bluuebunny/crossref_metadata_2025 huggingface dataset:
Facilitation of Psychiatric Advance Directives by peer-workers: results from DAiP
Authors: Tinland A. , Loubiere S. , Mougeot F.
Published: September 2022

Introduction

United Nations Convention on the Rights of Persons with Disabilities recognized that people with psychosocial disabilities have the same right to take decisions and make choices as other people. Consequently, direct or supported decision-making should be the norm and there should be no substitute decision-making. However, these principles are far from common practice in many mental health services. Joint-crisis plan (JCP) and Psychiatric advance directives (PAD) are interesting tools to translate the shared-decision making principle into clinical and practical reality. Most existing JCP or PAD involve facilitators, which improves their effectiveness, but facilitators are mostly professionals.

Objectives

In this context, DAiP study was launched to evaluate the efficacy of PAD facilitated by peer-workers.

Methods

DAiP was a multicenter randomized controlled trial conducted in 7 French mental health facilities, with a complementary qualitative approach. 394 adults with a DSM-5 diagnosis of schizophrenia (SCZ), bipolar I disorder (BP-I), or schizoaffective disorders (SCZaff
), who were compulsorily hospitalized in the past 12 months were enrolled from January 2019 and followed up for 12 months. Outcomes were compulsory admission rate, therapeutic alliance (4-PAS), quality of life (S-QOL), mental health symptoms (MCSI), empowerment (ES) and recovery (RAS).

Results

In this communication, we propose to describe the practices of facilitation of peer-workers and analyze outcomes in lights of process measurements (whether or not participants completed PAD document, shared PAD and with whom, met facilitator, used PAD

Conclusions

Involving peer-workers in the redaction of PADs coherently supports the current shift of mental health care from ‘substitute decision making’ to ‘supported decision making’.

Disclosure

No significant relationships.
Qualitative Study of Mental Health Improvements with Traditional Cultural Healers in North America
Authors: Mehl-Madrona L. , Mainguy B.
Published: September 2022

Introduction

Traditional cultural healers -- their methods and their results -- are often invisible to conventional medical practitioners. When confronted with a result that does not make sense, we often ignore it.

Objectives

We wanted to understand the process that happened between people and traditional cultural healers when these people experienced substantial improvement in mental health without psychiatric treatment.

Methods

We collected 56 case stories from people who consulted traditional cultural healers instead of conventional medical practitioners for serious mental health problems. We confirmed the stories with family members and interviewed the healers as well. We used constructivist grounded theory to explore commonalities in the stories from the clients’ points of view and from the healers’ perspectives. The context is indigenous people in North America.

Results

Patients had a range of diagnoses, including psychotic disorders (12), bipolar disorder (28), and evere unipolar depression (16). Co-morbid anxiety disorders were common (22). Improvement in mental health was associated with participation in ceremonies within a community, building relationships with members of that community, engaging in prescribed daily practices endorsed by that community, with a resulting report of feeling increases in social and spiritual connectedness. The healers believed strongly that the embeddedness in community contributed to the results and that spirit beings played important roles in helping people feel better. The use of psychiatric medications was minimal.

Conclusions

Psychiatry can acknowledge that people can have substantial improvements in mental health when working with traditional cultural healers outside of conventional settings. Studying these settings and results can improve conventional practice.

Disclosure

No significant relationships.
Aggressive phenotype editing by modulated immune cells
Authors: Markova E. , Serenko E. , Knyazheva M.
Published: September 2022

Introduction

In human society increased aggressiveness is one of the main social and health problems. Immune cells have a regulatory effect on the central nervous system functions, including regulation of behavior.

Objectives

The aim of the study was to investigate the effect of in vitro neuroleptic-modulated immune cells transplantation on behavioral phenotype and brain cytokines in aggressive syngeneic recipients.

Methods

(CBAxC57Bl/6) F1 aggressive male mice, developed in conditions of social confrontation, were undergoing the transplantation of syngeneic immune cells with in vitro chlorpromazine-modulated functional activity. Recipient’s behavioral phenotyping was performed using modern hardware and software complex EthoVision XT. The brain cytokines content was assessed by ELISA.

Results

It was found that repeated experience of aggression, accompanied by victories, leads to a change in male mice behavior, which manifests itself by increased motor activity, irritability, severe anxiety, and the appearance of stereotypies. Transplantation of chlorpromazine-modulated splenocytes in aggressive recipient was accompanied by decreased motor activity in the Open Field, increased open arm activity in Plus Maze, reflects anti-anxiety behavior; decreased time spent close to the partition and the total duration of attacks after removal of the partitionin in resident-intruder test, reflects decreased aggressive motivation. Behavioral changes in recipients were accompanied with cytokines brain changes: decreased IL-1β, IL-2, IL-6, INFγ in the hippocampus; increased IL-4 and decreased INFγ in the hypothalamus; decreased IL-1β in the frontal cortex.

Conclusions

Chlorpromazine - modulated immune cells have a positive aggressive behavior editing effect being involved in the central mechanisms underlying the development of aggressive reactions.

Disclosure

No significant relationships.
SSRIs treatment did not completely restore affective state in patients with the initial clinically confirmed major depressive disorder/generalized anxiety disorder after COVID-19 disease
Authors: Fedotova J. , Bereza Z.
Published: September 2022

Introduction

The major clinical outcomes of COVID-19 in the brain are associated with its deleterious neurological and mental health actions.

Today, there are limited findings concerning the studying of neuropsychiatric action for SARS-Cov-2 in humans after COVID-19 disease.

Objectives

The aim of the present study was to compare the efficacy of SSRIs (escitalopram, sertraline and fluoxetine) for 6 months therapy on the affective profile of man and women with the clinically confirmed Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD) cases following COVID-19 disease.

Methods

. For the assessment of affective profile in man and women (30-55 years) with the initial clinically confirmed MDD or GAD cases after COVID-19 disease, we used the different tests: Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety scale (ShARS Scale). The hormonal and monoamines levels in the serum blood were measured by ELISA tests before and after SSRIs therapy.

Results

After 6 months of SSRIs therapy, MADRS Scale showed a incomplete disappearance of the depressive/anxiety manifestations in both men and women with the initial clinically confirmed MDD case after COVID-19 (p<0,05). We found that SSRIs were able to reduce depression/anxiety levels only on 20% in man or on 30% in women with the initial MDD case after COVID-19 before treatment.

Conclusions

SSRIs treatmet alone failed to produce the decrease of depression/anxiety in the patients of both gender with the initial MDD or GAD diagnosis after COVID-19. The further randomized clinical trials involving new pharmacological therapies for psychiatric pations after COVID-19 disease are needed.

Disclosure

No significant relationships.
Clinical, genetic and environmental influences on weight gain and metabolic disorders induced by psychotropic drugs
Authors: Eap C.
Published: September 2022

Introduction

Weight gain and obesity are important health problems associated with psychiatric disorders and/or with psychotropic drug treatments. There is a high inter-individual variability in the susceptibility to drug induced weight gain and/or other cardiometabolic disorders.

Objectives

To study the genetic and environmental risk factors for weight gain and onset of metabolic syndrome during psychotropic treatment

Methods

Analysis in PsyMetab, a large (n>3000) ongoing longitudinal prospective cohort study investigating cardiometabolic disorders in psychiatric patients.

Results

Aside from well-known clinical risk factors for metabolic worsening (e.g. young age, first episode status, rapid weight gain during the first month of treatment and/or low initial BMI), additional risk factors have been recently identified. We showed an inverse association between socio-economic status (SES) and worsening of cardiometabolic parameters, adult patients with a low SES having a three-fold higher risk of developing metabolic syndrome over one year versus patients with a high SES (n=366). In addition, a causal inverse effect of educational attainment on BMI was revealed using Mendelian randomization in the UKBiobank (n=30’069). Results from an epigenome-wide association study (EWAS) performed in 78 patients before and after one month of treatment and from a genome-wide association study (GWAS) in 1924 patients will also be presented.

Conclusions

Differences in clinical, genetic and environmental factors contribute to the differences in weight gain and metabolic disorders induced by psychotropic drugs. When starting a psychotropic drug at risk, a prospective monitoring of clinical (e.g. weight and blood pressure) and biochemical (fasting glucose, lipid levels) parameters is essential.

Disclosure

Prof. Eap received honoraria for conferences or teaching CME courses from Janssen-Cilag, Lundbeck, Otsuka, Sandoz, Servier, Sunovion, Vifor-Pharma, and Zeller in the past 3 years. The other authors report no potential conflicts of interest. This work has
Benzodiazepine use during cariprazine treatment in acute schizophrenia
Authors: Correll C. , Sebe B. , Csehi R. , Acsai K. , Barabássy Á.
Published: September 2022

Introduction

Although antipsychotics are first-line treatments for schizophrenia, benzodiazepines (BZDs) are often used as concomitant medications in acutely exacerbated patients due to their anxiolytic and sedative effects. Cariprazine (CAR), a D3-preferring dopamine D2/D3 partial agonist antipsychotic, has been examined in many clinical studies for the treatment of acute schizophrenia, with and without benzodiazepines.

Objectives

To delineate the effects of benzodiazepine-use during cariprazine treatment in acute schizophrenia.

Methods

Pooled data of cariprazine-treated (1.5-6mg/day) and
placebo-treated patients from four short-term, randomised, double-blind trials (NCT00404573, NCT01104766, NCT01104779, NCT00694707) were analysed. Baseline characteristics (age, duration of illness) and efficacy outcome parameters (Total and Hostility Factor Score of the Positive and Negative Syndrome Scale [PANSS]) were compared in patients receiving benzodiazepines (for more ≥3 consecutive days) and not receiving benzodiazepines (<3 consecutive days).

Results

Altogether, 36.7% and 40.7% of the CAR-treated and PBO-treated patients required BZDs. BZD-taking was associated with a higher age in both the CAR-treated (p=0.0002) and PBO-treated (p<0.0001) patients, and with longer illness-duration in both treatment groups (p<0.0001). PANSS Total Score at baseline was similar for BZD users and non-users (CAR: LS Mean=96.36 and 96.27; PBO: LS Mean=95.55 and 96.66). Change from baseline in the PANSS Total Score was greater for patients who did not use BZD vs those who did (CAR: LS Mean= -23.8 vs LS Mean 17.2, p<0.0001; PBO: LS Mean= -14.0 vs LS Mean 12.9, p=0.5776).

Conclusions

These findings may suggest that requiring benzodiazepines is a potential indicator of longer illness duration and poorer response in acute schizophrenia.

Disclosure

I am an employee of Gedeon Richter Plc.
Characterising the evolution of antipsychotic polypharmacy and clozapine prescribing patterns in schizophrenia patients during psychiatric hospitalisations
Authors: Lagreula J. , Elens L. , De Timary P. , Dalleur O.
Published: September 2022

Introduction

A high prevalence of antipsychotic polypharmacy (APP) and low utilisation of clozapine is considered as inappropriate prescribing that can lead to suboptimal treatment, increased risk of poor response or adverse effects.

Objectives

To explore the evolution of prevalence of APP and associated factors as well as clozapine prescribing patterns between hospital admission and discharge.

Methods

We collected retrospective data on adult inpatients diagnosed with schizophrenia spectrum disorders in 2020-2021 in 6 Belgian hospitals.

Results

Of the 516 patients analysed, APP prescribing significantly increased from 47.9% on hospital admission to 59.1% at discharge. Both on admission and at discharge, APP was associated with treatment with a first-generation antipsychotic, not being treated with an antidepressant nor a mood stabilizer, high antipsychotic dosage, increased number of psychoactive cotreatments and total medicines. A lower number of comorbidities (OR=0.68, CI=0.50-0.91), no treatment with benzodiazepines (OR=0.02, CI=0.01-0.09) nor with trazodone or sedative antihistamines (OR=0.06, CI=0.01-0.03) and two or more previous antipsychotic trials (OR=4.91, CI=1.30-18.57) was associated with APP on admission only. APP at discharge was more frequent in patients with antipsychotic adverse effects (OR=2.57, CI=1.10-6.00), prior clozapine use (OR=16.30, CI=3.27-81.22) and not involuntary admitted (OR=0.26 CI=0.08-0.88). Contrary to admission, treatment with benzodiazepines was associated with APP at discharge (OR=10.9, CI=3.38-5.38). Only 9.3% of admitted patients were treated with clozapine. Although 28.1% were eligible, clozapine was introduced to 10 patients leading to 11% being discharged on it.

Conclusions

Inappropriate prescribing of antipsychotics to schizophrenia patients persist after psychiatric hospitalisations and are associated with identifiable characteristics.

Disclosure

No significant relationships.
SERVICE INNOVATION (SOUL PROGRAMME) - Charitable home-based outreach service for treatment of schizophrenia in Larkano, Pakistan: development, implementation and 10 year outcomes
Authors: Afghan S.S. , Junejo B. , Soomro G. , Soomro F. , Wagan R. , Faruqui R.
Published: September 2022

Introduction

There is a huge resource gap in mental health service provision & service utilisation in LAMIC including Pakistan. SOUL Programme has been established in the City of Larkana, on charitable donations, which utilises principles of home-based outreach and produces clinical and functional outcomes.

Objectives

SOUL programme focuses on collaborative working with patients & families. The objectives include recognition, treatment, family education & psychosocial support to maximize clinical, functional & occupational outcomes.

Methods

Single cohort intervention (patients recruited on continual basis over time) with innovative service structure and culturally relevant open label intervention design developed with local academic psychiatric unit in Larkano, Pakistan. Training was provided to local mental health professionals on diagnosis, delivering care & use of recognized clinical outcome measures.

Results

We have recruited a cohort of 160 patients on continual basis over time. Our analysis show a higher BPRS and lower GAF ratings for men in comparison to female cohort at the baseline. Our Ten year follow up has demonstrated statistically significant clinical / functional improvement on BPRS, CGI & GAF measures. The mean differences recorded for the individual measures after 12 months were BPRS, CGI-I and GAF and were all statistically significant. Innovative home-based community mental health intervention shows significant improvements in clinical and functional outcomes (with good effect size).

Conclusions

SOUL Programme is a highly effective and cost-efficient intervention model for treatment of schizophrenia in a developing country setting. Our 10 year follow up study confirms the feasibility of this intervention model through close working with families of our patients.

Disclosure

No significant relationships.
Descriptive study on the working conditions of residents of psychiatry in Madrid: working hours and 24-hour on call shifts
Authors: Cerame A. , Coucheiro P. , Cayuela L. , Maiques M. , Franco Soler A.
Published: September 2022

Introduction

Resident physician’s working conditions are linked to poor health outcomes of professionals and patient’s safety. Previous studies suggest that residents in Spain have difficulties enjoying mandatory rest after on-call shifts.

Objectives

This study aims at describing the working conditions: working hours and the absence of mandatory rest periods after a 24h on-call shift in residents of psychiatry in the region of Madrid.

Methods

A descriptive observational cross-sectional study was carried out through an anonymous survey adapted from the available literature.

Results

Up to 24,1% of the surveyed residents could not enjoy mandatory resting periods after a 24 hour on-call shift and the mandatory weekly rest of at least 36 hours was not done in up to 17% of the cases with statistical significance (p <0.05). The average number of 24 hours on call shifts residents had to work per month was 5, which exceeds the maximum weekly hours allowed by law.

Conclusions

The findings reveal a violation of resident physician labor rights in relation to resting times after on-call shifts, weekly breaks and working hours. These phenomena pose a significant threat to resident physician’s health and patient safety.

Disclosure

No significant relationships.
Clinical and immunological profile of patients with schizophrenia
Authors: Petrova N. , Mayorova M. , Churilov L. , Gvozdetskiy A. , Kudryavtsev I. , Sobolevskaia P. , Serazetdinova V.
Published: September 2022

Introduction

The question of the involvement of inflammatory and autoimmune processes in schizophrenia pathogenesis has become the most relevant in the last decade and yet is not fully understood.

Objectives

The study included 60 patients with paranoid schizophrenia (age 18 - 55 y.o.) and 30 healthy control group participants. Patients were in a stabilization state without a history of organic brain disorder or another verified somatic disease in the exacerbation phase.

Methods

Research methods included follow-up method, neuropsychological (PANSS, BAC-S), laboratory (enzyme immunoassay, flow cytometry), and statistical.

Results

Patients with schizophrenia had significant structural disorders of thinking, passive, apathetic withdrawal, negativism, impaired attention, psychomotor speed, volitional impulses. Cognitive impairment was detected in all study participants. Severe impairments are noted in the executive functioning, hand-eye coordination, attention, psychomotor speed. The severity of cognitive impairments correlated with the severity of clinical symptoms. Patients with schizophrenia had a significant decrease in central memory T-regulators levels, and an increase in Th1 and Th2 subsets, «double-positive» and «сlassic» Th17, Tfh2, «classic» Tfh17, and in Tfh17.1 (Pic.1).

Picture. 1. T-helper subsets in patients with schizophrenia. They also had high levels of CCL20, IL-10, IL-12, IL-1β, IL-27, IL-31, IL-4, IL-13, IL-6, IL-9, TNFα in comparison with a control group. A significantly decreased levels of IL-17A, IL-17F, IL-2, IL-22, and TNFβ were also described in this group of patients.

Conclusions

Patients with schizophrenia may be characterized by the presence of an inflammatory process and a high chance of autoimmunity. Aknowledgement. This work was supported by the grant of the Russian Federation Government, contract 14.W03.31.0009

Disclosure

No significant relationships.
The relationship between the recognition of specific basic emotions and negative symptom domains in patients with schizophrenia spectrum disorders
Authors: Zierhut M. , Boege K. , Bergmann N. , Hahne I. , Braun A. , Kraft J. , Ta T.M.T. , Ripke S. , Bajbouj M. , Hahn E.
Published: September 2022

Introduction

Current research suggests emotion recognition to be significantly impaired in individuals with schizophrenia spectrum disorders (SSD), whereby negative symptoms are theorised to play a crucial role. Emotion recognition deficits are assumed to be predictors of transition from clinical high risk to schizophrenia. So far, little attention has been given hereby to the subdomains of negative symptoms and recognizing the individual basic emotions.

Objectives

Our study aimed to explore the relationship between the recognition of the basic emotions and each negative symptom domain.

Methods

66 patients with a SSD diagnosis were recruited at the Charité – Universitätsmedizin Berlin. Correlational and regression analyses to control for the covariates (age, education, sex) were conducted between the recognition of the six basic emotions (anger, disgust, fear, happiness, sadness, surprise) using the Emotion Recognition Task of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the seven different subdomains of negative symptoms of the Positive and Negative Syndrome Scale (PANSS).

Results

revealed significantly negative correlations of blunted affect with the recognition of happiness, fear, and disgust. Difficulties in abstract thinking, also correlated positively with the recognition of fear. Additionally, we found a significant positive correlation between stereotyped thinking and difficulties in abstract thinking with the response latency in emotion recognition.

Conclusions

Individuals with SSD and domains of negative symptoms showed specific impairments in recognizing the representation of basic emotions. A longitudinal design to make causality statements would be useful for future research. Moreover, emotion recognition should be considered for early detection and individualized treatment.

Disclosure

No significant relationships.
Clinical features of UK Biobank subjects carrying loss of function variants in genes implicated in schizophrenia pathogenesis
Authors: Curtis D.
Published: September 2022

Introduction

The SCHEMA consortium has identified ten genes in which severely damaging variants substantially increase schizophrenia risk.

Objectives

To characterise the clinical features of carriers of variants causing complete loss of function (LOF) of these genes.

Methods

This research was conducted using the UK Biobank Resource and 200,000 exome-sequenced volunteers were screened to identify carriers of LOF variants in these genes. For these subjects, data fields were extracted which reflected educational and occupational functioning as well as clinical features including diagnoses and medication.

Results

LOF variants in CACNA1G were commoner than in SCHEMA cases, suggesting this was not a real schizophrenia susceptibility gene. 159 subjects carried LOF variants in one of the other nine genes and overall they did not have poorer educational or occupational functioning or increased mental or physical health problems. Detailed examination revealed that one had schizophrenia, one had psychotic depression and two had a developmental disorder. Otherwise, a number of subjects had features of minor mental illness such as depression or anxiety and these rates were somewhat increased in subjects carrying LOF variants in HERC1, of whom more than half reported having consulted their GP for such problems. However the majority appeared to be entirely normal from a neuropsychiatric point of view.

Conclusions

Although particular genetic variants can substantially increase the risk of schizophrenia, most people carrying them are entirely normal. This further supports the concept of schizophrenia as a distinct illness rather than representing the extreme of a trait which is present in the population.

Disclosure

No significant relationships.
Tryptophan metabolism in bipolar disorder
Authors: Fellendorf F. , Platzer M. , Birner A. , Queissner R. , Bengesser S. , Lenger M. , Maget A. , Tmava-Berisha A. , Dalkner N. , Fuchs D. , Gostner J. , Reininghaus E.
Published: September 2022

Introduction

Immune mediated inflammatory processes are involved in the aetiopathogenesis of bipolar disorder (BD) and weight associated comorbidities. Tryptophan breakdown via indoleamine 2,3-dioxygenase-1 (IDO-1) along the kynurenine axis concomitant with a pro-inflammatory state was found more active in BD but also associated with overweight/obesity.

Objectives

Aims of our study were to investigate 1.) the tryptophan metabolism in BD compared to mentally healthy controls, 2.) differences in weight classes, 3.) in a longitudinal setting, dependent on the incidence of BD episodes and euthymia.

Methods

At the Medical University Graz anthropometric and clinical data as well as peripheral tryptophan and kynurenine were assessed in serum samples of 226 individuals with BD and 142 controls. For 75 individuals with BD a longitudinal assessment with three samples was performed. Serum concentrations of tryptophan and kynurenine were determined by reverse-phase high-performance liquid chromatography. The kynurenine/tryptophan was used as a proxy for IDO-1 activity.

Results

showed a higher kynurenine/tryptophan ratio in BD compared to controls and in overweight compared to normal weight persons. Levels remained stable over time. In the longitudinal course, no differences were found between individuals who were constantly euthymic or not as well who had an illness episode or none.

Conclusions

Findings indicate that IDO-1 activity might constitute more a trait and not a state marker of BD. Accelerated tryptophan breakdown along the kynurenine axis may be further facilitated by overweight. This may increase the risk of accumulation of neurotoxic metabolites which impacts BD symptomatology, cognition, and somatic comorbidities.

Disclosure

No significant relationships.
Bipolar Stigma in Jewish Communities in the United States
Authors: Smith L. , Brewer K. , Gearing R. , Carr L.C. , Clark D. , Robinson A. , Roe D.
Published: September 2022

Introduction

This study investigated differences in mood disorder public stigma endorsed by Jewish adults. Specifically, it examined the association between public stigma and the symptomatology and gender of individuals with mood disorders and characteristics of respondents. The symptomatology investigated included major depressive disorder and bipolar disorder presenting with mania or depression. The public stigma factors measured for mood disorders were recovery, relationship disruption, hygiene, anxiety, and treatment/professional efficacy.

Objectives

Do symptomatology and gender predict stigma for mood disorders? For Jewish adults, do gender, age, religious characteristics, mental health history, and perceived stigma for mental illness predict their stigma toward individuals with mood disorders?

Methods

A convenience sample of 243 Jewish adults were randomly administered vignettes using a factorial design. MANCOVA was used for analysis. The Mental Illness Stigma Scale (Day et al., 2007) and the Devaluation of Consumer scale (Struening et al., 2001) were used to measure public and perceived stigma respectively.

Results

showed that recovery, relationship disruption, and hygiene stigmas were associated with vignette subject symptomatology, an interaction was found between respondent gender and age for treatability/professional efficacy stigma, and perceived stigma was correlated with public stigma factors. Consistent with previous research, the highest levels of stigma were found for individuals with bipolar disorder presenting with mania (Wolkenstein & Meyer, 2008).

Conclusions

These findings increase our knowledge of mood disorder stigma existing in the Jewish community and supports research showing that bipolar disorder presenting with mania is the most stigmatized type of mood disorder symptomatology (Wolkenstein & Meyer, 2008).

Disclosure

No significant relationships.
Patient violence towards their family carers: A qualitative exploration of carers’ experiences in psychosis
Authors: Wildman E. , Kuipers E. , Macmanus D. , Onwumere J.
Published: September 2022

Introduction

Compared to the general population, people living with schizophrenia spectrum disorders (SSD) are more likely to perpetrate acts of violence. When this happens, family members (informal carers) are most commonly the victims. However, family violence by people with SSD is often a taboo topic and largely neglected within public discourse, research, and clinical domains. Consequently, our understanding of families’ experiences and support needs are limited.

Objectives

To develop a detailed understanding of the subjective experiences, and impact, of patient violence towards family carers.

Methods

Individual semi-structured interviews were held with family carers of adults with SSD and a history of violence perpetration towards their family carer. Interview data were subject to thematic analyses using NVivo software.

Results

Twenty-one UK based carers that were predominately White British (90%) and female (81%) were interviewed. Key themes highlight the range of physical and mental injuries endured by carers following patient violence, and speak to carers’ experiences of suffering, living in a constant state of hypervigilance, as well as social isolation in the context of shame, stigma, and an absence of professional and informal support.

Conclusions

Family violence by people living with SSD can and does happen. Yet, too often, carers are left with no option but to continue supporting their relative in the absence of support, even in contexts where this compromises their own safety. The devastating impact of violence is far-reaching, across all levels of the family-system. The findings highlight the danger of neglecting family violence by people with SSD in research and clinical fields.

Disclosure

No significant relationships.
Altered dynamic functional topology in first-episode untreated patients with schizophrenia can aid in early diagnosis
Authors: You W. , Luo L. , Li Q. , Wang Y. , Wang Y. , Gong Q. , Li F.
Published: September 2022

Introduction

There is a growing consensus on brain networks that it is not immutable but rather a dynamic complex system for adapting environment. The neuroimaging research studying how brain regions work collaboratively with dynamic methods had demonstrated its effectiveness in revealing the neural mechanisms of schizophrenia.

Objectives

To investigate altered dynamic brain functional topology in first-episode untreated schizophrenia patients (SZs) and establish classification models to find objective brain imaging biomarkers.

Methods

Resting-state-functional magnetic resonance data for SZs and matched healthy controls were obtained(Table1).

Power-264-template was used to extract nodes and sliding-window approach was carried out to establish functional connectivity matrices. Functional topology was assessed by eigenvector centrality(EC) and node efficiency and its time-fluctuating was evaluated with coefficient of variation(CV). Group differences of dynamic topology and correlation analysis between Positive and Negative Syndrome Scale(PANSS) scores and topology indices showing group differences, which also were used in establishing classification models, was examed.

Results

The CV of node efficiency in angular and paracingulate gyrus was larger in SZs. There are 13 nodes assigned into several brain networks displaying altered CV of EC between groups(Figure1.A). Fluctuation of EC of the node in DMN, which was lower in SZs, showed negative correlation with PANSS total scores(Figure1.B). Dynamic functional topology of above nodes was used to train classification models and demonstrated 80% and 71% accuracy for support vector classification(SVC) and random forest(RF), respectively(Figure2).

Conclusions

Dynamic functional topology illustrated a capability in identifying SZs. Aberrated dynamics of DMN relevant to severity of patient’s symptoms could reveal the reason why it contributed to classification.

Disclosure

No significant relationships.
Impact of early onset of chronic physical multimorbidities on schizophrenia spectrum disorder treatment outcome
Authors: Šimunović Filipčić I. , Filipcic I.
Published: September 2022

Introduction

Despite of the heightened risks and burdens of physical comorbidities across the entire schizophrenia spectrum disorders (SSD), relatively little is known about physical multimorbidity (CPM) in this population. The study’s main objective was to explore the differences in the CPM prevalence between SSD patients and the general population (GEP).

Objectives

The primary outcome was to explore the difference in CPM prevalence in the younger SSD and GEP groups (<35 years).The secondary outcome was the number of psychiatric readmissions.

Methods

This nested cross-sectional study enrolled 343 SSD patients and 620 GEP participants.

Results

Younger SSD patients had more than three-fold higher odds for CPM than GEP. We also demonstrated an association between the presence of CPM and the number of psychiatric admissions in the SSD population independently of possible confounders. We did not observe significant interaction of CPM and age in the prediction of clozapine use. Younger women with SSD had statistically significant, almost four-fold higher odds of CPM than women from GEP.

Conclusions

This study suggests that women with SSD are at increased physical comorbidity risk compared to men, particularly early in the course of psychiatric illness. Our results highlight the importance of addressing physical health from the first contact with a mental health service to preserve general health, and provide the best possible treatment outcome. Treatment of SSD must be customized to meet the needs of patients with different physical multimorbidity patterns.

Disclosure

No significant relationships.
Health resource utilization, costs, and community treatment order status before and after the initiation of second-generation long acting-injectable antipsychotics in patients with schizophrenia in Alberta, Canada
Authors: Chue P. , Wong K.O. , Klarenbach S. , Martins K. , Dursun S. , Snaterse M. , Richer L.
Published: September 2022

Introduction

Long-acting injectable (LAI) antipsychotics and community treatment orders (CTOs) are used in patients with schizophrenia to improve treatment effectiveness through adherence.

Objectives

Understanding healthcare resource utilization (HRU) and associated costs, and medication adherence in patients with schizophrenia overall and by CTO status before and after second generation antipsychotic (SGA) LAI initiation may guide strategies to optimize health.

Methods

A retrospective observational single-arm study using administrative data from Alberta was performed. Adults with schizophrenia who initiated SGA-LAI (index date) were included. Medication possession ratio (MPR) was determined; paired t-tests were used to examine differences in HRU and costs ($CDN) between the 2-year pre-index period and 2-year post-index period. Stratified analysis by presence or absence of an active CTO during the pre-post periods was performed.

Results

Among 1,211 patients who initiated SGA-LAIs, MPR was greater post-index (0.84) compared with pre-index (0.45; 95% confidence interval [CI] 0.36, 0.41). All-cause and mental health-related HRU and costs were lower post-index versus pre-index (p<0.001); total all-cause HRU costs were $33,788 lower post- versus pre-index ($40,343 [standard deviation, SD $68,887] versus $74,131 [SD $75,941], 95% CI [-$38,993, -$28,583]), and total mental health-related HRU costs were $34,198 lower post- versus pre-index ($34,205 [SD $63,428] CDN versus $68,403 [SD $72,088] CDN, 95%CI [-$39,098, -$29,297]). Forty-three percent had ≥1 active CTO during the study period; HRU and costs varied according to CTO status.

Conclusions

SGA-LAIs are associated with improved adherence, and lower HRU and costs however the latter vary according to CTO status.

Disclosure

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this abstract: SD and MS have no competing interest to declare. LR, SK, KW, and KM are members of the Real-World Evidence
DiscoVR: results of a multicenter RCT on a social cognitive virtual reality training to enhance social cognition in psychosis
Authors: Pijnenborg G. , Nijman S. , Veling W.
Published: September 2022

Introduction

Functional deficits, that is, problems in fulfilling appropriate social roles in daily life, are very common in people with a psychotic disorder. In recent years, Virtual Reality (VR) has emerged as a potential tool to improve SCT. Our research group has developed an immersive VR-SCT (‘Dynamic Interactive Social Cognition Training in Virtual Reality’: ‘DiSCoVR’).

Objectives

To evaluate to effects of a VR-based social cognition training (SCT) for people with a psychotic disorder.

Methods

This intervention was compared the an active VR-control condition in a multicenter RCT. Both interventions contained sixteen individual 45-60-minute on-site sessions, administered twice a week. Main study outcomes are social cognition and social functioning in daily life assessed with experience sampling.

Results

From baseline to post-treatment (n=72), none of the time*group interactions were significant, indicating an absence of treatment effects. A significant effect of time was observed for the SERS total score (b=9.84, 95% CI=3.81-15.87, p=.002), indicating overall improvement in self-esteem.

Conclusions

We did not find any significant treatment effects. An effect of time on self-esteem was found at post-treatment, but not follow-up, suggesting a temporary improvement in self-esteem in both groups. One way to interpret these results is that, contrary to other SCT interventions, DiSCoVR does not improve social cognition or social functioning. This could be due to characteristics of the treatment protocol. Another possibility is that, contrary to the premise of VR-SCT, our VR environments inadequately simulated reality. Adapting an established protocol to VR, could further elucidate the merit of VR as a training method.

Disclosure

No significant relationships.
Does country of resettlement influence the risk of suicide in refugees? A case-control study in Sweden and Norway
Authors: Amin R. , Mittendorfer-Rutz E. , Mehlum L. , Runeson B. , Helgesson M. , Tinghög P. , Björkenstam E. , Holmes E. , Qin P.
Published: September 2022

Introduction

Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent, inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature.

Objectives

We aimed to investigate the risk of suicide among refugees in Sweden and Norway according to their sex, age, region/country of birth and duration of residence.

Methods

Each suicide case between the age of 18-64 years during 1998 and 2018 (17,572 and 9,443 cases in Sweden and Norway, respectively) was matched with up to 20 population-based controls, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide.

Results

The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI: 0.5-0.6) and 0.3 (95% CI: 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI: 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age.

Conclusions

The findings of almost similar suicide mortality advantages among refugees in two host countries may suggest that resiliency and culture/religion-bound attitudes could be more influential for suicide risk among refugees than other post-migration environmental and structural factors in the host country.

Disclosure

No significant relationships.
Use of hormonal contraception and attempted suicide: a nested case-control study
Authors: Toffol E. , Partonen T. , Latvala A. , But A. , Heikinheimo O. , Haukka J.
Published: September 2022

Introduction

In Finland more than 40% of fertile aged women used some type of hormonal contraception (HC) in the period 2010-2013. A proportion of women using HC complains of side effects, including mood symptoms. The relationship between the use of HC and the risk of attempted suicide (AS) is still a matter of debate.

Objectives

To assess the association of the use of HC with the risk of AS during 2017-2019.

Methods

Data were retrieved from the Prescription Centre, Care Register of Health Care, Register of Primary Health Care Visits and Statistics Finland. A total of 587 823 women, aged 15-49 years, using and not using HC in 2017 were analysed in the initial incidence study. All incident AS cases during 2018-2019, and their 4:1 age-matched controls (1 174 346 person-years) were analysed in a nested case-control setting via conditional logistic regression models.

Results

Altogether 818 AS cases occurred during the follow-up (incidence rate: 0.70/1000 person-years, 95% CI 0.65–0.75), with an IRR of HC vs. no-HC use of 0.73 (0.63–0.83). Current use (in the 180 days before the event) of estradiol- or ethinylestradiol-containing HC was associated with a lower risk of AS (0.53, 0.33–0.87; 0.49, 0.37–0.64, respectively) compared to non-use of HC. After controlling for covariates (marital and socioeconomic status, education level, use of psychotropic medications), only current use of HC containing ethinylestradiol remained significant (0.39, 0.23–0.65).

Conclusions

A lower risk of AS is associated with the use of HC, and specifically of ethinylestradiol-containing
HC.

Disclosure

No significant relationships.
Altered Executive Function in Suicide Attempts
Authors: Fernández J. , Alberich S. , Zorrilla I. , González-Ortega I. , López M.P. , Pérez-Solà V. , Vieta E. , González-Pinto A.M. , Saiz P.A.
Published: September 2022

Introduction

Executive function organizes and directs behaviour but alterations in this cognitive domain can lead to inaccurate perception, interpretation and response to environmental information, which could be a risk factor for suicide.

Objectives

To explore executive function performance of depressed recent suicide attempters in comparison to depressed past suicide attempters, depressed non-attempters and healthy controls.

Methods

96 participants from the Psychiatry Department of the Araba University Hospital-Santiago were recruited as follows: 20 patients with a recent suicide attempt (<30days) diagnosed with a Major Depressive Disorder (MDD), 33 MDD patients with history of attempted suicide, 23 non-attempter MDD patients and 20 healthy controls. All participants underwent a clinical interview and neuropsychological assessment on executive function with the Wisconsin Sorting Card Test. Backward multiple regressions were performed adjusting for significant confounding variables. For group comparisons ANOVA test and Bonferroni post hoc test were performed with p<0.05 significance level.

Results

Patient groups did not differ regarding severity of depression. All patient groups performed significantly worse than healthy controls on executive function. Adjusted comparisons between patient groups indicated that recent suicide attempters had a poorer performance in this cognitive domain in comparison to both depressed lifetime attempters and depressed non-attempters (B=0.296, p=0.019 and B=0.301, p=0.028 respectively).

Conclusions

Executive function performance is altered in recent suicide attempts. As impaired executive function can be a risk factor for suicide, preventive interventions on suicide should focus on its assessment and rehabilitation.

Disclosure

No significant relationships.
Adverse childhood experience referring to parental relationship is associated with the risk of alcohol dependence and with COMT Val158Met polymorphism, but out of gene-environment interactions
Authors: Merkulova T. , Chuprova N. , Solovieva M. , Nikolishin A. , Kibitov A. , Grechany S. , Baranok N. , Rybakova K. , Soldatkin V. , Yakovlev A. , Trusova A. , Ponizovsky P. , Krupitsky E.
Published: September 2022

Introduction

Gene-environment interactions (GxE) are considered to make a substantial impact on the risk of alcohol dependence (AD).

Objectives

The aim of the study: to test the associations between the functional polymorphism Val158Met (rs6265) in the catechol-O-methyl transferase (COMT) gene, affecting dopamine neurotransmission, and adverse childhood experiences (ACE) and their GxE interactions with AD risk.

Methods

The study included 149 AD inpatients (mean age 29.9 (SD=3.91), 16.1% females) and 201 healthy volunteers (23.3 (2.48), 30.1% females). The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used for assessing ACE. COMT Val158Met polymorphism was detected by RT-PCR.

Results

First, COMT Val158Met polymorphism was associated only with adverse childhood experience referring o parental relationship (ACE-IQ), but differently in two groups. Healthy minor Met158 carriers have lower scores on the subscale “relationship with parents/guardians” (P) (p=0.025) and “physical neglect” (PN) (p=0.059) vs. homozygous Val158 carriers. However, AD patients - Met158carriers have a tendency to a higher score on the subscale “one or no parents, parental separation or divorce” (PSD) (p=0.078). Then logistic regression revealed associations of these ACE scores with increased AD risk: P (p=0.001, OR=1.186, 95%CI [1.069-1.315]), PN (p=0.024, OR=1.254, 95%CI [1.030-1.526]), and PSD (p=0.016, OR=1.499, 95%CI [1.080-2.082]). No associations of COMT Val158Met alone or in interactions with these ACE-IQ scores with the AD risk were found.

Conclusions

Adverse childhood experience referring to parental relationship is associated with alcohol dependence risk and separately with COMT Val158Met, but no clear interactions in frame of GxE has been supported.

Disclosure

No significant relationships.