers, and wheelchairs are helpful in maintaining mobility (4). Similarly, we observed that the patient’s need for care has been continuing.

Disclosure of Interest

None Declared
Actual status of early intervention services in Germany
Authors: Bechdolf A.
Published: August 2023

We will give an overview of the status of early intervention services for psychosis in Germany. We recently established a website which provides people in Germany with the nearest early detection an intervention service available (https://www.psycho-check.com). However, the overall implementation rate of early detction in Germany is quite heterogenous. We will also present recent research and ongoing projects from Germany including the first evaluation of specialized inpatient services for early psychosis, first evaluations of Individual placement and support and a mindfulness based group intervention in people with early psychosis as well as a newly desigend youth mental health service called soulspace (www.soulspace-berlin.de).

Disclosure of Interest

None Declared
Etiology and pharmacological treatment of delirious syndrome
Authors: Hamidović J. , Dostović Hamidović L. , Haskic S. , Prljača E. , Brigić A. , Mešanović M.
Published: August 2023

Introduction

Patients in psychiatric department, especially in the intensive care unit, often develop delirium syndrome, which leads to a high risk of morbidity and mortality. The etiology is multifactorial. The most common causes are alcoholism and dementia. Pharmacological treatment of delirious syndrome is the most important part of the treatment, which includes various psychopharmaceuticals that are effective both in the treatment of delirium and in improving cognitive functions. Haloperidol is the drug of first choice and from atypical antipsychotics, the most commonly used are risperidone and olanzapine. Benzodiazepines are used in the treatment of delirium tremens.

Objectives

The objective of the work is to determine the most common cause of delirious syndrome and the treatment of those patients.

Methods

We analyzed 52 patients who were treated for delirious syndrome at the Department of Psychiatry , University Clinical Center Tuzla, Bosnia and Herzegovina in the period from January 1, 2019. until June 1, 2022. Data were taken from medical records and the hospital information system.

Results

The total number of patients was 52 and 23 (44.23%) were treated for delirium tremens, and the rest were treated for delirium syndrome of another cause. The most common other causes were dementia in 21 (40.38%) patients, followed by sepsis, infectious syndrome and tumors in 6 (11.53%) patients, and cerebrovascular cause in 2 (3,84%) patient. In a therapeutic approach of delirious syndrome, all patients with delirium tremens were treated with benzodiazepines: 11 (47.82%) patients with diazepam monotherapy, then diazepam and promazine 7 (30.43%) patients, diazepam and haloperidol 3 (13,04%) patients, and diazepam, olanzapine and haloperidol 2 (8.69%). In the therapy of other delirious syndromes, 11 (37.93%) patients were treated with risperidone, haloperidol 8 (27.58%), promazine 3 (10.34%), quetiapine 4 (13.79%), and olanzapine, clozapine and aripiprazole 1 patient each (3.44%). It is important to point out that there was no fatal outcome in the processed sample of patients.

Conclusions

The most common etiological cause of delirious syndrome is the consequence of alcohol withdrawal. Delirium superimposed on dementia is the second most common. The priority of treatment is focused on pharmacological treatment. Atypical antipsychotics (risperidone) are most often used. Haloperidol is the second most common. Benzodiazepine (diazepam) was most often used in the treatment of delirium tremens.

Disclosure of Interest

None Declared
Validation of HCL-33 in screening for bipolar disorder in patients with depressive episode
Authors: Kola K. , Elezi F.
Published: August 2023

Introduction

Hypomania Check List 33 (HCL-33) constitutes a self-rating questionnaire for lifetime history of hypomanic symptoms, used in patients who present with depressive symptoms and a further screening for bipolar disorder is required.

Objectives

- Translation and cultural adaptation of HCL-33

- Measuring psychometric abilities, gender and age differences in score

Methods

In order to culturally adapt, standardize and validate the instrument for the Albanian context, the reliability and validity of the HCL-33 was examined using an sample of 99 patients, of whom 22 were diagnosed as bipolar disorder but all presented with a depressive episode.

In order to reach reliability, internal consistency analyses were performed.

Results

The factor analysis yielded two factor, with an internal consistency of .838 and .736 from the Cronbach’s alphas, with a total alpha of .765, falling within the “good to excellent” range.

Furthermore, Albanian norm scores and cut-off scores have been generated for the Albanian version of HCL-33. The article provides evidence regarding the psychometric propërties and utility of HCL-33 in the Albanian adult population for clinical assessment, outcome evaluations and research purposes. With a cut-off value of 16, sensitivity was 73% and specificity was 53%, with a prevalence of 22% and positivie predictive value of 30% and negative predictive value 87%.

Gender differences were not relevant in the total scoring, but there was a positive correlation between age an HCL-33 scoring (r(n=99)=.243, p≤.01), especially with Factor II (r(n=99)=.211, p≤.05).

Conclusions

The article provides evidence regarding the psychometric properties and utility of HCL-33 in the Albanian adult population as a screening tool for bipolar disorder in patients presenting with a depressive episode.

Disclosure of Interest

None Declared
Legalization of cannabis for medical and recreational use
Authors: Hasin D.
Published: August 2023

Since 1996, 39 of the 50 US states have enacted medical cannabis laws (MCL) and since 2012, 21 states and Washington D.C. (DC) enacted recreational cannabis laws (RCL). Many individuals can use cannabis without harm, and legalization helps achieve social justice and financial aims. However, 20%-33% of cannabis users develop cannabis use disorder (CUD), which is associated with impaired functioning, psychosocial, physical and psychiatric problems. Despite these risks, Americans increasingly see cannabis use as harmless or even beneficial in treating or preventing health problems. The prevalence of frequent cannabis use and CUD has increased in US adults in recent years. Studying the role of MCL and RCL in these nationally increasing prevalences is challenging due to staggered-adoption dates of state legalizations, few years of data available to study RCL, and other potential influences on cannabis use and CUD. Using self-report data from US national surveys, MCL have been shown to have little influence on adolescent cannabis use, but increase adult illicit cannabis use and CUD. Fewer studies have examined RCL; in these, RCL increases adult use and CUD. However, studies are needed in national patient populations with multiple risk factors for CUD, including painful medical conditions and a high prevalence of psychiatric disorders. We used data from the electronic health records (EHR) database of the US Veterans Health Administration (VHA), the largest integrated healthcare system in the US, to examine trends in provider-diagnosed ICD-9-CM and ICD-10-CM CUD over time, differences in these trends by patient characteristics, and the role of MCL and RCL in the trends. CUD diagnoses more than doubled overall in the VHA, from 0.85% in 2005 to 1.92% in 2019. Increases were found across age, sex, and racial/ethnic subgroups of patients, with greater rates and increases among patients with chronic pain and with psychiatric disorders. Among patients living in MCL and RCL states, increases in CUD were larger than among patients in other states, although the size of legalization effects suggested that other factors are important in driving up prevalence, e.g., online commercialized information and other forms of advertising. The tensions between public health aims, social justice and financial gain will be discussed.

Disclosure of Interest

None Declared
Culturally adapted psychoeducation for bipolar disorder in a low-resource setting: protocol for a multicentre randomized controlled trial
Authors: Husain I. , Umer M. , Asif M. , Bukhsh A. , Kiran T. , Ansari M. , Aslam H. , Bhatia M. , Dogar F. , Husain O. , Khan H. A. , Mufti A. A. , Mulsant B. , Naeem F. , Naqvi H. A. , De Oliveria C. , Siddiqui S. , Tamizuddin A. , Wang W. , Zaheer J. , Husain N. , Chaudhry N. , Chaudhry I.
Published: August 2023

Introduction

Bipolar disorder (BD) is a source of marked disability, morbidity, and premature death. There is a paucity of research on personalized psychosocial interventions for BD, especially in lowresource settings. A previously published pilot randomized controlled trial (RCT) of a Culturally adapted PsychoEducation (CaPE) intervention for BD in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes towards BD, and improvement in mood symptom scores and health-related quality of life measures compared to treatment-as-usual (TAU).

Objectives

This protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan.

Methods

A multicentre individual, parallel arm, RCT of CaPE in 300Pakistani adults with BD. Participants over the age of 18, with adiagnosis of bipolar I and II and who are currently euthymic, will berecruited from seven sites including Karachi, Lahore, Multan,
Rawalpindi,Peshawar, Hyderabad and Quetta. Time to recurrence will be the primaryoutcome assessed using Longitudinal Interval Follow-up Evaluation(LIFE). Secondary measures will include mood symptomatology, qualityof life and functioning, adherence to psychotropic medications, andknowledge and attitudes towards BD.

Results

Full ethics approval has been received from National Bioethics Committee (NBC) of Pakistan and Centre for Addiction and Mental Health (CAMH), Toronto, Canada. The study has completed sixty-five screening across the seven centres, of which forty-eight participants have been randomised.

Conclusions

A successful trial will lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority patients with BD.

Disclosure of Interest

None Declared
Coping strategies in bipolar patients: A comparative study with siblings and healthy controls
Authors: Stambouli M. , Saguem B. N. , Bouhlel S. , Ben Mahmoud I. , Chebbi W. , Nakhli J.
Published: August 2023

Introduction

Data regarding coping strategies used by bipolar patients to deal with psychosocial stress and their consequences in adaptational outcomes are scant. Moreover, family studies have reported the presence of several similarities between bipolar patients and their relatives regarding genetics, biology, personality traits, temperaments and stressful lived life experiences. Bipolar patients and their siblings had significantly higher global score of life events and more events in the field of work, socio-family events and health than control subjects. This might suggest that patients with bipolar disorder would be distinguished from their family members by the coping strategies they use to deal with stress.

Objectives

In this study, we aimed to compare perceived stress and coping strategies of remitted bipolar I patients with those of their siblings and controls.

Methods

A descriptive and comparative study of case-control type was conducted. Were included 46 bipolar I patients, 46 siblings and 50 controls. The three groups were matched for age and sex. Assessments of perceived stress and coping strategies were performed using the 10-item Perceived Stress Scale (PSS) and the 28-item Brief COPE respectively.

Results

Mean age of bipolar I patients was 39 ± 13 years. Thirty-one patients (67%) reported family history of one or more psychiatric disorders.Mean duration of bipolar disorder was 11.83 ± 9.92 years.

There was no significant difference between the three groups on PSS scores. Bipolar patients and siblings were more likely to use emotion-focused coping strategies than controls (p=0.001). Controls used problem-focused coping strategies more than bipolar patients (p = 0.02). Compared to controls, bipolar patients were less likely to use active coping and planning, but they showed higher scores in the dimensions of humor, religion and behavioral disengagement with intergroup p value: 0.02; 0.019; 0.002 respectively.

Conclusions

Our findings suggest that bipolar I patients were more likely to use maladaptive coping strategies to deal with stress than their siblings. Based on this observation, it seems advisable to study coping strategies used by bipolar patients, in order to reinforce adaptive strategies and to reduce maladaptive ones.

Disclosure of Interest

None Declared