bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of insight quality on treatment adherence in schizophrenia
Authors: Rami A. , Sana E. , Mejda C. , Rahma D.
Published: August 2023

Introduction

Schizophrenia is a chronic, frequent, and disabling psychiatric condition. The prognosis is more severe in the absence of treatment.

Objectives

The aims of our study were to evaluate the quality of treatment adherence and the quality of insight of patients with schizophrenia and to assess the implication of these factors as predictors of poor adherence.

Methods

We conducted a cross-sectional and analytical study. We recruited 150 patients with schizophrenia treated at Razi Hospital of Manouba, divided into 113 patients with good adherence compared to 37 patients with poor adherence. We used the Medical Adherence Report Scale (MARS) to assess the quality of therapeutic adherence and the Birchwood Insight Scale for Insight Assessment.

Results

Poor treatment adherence in patients with schizophrenia was significantly associated with poor insight (p=0.001). Good adherence was associated with positive perception of treatment effectiveness (p<0.001). The predictive factor for poor adherence to therapy in multivariate analysis, after adjusting for the confounding variables was the negative perception of side effects (p=0.02). The predictive factor for good adherence was the presence of insight into the need for treatment (p=0.002).

Conclusions

To prevent poor treatment adherence, a systematic screening for predictive factors and adequate management of schizophrenia would be imperative.

Disclosure of Interest

A. Rami Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, E. Sana Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, C. Mejda Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no, D. Rahma Shareolder of: no, Grant / Research support from: no, Consultant of: no, Employee of: no, Paid Instructor of: no, Speakers bureau of: no
Effect of D2R, NMDAR and CB1R genetic variants associated with cannabis use and childhood trauma in first-episode psychosis in a Brazilian population
Authors: Loureiro C. M. , Corsi-Zuelli F. , Fachim H. A. , Shuhama R. , Menezes P. R. , Dalton C. F. , Louzada-Junior P. , Belangero S. I. N. , Coeli-Lacchini F. B. , Reynolds G. P. , Lacchini R. , Del-Ben C. M.
Published: August 2023

Introduction

Gene-environment interactions increase psychosis risk (Gayer-Anderson et al. Soc Psychiatry Psychiatr Epidemiol 2020; 55(5):645-657). However, identifying the genetic variants involved and how they interact with environmental risk factors underlying psychosis remains challenging.

Objectives

To investigate whether there are gene-environment interactions in the relationships of childhood trauma, lifetime cannabis use, and single nucleotide variants (SNVs) of dopamine D2 receptor (D2R: DRD2), N-methyl-d-aspartate receptor (NMDAR: GRIN1, GRIN2A and GRIN2B) and cannabinoid receptor type 1 (CB1R: CNR1) with psychosis.

Methods

In a population-based case-control study nested in an incident study (STREAM, Brazil) (Del-Ben et al. Br J of Psychiatry 2019; 215(6):726-729), part of the EU-GEI consortium (Gayer-Anderson et al. Soc Psychiatry Psychiatr Epidemiol 2020; 55(5):645-657), 143 first-episode psychosis patients and 286 community-based controls of both sexes aged between 16 and 64 years were included over a period of 3 years. Twenty-three SNVs of D2R (rs1799978, rs7131056, rs6275), NMDAR (GRIN1: rs4880213, rs11146020; GRIN2A: rs1420040, rs11866328; GRIN2B: rs890, rs2098469, rs7298664), and CB1R genes (CNR1: rs806380, rs806379, rs1049353, rs6454674, rs1535255, rs2023239, rs12720071, rs6928499, rs806374, rs7766029, rs806378, rs10485170, rs9450898), were genotyped from peripheral blood DNA using a custom Illumina HumanCoreExome-24 BeadChip. Environmental adversities were evaluated using the Cannabis Experience Questionnaire (Di Forti et al. The Lancet Psychiatry 2009; 6(5):427–436) and the Childhood Trauma Questionnaire (Grassi-Oliveira et al. Rev Saude Publica 2006; 40(2):249-55). Associations between SNVs and environmental risk factors were performed using the nonparametric multifactor dimensionality reduction software (version 3.0.2).

Results

Single locus analysis showed no association among the 23 SNVs with psychosis; however, gene-environment analysis was significant for the polymorphic loci rs12720071 and rs7766029 in CNR1. The best association models were the two-factor representing by the combination of CNR1 rs12720071 with lifetime cannabis use (p<0.001), and CNR1 rs12720071 with childhood trauma (p<0.05), both suggesting an increased risk of psychosis. Additionally, when considering the interaction of both environmental factors in the same model, we found CNR1 rs7766029 to be associated with psychosis (p<0.001).

Conclusions

Our study supports the hypothesis of gene-environment interactions for psychosis involving the T allele carriers of CNR1 SNVs (rs12720071 and rs7766029), childhood trauma and lifetime cannabis use in psychosis.

Disclosure of Interest

None Declared
Clozapine levels and therapeutic response: using individual patient meta-analysis data for a ROC Curve analysis
Authors: Northwood K. , Pearson E. , Wagner E. , Warren N. , Siskind D.
Published: August 2023

Introduction

Clozapine has been well established as the most efficacious medication for treatment refractory schizophrenia. Optimising the benefit during clozapine trial is an important clinical consideration. Therapeutic drug monitoring of clozapine plasma or serum levels has formed a critical part of this. Though there is no agreed standardised therapeutic range, advice traditionally recommends a clozapine level of >350ng/mL in order to effect best response. Most studies analysing the relationship between treatment response and clozapine level are older, have small sample sizes, and do not consider whether additional factors might assist in determining optimal clozapine level for response.

Objectives

We conducted a systematic review of PubMed, PsycInfo and Embase for studies that provided individual participant level data on clozapine levels and response.

Methods

This data was analysed using Receiver Operating Characteristic (ROC) curves to determine the prediction performance of serum clozapine levels for treatment response.

Results

We were able to include data on 294 individual participants. ROC analysis yielded an area under the curve (AUC) of 0.612. The clozapine level at the optimal Youden index was 372ng/mL, and at this level there was response sensitivity of 57.3%, and specificity of 65.7%. The interquartile range for treatment response was 223ng/mL – 558ng/mL. There was no improvement in ROC performance with mixed models including patient sex, age or length of trial.

Conclusions

Clozapine dose should be optimised based on clozapine therapeutic levels. We found that a range between 250 – 550ng/mL could be recommended, while noting that a level of >350ng/mL is most optimal for response.

Disclosure of Interest

None Declared
“You can’t put your head down like an ostrich” - Emotional experiences associated to clozapine treatment protocol reported by patients with schizophrenia seen in a Brazilian university specialized service: a clinical-qualitative study
Authors: Turato E. R. , Santos J.-B.
 A. , Dalgalarrondo P. , Dantas C. R. , Specian-Jr F.-C. , Valladão L. S.
Published: August 2023

Introduction

Understanding the psychological meanings of a rigorous protocol for introducing a drug to patients is a challenge of emotional management for clinical professionals. Clozapine is an effective drug for patients with schizophrenia resistant to treatment with first and second-generation antipsychotics. This medication has agranulocytosis as an important side effect. The medication protocol requires frequent blood draws to monitor any effect on blood cells. Investigating patients’ emotional perceptions about the experience with this procedure was the triggering question of our study.

Objectives

To interpret emotional/symbolic meanings attributed by patients with schizophrenia to the protocol of introduction of clozapine in follow-up at a specialized university service.

Methods

Clinical-qualitative design of Turato. Semi-directed interviews with open-ended questions in-depth were conducted face-to-face with participants using clozapine. Closed sample by the theoretical information saturation criterion described by Fontanella. Data were treated by Faria-Schutzer’s Clinical-Qualitative Content Analysis, employing psychodynamic concepts of the theoretical framework of Medical Psychology.

Results

From the analysis of nine patients, three categories emerged: 1) “Anyway, I come here to stay alive”: frequent blood collections of the protocol seem to have a good impact on patient’s adherence to treatment; 2) To re-signify a psychiatric illness: the protocol reinforcing an embodiment of a medical diagnosis; 3) “It is a very big precaution”: the protocol as real and emotional support to deal with the possibility of serious side effects.

Conclusions

Although blood collection is a repetitive experience for patients, such a routine does not mean that the procedure brings symbolizations that are more charged than the disease itself. Patients can benefit from the commitment to attend blood collection frequently, as it removes them from possible social isolation, allowing social interaction; it brings the perception of emotional security due to the commitment to the clinical team. These benefits can lead the patient to develop new meanings for their life condition. Future qualitative research can be conducted to study the meanings of medical protocols in other diagnostic situations.

Disclosure of Interest

None Declared
Treatment of comorbid anxiety symptoms and insomnia in patients with schizophrenia: A review of Pros and Cons.
Authors: Román E. , González-Rodríguez A. , Natividad M. , Izquierdo E. , Guàrdia A. , Calvo E. , Monreal J. A.
Published: August 2023

Introduction

Recent studies report a prevalence of comorbid anxiety disorder of 38% and 80% of sleep disorders in schizophrenia. Insomnia has been associated with worsening of psychopathological symptoms and increased hospitalization rates.

Objectives

The aim of our work was to review mechanisms of action and the use of benzodiazepines, GABAergic drugs and melatonin for the treatment of anxiety and insomnia in schizophrenia.

Methods

We carried out a narrative review of studies focusing on the treatment of anxiety disorders and insomnia in schizophrenia through PubMed and Google Scholar (2002-September 2022). The use of benzodiazepines, GABAergic drugs and melatonin in schizophrenia are discussed, illustrating them with case reports.

Results

A total of 32 studies were included. (A)Benzodiazepines (BZD) work facilitating the inhibitory actions of gamma-aminobutyric acid (GABA) by binding GABA type A receptors. The beneficial effect of combined use of antipsychotics and BZD is controversial (cognitive complications, sedation, overdosing, substance use, etc). (B)GABAergic drugs: gabapentin (GP) and pregabalin (PG) (structurally related molecules), have no direct GABAergic action and act inhibiting voltage-gated calcium channels. The efficacy of GP and PG in the treatment of anxiety symptoms in schizophrenia is understudied. Positive effects of GP in schizophrenia suffering from restless legs syndrome receiving clozapine. (C )Melatonin, an hormone produced in the pineal gland has been used to treat insomnia. Positive effects on metabolic syndrome and cardiovascular risk factors have been reported. Several works considered it an alternative in schizophrenia.

Conclusions

Few evidence is available on the use of BZD, GP, and PG in schizophrenia. Melatonin is a promising compound to treat insomnia.

Disclosure of Interest

None Declared
How to fix the leaky pipeline in Academic Psychiatry
Authors: Frangou S.
Published: August 2023

The leaky pipeline is a visual metaphor for the under-representation of women in leadership positions in Academic Psychiatry despite their over-representation in medical schools, residency programs, and junior academic positions. The presentation focuses on the key obstacles that pertain to personal and societal attitudes and institutional barriers and proposes empirically tested and pragmatic solutions.

Disclosure of Interest

None Declared
Evaluation of serotonin and serotonin transporter levels among Obstructive Sleep Apnea patients
Authors: Gabryelska A. , Strzelecki D. , Sochal M.
Published: August 2023

Introduction

Obstructive sleep apnea (OSA) is characterized by recurrent pauses in breathing during sleep leading to sleep fragmentation and further excessive daytime sleepiness. Therefore, OSA patients are at high risk of suffering from complications from psychiatric disorders. Serotonin is a known neurotransmitter and together with serotonin transporter (SERT) is involved in the development of depression and insomnia.

Objectives

The study aimed to evaluate serotonin and SERT levels among OSA and healthy individuals and their association with insomnia and depression symptoms.

Methods

Forty individuals following polysomnography (PSG), based on the apnea-hypopnea index (AHI), were divided into 2 groups: the OSA group (AHI30; n=20) and the control group (AHI<5; n=20). Participants filled out questionnaires: Beck Depression Inventory (BDI) and Athens Insomnia Scale (AIS). Peripheral blood was collected in the morning after PSG. Protein concentrations were measured using ELISA. Further groups were divided into subgroups based on the standard cut-off points: without (AIS (-)) and with (AIS (+)) insomnia symptoms (AIS>5) and without (BDI (-)) and with (BDI (+)) depression symptoms BDI (BDI>19).

Results

No differences between the OSA and control groups in serotonin (128.8 (73.4 – 209.0) vs. 132.7 (69.9 – 214.6) ng/ml, p=0.805 and SERT (55.8 (39.7 – 64.80) vs. 576.4 (424.2 – 658.3) pg/ml, p=0.564) levels were observed. In OSA group SERT level correlated with AHI (r=0.409, p=0.043), desaturation index (r=0.504, p=0.024) and mean oxygen desaturation during night (r=-0.522, p=0.018), while serotonin level was associated with BMI (r=0.550, p=0.012), but not PSG parameters. Serotonin level was higher in the AIS (+) group but only in healthy individuals. Further, serotonin levels decreased in the BDI (+) group, yet this finding was observed only in the control group.

Conclusions

The results show that serotonin levels are associated with the presence of insomnia in depression, but quite interestingly only among healthy individuals. The association between oxygen desaturation and SERT levels suggests the involvement of hypoxia in the serotonin signaling pathway. Yet further studies on larger populations are needed to better understand the mechanisms responsible for the development of psychiatric complications in OSA patients.

Disclosure of Interest

None Declared
Sleep Quality in Medical Students of a Portuguese University: a cross-sectional Study
Authors: Gonzaga R. , Brás J. , Costa A. P. , Peixoto C. , Fialho J.
Published: August 2023

Introduction

Sleep is a complex physiological process present in all living beings, performing essential functions for various biological functions. The prevalence of sleep disorders has increased exponentially, as well as studies relating to sleep patterns of the general population.

University students are especially vulnerable to a decrease in sleep quality, particularly medical students. Even so, the literature on sleep quality in medical students is scarce, especially when referring to Portugal, where studies are almost non-existent.

Objectives

To evaluate sleep quality in medical students and to analyze the differences in sleep quality according to age, sex, cohabitation and physical activity. It is also intended to compare the sleep quality of medical students throughout the various phases of the medical course.

Methods

This is a cross-sectional study involving medical students at the University of Beira Interior, Covilhã, Portugal. All medical students were invited to complete the Pittsburgh Sleep Quality Index (PSQI), which has been validated for the portuguese population. First, the scores obtained in each of the components of the PSQI and the global PSQI score were analyzed for the global population. Lastly, the global PSQI score was correlated with each of the sociodemographic variables to verify the existence of a statistically significant relationship.

Results

296 students completed the instrument. Of these, 62.2% classify their sleep quality as good; 42.4% scored 2 in the sleep latency component; 50% reported sleeping 6 to 7 hours; 73.9% stated an adequate sleep efficiency; 85.5% mentioned few or no sleep disturbances; 83,8% said they never used sleep medication; and 60.8% had low or no sleepiness or daytime dysfunction.

As for the overall PSQI score, 72.6% of the students had a score greater than 5, indicating a poor quality of sleep. 74.7% of female respondents have a low quality of sleep, as well as 67.7% of male respondents. Likewise, 91.3% of students who live alone have poor sleep quality, as well as 76.8% of those living with family members and 69.8% of those living with colleagues.

Regarding the course year, 82.4% of the first-year students report a poor quality of sleep, as well as 77.5% of the second-year students, 72.1% of the third-year students, 77.8% of the fourth-year, 65.8% of the fifth-year students and 71.4% of the sixth-year students.

Conclusions

Medical students seem to be more likely to have poor sleep quality, especially when compared to other university students. Thus, further studies are needed to prove this susceptibility as well as therapeutic interventions aimed at improving sleep parameters.

Disclosure of Interest

None Declared
Clinical and neuroendocrine correlates of childhood maltreatment history in adults with bipolar disorder
Authors: Donato S. , Attianese N. , Battipaglia M. , Ceres R. , Monteleone A. M. , D’Agostino G. , Cascino G.
Published: August 2023

Introduction

Childhood maltreatment (CM) has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD.

Objectives

The aim of this study is to explore the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis.

Methods

One hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM−). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test. Saliva cortisol concentrations were determined by an enzyme immunoassay method, using a commercially available ELISA kit.

Results

According to CTQ, 62 had a history of childhood maltreatment and 44 had not. CM was significantly more frequent in females than males. CM+ patients showed significant higher body mass index (p = .01), number of suicide attempts (p = .03), and more severe mania symptoms (p = .01) than CM− ones. Significant associations between lifetime suicide attempts and any type of childhood maltreatment (OR = 2.79; CI = 1.01-7.73) and between emotional abuse and the presence of psychotic symptoms (OR = 2.74, CI = 1.11-6.74) or mixed mood episodes were found (OR = 2.62, CI = 1.07-6.43). Moreover, CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM− ones.

Conclusions

Our results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatment and show for the first time that childhood trauma exposure is associated to impaired CAR in adults with BD.

Disclosure of Interest

None Declared
The involvement of hyperhomocysteinemia in the development of characterized depressive disorder in children and adolescents
Authors: Elmaataoui Z. , BELHADGA H. , KISRA H.
Published: August 2023

Introduction

Elevated blood levels of homocysteine have been associated with several psychiatric and neurodegenerative disorders such as schizophrenic disorders, Alzheimer’s disease, Parkinson’s disease and depression. The hypothesis is that genetic and environmental factors elevate homocysteine levels, which causes vascular diseases of the brain, and/or changes in neurotransmitters, which cause various mental disorders.

Objectives

The objective of our work is to discuss the association between hyperhomocysteinemia and the characterized depressive disorder

Methods

we conducted our study through the discussion of a clinical vignette

Results

We report here a case of hyperhomocysteinemia with vitamin B 12 deficiency in a 16-year-old female patient who presented with a characterized depressive disorder.

She was initially treated with a selective serotonin inhibitor combined with parenteral injections of vitamin B12. The patient’s clinical condition improved after the first week. The discussion will attempt to clarify the role of vitamin therapy in the improvement of the patient’s depressive symptoms and its relationship with hyperhomocysteinemia.

We report here a case of hyperhomocysteinemia with vitamin B 12 deficiency in a 16-year-old female patient who presented with a characterized depressive disorder.She was initially treated with a selective serotonin inhibitor combined with parenteral injections of vitamin B12. The patient’s clinical condition improved after the first week. The discussion will attempt to clarify the role of vitamin therapy in the improvement of the patient’s depressive symptoms and its relationship with hyperhomocysteinemia.

Conclusions

Statistical data, physiological and genetic aspects seem to point to the involvement of hyperhomocysteinemia in the development of characterized depressive disorder. However, the results remain variable, even contradictory, and several confounding factors must be considered in these studies: ethnic, geographical, cultural (in terms of diet) and age factors are all elements that seem to intervene and that do not always make it possible to know whether hyperhomocysteinemia is a direct cause of depression or the consequence of mechanisms linked to folate and B12 deficiencies.

Disclosure of Interest

None Declared
Refugees, war trauma and mental health: knowledge and experience from trainees and early career psychiatrists
Authors: Bianchi S. , Riboldi I. , Őri D. , Pompili S. , Pavel C. , Seker A. ,   E. Psychiatry Across Borders Working Group
Published: August 2023

Introduction

Psychiatry Across Borders working group of the European Federation of Psychiatric Trainees has the mission to improve psychiatric training in transcultural psychiatry and trauma-related topics in Europe. It started conducting a survey in 2016, to assess trainees’ experiences in forcibly displaced people mental health (Frankova et al. Transcult.Psychiatry, in press).

Objectives

To investigate European psychiatric trainees’ and Early Career Psychiatrists’ (ECPs) training about trauma and refugees’ mental health, focusing on educational and clinical difficulties occurring while assisting war refugees or in Eastern Europe, due to the ongoing conflict.

Methods

A new survey for European psychiatric trainees and ECPs was designed. A web questionnaire was shared through various channels, including social media, in September 2022. It included an informed consent form and investigated socio-demographic data, training in trauma and refugees’ mental health, clinical practice in war areas or with war refugees.

Results

As of 16/10/22, 31 were the responders, mainly adult psychiatrists (93.6%). Although the 87.1% worked with forcibly displaced people, only 29% received a specific training, and 53.6% didn’t feel prepared to face war trauma-related disorders. However, 64.3% could reach out to a teamwork member specialized in the topic, and 72.2% to interpreters. The 67.7% worked with actual war refugees, mainly addressed to psychiatric services due to new onset of psychiatric symptoms, especially insomnia (66.7%), often diagnosed with Acute Stress Reaction (66.7%) and treated with psychiatric drugs (83.3%). Two colleagues working in war areas participated in the survey: both lost patients at follow-up and experienced increased workload or lack of means (i.e., drug supply) or support.

Conclusions

This survey can spot educational needs in transcultural psychiatry, helping to program targeted interventions for psychiatric trainees and ECPs, aimed at implementing clinical practice towards the common goal of social cohesion.

Disclosure of Interest

None Declared
Non-pharmacological interventions for people presenting in crisis to emergency departments and inpatient wards: a scoping, typology, and systematic review
Authors: Huber J. P. , Milton A. , Brewer M. , Norrie L. , Glozier N.
Published: August 2023

Introduction

People presenting to hospital in a crisis of mental ill-health usually present via Emergency Departments, and are often admitted for brief interventions. Unlike drug treatments, the evidence base for brief non-pharmacological interventions has not been systematically evaluated.

Objectives

1. To describe brief non-pharmacological interventions used in Emergency Departments and inpatient psychiatric units, for those in a crisis of mental ill-health, and evaluate the study types and outcome measures used to evaluate them;

2. To conduct a systematic review of this evidence

Methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, DARE, Embase, MEDLINE, PsycINFO, and relevant government and non-government organisation websites for peer reviewed journal articles, including both qualitative and quantitative articles. Interventions were sorted into Categories and Types to manage heterogeneity.

Results

We found 47 studies. Interventions were highly varied, and we created a taxonomy to understand this heterogeneity. Most studies were quasi-experimental trials (n=26; 55%) or qualitative studies (n=13; 27%) and only 8 RCTs (17%). Twelve were high quality (26%). Interventions were mostly found to have no effect on measured outcomes, though outcome measures may not have been best suited to expected domains of change.There was a broad range of outcome foci reflecting inconsistency in goals of interventions. No interventions were found to reduce the incidence of self-harm on the inpatient ward. One study suggests that inpatient safety planning may reduce readmission rates. Aggression-related outcomes for inpatient sensory modulation rooms were equivocal. Brief admissions with psychotherapy may reduce suicide attempt repetition and re-hospitalization, whereas brief admissions without psychotherapy may improve function but not re-hospitalization rates. Face-to-face psychoeducation for panic in the ED was associated with a reduction in ED presentation rates, but brochure-only psychoeducation may increase ED presentation rates.

Conclusions

This review found little evidence to guide much of what clinicians do for people in crisis in hospital. There is a need to develop a framework for brief non-pharmacological interventions, address the quality and size of studies, and identify consistent outcome measures for non-pharmacological interventions. The data is insufficient to make clear recommendations for appropriate brief non-pharmacological interventions for people in crisis in Emergency Departments and Psychiatric Inpatient Units. Multiple promising interventions are available for further study, however there is a dearth of research and more rigorous testing is needed.

Disclosure of Interest

None Declared
Follow-up Study Tracking Children’s Development from Preschool till Middle School
Authors: Nomura K. , Yokoyama K.
Published: August 2023

Introduction

Screening for early detection of health issues and support are provided to children needing developmental support. In Japan, a significant percentage of infants requiring support are identified during health checkups. Sometimes, however, problems are first observed when children are of school age. It is, therefore, important to identify the age at which children need early support.

Objectives

Of the children born in 2005 in Kanie-cho, in Japan, 106 participated in the survey at all time points: age 5, first grade, fifth grade, and eighth grade.

Methods

The medical checkup results of the participants at age 5 were used to determine who among them needed support After entering school, the participants who scored less than 70 points on the Children’s Global Assessment Scale, where their adjustment was assessed based on the interview with the homeroom teacher, were considered maladjusted.

Results

The results are presented in Table 1.

Thirty participants needed supports at age 5; of these, 20 (66.7%) were maladjusted at any point in their school years—19 (95%) in the first grade, 14 (70%) till the fifth grade, and five (25%) till the eighth grade.

Of the 76 participants who did not need support in early childhood, 24 (31.6%) were maladjusted at some point in their school years—nine (37.5%) experienced maladjustment in the first grade, but none of them continued to be maladjusted till the fifth grade, and 14 (58.3%) who were not maladjusted in the first grade experienced it in the fifth or eighth grade (adolescents).

Thus, the participants maladjusted in their school years were categorized as follows:

1. The developmental disorders group (experiencing maladjustment throughout since early childhood): 19

2. The “first grade problem” group (experiencing transient problems only in the first grade): 9

3. The adolescent group (experiencing problems during adolescence): 14

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Conclusions

Since maladjusted children with developmental disabilities are identified in early childhood, support can be provided before they reach school age. Many children with developmental disabilities improve their adjustment as they grow up. It is thus advisable to take a long-term perspective in dealing with problematic behaviors.

From late school age to adolescence, problems unrelated to developmental disabilities emerge. By listening to the child’s upbringing, it may be possible to ascertain whether or not the problem stems from a developmental disability.

Disclosure of Interest

None Declared
Substance Use among youths in Uganda during the COVID-19 pandemic: Associated factors and prevalence:
Authors: Ssenyonjo L. , Ddumba I.
Published: August 2023

Introduction

Although studies have demonstrated that younger people are at high-risk of instigating alcohol, substance use and development of related disorders, the trend is gradually changing. An observed gradual initiation and substance use among older persons, especially during the COVID-19 pandemic. However, there is dearth of data on about the prevalence and determinant of substance use during COVID-19 pandemic in Uganda.

Objectives

Determine the prevelence and determinants of susbstance use during COVID-19 pandemic in Uganda

Methods

A cross-sectional design and probability based sampling was applied. Data was collected among 474 older persons aged 50 years and above, that resided in the central region of Uganda. A multivariate logistic regression was used to assess the socio-economic, demographic and health related correlates of alcohol and tobacco use.

Results

9.2% and 5.4% of older persons were taking alcohol and smoking before the COVID-19 pandemic. However, an observed increase of 14% of smoking and alcohol intake among older persons during the pandemic. Being male had higher odds of substance use than their female counterparts. Older persons with tertiary education and low (poor) wealth quantile, had lower odds of substance use than their counterparts.

Conclusions

Our finding highlights increased substance use among older persons during the COVID-19 pandemic. Designing targeted measures and policies to deter the substances use among older persons is critical to address this vice, especially during the pandemic and possible future disease outbreaks.

Disclosure of Interest

None Declared
Psilocybin as an antidepressant strategy - a review of safety aspects
Authors: Zeiss R.
Published: August 2023

Introduction

Psilocybin is considered a classical psychedelic and is increasingly attracting scientific and media attention as an alternative approach to the treatment of various mental disorders.

Apart from its efficacy, an important question is the tolerability and safety of psilocybin in general and in a controlled environment. Accurate knowledge of drug safety aspects might be essential for applicability in clinical practice and for drug adherence.

Objectives

This paper aims to provide an overview of drug safety aspects of psilocybin.

Methods

A narrative review was conducted. The literature search was conducted using the bibliographic database MEDLINE.

Results

The literature search of papers published in recent years showed no serious side effects under psilocybin in controlled study conditions. Common reported ADRs were headache, gastrointestinal complaints such as nausea, diarrhoea and vomiting, tachycardia and arterial hypertension. The lethal dose of psilocybin is many times higher than the therapeutic dose and overdose deaths have not been identified.

An often mentioned problem is the occurrence of hallucinogenic persisting perception disorder (HPPD) which, however, did not occur in the studies examined and is most likely to be a problem in the context of recreational use. The results on the safety of psilocybin must be regarded as preliminary; in the studies conducted, risk populations were predominantly excluded, which is, however, relevant for everyday clinical practice. The risk of delusional experiences and so-called “bad trips” is also a relevant safety risk, as it can be associated with risky behaviours. However, these would also be observed more in the area of recreational use.

Conclusions

The use of psilocybin in rigorously controlled study designs appears to be predominantly safe and without serious side effects. At the same time, it should be noted that the results must be considered preliminary and many questions remain open. Many of the risks are more likely to occur in uncontrolled recreational use of psilocybin. At the same time, we see a certain risk in the use of a substance associated with high expectations and a certain “fame” that, without appropriate regulations, the boundaries between sensible therapeutic use and abusive use could become blurred and permeable.

Disclosure of Interest

None Declared
Factors linked to suicide risk in a diverse sample of psychiatric patients
Authors: Pontiggia M. , Bonaldi S. , Gramaglia C. , Zeppegno P. , Madeddu F. , Calati R. , Magliocca S.
Published: August 2023

Introduction

Suicidal behavior is a global public health problem. Among the most investigated theories for the explanation of suicide there is the interpersonal-psychological theory of suicide (IPTS) by Thomas E. Joiner. IPTS focuses on 3 variables related to lethal suicide attempt: thwarted belongingness, perceived burdensomeness and acquired capability for suicide.

Objectives

We aimed to understand which variables were mostly related to suicidal ideation (SI) and suicide attempts (SA) in a sample of psychiatric patients.

Methods

A sample of 80 psychiatric patients including inpatients (n=18), outpatients (n=21) and patients from various Italian rehabilitative psychiatric communities (n=41) was recruited between June 7th, 2021 and September 12th, 2022. We administered a battery of various scales, including State-Trait Anxiety Inventory, STAI, Beck Depression Inventory, BDI, Reasons For Living Inventory, RFLI, Acquired Capability for Suicide Scale-Fearlessness About Death, ACSS-FAD, Rosenberg self-esteem scale, RSES, Mental pain questionnaire, MPQ, Interpersonal Needs Questionnaire, INQ. For each scale we compared a) patients with and without lifetime SI; b) patients with and without history of SA. Then, we performed two logistic regression models (stepwise backward method), one for SI and one for SA.

Results

Both patients with SI and SA have higher anxiety (STAI), depression (BDI), mental pain (MPQ), perceived burdensomeness (INQ), thwarted belongingness (INQ), fearlessness about death (ACSS_FAD) and lower self-esteem (RSES), beliefs about coping strategies (RFLI) and moral objections (RFLI). Depression (BDI) and beliefs about coping strategies (RFLI) were the variables most strongly associated with SI; higher fearlessness about death (ACSS-FAD) and low self-esteem levels (RSES) were the variables most strongly associated with history of SA. The SI model was able to predict 84% of ideation cases; the SA model was able to predict 74% of the attempts.

Conclusions

The results supported that improving the ability to cope with suicidal thoughts is a key component of therapeutic work with suicidal patients. In addition, according to the IPTS, the history of SA has been particularly explained by fearlessness about death. Hence it may be important to focus on these aspects in suicide prevention.

Disclosure of Interest

None Declared
European federation of psychiatric trainees - Exchange Programme - appreciated by trainees in spite of language-related challenges
Authors: Kraxner F. H. , Lengvenytė A. , Dias M. C.
Published: August 2023

Introduction

Differences in psychiatry training vary substantially across Europe. Such organisations as the European Federation of Psychiatry Trainees (EFPT), the European College of Neuropsychopharmacology, and the European Psychiatry Association, have committed to offer international experiences based on the premise that it could foster international collaboration, aid early career professionals to progress professionally and spark discussion regarding different practices across Europe.

To date, there are no studies that focus on the exchange experience in mental health professionals.

Objectives

We present the synthesis of the first seven years answers from 2012 to 2019 to the post-exchange online evaluation form, which trainees had to fill in in order to receive an attendance certificate.

Methods

The present study analysed the answers of 182 psychiatry trainees or recent graduates who took part in the EFPT exchange program during 2012 and 2019 and filled in the internet-based evaluation form. The inclusion criteria were currently in training or recently finished training as a psychiatrist in Europe and filling in the questionnaire. The exclusion criterion was participation in the EFPT exchange program for the second or subsequent time.

All trainees were systemically asked to complete the online evaluation form after the exchange period. The form includes sociodemographic, training in host country-related, and exchange experience-related questions. Experience measures were evaluated using the 4-point Likert scale. Data was anonymized before the analysis. The study followed the principles of the Declaration of Helsinki.

Results

From the 198 individuals who filled the questionnaire, 182 were involved in final analyses. The majority of participants were females in the second half of their training. The average age was 29 years. The largest number of applicants were from Turkey, whereas the United Kingdom hosted the most participants. One-third of the participants had previous international exchange experience.

Most trainees were exposed to both outpatient and inpatient treatment settings and were involved in educational or research activities. 96.7% of participants indicated that they were satisfied or very satisfied with the experience, 95.6% said that the exchange was useful or very useful, and 98.9% were likely or very likely to recommend exchange to colleagues. A description of trainees and exchange placements is presented in a table (couldn’t be uploaded).

Conclusions

To our knowledge, this study is the first to assess the experience of psychiatry trainees who went on exchange during their professional training. Vast majority of trainees were satisfied with their exchange, thought it would be useful for their clinical practice and would recommend it to their colleagues. These findings are in line with other studies that examined medical exchange experiences .

Disclosure of Interest

None Declared
An alternative assessment pathway: Lessons from Australia and New Zealand
Authors: Lakra V.
Published: August 2023

Introduction

The COVID-19 pandemic disrupted specialist training across Australia and New Zealand particularly in the area of assessments. Large-scale face-to-face exams were especially vulnerable to disruptions including lockdowns, travel and density restriction and required the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to introduce alternatives.

Following several small-scale Objective Structured Clinical Exams (OSCEs) in late 2020 and 2021 (both AV and multi-site), the RANZCP introduced an Alternative Assessment Pathway (AAP) after an exam cancellation in November 2021.

Objectives

To discuss the introduction of an Alternative Assessment Pathway at the RANZCP and share progress regarding the broader changes to assessment models under consideration.

Methods

The AAP was co-designed with trainees and Specialist International Medical Graduates and introduced in December 2021 as an interim measure to assess clinical competence in the absence of an OSCE. It comprises a portfolio review of completed end-of-rotation forms and, if required, a case-based discussion held via Zoom.

Results

The AAP has been held over two rounds (December 2021 and March 2022) with 97% and 90% pass rates respectively (data correct as at 6 October 2022). An evaluation into the pathway is currently underway.

In July 2022, the RANZCP introduced the Clinical Competency Assessment as a continuation of the AAP (with some modifications) for the remainder of 2022 and 2023.

Conclusions

While the pandemic has become a catalyst for change, the RANZCP has been considering broader changes to the theory and practice of its assessments for some time. The presentation will provide an overview of its short-term clinical assessment model and share progress regarding change to the long-term assessment strategy.

Disclosure of Interest

None Declared
Psychopathological aspects in patients with diabetes
Authors: Trifu S. , Vasile A. I. , Ciubară A.
Published: August 2023

Introduction

This paper highlights the mutual influences and the relationships between the variables of type II diabetes, the type of psychiatric conditions, the administered treatment schemes, the imaging examinations and the impact on the functioning and quality of life of the patients.

Objectives

Analysis of the influences between diabetes and psychiatric disorders, studying the relationships between the variables of type 2 diabetes, the type of psychiatric disorders, treatmentregimens, imaging examinations and the impact on the functioning and quality of life of patients.

Methods

Psychiatric interview, Hamilton, Reisberg and Rosenberg scales, laboratory analysys

Results

Patients with pre-existing diabetes, psychiatric disorders led to deterioration of its evolution, documented by HbA1c values, treatment schedule, frequency of diabetic emergencies; the increased frequency of psychotic phenomena (hallucinations and delusional ideas) is directly proportional to the number of diabetic emergencies; patients with uncontrolled, long-term diabetes have higher scores on HAM-D and Reisberg scales, while patients with controlled diabetes have higher scores on the self-esteem and quality of life scales; in patients with taste or odor disorders, cortical atrophy may be seen on CT examination, elevated HbA1c levels and the presence of polyneuropathy; alcohol consumption, smoking, high cholesterol levels, determine the advancement of diabetic complications, and these in turn correlate with higher scores on the HAM-D scales, Reisberg; patients who show large variations in blood glucose in the first days after hospitalization are those who exhibit irritability, irritability, nervousness and heteroaggression at the time of hospitalization;

Conclusions

65% patients with depressive disorders, 10% - with organic personality disorder, 25% - with affective disorders and 30% associated with cognitive impairment. The duration of diabetes mellitus, glycosylated hemoglobin levels and the presence of diabetic complications is directly related to the HAM-D and Reisberg scores; and inversely proportional to quality of life scores and self-esteem.

Disclosure of Interest

None Declared
Self-Compassion and General Well-Being among Self-Quarantined Residents: Mediation by Certainty in Control and Moderation by Positive Coping
Authors: Li A. , Wang S.
Published: August 2023

Introduction

The outbreak of the Coronavirus Disease 2019 (COVID-19) has caused adverse outcomes on tens of millions of people worldwide, both physically and psychologically. As a public health response, quarantine has been recruited as a national measure in COVID-19, which subjects people who are suspected and confirmed cases to strictly isolation. Unfortunately, people may suffer from various adverse effects under self-quarantine at home. Thus, it is crucial to explore how to improve the psychological outcomes of self-quarantined residents to provide future intervention targets.

Objectives

During the COVID-19 pandemic, mandatory quarantine may threaten people’s psychological health and well-being. This study aimed to test the relationship between self-compassion and general well-being among self-quarantined residents and to examine the mediating role of certainty in control (i.e., a component of psychological security) in the relation. It further explored the moderated role of positive coping in the correlation between self-compassion and certainty in control.

Methods

Participants were 312 self-quarantined residents (120 men, 192 women) from a community in Liaoning Province, China, who completed online questionnaires of the Self-Compassion Scale (SCS), Security Questionnaire (SQ), Simplified Coping Style Questionnaire (SCSQ), and General Well-Being Scale (GWBS). A moderated mediation model was conducted to test the hypotheses.

Results

The moderated mediation model suggested that self-compassion was positively associated with well-being. Certainty in control partially mediated the relationship between self-compassion and general well-being. Moreover, positive coping moderated the relationship between self-compassion and certainty in control. The link between self-compassion and certainty in control was stronger among low-level positive coping people than high-level
ones.

Conclusions

Findings reveal that increased psychological security (e.g., certainty in control) by self-compassion contributes to general well-being during the self-quarantined period. People with low positive coping may benefit more from self-compassion. This study thus broadens the understanding of the mechanism underlying self-compassion on positive functioning and well-being. Psychological interventions should focus on self-compassion to enhance the general well-being of quarantined people in the pandemic.

Disclosure of Interest

None Declared